Find out how this restoration is all you need to say goodbye to cracked, chipped teeth.
Accidents happen. Even teeth, which are very strong and durable, can become chipped, cracked, or damaged by decay, trauma, or an infection; however, if the tooth is still viable then our Denver, CO, dentists, Dr. Steven Wilk and Dr. Jeffrey Revoir, may recommend getting a dental crown.
What is a dental crown?
The concept of dental crowns has been around for centuries; however, modern dentistry has made these tooth-shaped caps look as close to the natural crown of a tooth as possible.
Crowns are often made from porcelain or composite resin, and the material is even matched to the shade of your tooth to ensure that your crowns blend in with the rest of your smile and look as realistic as possible. This restorative dental cap is hollow so that it can fit over the entire visible portion of a tooth to protect it from further damage while also restoring functionality, strength, and appearance.
When are dental crowns used?
Our Denver cosmetic dentists might recommend getting a dental crown for a number of reasons. You might benefit from a dental crown if you have:
- A weak or severely worn tooth
- A tooth damaged by extensive decay that a dental filling can’t support
- A tooth that has to undergo root canal treatment
- A tooth that is severely cracked or fractured
- A tooth that is malformed or contains serious internal discolorations
- To cover a dental implant
- To stabilize a dental bridge
As you can see, dental crowns can serve both restorative and cosmetic purposes. Before getting a dental crown, our Denver restorative dentists will need to make sure that a crown is the best way to protect a tooth. Sometimes a tooth that has a crack or fracture that goes below the gumline is no longer viable and will need to be removed. This is why we may need to run X-rays to determine the extent of the damage and whether the tooth is still repairable.
No matter whether you have questions about dental crowns or you need to schedule a routine consultation to find out whether a crown could restore your smile then it’s time you turned to the experts at Artistic & Family Dental in Denver, CO. Book an appointment with us today.
Veneers are a versatile dental restoration which can benefit you in many ways. However, understanding how this treatment works, when your dentist may recommend it, and what veneers can do for you are important aspects of determining if this is the best cosmetic dental procedure for you. Find out more about veneers with Dr. Steven Wilk and Dr. Jeffery Revoir at Artistic and Family Dental in Denver, CO.
What is a dental veneer?
A veneer is a tooth-colored, super-thin piece of porcelain which fits over a tooth to change its appearance. The veneer itself resembles a half shell which covers the surface of the tooth. Your dentist bonds the veneer to the tooth permanently after preparing the tooth by removing a small layer of enamel. This roughens the tooth, makes room for the porcelain and helps with ensuring a strong and effective bond. A dental laboratory customizes each veneer based on a clay impression or 3D model of your mouth, carefully designing and carving it to fit seamlessly into your smile.
When might my dentist recommend veneers?
Porcelain veneers can subtly change a tooth’s appearance or completely overhaul your smile. Your dentist may recommend veneers to improve the appearance of teeth with the following abnormalities:
- too-long or too-short teeth
- too-wide or too-narrow teeth
- uneven teeth
- slight crowding
- small gaps
The Benefits of Dental Veneers in Denver, CO
Dental veneers can improve the appearance of your smile and help you look and feel the way you deserve. Dental veneers are made of porcelain, a tooth-colored material which has many of the same light-reflecting and other aesthetic qualities as natural teeth. Porcelain does not stain and is durable, lasting many years before requiring maintained or replacement. Veneers are versatile and can help a wide range of patients.
For more information on dental veneers, please contact Dr. Steven Wilk and Dr. Jeffery Revoir at Artistic and Family Dental in Denver, CO. Call (303) 758-2980 to schedule your consultation for dental veneers with your dentist today!
Straighten your smile discreetly with Invisalign clear aligners. Invisalign is an exciting alternative to traditional braces for straightening crooked teeth or correcting uneven spacing between them. Instead of the hard brackets associated with metal or ceramic braces, Invisalign utilizes comfortable, soft aligner trays. The trays can even be removed when eating, brushing or flossing. At Artistic & Family Dental, Dr. Steven Wilk and Dr. Jeffery Revoir are your dentists for Invisalign in Denver, CO.
What is Invisalign?
Invisalign is an exciting alternative to traditional braces for giving you a beautiful, straight smile. Traditional braces move the teeth through the use of hard brackets and wires. Invisalign moves the teeth using custom-fit soft trays. There is no metal or ceramic hardware. The soft trays are flexible and fit comfortably over the top and bottom rows of teeth. Every few weeks, a different set of trays is provided. Each new set of trays has a slightly different positioning of the teeth, which is how the teeth are gently moved into place over time.
Advantages of Invisalign
There are several advantages to choosing Invisalign over traditional braces for straightening your smile. Traditional braces can be uncomfortable as the metal or ceramic brackets and wires can poke and irritate the mouth. Further, for both metal and ceramic braces, the brackets are cemented into place on the teeth and cannot be removed except by a dentist or orthodontist. Additionally, for metal braces specifically, they are readily noticeable to others since they are silver in color. None of these factors is a concern with Invisalign.
Invisalign remedies many of the perceived disadvantages often associated with traditional braces. If you are hesitant to get traditional braces but want to straighten your smile, Invisalign might be the solution. Ask your dentist in Denver if Invisalign can work for you. Some advantages of Invisalign include:
- The aligner trays are clear, making them discreet and unnoticeable.
- The aligner trays are made from flexible, soft plastic and are comfortable to wear.
- There are no hard metal or ceramic brackets and wires to poke or irritate the mouth.
- The aligner trays are removable and can be taken out when eating or drinking to prevent food bits from getting trapped in the trays.
- Trays can be removed to more thoroughly brush and floss between teeth.
- Since trays fit over the teeth, they provide protection against excessive wear for individuals who regularly grind or clench their teeth.
Invisalign gives you the opportunity to straighten your smile discreetly without conspicuous and uncomfortable hard brackets and wires. For Invisalign in Denver, schedule an appointment with Dr. Wilk and Dr. Revoir by calling Artistic & Family Dental at (303) 758-2980.
What's your best option for a great looking smile? Try aesthetic services from your cosmetic dentists in Denver, CO, Dr. Steven Wilk and Dr. Jeffrey Revoir. Whether you have enamel defects such as stains or chips or your teeth are oddly shaped and spaced, the team at Artistic & Family Dental will enhance your appearance and your self-confidence, too. Start your new look with a friendly consultation with your cosmetic dentist at his modern Denver office.
Your smile analysis
When you consult with Dr. Wilk or Dr. Revoir, your questions will be answered and your goals, carefully assessed. The dentist will examine your gums and teeth, and he'll and take X-rays, photos and other kinds of modern imaging as he feels are pertinent. Then, you'll look at what treatments can accomplish the changes you desire.
And don't worry. Your dentist has your interests at heart. That means your cosmetic treatments will dovetail with the preventive and restorative aspects of your long-term treatment plan.
Offered cosmetic treatments
Many people want their enamel color to improve, states the American Academy of Cosmetic Dentistry. After all, smiles do become dark, dull and dingy over time, especially if the person smokes, drinks dark beverages or eats foods that stain (curry or soy sauce as examples). If this applies to you, your cosmetic dentist in Denver may offer professional teeth whitening. It's safe, fast and economical. Applied at home using perfectly fitted trays, hydrogen peroxide gel lifts discolorations out of tooth enamel. What's left is a dramatically brighter smile that will stay like that indefinitely.
Other options for improving defects such as chips, cracks and small gaps include composite resin bonding. This quick procedure repairs and reshapes flaws with a tooth-colored mixture of glass particles and acrylic. Dr. Wilk or Dr. Revoir uses a special hardening light to make the enhancement permanent and then polishes the material to a natural-looking shine.
Bonding may be combined with porcelain veneers on selected healthy teeth. Veneers cover larger defects with tooth-shaped shells custom-made from fine porcelain. After some minimal enamel resurfacing, veneers are bonded in place with a color-enhanced and permanent adhesive. The results last for years with good oral hygiene practices at home and semi-annual care at Artistic & Family Dental.
Finally, tooth-colored fillings and all-porcelain dental crowns combine the finest in cosmetic and restorative dental techniques. Your dentist crafts the fillings from composite resin and bonds them directly to healthy tooth structure, eliminating the need for unsightly metal fillings. Tooth-colored ceramic crowns protect, support and beautify teeth which have lost much of their structure to decay, root canal therapy or injury.
Look your best, and feel great in Denver, CO
It's amazing how cosmetic enhancement can improve your smile and your personal outlook. Find out more by contacting Artistic & Family Dental for a smile analysis. Let Dr. Wilk or Dr. Revoir guide you through your options to arrive at your best look. Call (303) 758-2980 today.
Are you wondering if your daytime exhaustion or loud snoring could be something more?
According to the CDC, about one in three American adults aren’t getting enough sleep. Perhaps you find yourself wide-awake in the middle of the night, or maybe you have a good sleep schedule but despite the hours you still wake up tired. Do you feel as if no matter how much sleep you get you still feel like a zombie in the morning? If so, then maybe you have sleep apnea. Our Denver, CO, sleep apnea dentist Dr. Steven Wilk is here to shed some light on the subject.
What is sleep apnea?
This sleep disorder affects millions of American adults, some of which don’t even know that they have this problem. This condition causes a person to stop breathing throughout the night. These breathing cessations can happen hundreds of times in just one night’s sleep, and with the lack of oxygen getting to the brain this not only causes daytime exhaustion and irritability but it can also lead to long-term health problems like high blood pressure or an increased risk of stroke or heart attack. This is why it’s so important to seek medical attention if you think you may have sleep apnea.
What are the symptoms?
So, you may be wondering what some of the telltale signs of sleep apnea are. Well, this condition will manifest itself in different ways. You may find that you wake up with headaches every morning or you may find that no matter how much sleep you get that you still don’t wake up feeling refreshed. You may feel as if you are in a sleepy fog all day. Because of this, you may also notice that you are prone to anxiety, irritability and even depression. Those with sleep apnea are also more likely to suffer from loud, disruptive snoring.
How can my Denver general dentist treat sleep apnea?
If you’ve been diagnosed with sleep apnea our dentist can also help treat your symptoms. No, you didn’t read that wrong. Our very own Dr. Wilk specializes in treating sleep apnea with the use of oral appliance therapy. While this treatment isn’t right for everyone, it can be a great way to treat symptoms of mild-to-moderate sleep apnea. Just by wearing this custom oral device (which looks similar to a mouthguard) every night while you sleep we can help you get a better night’s rest.
If all signs point to sleep apnea, then it’s time you sought a qualified sleep specialist to help you out. If you are interested in finding out more about oral appliance therapy and whether it could help you then call Artistic & Family Dental in Denver, CO, today.
Discover the fantastic advantages of getting cosmetic dentistry in Denver, CO.
Anyone can get cosmetic dentistry. You don’t have to be rich or famous to improve your smile, no matter how big or small the changes. Maybe you want to buff out small uneven chips in your teeth or you want to whiten your smile. Perhaps you really need to straighten your teeth and give them a serious makeover. No problem! Our Denver, CO, cosmetic dentists Dr. Steven Wilk and Dr. Jeffery Revoir can help with a variety of different options.
What is the purpose of cosmetic dentistry?
Cosmetic dentistry is a wonderful way to enhance and improve upon the overall appearance of your smile. A lot of people get cosmetic and restorative dentistry confused, but true cosmetic dentistry is meant to improve on only cosmetic issues and imperfections rather than function problems, even though some restorative treatments can also give a cosmetic boost to your smile.
What cosmetic dentistry options are out there?
If you can think of something you want to change about your smile we can often find a way to do it. Some people come in and decide on only one cosmetic procedure while someone else may need more than one treatment to get the smile they want. A lot depends on your specific needs and goals, which we will discuss during your consultation.
Here is just a highlight of some of the cosmetic treatment options to consider:
Teeth whitening: Are you dealing with a yellowing, dull smile? Then our professional whitening system could get your teeth several shades whiter in just one chairside whitening session.
Dental bonding: Have minor chips and cracks in your teeth? Have a small gap between your teeth that you would like to close up? No problem! This tooth-colored resin can be applied and molded over these areas to reshape the tooth and hide these problem areas.
Dental veneers: Have more serious problems such as uneven or misshapen teeth that dental bonding won’t be able to tackle? This is where veneers come in. These thin porcelain shells are painlessly bonded to the front of your teeth to change the color, length or size of your smile.
Do you have questions about cosmetic dentistry? Want to find out what treatment option fits best with Artistic & Family Dental in Denver, CO,
What your dentists in Denver want you to know
If genetics didn’t give you a straight smile, don’t worry. Now you can straighten your smile easily, comfortably and quickly thanks to Invisalign, the virtually invisible, state-of-the-art method of orthodontic treatment. Your dentists Dr. Steven Wilk and Dr. Jeffery Revoir at Artistic & Family Dental in Denver, CO, want to tell you about the benefits of Invisalign.
Invisalign can help with many major cosmetic and functional problems with your teeth and bite. Invisalign can correct:
- Twisted, rotated or badly aligned teeth
- Underbite or overbite
- Crossbite or open bite
Invisalign is the treatment of choice for orthodontic treatment because:
- Treatment is quick-- usually completed in 9 to 15 months.
- Treatment is comfortable-- the appliances are smooth plastic with no sharp metal parts.
- Treatment is discreet-- the appliances are clear and virtually invisible to the people around you.
- Treatment is healthy-- you can remove the appliances to brush and floss normally.
One of the most common complaints about orthodontic treatment is food getting caught in your braces. Now, thanks to Invisalign, you don’t have to worry about that. You can remove the appliances to eat the foods you love.
Another complaint about conventional orthodontic treatment is how easy it is to break or bend a bracket. With Invisalign, you don’t have to worry about that either because there are no metal parts. The smooth plastic of Invisalign has not sharp parts to break, bend or irritate your soft tissue.
At Artistic & Family Dental, your treatment begins with your first set of appliances, called aligners. You wear these for two weeks and then move on to another set of aligners. You wear these for two weeks. You continue moving to a different set of aligners every two weeks as your teeth gradually shift into position. Your treatment is complete at 9 to 15 months. It’s that easy to get the straight smile you’ve been waiting for!
If you want a straight smile, Invisalign can help. Invisalign treatment is fast, easy, comfortable, and gives great results. You will also look great while you are straightening your teeth. No more unsightly metal brackets and wires. For more information on Invisalign treatment call your dentists at Artistic & Family Dental in Denver, CO. Get the smile you’ve always wanted by calling today!
Without a doubt, an effective root canal treatment can extend the life of a tooth for many years. But sometimes even a well-maintained tooth can fall prey to disease months or even years after a root canal treatment. While there are a number of reasons to account for this failure, a common one is so tiny it could have easily been missed during the first treatment.
A root canal is an open space within the tooth that contains the pulp. The pulp is a connective tissue with a network of nerve fibers connected to the root that alert the brain to environmental changes involving the tooth. It is most important during the tooth’s early development, but becomes less important as we age. The pulp is susceptible to infection from tooth decay or periodontal (gum) disease, which if left untreated can threaten the tooth’s survival. During a root canal treatment, we enter these spaces, clear out the diseased pulp and fill the canal with a bio-compatible filling; we then seal it off to deter further decay.
The treatment could ultimately fail, though, because of accessory or lateral canals missed during the procedure. Like a tree with smaller branches growing out of its larger limbs, accessory canals are smaller access ways that branch off of the main root canals. These accessory canals, which can occur anywhere along a main canal, can be quite small and not easily detected during an initial root canal treatment. They are especially susceptible to infection due to gum disease if they open into the periodontal membrane, the main attachment point between teeth and bone.
If we suspect the presence of accessory canals (either initially or after ensuing problems following a root canal treatment), this could require the skills of an endodontist, a dentist who specializes in the treatment of a tooth’s interior. Accessory canals are treated in much the same way as larger canals, but may require an endodontist’s specialized microscopic equipment and filling techniques. Effective treatment of these smaller accessory canals will certainly improve the chances of a successful, long-term outcome for the tooth.
If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Accessory Canals.”
Eaten in a fast food restaurant lately? If so, maybe you’ve noticed some changes in the big, colorful signs behind the counters. Many have begun promoting a few “healthier” selections (like salads and grilled items) and giving a more extensive listing of nutritional information. But there’s one thing you might not have noticed on those displays: a listing for soda among the beverage choices in the kiddie meal packages. That’s because they are no longer there.
Recently, Burger King quietly removed sugary fountain drinks from the in-store and online menu boards that show what you get with kids’ meals. They were following the lead of McDonalds and Wendy’s, both of which made similar moves in prior months. You can still get a soda with your kiddie burger if you specifically ask for one, but we’re hoping you won’t; here’s why.
For one thing, youth obesity has nearly tripled in the past three decades. As the U.S. Centers for Disease Control and Prevention (CDC) has noted, it’s now an epidemic affecting more than one in six children and adolescents. Many of the extra calories kids get are blamed on sugary drinks: According to a study by the Harvard School of Public Health, children’s daily calorie intake from these beverages rose by 60 percent in recent years. Obesity makes kids more likely to get many diseases, and can lead to problems in psychological and social adjustment.
But that’s not all. As dentists, we’re concerned about the potential for soda to cause tooth decay, which is still the number one chronic disease in children around the world. The association between sugary drinks and cavities is clear. So is the fact that tooth decay causes pain, countless hours of missed school and work, and expense that’s largely unnecessary, because it’s a disease that is almost 100 percent preventable.
While the new signage at fast food restaurants won’t make soda disappear, it does tend to make it less of an automatic choice. Anything that discourages children from routinely consuming soda is bound to help — and let’s point out that the same thing goes for other sweet and acidic beverages including so-called “sports” and “energy” drinks. It’s best to try and eliminate these from your child’s diet; but if you do allow them, at least limit them to mealtimes, and give your mouth a break from sweets between meals. That gives the saliva enough time to do its work as a natural buffer and acid-neutralizer.
What else can you do to help keep your child’s oral hygiene in tip-top shape? Be sure they brush their teeth twice and floss once every day, and bring them in for regular checkups and cleanings. But if you do suspect tooth decay, don’t delay treatment: Left alone, decay bacteria can infect the inner pulp of the tooth, resulting in severe pain, inflammation, and possibly the need for root canal treatment.
If you would like more information about children’s oral health, please contact us or schedule an appointment. You can learn more by reading the Dear Doctor magazine articles “How to Help Your Child Develop the Best Habits for Oral Health” and “Top 10 Oral Health Tips For Children.”
A focus on dental care in senior citizens is just as important as it is for children. Indeed, oral health in your later years can be a major factor in your quality of life.
For one, aging effects on other parts of the body can make dental care more challenging. Some hygiene tasks once performed easily become harder — arthritis, for example, or loss of muscle strength may make it difficult to hold a toothbrush or floss. In such cases, you may need to find new ways to make the task easier: a power toothbrush with a larger handle; pre-loaded floss holders or a water flosser; or adaptations to a manual brush to make it easier to hold, like attaching a tennis ball or bike handle.
Other age-related conditions — and their treatments — can negatively impact oral health. Less saliva production, which is a consequence of aging or certain drugs, increases the risk of tooth decay or periodontal (gum) disease. Older adults often develop gastric reflux problems that can introduce tooth enamel-eroding stomach acid into the mouth. And medications called bisphosphonates, often prescribed to treat osteoporosis, may interfere in rare cases with bone healing after tooth extraction or similar procedures.
Prior dental work can also prove challenging to treating dental disease. It becomes more difficult to preserve teeth threatened with decay if there are significant restorations or appliances to work around. Pain perception can also diminish with age, so that dental disease may not be noticed until later stages when significant damage has already occurred.
Oral care requires more attention as we grow older, or as we care for older family members. Your best defense against disease is to continue regular six-month visits with us. In addition to normal cleanings and checkups, we’ll also screen for oral cancer (a more prevalent occurrence in older adults), review your prescriptions or other supplements and medications for any possible side effects to oral health, check the fit of any dentures or other restorations and evaluate the effectiveness of your hygiene.
While other age-related conditions may capture the majority of your attention, you shouldn’t allow that to neglect your dental care. With your continued efforts, along with our support and your family’s, you can continue to enjoy good oral health throughout your lifetime.
Nearly half of all Americans have some form of periodontal (gum) disease. Without proper daily hygiene and treatment, this aggressive disease can ultimately cause tooth loss. It also appears the effects of gum disease reach beyond the mouth, as researchers have found relationships between it and other systemic diseases.
Inflammation, the body’s response to infection, is at the center of these relationships. In the case of gum disease, periodontal tissues become inflamed as the body attempts to isolate and fight the infection. If the inflammation becomes chronic, however, it will begin to damage gum tissues.
Inflammation is also a major feature of diabetes, a condition in which the pancreas doesn’t produce enough insulin. Without enough of this hormone that transforms sugar into usable energy for the body, the sugar accumulates in the blood stream; as a result, the patient becomes more susceptible to an exaggerated inflammatory response when the body encounters an infection. This is especially true for periodontal infections: the resulting inflammation can be greater and harder to control in diabetic patients. What’s more, uncontrolled gum disease may worsen their blood sugar levels.
Although not as prominent as with diabetes, cardiovascular disease also seems to share a connection with gum disease. This collection of chronic conditions like high blood pressure or restricted blood vessel flow raises the risk of heart attack or stroke. Like gum disease, inflammation is a major component in the progression of cardiovascular disease — in fact, both diseases leave similar chemical “markers” in the blood that indicate their early development.
Ongoing research has also produced some promising treatment findings for both gum disease and inflammatory diseases, which also include osteoporosis, respiratory disease and rheumatoid arthritis. We’re now finding in many cases that treating one side of the disease connection can have positive effects on the other side. For example, diabetics who receive professional treatment for gum disease may see better blood sugar control.
With this in mind, the best approach is to practice effective, daily oral hygiene to reduce the risk of gum disease, coupled with regular office cleanings and checkups. Not only will this help you maintain optimum oral health, it may also contribute to better management of other conditions you may have.
If you would like more information on the relationship between periodontal (gum) disease and other diseases, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”
Chewing tobacco, especially among young athletes, is considered fashionable — the “cool” thing to do. Many erroneously think it’s a safe alternative to smoke tobacco — it is, in fact, the source of numerous health problems that could ultimately lead to disfigurement or even death.
Chewing or dipping tobacco is especially linked with the sport of baseball. Its traditions in baseball go back to the late Nineteenth Century when players chewed to keep their mouths moist on dusty fields. The habit hit its greatest stride after the surgeon general’s warning on cigarettes in the late 1950s. Now, players wishing to emulate their major league heroes are prone to take up chewing tobacco at an early age.
But the habit comes with a price tag. Individuals who chew tobacco are more susceptible to oral problems like bad breath, mouth dryness, or tooth decay and gum disease. Users also increase their risk for sexual dysfunction, cardiopulmonary disease (including heart attack and stroke) and, most notably, oral cancer.
Derived from the same plant, chewing and smoke tobacco share a common trait — they both contain the highly addictive drug nicotine. Either type of user becomes addictive to the nicotine in the tobacco; and like smoking, a chewing habit can be very difficult to stop.
Fortunately, many of the same treatments and techniques for quitting smoking can also be useful to break a chewing habit. Nicotine replacement treatments like Zyban or Chantix have been shown effective with tobacco chewing habits. Substituting the activity with gum chewing (non-nicotine, and with the sweetener Xylitol), or even an herbal dip can also be helpful.
Like other difficult processes, it’s best not to try to quit on your own. You should begin your efforts to quit with a consultation with your doctor or dentist — they will be able to prescribe cessation medications and provide other suggestions for quitting. You may also find it helpful to visit a behavioral health counselor or attend a tobacco cessation support group.
Rather than just one approach, successful quitting usually works best with a combination of techniques or treatments, and perhaps a little trial and error. The important thing is not to give up: the improvements to your dental health — and life — are worth it.
If you would like more information on quitting chewing tobacco, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Quitting Chewing Tobacco.”
While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.
Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.
It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.
Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.
Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.
The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.
If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”
Periodontal (gum) disease is mainly caused by bacterial plaque built up on tooth surfaces due to ineffective oral hygiene. For most cases, treatment that includes plaque and calculus (tartar or calcified plaque) removal and renewed daily hygiene is highly effective in stopping the disease and restoring health to affected gum tissues.
However, you might have additional health factors that may make it more difficult to bring the disease under control. If your case is extreme, even the most in-depth treatment may only buy time before some or all of your teeth are eventually lost.
Genetics. Because of your genetic makeup, you could have a low resistance to gum disease and are more susceptible to it than other people. Additionally, if you have thin gum tissues, also an inherited trait, you could be more prone to receding gums as a result of gum disease.
Certain bacteria. Our mouths are home to millions of bacteria derived from hundreds of strains, of which only a few are responsible for gum disease. It’s possible your body’s immune system may find it difficult to control a particular disease-causing strain, regardless of your diligence in oral care.
Stress. Chronic stress, brought on by difficult life situations or experiences, can have a harmful effect on your body’s immune system and cause you to be more susceptible to gum disease. Studies have shown that as stress levels increase the breakdown of gum tissues (along with their detachment from teeth) may also increase.
Disease advancement. Gum disease can be an aggressive infection that can gain a foothold well before diagnosis. It’s possible, then, that by the time we begin intervention the disease has already caused a great deal of damage. While we may be able to repair much of it, it’s possible some teeth may not be salvageable.
While you can’t change genetic makeup or bacterial sensitivity, you can slow the disease progression and extend the life of your teeth with consistent daily hygiene, regular cleanings and checkups, and watching for bleeding, swollen gums and other signs of disease. Although these additional risk factors may make it difficult to save your teeth in the long-run, you may be able to gain enough time to prepare emotionally and financially for dental implants or a similar restoration.
If you would like more information on the treatment of gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal (Gum) Treatment & Expectations.”
We have learned that an important part of oral health is education — but more importantly, making it fun to learn so that you retain (and apply) what you learn! For this reason, we have put together the following self-test so that you can quickly access your knowledge on the subject of mouthguards.
- The first sport to use (and require) protective mouthguards was:
- ice hockey
- Research conducted by the American Dental Association (ADA) found that individuals are ___ times more likely to damage their teeth when not wearing a mouthguard while engaged in contact sports or rigorous physical exercise.
- As a rule of thumb, females do not require mouthguards because they are not as physically active as their male counterparts.
- The American Academy of General Dentistry (AAGD) reports that mouthguards prevent more than ______ injuries to the mouth and/or teeth each year.
- Which of the following sports or activities does the ADA recommend that participants wear protective mouthguards:
- all of the above
- The US Centers for Disease Control (CDC) reports that more than ______ sports-related injuries end-up in the emergency room each year with injury or damage to the teeth and mouth.
- Over-the-counter mouthguards are just as effective as professionally made mouthguards.
- In addition to the trauma of having a tooth (or teeth) knocked out, individuals who have suffered from this type of injury may end up spending ______ per tooth over a lifetime for teeth that are not properly preserved and replanted according to the National Youth Sports Foundation for Safety.
- $10,000 to $20,000
- $15,000 to $25,000
- $25,000 to $35,000
- Less than $10,000
Answers: 1) b, 2) d, 3) b, 4) a, 5) d, 6) c, 7) b, 8) a
You can learn more about the importance of mouthguards when you continue reading the Dear Doctor magazine article “Athletic Mouthguards.” And if you have already experienced a dental injury, it may not be too late. However, we need to evaluate the damage so that we can establish a plan for restoring optimal oral health. Contact us today to learn more about protecting your mouth and teeth or to schedule an appointment.
While dental implants are considered the gold standard for tooth replacement, removable dentures are still a viable choice, especially for patients with edentulism (complete tooth loss). Removable dentures have also undergone considerable advancement to improve their function, appearance and longevity.
But even with these advancements, dentures still require a fair amount of skill, experience and — of utmost importance — a sense of art. If you’re considering this option, long-term success depends on a careful process of construction, fit adjustment and regular checkups to maintain that fit.
Our first step is to determine exact tooth placement on each denture. Using facial features (or photos before tooth loss) we establish placement landmarks so that corresponding upper and lower teeth align properly. We also consider tooth size, their orientation in relation to the lip, and the needed space to leave between the upper and lower teeth when they are at rest. We make these determinations based on accepted standards of beauty, but also taking into account your particular comfort level with any features that might alter your appearance.
The denture’s gums must also look realistic when you smile, especially if your upper lip rises above the teeth to expose more gum tissue. We also want to match the color and texture of your natural gums, as well as incorporate palatal rugae, the little ridges behind the upper front teeth that aid with speech and chewing food.
When we first place the new dentures in your mouth, we may need to adjust them for balance between the upper and lower sets when they come together. An imbalanced fit could have an adverse effect on your ability to bite, chew and speak normally.
Your dentures should have a good, comfortable fit. Over time, however, you will encounter some degree of bone loss because you no longer have your natural teeth to stimulate bone growth and absorb the forces created during function when your teeth contact. This and other factors may cause your dentures to become loose and uncomfortable to wear. For that reason, it's important for you to visit us regularly to maintain that good fit and check the health of underlying tissues and bone.
Careful planning and denture construction help ensure your new dentures successfully restore form and function to your mouth. Regular monitoring will also ensure they continue to serve you well for as long as possible.
If you would like more information on removable dentures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removable Full Dentures.”
One of our primary goals in dentistry is to deliver effective treatment to patients with the least amount of discomfort. This is especially true after a procedure — controlling pain and inflammation will actually help reduce recovery time.
There are many strong pain relievers available, including prescription opiates like morphine or codeine. It has been shown, however, that healing and comfort are enhanced with non-steroidal anti-inflammatory drugs (NSAID) because they not only minimize pain, but they also reduce inflammation after a procedure. One common NSAID is Ibuprofen, which works by blocking prostaglandins, a substance released by inflamed, damaged tissues. NSAIDs are very popular with dentists and other health professionals because they act primarily on the inflammation site and don’t impair consciousness like opiates. They’re also usually less expensive than pain medication requiring a prescription.
While relatively safe, NSAIDs do have side effects that could cause serious problems for some patients. The most common caution regards NSAID’s tendency to thin blood and reduce the natural clotting mechanism, especially if taken habitually over a period of time. They can damage the kidneys and the stomach lining (causing ulcers or dangerous bleeding), and they’ve also been linked to early miscarriages and heart attacks.
For these reasons, NSAIDs are not recommended for pregnant women, patients with a history of stomach or intestinal bleeding, or patients being treated for heart disease. In the latter case, NSAIDs may interfere with the effectiveness of low-dose aspirin therapy (another type of NSAID) to prevent future heart attacks or strokes.
Health officials recommend all patients limit their dosage of a NSAID to no more than 2400 milligrams a day for short term pain relief, unless otherwise advised by a doctor. For the most part, a single 400 mg dosage is usually sufficient for pain control during a post-procedure recovery.
Your dentist will typically obtain your medical history before you undergo a dental procedure, including the medications you’re taking. Depending on your current health status and the type of procedure you’re undergoing, your dentist will recommend a pain control regimen to follow after the procedure is over.
Following those recommendations, and alerting your healthcare provider if you encounter any side effects from pain medication, will help assure your recovery period after dental work is short, safe and uneventful.
If you would like more information on the use of NSAIDs to control discomfort after a dental procedure, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Pain With Ibuprofen.”
While the prevention and treatment of tooth decay has improved dramatically over the last half century, it continues to be a major health issue, especially for children. One in four children 5 and younger will develop some form of the disease.
Although tooth decay in children stems from the same causes as in adults — the presence of decay-causing bacteria in plaque, unprotected teeth and the right mix of carbohydrates like sugar left in the mouth — the means by which it occurs may be different. We even define tooth decay differently in children as Early Childhood Caries (ECC), “caries” the dental profession’s term for tooth decay.
ECC highlights a number of cause factors specific to young children, such as: continuous use of a bottle or “sippy cup” filled with juice or other sweetened beverages; at-will breast-feeding throughout the night; use of a sweetened pacifier; or regular use of sugar-based oral medicine to treat chronic illness.
If you noticed sugar as a common denominator in these factors, you’re right. As a primary food source for bacteria, refined sugar is a major trigger for the disease especially if it constantly resides in the mouth from constant snacking or sipping. In fact, it’s the primary driver for a particular pattern of decay known as Baby Bottle Tooth Decay (BBTD). This pattern is specifically linked to sleep-time bottles filled with juice, milk, formula or other sweetened beverages, given to an infant or toddler to help soothe them through the night or during naps.
All these factors cause a cycle of decay. To interrupt that cycle, there are some things you as a parent should do: perform daily hygiene with your child to reduce decay-causing bacteria; reduce the amount and frequency of carbohydrates in the diet, particularly sugar; and protect the teeth by having us apply fluoride or sealants directly to the teeth.
Early tooth decay could affect your child's oral health for years to come. With a little care and vigilance, you improve your chances of avoiding that encounter.
If you would like more information on preventing tooth decay in children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dentistry & Oral Health for Children.”
1. What is dental erosion?
a. tooth decay; b. dissolving of tooth enamel by acids in food or drink; c. destruction of tooth material by wear; d. attacks on teeth by bacteria
2. Which of these drinks does not cause dental erosion?
a. orange juice; b. cola drinks; c. water; d. energy drinks
3. Soda sweetened with artificial sweeteners does not cause dental erosion.
a. true; b. false
4. Brushing your teeth immediately after consuming acidic food or drinks may make erosion worse.
a. true; b. false
5. Waiting after consuming acidic foods or drinks allows time for your saliva to neutralize the acid and add calcium back to the enamel in your teeth.
a. true; b. false
6. How long should you wait before brushing after consuming acidic foods or drinks?
a. 10 minutes; b. 20 minutes; c. 30 minutes to an hour d. eight hours
7. Loss of tooth surface material due to dental erosion is reversible.
a. true; b. false
8. People who suffer from bulimia, a psychological condition in which they frequently induce vomiting, often develop severe dental erosion from stomach acid.
a. true; b. false
9. What is the meaning of a low pH value?
a. high pH means high acidity; b. low pH means high acidity; c. neutral pH means high acidity; d. none of the above
10. Properties of a beverage that define their likelihood to erode your teeth are its acidity and its buffering capacity (resistance to being neutralized by saliva.)
a. true; b. false
11. Cola beverages, sports and energy drinks, and fruit juices have a low pH and high buffering capacity. What other factors determine their likelihood of causing dental erosion?
a. acid concentration; b. drinking them more frequently; c. swishing them around in your mouth; d. all of the above
12. How can you reduce dental erosion from the beverages you drink?
a. drink acidic beverages only at mealtimes and not all day long; b. drink beverages with added calcium; c. sip drinks through a straw to reduce contact with your teeth; d. all of the above
Answers: 1b, 2c, 3b, 4a, 5a, 6c, 7b, 8a, 9b, 10a, 11d, 12d
How did you score on our quiz? We hope you gained some information that will help you reduce dental erosion and preserve your teeth’s vital protective enamel.
Tooth sensitivity can be disheartening: you’re always on your guard with what you eat or drink, and perhaps you’ve even given up on favorite foods or beverages.
The most common cause for this painful sensitivity is dentin exposure caused by receding gums. Dentin contains tiny open structures called tubules that transmit changes in temperature or pressure to the nerves in the pulp, which in turn signal pain to the brain. The enamel that covers the dentin, along with the gum tissues, creates a barrier between the environment and dentin to prevent it from becoming over-stimulated.
Due to such causes as aggressive over-brushing or periodontal (gum) disease, the gum tissues can recede from the teeth. This exposes portions of the dentin not covered by enamel to the effects of hot or cold. The result is an over-stimulation of the dentin when encountering normal environmental conditions.
So, what can be done to relieve painful tooth sensitivity? Here are 3 ways to stop or minimize the symptoms.
Change your brushing habits. As mentioned, brushing too hard and/or too often can contribute to gum recession. The whole purpose of brushing (and flossing) is to remove bacterial plaque that’s built up on tooth surfaces; a gentle action with a soft brush is sufficient. Anything more than two brushings a day is usually too much — you should also avoid brushing just after consuming acidic foods or liquids to give saliva time to neutralize acid and restore minerals to the enamel.
Include fluoride in your dental care. Fluoride has been proven to strengthen enamel. Be sure, then, to use toothpastes and other hygiene products that contain fluoride. With severe sensitivity you may also benefit from a fluoride varnish applied by a dentist to your teeth that not only strengthens enamel but also provides a barrier to exposed dentin.
Seek treatment for dental disease. Tooth sensitivity is often linked to tooth decay or periodontal (gum) disease. Treating dental disease may include plaque removal, gum surgery to restore receded gums, a filling to remove decay or root canal therapy when the decay gets to the tooth pulp. These treatments could all have an effect on reducing or ending your tooth sensitivity.
If you would like more information on the causes and treatments for sensitive teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Sensitivity.”
The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.
At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.
Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.
Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.
At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.
If you would like more information on the effects and treatment of impacted teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”
Ah, the baby teeth: those cute little pearl buttons that start to appear in a child’s mouth at around 6 to 9 months of age. Like pacifiers and bedtime stories, they’ll be gone before you know it — the last usually disappear by age 10-13. So if the dentist tells you that your young child needs a root canal, you might wonder why — isn’t that tooth going to be lost anyway?
The answer is yes, it is — but while it’s here, it has some important roles to play in your child’s development. For one thing, baby teeth perform the same functions in kids as they do in adults: Namely, they enable us to chew, bite, and speak properly. The primary teeth also have a valuable social purpose: they allow us to smile properly. If a baby tooth is lost prematurely at age 6, the child may suffer detrimental effects for five years or more — and that’s a long time for someone so young!
Even more important, baby teeth have a critical function in the developing mouth and jaw: Each one holds a space open for the permanent tooth that will eventually replace it — and it doesn’t “let go” until the new tooth is ready to come in. If a primary (baby) tooth is lost too soon, other teeth adjacent to the opening may drift into the empty space. This often means that the permanent teeth may erupt (emerge above the gum line) in the wrong place — or sometimes, not at all.
The condition that occurs when teeth aren’t in their proper positions is called malocclusion (“mal” – bad; “occlusion” – bite). It can cause problems with eating and speaking, and often results in a less-than-perfect-looking smile. It’s the primary reason why kids get orthodontic treatment — which can be expensive and time-consuming. So it makes sense to try and save baby teeth whenever possible.
Procedures like a root canal — or the similar but less-invasive pulpotomy — are often effective at preserving a baby tooth that would otherwise be lost. But if it isn’t possible to save the tooth, an appliance called a space maintainer may help. This is a small metal appliance that is attached to one tooth; its purpose is to keep a space open where the permanent tooth can come in.
If your child is facing the premature loss of a primary tooth, we will be sure to discuss all the options with you. It may turn out that preserving the tooth is the most cost-effective alternative in the long run. If you have questions about your child’s baby teeth, please contact us or schedule an appointment for a consultation.
Tongue and other piercings are a current fad or trend, but can often lead to unforeseen problems.
Piercing the tongue and installing a metal ornament called a tongue bolt commonly leads to chipped teeth, sensitivity, and pain. More frequently, it can cause problems with the gums, such as recession, inflammation, infection, bone loss, and even nerve damage.
In one case reported by the American Medical Association, a teenager suffered 20 to 30 daily electrical shocks in many areas of her face after having her tongue pierced and installing a tongue bolt. A neurologist found that the bolt irritated the nerves to her tongue, causing the symptoms. After the bolt was removed, the shocks and symptoms ceased and her tongue healed.
Having the bolts placed may be painful. The tongue is rich in nerves and blood vessels and a lot of bleeding can occur, which can be difficult to stop. Think about how painful it is when you bite your tongue or lip accidentally. And tongue and lip bolts are not generally placed by health professionals or under sterile conditions.
If you are considering getting an oral piercing, make an appointment with us to discuss all the possible ramifications before you make the decision to go ahead. If you already have an oral piercing, be sure to come in for frequent checkups.
Contact us today to schedule an appointment to discuss your questions about oral piercings. You can also learn more by reading the Dear Doctor magazine article on “Body Piercings and Teeth: The dangers of tongue and lip piercing.”
Although sometimes controversial, body piercing has exploded in popularity, especially among young people. Aside from the social debate about such practices, there are health risks to consider. Oral piercings, in particular — especially of the tongue — could have an adverse effect on your dental health.
The trouble begins with the piercing procedure itself. The tongue is composed of a number of muscle groups that given its wide range of function require a lot of energy. To supply this energy the tongue has a large network of blood vessels; during a piercing it's not uncommon for profuse bleeding to occur. The tongue also contains a lot of nerve fibers — a piercing may result not only in severe pain, but in possible nerve damage too.
The tongue bolt, the most common tongue piercing, can cause a lot of damage in the mouth during wear, such as tooth chipping and increased sensitivity. It can also interfere with oral hygiene and contribute to the growth of tooth decay and gum disease. And, as with any cut or abrasion to soft tissue, piercings increase the risk of infection.
There are also issues if and when you decide to give up the tongue bolt — fortunately, though, not to the same degree as during wear. Cuts to the tongue tend to heal quickly, so the piercing hole may fill in spontaneously. In some circumstances, however, a surgical procedure (similar to one performed on large ear piercings) may be required to repair the piercing hole.
For the long-term sake of your oral health, we would advise against having your tongue or lips pierced. And, if you already have a piercing, please consider giving it up — in the long run you'll be doing your teeth, gums and other tissues in your mouth a favor.
If you would like more information on oral piercing and its effects, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How to Help Your Child Develop the Best Habits for Oral Health.”
Modern dentistry offers several great ways to permanently replace missing teeth, including high-tech dental implants and traditional fixed bridgework. But sometimes, for one reason or another, it isn’t possible to have these treatments done right away. If you need an aesthetic way to temporarily replace missing teeth, a flexible partial denture could be the answer you’re looking for.
Certain kinds of removable partial dentures (RPDs) can be used as permanent tooth replacement systems, especially for people who aren’t candidates for dental implants or fixed bridges. But in the past, if you needed a temporary tooth replacement, one of the few alternatives was the type of rigid RPD often called a “flipper.” This consists of a firm, relatively thick acrylic base that supports one or more lifelike replacement teeth. It attaches to the “necks” of existing natural teeth via metal clasps, which gives it stability and strength.
However, the same rigidity and thickness that gives these rigid RPDs their durability can make them uncomfortable to wear, while the acrylic material they are made of is capable of staining or breaking. Over time, the RPDs are prone to coming loose — and they are also easy to flip in and out with the tongue, which gives them their nickname.
Flexible partial dentures, by contrast, are made of pliable polyamides (nylon-like plastics) that are thin, light and resistant to breakage. Instead of using metal wires to attach to the teeth, flexible RPDs are held securely in place by thin projections of their gum-colored bases, which fit tightly into the natural contours of the gumline. Their elasticity and light weight can make them more comfortable to wear. Plus, besides offering aesthetic replacements for missing teeth, their natural-looking bases can cover areas where gums have receded — making existing teeth look better as well.
All RPDs must be removed regularly for thorough cleaning — but it’s especially important for flexible RPD wearers to practice excellent oral hygiene. That’s because the projections that hold them in place can also trap food particles and bacteria, which can cause decay. And, like most dentures, RPDs should never be worn overnight. Yet with proper care, flexible RPDs offer an inexpensive and aesthetic way to temporarily replace missing teeth.
Since their introduction over three decades ago, dental implants have evolved into dentistry’s premier tooth replacement choice. While their primary purpose is to replace missing teeth and rejuvenate a patient’s smile, they’re also regarded for another important benefit: they can slow or stop bone loss accelerated by the loss of teeth.
Like all living tissue, bone has a life cycle. Older bone dissolves and is absorbed by the body, a process called resorption. New bone forms and grows to replace the resorbed bone in response to stimuli occurring within the body. In the jaw, this stimulation comes from the forces the teeth receive when we bite or chew.
When a tooth is lost, however, it no longer transmits these force stimuli to the adjacent bone. This results over time in less new growth to replace resorbed bone, and the overall bone mass shrinks. In fact, about a quarter of the normal bone width will diminish in the first year alone after tooth loss. Other serious problems follow, like gum recession or chewing and speaking difficulties. A person’s appearance may also suffer, because as resorption continues unchecked, the underlying foundational bone will continue to shrink. As more teeth are lost, a decrease in the distance between the nose and chin may result causing the lower third of the face to become smaller in size.
Dental implants can interrupt this process by encouraging bone growth around the implant. Implants are made of “osseophilic” titanium, meaning the metal has a natural affinity with bone. After implantation, bone cells will begin to grow and attach to the titanium post. The enhanced growth stabilizes bone loss by providing stimulation to the bone as teeth once did, thereby maintaining bone levels and minimizing potential effects on the patient’s appearance.
Ironically, too much bone loss could make the installation of implants more difficult, since they require a minimum level of bone mass for anchorage. Receiving an implant as soon as is practical once a tooth is lost will minimize the chances of that occurring — and a better chance of improving bone health overall.
If you would like more information on how dental implants improve bone health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”
Fluoride has been proven to strengthen tooth enamel against decay. That’s why it’s not only added to toothpaste and other dental products, but also to drinking water — in nearly three-quarters of U.S. water systems.
While research has eased most serious health questions about fluoride, there remains one moderate concern. Too much fluoride over time, especially in infants and young children, could lead to “enamel fluorosis,” an excess of fluoride in the tooth structure that can cause spotting or streaking in the enamel. While often barely noticeable, some cases of fluorosis can produce dark staining and a pitted appearance. Although not a symptom of disease, fluorosis can create a long-term cosmetic concern for the person.
To minimize its occurrence, children under the age of 9 shouldn’t regularly ingest fluoride above of the recommended level of 0.70 ppm (parts per million). In practical terms, you as a parent should monitor two primary sources of fluoride intake: toothpaste and drinking water.
Young children tend to swallow toothpaste rather than spit it out after brushing, which could result in too much fluoride ingestion if the amount is too great. The American Academy of Pediatric Dentistry therefore recommends a small “smear” of toothpaste for children under two, and a pea-sized amount for children up to age six. Brushing should also be limited to no more than two times a day.
Your child or infant could also take in too much fluoride through fluoridated drinking water, especially if you’re using it to mix infant formula. You should first find out the fluoride levels in your local water system by contacting the utility or the health department. If your system is part of the U.S. Centers for Disease Control and Prevention’s (CDC) “My Water’s Fluoride” program, you may be able to access that information on line at http://apps.nccd.cdc.gov/MWF/Index.asp.
If the risk for developing fluorosis in your area is high, you can minimize your infant’s intake with a few recommendations: breastfeed rather than use formula; use “ready-to-feed” formula that doesn’t need mixing and contains lower fluoride levels; and use bottled water specifically labeled “de-ionized,” “purified,” “de-mineralized,” or “distilled.”
Fluoride can be a wonderful adjunct to dental care in reducing risk for tooth decay. Keeping an eye on how much fluoride your child takes in can also minimize the chance of future appearance problems.
If you would like more information on the possible effects of fluoride on young children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”
Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.
The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.
While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.
Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.
If you would like more information on treatment for a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth.”
While it doesn’t garner the star power of blood, saliva is still an important bodily fluid. A true multi-tasker, saliva contributes in many ways to the function and health of the body, from stronger teeth to more efficient digestion.
Here are six ways saliva helps your mouth and body function properly and stay healthy.
The mouth’s natural cleanser. Bacteria are responsible for much of the dental disease that plagues us, particularly tooth decay and gum disease. Saliva clears the mouth of food remnants, bacteria’s primary feeding source, after we eat. This leaves a cleaner mouth and fewer bacteria to cause infection.
The immune system’s partner. Saliva contains an antibody called Immunoglobulin A (IgA) that attacks disease-causing microorganisms. Along with secreting other antibacterial agents like lactoferrin and lyzozyme that curb the growth and development of bacteria, saliva serves as the body’s first line of defense against pathogens entering through the mouth.
Acid neutralizer. The optimal oral environment is a neutral pH of 7. Many of our foods and beverages, though, are highly acidic, which can raise the mouth’s acid level. The acidic environment causes the minerals in tooth enamel to soften and dissolve (a process called de-mineralization). Saliva restores the balance by neutralizing any remaining acid after we eat (a process that takes about 30 to 60 minutes).
Mineral replacer. Even under normal conditions, enamel will de-mineralize to some extent whenever the mouth becomes acidic. Saliva restores some of the enamel’s lost minerals like calcium and phosphate while it’s neutralizing acid. If fluoride is also present in saliva from fluoridated drinking water or toothpaste, it too is absorbed by the enamel making it stronger and more resistant to acid attacks.
Digestion enhancer. Saliva lubricates the mouth while we eat, making it easier for us to chew (and taste) our food. Saliva also releases the enzyme amylase as we chew to break down starches before the food enters our stomach. The end result is more efficient and comfortable digestion.
The wave of the future in diagnostics. Like blood and urine, saliva contains genetic and disease markers that could tell a physician if a patient has a certain condition. Since collecting a saliva sample is much easier than with these other bodily fluids, diagnosing disease with saliva will become more prevalent as more calibrated devices reach the market.
If you would like more information on the role of saliva in the body, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saliva.”
We’re all susceptible to gum disease when we fail to practice effective daily brushing and flossing. But you may have a greater risk of gum disease (and more severe forms of it) if any of the following categories pertain to you:
Aging. Gum disease risk naturally increases with age. We can lower the risk with an effective daily hygiene regimen, along with a minimum of two office cleanings and checkups each year. Brushing and flossing removes bacterial plaque and food particles which accumulate on tooth surfaces. The longer plaque remains in contact with gum tissues, the greater the chances of infection.
Pregnancy. Although women tend to take better care of their teeth than men, they still face unique issues that increase their risk. During pregnancy, for example, certain hormone levels rise, which cause the gums to become more responsive to bacteria. Other hormonal fluctuations throughout a woman’s life, including taking certain drugs for birth control or during menopause, can cause similar situations.
Family History. You could be at higher risk if members of your immediate family have a history of gum disease. Researchers estimate that 30% of the U.S. population has a genetic predisposition to the disease; it’s also possible for family members to transfer bacteria to other family members by way of saliva contact or shared eating utensils.
Smoking. Nicotine, the active ingredient in tobacco smoke, causes changes in the blood vessels of the mouth that could inhibit the flow of antibodies (produced by the body to fight infection) in the bloodstream. As a result, smokers experience more rapid disease development and greater detachment between teeth and gums than non-smokers.
Other Inflammatory Conditions. A number of studies indicate people with other inflammatory conditions like heart disease, arthritis or diabetes have a higher risk for gum disease. Some researchers have even suggested that bacteria associated with gum disease pass into the blood stream and threaten other parts of the body — an added incentive to seek treatment and stop the disease’s advancement.
If you fall into any of these risk categories, it’s even more urgent that you practice effective daily hygiene with regular office checkups. Additionally, if you begin to notice bleeding gums, tenderness and swelling, or loose teeth, contact us as soon as possible for an evaluation.
If you would like more information on the diagnosis and treatment of gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Assessing Risk for Gum Disease.”
Adult teeth aren’t meant to be loose — it’s a sign that something is wrong. And while there are treatments, time is of the essence before permanent tooth or bone loss occurs.
Loose teeth can occur for many different reasons. Bite-related problems are fairly common, referred to as occlusal trauma (“occlusal” – bite; “trauma” – injury). This could be the result of excessive force placed on otherwise normal teeth and jaws — chronic clenching or grinding habits, for example. On the other hand, even normal biting or chewing can cause teeth to loosen if bone loss from gum disease has become excessive, reducing the remaining attachment to bone to inadequate levels. In some cases it can be a result of both excessive force and weakened bone levels.
Of these reasons, the most common cause is the weakened attachment of the teeth to the bone due to gum disease. If this is the case, it’s important first to treat the gum disease by an appropriate strategy for the disease present and then implement an effective dental hygiene program to inhibit reoccurrence.
As for the problem of loose teeth, there are measures to address it. Occlusal bite adjustment reduces the degree of force when biting or chewing by reshaping the biting surfaces through selective grinding. Splinting is another technique in which the teeth are joined together to make them more rigid and to redistribute the biting force among several teeth. This can be done with material bonded across the outside of several teeth or with a metal splint affixed within a pre-cut channel across the teeth. A more permanent option is to create a series of crowns to affix to the teeth and then fuse them together.
Although more complex, orthodontics to correct misaligned teeth is another option. Not only will it improve the bite and potentially reduce bite forces, it may also improve the health of the supporting periodontal attachment.
Before undertaking any treatment, you should first undergo a thorough exam to determine the true cause of your loose teeth and any underlying conditions. From there we can recommend the best approach for treating and preserving your teeth.
If you would like more information on treatments for loose teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treatment for Loose Teeth.”
Even though they eventually fall out, primary (baby) teeth play several vital roles in your child's development. Among other things, they serve as important guides for the developing permanent teeth that will replace them. If any are lost prematurely, the remaining baby teeth start to shift, migrating forward, decreasing the space necessary for the permanent teeth to erupt into their proper positions. This could result in a need for future orthodontics that may have been unnecessary. So it's important to keep primary teeth healthy and in place until they are ready to come out naturally.
Signs & Symptoms of Teething
Primary (baby) teeth typically begin emerging between six and nine months, though as early as three or as late as 12 months can occur. Usually, but not necessarily, the two lower front teeth appear first. All 20 primary teeth are generally in by the age of three.
Some typical signs of teething include: irritability, gum swelling, gnawing, drooling (due to increased saliva production), chin (facial) rash (due to excessive drooling), disrupted sleeping patterns, ear rubbing, and decreased appetite. Symptoms generally start about four days before a tooth emerges, are most intense during the week when the tooth breaks through the gum, and subside about three days following the event.
You may notice small, bluish, translucent “eruption cysts” on your baby's gum where a tooth is breaking through; sometimes blood mixes with the fluid in a cyst, at which point it's called an eruption hematoma. Both generally disappear on their own when the tooth erupts and pops them.
Suggestions for Soothing
To help keep your teething baby as comfortable as possible, try the following:
- A chilled rubber teething ring, pacifier, or cold wet washcloth
- Gentle gum massage using a clean finger
- Cold foods like popsicles when your child is old enough (just be careful about feeding him or her too much sugar, which can cause decay even in newly emerging/emerged teeth)
- Over-the-counter pain medication such as ibuprofen or acetaminophen in the appropriate dosage
The onset of teething is the perfect time to begin focusing on your child's pediatric dental care. Even though baby teeth eventually fall out, the quality of their care will have a direct and long-lasting impact on the health of the permanent teeth that follow.
If you would like more information about baby teething, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teething Troubles.”
Lasers have transformed our everyday lives, especially in healthcare. These intense beams of light of a single wavelength have revolutionized all manner of diagnostics and treatments, from general surgery to cosmetic therapy.
Dentistry has also been influenced by the laser revolution. Here are just a few of the areas where they’re growing in use and popularity.
Early disease detection. Laser instruments can take advantage of “fluorescence,” the tendency of bacteria to “glow” when exposed to certain wavelengths of light. This is proving more effective in detecting early tooth decay in pits and fissures (very tiny areas in a tooth’s biting surface) than traditional needle-like probing instruments called dental explorers. Newer lasers can now detect the same fluorescent qualities in soft tissues, which may reduce the detection time for oral cancer and make the difference between life and death.
Dental caries treatment. Lasers have become an alternative to the dental drill in treating teeth with dental caries (decay). Although with larger cavities lasers are somewhat slower than the conventional drill, they truly shine when it comes to early enamel caries and small cavities because they can be quite precise in the amount of tooth structure they remove. This feature allows them to be less invasive than a dental drill.
Periodontal treatment. Periodontal (gum) disease is an infection caused mainly by bacterial plaque and calculus (hardened plaque deposits) that have adhered to tooth surfaces. Lasers are emerging as an alternative to conventional periodontal (gum) surgery to treat voids or spaces below the gum line called periodontal pockets that have formed because of gum tissue detachment as supporting bone is lost. With their ability to target and destroy infected tissue without damaging nearby healthy tissue, lasers can achieve similar outcomes as traditional techniques but with less tissue damage and discomfort to patients afterward.
Research and development into laser technology continues to perfect these and other applications that promise to make dental procedures less invasive and more comfortable for patients.
Periodontal (gum) disease is an infectious condition that if left untreated could lead to tooth loss. While gum disease is primarily caused by a thin layer of bacterial plaque and calculus left on the teeth due to poor hygiene, you may also have extenuating factors that may make you more susceptible to the disease.
Gum disease is actually a group of infectious diseases in which some forms are more difficult to control than others. All these forms arise from interactions between the bacteria in the dental plaque and your body’s immune system. Depending on both your body’s individual response and the disease form, your resistance to the resulting bacterial infection may be low.
That low resistance to certain strains of bacteria may be genetic — something you’ve inherited from your parents. Your stress level, particularly when it’s high, can also diminish your body’s ability to resist disease. There are also numerous strains of bacteria that could lead to gum disease — your body may not be able to effectively resist the particular “mix” of strains contained in your dental plaque.
Aside from lifestyle issues like stress or oral hygiene, we can at least test and verify any susceptibility you may have due to uncontrollable factors like genetics or the particular bacterial makeup within your plaque. Unfortunately, a minority of people will continue to deal with gum disease even after treatment and adopting a more effective hygiene regimen. Although we can’t cure the disease, we can certainly control it with regular monitoring and treatment when necessary.
The key is to adopt a long-term strategy that will seek to preserve the teeth for as long as possible. In some cases, the best treatment approach is to prolong the life of the affected teeth for as long as possible to give you time to prepare emotionally and financially for eventual tooth replacement.
Indeed, any patient experiencing some form of gum disease should seek professional treatment, followed by a daily oral hygiene program and regular checkups and office cleanings. Taking the right steps in consultation with your dentist will assure you’ll preserve your teeth for as long as possible.
If you would like more information on treatment for periodontal disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal (Gum) Treatment and Expectations.”
Picture this: You’re feeling some mild irritation in your mouth, which seems to be coming from the area near your tongue. You go to the mirror, open wide… and notice a series of red patches on the tongue’s surface, which are surrounded by whitish borders. Should you drop what you’re doing and rush to get medical help right away?
Sure, a visit to the dentist might be a good idea to rule out more serious problems — but first, sit down and relax for a moment. Chances are what you’re experiencing is an essentially harmless condition called “benign migratory glossitis,” which is also known by its common name — geographic tongue. While it may look unusual, geographic tongue isn’t a serious condition: It’s not cancerous or contagious, and it doesn’t generally lead to more severe health problems. However, it can make your tongue feel a bit more sensitive, and may occasionally lead to mild sensations of burning, stinging or numbness.
The appearance of reddish patches on the tongue results from the temporary loss of structures called papillae: tiny bumps which normally cover the tongue’s surface. These patches may appear or disappear over the course of days — or even hours — and sometimes appear to change their shape or location.
What causes geographic tongue? Several factors seem to be responsible for setting off the problem, but as of yet the actual cause of the disease is unknown. Among these triggers are emotional stress and psychological upsets, hormonal disturbances, and deficiencies in zinc or vitamin B. The condition, which affects between one and three percent of the population, is seen more frequently in non-smokers, in women, and in those with a family history of the problem. It is also associated with people who suffer from psoriasis, a common skin condition, and those who have a fissured (deeply grooved) tongue.
Unfortunately, there is no “cure” for geographic tongue — but the good news is that treatment is usually unnecessary. If you’re experiencing this condition, it may help if you avoid foods with high levels of acidity (like tomatoes and citrus fruits), as well as hot and spicy foods. Alcohol and other astringent substances (like some mouthwashes) may also aggravate it.
While geographic tongue isn’t a serious condition, it can cause worry and discomfort. That’s why it’s a good idea for you to come into the office and have it checked, just to make sure. A thorough examination can put your mind at ease, and rule out other conditions that may be more of a concern. We may be also able to help you manage this condition by prescribing anesthetic mouth rinses, antihistamines, or other treatments.
If you would like more information about geographic tongue, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Geographic Tongue.”
Tooth preservation is the ultimate aim of a root canal treatment. But how long should you expect a treated tooth to last? The answer will depend on a few different variables.
A root canal treatment is necessary when a tooth’s pulp — the inner tissue made of nerves, blood vessels and connective tissues — becomes infected with disease. As the pulp dies, the infection spreads into the adjacent bone; this can eventually lead to loss of the tooth.
To stop this process, we enter the tooth and remove all of the pulp, disinfect the pulp chamber and the root canals, and then fill the chamber and canals. Depending on the type of tooth and level of decay, we seal the tooth with a filling or install a crown to prevent re-infection. it’s then quite possible for a treated tooth to survive for years, decades, or even a lifetime.
There are a number of factors, though, that may affect its actual longevity. A primary one depends on how early in the disease you receive the root canal treatment. Tooth survival rates are much better if the infection hasn’t spread into the bone. The earlier you’re treated, the better the possible outcome.
Tooth survival also depends on how well and thorough the root canal is performed. It’s imperative to remove diseased tissue and disinfect the interior spaces, followed by filling and sealing. In a related matter, not all teeth are equal in form or function. Front teeth, used primarily for cutting and incurring less chewing force, typically have a single root and are much easier to treat than back teeth. Back teeth, by contrast, have multiple roots and so more root canals to access and treat. A front tooth may not require a crown, but a back tooth invariably will.
These factors, as well as aging (older teeth tend to be more brittle and more susceptible to fracture), all play a role in determining the treated tooth’s survival. But in spite of any negative factors, a root canal treatment is usually the best option for a diseased or damaged tooth. Although there are a number of good options for replacing a lost tooth, you're usually better in the long run if we can preserve your natural tooth for as long as possible.
If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment: How Long Will it Last?”
You have a beautiful smile, but you hesitate to show it because of your stained teeth. Fortunately, whitening techniques could take away that embarrassment.
There are two basic types of tooth staining or discoloration: extrinsic, in which the stain is on the surface of the teeth and mostly caused by substances like coffee, wine or tobacco; and intrinsic, which occurs deep within the tooth, caused by such factors as aging, previous dental treatments and fillings, the use of antibiotics (tetracycline, predominantly), or over-exposure to fluoride.
Whitening or bleaching is an effective and relatively affordable solution for many instances of both intrinsic and extrinsic staining. Bleaching solutions are available in over-the-counter (OTC) home kits or as a professional application in the dental office.
Most bleaching solutions use carbamide peroxide, a chemical compound that is effective in removing most stains. OTC home applications contain carbamide peroxide (or an equivalent) in concentrations of about 10% as opposed to 15-35% found in professional solutions. Though less costly than a professional application, OTC products take longer (usually up to three weeks) to achieve desired results. With its stronger solution, a professional application in our office can achieve the same level of brightness in only one or two visits. We may also use special lighting to accelerate the chemical process, as well as rubber dams or gels to protect gums and soft tissues from solution irritation during the procedure.
Although effective, whitening isn't a permanent solution — over time the effect will fade, usually six months to a year depending on how you care for your teeth. Matching tooth color can also be difficult in some cases, especially if you have a mix of natural teeth and artificial crowns or bridges. And, whitening may not be adequate for some types of staining.
Regardless of which application you wish to use — OTC or professional — it's a good idea to visit us first for a professional consultation. We can recommend whether whitening is a good choice for your particular type and level of staining, or if some other option like porcelain veneers might be the better choice. Regardless, there are solutions to the problem of staining, and a way to gain a brighter smile.
If you would like more information on bleaching, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Whitening.”
While dental implants are the preferable choice for teeth replacement, your life circumstances may cause you to postpone it or some other permanent restoration. In the meantime, you need a temporary solution for your tooth loss.
Removable partial dentures (RPDs) have met this need for many years. RPDs are traditionally made of rigid, acrylic plastic resin and fasten to existing teeth with metal clasps. While effective as temporary tooth replacements, RPDs do have their drawbacks: they can be uncomfortable, develop a loose fit and are prone to wear and staining.
Recently, though, new RPDs made of a flexible type of nylon are addressing some of these drawbacks. Because the nylon material is thermoplastic (able to change shape under high heat), it can be injected into a cast mold of a patient’s mouth to create the denture base, to which life-like replacement teeth are then attached. And rather than a metal clasp, these RPDs have thin, finger-like nylon extensions that fit snugly around existing teeth at the gum line.
The new RPDs are lightweight, resistant to fracture and offer a more comfortable, snugger fit than the older RPD. And because the nylon material can be made to closely resemble gum tissue, the base can be designed to cover receding gum tissue, which may further improve the appearance of a patient’s smile.
On the downside, these new RPDs are difficult to reline or repair if they’re damaged or the fit becomes loose. And like all RPDs, they must be regularly removed and cleaned thoroughly to prevent any accumulating bacterial biofilm that could increase the risk of gum disease or tooth decay (the attachment extensions are especially susceptible to this accumulation). They should also be removed at night, since the reduction in saliva flow while you sleep can worsen bacterial buildup.
Still, the new flexible RPD is a good choice to bridge the time gap between lost teeth and a permanent restoration. They can restore lost function and improve your smile during the transition to implants or a fixed bridge.
By the time you reach adulthood, roughly 100 trillion microscopic organisms will have taken up residence in and on your body, outnumbering your own cells 10 to 1. Most are bacteria, a domain of the animal kingdom considered synonymous with disease. But only a few of the thousands of bacterial species cause us harm; the rest are either benign or actually beneficial to our health, including in our mouths.
Dentistry pioneered much of our knowledge about bacteria, developing processes used to identify, classify and understand those species inhabiting our mouths. Science as a whole is catching up with the Human Microbiome Project (HMP) begun in 2007. Through HMP, researchers have catalogued and begun to study more than 10,000 bacterial species.
We’re finding that our bodies develop a symbiotic relationship with many of these creatures invisible to the naked eye. During our infancy the bacteria we ingest from birth and breast feeding begin to interact with our body’s immune system, “teaching” it to refrain from attacking friendly organisms that contribute to health and searching and destroying enemy species that cause disease.
We’re also learning that an imbalance with our individual population of bacteria has links with disease. Our digestive system is a prime example: bacteria related to obesity can overpopulate our digestive tract, while malnutrition can create an environment that produces too many bacteria that inhibit digestion of vitamins and other nutrients.
The same microbial imbalance can occur in the mouth. For example, our typical Western diet encourages the growth of bacteria most associated with tooth decay (Streptococcus mutans). We’re also finding that tobacco smoking creates a mouth environment more conducive to the bacteria that cause gum disease. Just by quitting smoking you can alter that environment to encourage growth of health-promoting bacteria and inhibit growth of malevolent species.
The desired outcome of this knowledge is to develop treatments that target disease-causing bacteria without harming those beneficial to us (as often occurs with traditional antibiotics). In dentistry, such possibilities could help stop the spread of tooth decay, gum disease or similar bacterial infections, while fostering a healthier oral environment that prevents disease and protects health.
Dental implants have emerged as the premier replacement option for lost teeth. Their life-like appearance, durability and versatility have made them extremely popular with patients.
Implants aren’t a quick fix, though: in most cases the process takes months to complete. Here’s a chronological overview of what you can expect if you decide on dental implants.
Stage 1: Planning. The process begins at least a few weeks before the actual implantation with an examination to determine what’s best for your individual case. Implant materials and designs are quite numerous, enabling us to precisely match individual tooth types, shapes, lengths and color. We then use x-rays or CT scanning to identify the best locations for the implants — careful planning here increases the chances that implantation will go smoothly and the final outcome will be aesthetically pleasing.
Stage 2: Implantation. Once we’ve finished planning, it’s time to surgically insert the titanium implants into the pre-determined locations in the jawbone identified during Stage 1. While this procedure is relatively minor and routine, the surgeon still operates with precision and care to ensure the best functional and aesthetic outcome.
Stage 3: Integration. In most cases after implantation, we’ll need to wait for a few weeks before attaching the final crowns. Because bone has an affinity for titanium, it will grow and adhere to the implant during this waiting period, anchoring it securely into the bone that will increase its long-term durability. We attach temporary teeth made of acrylic plastic (along with giving you some precautions on biting and chewing) to help you function normally during the waiting period.
Stage 4: A Transformed Smile! Once integration has been achieved and the gum tissues fully healed, we can then attach the permanent crowns. These crowns are typically made of strong, durable materials that will fit the healed gum tissues more precisely than your temporary crowns. Depending on the type of implant used, the crowns are either cemented or screwed into place onto the implant.
The process of dental implantation involves a lot of time, effort and precision. In the end, though, it’s well worth it — the joy of new teeth that will function well for years and look great too!
If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “New Teeth in One Day.”
Think of a contagious disease and you may picture one of the great outbreaks of the past: the terrible flu epidemic of 1918, the ever-present threat of polio in the early 20th Century, and the ancient (and still widespread) danger of cholera in overcrowded urban areas. Or you may think of the common cold, a familiar contagious malady that’s still very much with us. Yet there’s one contagious disease you may not think of, but probably should: tooth decay.
Many people don’t realize that tooth decay is contagious. But the fact is, decay bacteria can be passed between people like a bad cold — and it happens all the time.
Sugar usually gets the blame for tooth decay; a recent survey found that 81 percent of Americans say it’s responsible for cavities. But sugar alone isn’t the culprit. Cavities are actually caused by certain types of bacteria that cling to the teeth in the absence of proper oral hygiene. These bacteria process sugar from the foods we eat, and then secrete acidic byproducts that erode the hard enamel of the teeth. This causes the formation of the tiny holes we call cavities.
Children aren’t born with S. Mutans. But studies show that most of them “catch” it from their caregivers — often, their parents. By the time they are two years old, over 80 percent of kids will have detectable levels of the bacteria. Whether or not they pick up harmful microorganisms — and how much they have — depends on the infectiousness of the strain, and on the caregiver’s attention to oral hygiene.
How can you prevent the spread of decay-causing bacteria? Essentially, by limiting its transfer from your mouth to your baby’s mouth. So don’t “clean” a baby’s pacifier by putting it in your mouth, and don’t share utensils — for example, by tasting baby’s food with his or her spoon. While it’s ever so tempting, avoid kissing baby’s lips, especially if there is a chance of transferring saliva. And don’t even think of “pre-chewing” baby’s food — no matter what some self-appointed health gurus may say.
There’s still another way to limit the spread of decay-causing microorganisms: Make sure your own practice of oral hygiene is top-notch! Oral bacteria can spread not only from parents to babies, but also between adults. Maintaining good oral health means brushing and flossing every day, and getting regular check-ups: It’s important for you, and for everyone you care about.
If you have questions about tooth decay prevention or oral hygiene care, please contact us or schedule an appointment for a consultation. You can read more in the Dear Doctor magazine articles “Tooth Decay” and “How to Help Your Child Develop the Best Habits for Oral Health.”
When you’re trying to maintain a good oral hygiene routine, your toothbrush is bound to see a lot of action. Day in and day out, it gets used about twice a day, every day — morning and night, whether you’re feeling great or under the weather, in a hurry or not. And it's stored in the bathroom: a moist environment with the potential for exposure to plenty of bacteria (and not just the ones that live in your mouth). So after all of that service, does your toothbrush itself need any particular care or cleaning — and do you need to worry about getting sick from brushing?
Let’s answer the last question first. It’s very unlikely that you can re-infect yourself with an illness (a cold, for example) from using your own toothbrush. That’s because once you’ve been infected, the antibodies that are built up in response to the invading germs will generally prevent you from getting the same disease for some time afterward. Using someone else’s toothbrush, however, is a never a good idea — especially if they are sick (whether they show any symptoms or not), and doubly so if the bristles are still wet. It’s very possible to transfer all kinds of bacteria — even the bacteria that cause tooth decay — from person to person this way.
Can bacteria really survive for any length of time on your toothbrush? The short answer is yes, as they can (and do) live almost everywhere. But for people in a normal state of health, there’s no real reason to worry: Through long exposure, your body is generally quite capable of defending itself from these microorganisms. The American Dental Association states, “[T]here is insufficient clinical evidence to support that bacterial growth on toothbrushes will lead to specific adverse oral or systemic health effects.”
However, if you or a family member have a compromised immune system (due to radiation treatment, chemotherapy or disease, for example), it might make sense to take some precautions. Using an antibacterial mouthrinse before you brush can reduce the amount of bacteria in your mouth — and on your toothbrush. Washing the brush afterward with an antimicrobial cleaner or sanitizer can also decrease the level of bacteria that remains on the toothbrush.
For everyone else, it’s best to follow a few common-sense steps for toothbrush care: Rinse your brush with tap water after you use it, to remove any remaining toothpaste and debris; store it upright, where it can air-dry before it’s used again (not in a closed container, where bacteria can thrive); and get a new brush every three months. Your toothbrush is a major weapon in the fight against tooth decay — keeping it in good shape will help you maintain a healthy mouth and a healthy body.
If you have questions about toothbrushing or oral hygiene care, please contact us or schedule an appointment for a consultation. You can read more in the Dear Doctor magazine article “Oral Hygiene Behavior.”
Porcelain veneers are a proven way to achieve a new smile. Composed of thin layers of dental porcelain and other materials laminated together to form one life-like unit, veneers are applied to the outside of a prepared natural tooth to enhance its appearance. Given the right circumstances, they’re an excellent solution for correcting mild to moderate spaces between teeth, slight deviations in tooth position, and problems with the color and shape of a tooth.
Veneers are very strong and can resist most of the forces you generate when you chew your food. But dental porcelain is also a form of glass — strong but not indestructible. Following a few maintenance guidelines will help you avoid damaging a porcelain veneer and incurring additional dental care costs.
Practice daily oral hygiene. Although veneers aren’t subject to disease or decay, the tooth structure they cover and the surrounding gum tissues are. You should, therefore, brush and floss veneered teeth just as you would any other tooth. And, there’s no need for specially formulated toothpastes — any non-abrasive fluoride brand will work.
Avoid excessive biting or chewing. While it’s a good practice for natural teeth to avoid applying too much biting force to hard materials, it’s especially important for veneers. Attempting to open hard-shell nuts with your teeth or chewing on bones, pencils and other hard objects are just a few of the activities that could lead to a shattered veneer.
Use a bite guard for clenching habits. People who excessively grind or clench their teeth (a condition called bruxism) can also put undue stress on their veneers. We can help alleviate some of this stress by fashioning a bite guard you wear at night. The guard will help protect your veneers from teeth grinding while you sleep.
Limit foods and drinks that cause staining. Tea, coffee, wine and similar substances can leave teeth stained and dingy. Although your new veneers won’t typically stain, the natural teeth around them can — the brighter veneers would then stand out prominently from the dingier natural teeth.
Porcelain veneers are proven “smile changers.” Taking care of them with a few common sense precautions will ensure the change is long-lasting.
If you would like more information on porcelain veneers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Smile Design Enhanced With Porcelain Veneers.”
How much do you really know about Revolutionary War hero and famous disturber-of-the-peace Paul Revere? Take this quiz and find out! True or False:
- Paul Revere cried “The British are coming!”
- Paul Revere rode to Concord, Massachusetts.
- Paul Revere practiced dentistry.
The first two answers are false: Revere, like most colonists, considered himself British at the time (but might have said “the regulars” are coming); and he never made it as far as Concord, though one of his midnight-riding companions did. The last statement, however, is true: When things got slow in his regular trade of silversmithing, Revere hung out a shingle to broadcast his skills as a dentist.
“Paul Revere can fix [teeth] as well as any surgeon dentist who ever came from London, he fixes [dentures] in such a manner that they are not only an ornament but of real use in speaking and eating,” his advertisement in a Boston newspaper is supposed to have read. Revere specialized in fitting dentures made of metal and walrus ivory in his patient’s mouths. (There is no record, however, that he ever worked on George Washington’s false teeth.)
The practice of dentistry has come a long way since 1776. But the ideal set of dentures — one that’s both aesthetically pleasing and fully functional — remains a valid goal today. But now, instead of going to a metalworker, you’ll visit a denture specialist: your dentist.
We understand that dentures need to have a perfect, comfortable fit so they can do their work. That’s why we take the time to make an individual mold of your mouth as the first step of the process. Then we choose prosthetic teeth in the shape, size and shade that’s right for you. When everything is satisfactory, the dentures will be custom-fabricated in a dental laboratory using high-quality materials that are lifelike and durable. Finally, we will make sure that your new dentures look, feel and function the way they should.
If you have older dentures that no longer fit as they should, come in to our office for a check-up. It’s sometimes possible to repair or re-line dentures; in other cases, it’s best to have a new set made. Ill-fitting dentures aren’t just uncomfortable — they can also lead to oral infections and nutritional difficulties.
For more information about dentures or denture repair, please contact our office to schedule a consultation. You can learn more in the Dear Doctor magazine articles “Loose Dentures” and “Removable Full Dentures.”
The main strategy in fighting dental disease is to try to prevent it in the first place. The success of this strategy depends largely on effective oral hygiene with three essential elements: daily brushing, daily flossing, and semi-annual checkups with professional cleaning.
Many people have little trouble incorporating brushing into their daily routine; flossing, though, is a different matter for some. They may feel it’s too time-consuming or too hard to perform. Patients with orthodontic appliances especially may encounter difficulty navigating the floss around the appliance hardware.
Flossing, though, is extremely important for removing bacterial plaque, the primary aim of oral hygiene. This thin film of food remnant that builds up and sticks to the teeth is the breeding ground for bacteria that cause both tooth decay and periodontal (gum) disease. It’s important that as much plaque as possible is removed from the teeth and gum surfaces every day. While brushing removes plaque from the open surfaces of the teeth, flossing removes plaque clinging between teeth and around the gums that can’t be accessed with a toothbrush.
If traditional flossing is too difficult, there’s a viable alternative using an oral irrigator. Also known as a water flosser, an oral irrigator directs a stream of pressurized, pulsating water inside the mouth to blast away plaque in these hard to reach places. The hand applicator comes with a variety of tips that can be used for a number of dental situations, such as cleaning around braces or implants. In home use since the early 1960s, the latest versions of oral irrigators have proven to be very effective, especially for orthodontic patients — research shows an oral irrigator used in conjunction with brushing can remove up to five times more plaque than just brushing alone.
That being said, traditional flossing is also effective at plaque removal when performed properly. Sometimes, resistance to flossing can be remedied with a little training during dental checkups. We can work with you on techniques to improve your flossing activity, as well as train you to use an oral irrigator.
Whichever method you choose, it’s important for you to incorporate flossing (or irrigation) into your daily routine. Removing plaque, especially in those hard to reach places, is essential for reducing your risk of developing destructive dental disease.
If you would like more information on flossing or oral irrigation, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cleaning Between Your Teeth.”
If you’re in the habit of making New Year’s resolutions, perhaps you’ve made familiar promises like losing weight, running a 5k race or joining a gym. How about this one: “I resolve this year to take better care of my teeth.” Better yet, you needn’t wait for the next January 1st — you can begin better oral hygiene habits today.
Although maybe not as glamorous as other self-improvement habits, oral hygiene still promises huge benefits not only for your teeth and gums, but also for your general health and possibly your wallet. Daily brushing and flossing reduces your risk of tooth decay and periodontal (gum) disease, which can in turn reduce your long-term dental care costs. Besides, clean teeth just look better!
If brushing your teeth hasn’t been a regular habit for you, here are a few tips to get you on the right track:
Pick the right brush. For most people, a soft bristled, multi-tufted toothbrush is the best choice. If you’re not sure what kind of brush to use, ask us for recommendations.
Look for the basics in toothpaste. Store shelves are filled with toothpastes promising everything from teeth whitening to tartar control. Just be sure of two things: that the product contains fluoride (proven to reduce the risk of tooth decay) and it has the American Dental Association’s Seal of Approval. If you have sensitive teeth, ask us about toothpaste options that address this or other special situations.
Easy does it with the technique. Over-vigorous brushing can harm your teeth’s enamel and cause gum recession. Hold the brush handle between your fingertips with no more pressure than you would hold a pencil. Position the brush-head at the gum line at about a 45-degree angle and gently clean all your tooth surfaces. If you’re trying this approach for the first time, the task should take about two minutes.
Visit your dentist twice a year to keep on track. Think of your dental healthcare team as your “personal trainers” in oral hygiene. Besides monitoring your overall dental health and removing hard to reach plaque through semi-annual cleanings, they’ll also coach you on your new lifetime habit of better oral hygiene.
If you would like more information on oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene.”
Maybe you've seen some marketing material for dental implants featuring smiling, silver-haired seniors. Perhaps this made you think that implants are a tooth replacement system that's primarily intended for older adults. If so, let's change that impression right now: Dental implants are suitable for almost all adults, not just older folks!
Today's best option for tooth replacement, implants can help most people who suffer from the problem of missing or failing permanent teeth. (In children, however, where the jaw is still growing, implants aren't generally used.) Of course, it is our goal as dentists to preserve as many of the natural teeth as possible. But when that isn't possible, implants offer the best option for tooth replacement.
The Implant System
What makes the dental implant system such a great option for replacing lost teeth? Let's start with the implant itself. This small, screw-shaped device is made of titanium metal, which has a unique property: When placed in the jaw, in a minor surgical procedure, it becomes fused with the living bone tissue. This provides a solid anchor for the visible part of the replacement tooth, the crown, which is attached to the implant by a connecting piece called an abutment.
Because the implant is securely fixed in the jaw, it provides the replacement tooth with a firm foundation that won't come loose — and it doesn't depend on other teeth for support, like bridges do. It also stops the process of bone loss, which occurs in the area of the jaw where a missing tooth was formerly located. The erosion of bone, which begins as soon as a tooth is lost, can create the appearance of premature aging, and may eventually lead to further dental problems.
Why You May Need Implants
Older folks aren't the only ones who experience tooth loss; younger people suffer from this problem too. Accidents and injuries are one cause, whether they are sports-related, or result from habits like biting pencils or grinding teeth. Lifestyle may be another factor. Poor nutrition, excessive consumption of sugary substances (including certain “sports” and “energy” drinks), and the lack of proper dental hygiene and professional care can allow moderate problems to get much worse.
A major cause of tooth loss is disease, such as tooth decay or periodontal disease. These can be a problem at any age. But a few conditions may cause serious dental problems in younger people — bulimia, for example. When stomach acids enter the mouth, they can rapidly erode the tooth enamel. Gastroesophageal reflux disease (GERD) can create similar problems.
When Should You Get Implants?
Preserving your natural teeth whenever possible is a major goal of modern dentistry. But when teeth can't be saved, it's time to consider implants. While they are initially more expensive than more traditional tooth replacement methods (like bridges or removable dentures), they can last for the rest of your life with only routine care. That's something no other method can claim, and it makes them a great value, especially for younger people. Plus, they feel completely natural and look great.
Is it a root canal problem, a gum infection, or both?
Sometimes it's difficult to pinpoint the source of tooth pain; it can result from an infection of the tooth itself, or of the gum, or even spread from one to the other. Identifying the origin of a toothache is important, however, so we can choose the right treatment and do all that we can to save the tooth.
When a tooth becomes decayed, bacteria can infect the sensitive, living nerve tissue deep inside the tooth known as the root canal. This condition is called an endodontic (“endo” – inside; “dont” – tooth) problem. The infection inside the tooth can spread to the periodontal ligament (“peri” – around; “dont” – tooth) that encases the tooth and attaches it to the jawbone. Occasionally, infection of endodontic (root canal) origin can spread out from the end of the tooth root all the way up the periodontal ligament, and into the gum.
The reverse can also happen: dental pain can originate from periodontal (gum) tissues that have become diseased. Gum disease is caused by a buildup of bacterial biofilm (plaque) along the gum line. It results in detachment of the gums along the tooth surface. In advanced cases, this bacterial infection can travel into the nerve tissues of the dental pulp through accessory canals or at the end of a tooth.
To figure out where pain is coming from when the source is not obvious, we need to take a detailed history of the symptoms, test how the tooth reacts to temperature and pressure, and evaluate radiographs (x-ray pictures).
Unfortunately, once dental disease becomes a combined periodontal-endodontic problem, the long-term survival of the tooth is jeopardized. The chances for saving the tooth are better if the infection started in the root canal and then spread to the gums, rather than if it started as gum disease that spread into the root canal of the tooth. That's because in the latter case, there is usually a lot of bone loss from the gum disease. Effectively removing plaque from your teeth on a daily basis with routine brushing and flossing is your best defense against developing gum disease in the first place.
If you would like more information about tooth pain, gum disease or root canal problems, please contact us or schedule an appointment for a consultation. You can also learn more about this diagnostic dilemma by reading Dear Doctor magazine's article “Confusing Tooth Pain.”
At one time people who had lost all their teeth faced a grim future. With no feasible alternative, their tooth loss severely limited their ability to eat or speak. Their appearance suffered too, not only from the missing teeth but from bone loss in their facial structure.
We’ve come a long way since then — today, it’s possible to restore complete tooth loss with a permanent set of implant-supported teeth. Unlike other options like removable dentures, implantation can stop and even reverse bone loss caused by missing teeth. And because it now only takes a few strategically-placed implants to support an entire fixed bridge of teeth, the implant option is more affordable than ever.
In essence, implants are tooth root replacement systems. The titanium post that is surgically placed within the jawbone is osseophilic (“bone-loving”), which means bone will grow and adhere to it in a few weeks to further secure it in place. A dental restoration — a single crown (the visible portion of the tooth) or an entire bridge or arch — is then cemented or screwed to the implant.
While dental implants for single teeth normally require full bone integration before the permanent crown is set, it’s often possible for an implant-supported bridge of many teeth to be set at the same time as implantation. The bridge is attached to four or more implants that support the bridge like the legs of a stool; the teeth within the bridge also act to support each other. Both of these factors help to evenly distribute the biting force, which reduces the risk of crown failure before complete bone integration. You would still need to limit yourself to a soft food diet for 6-8 weeks while the bone integration takes place, but the procedure is essentially completed when you leave the dentist’s office.
As marvelous as the possibilities are with implant restorations, it still requires a great deal of planning and artistry from a team of dental professionals to realize a successful outcome. But working together, you and your team can achieve what wasn’t possible even a few years ago: a complete set of life-like, fully functional implant-supported teeth — and a new smile to boot!
If you would like more information on implant-supported teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “New Teeth in One Day.”
There is nothing pleasant about having a loose tooth. It can be very unsettling to feel your tooth move around, and you may be worried about losing the tooth entirely. If you notice any looseness in your teeth, you should make an appointment with our office immediately, so that we can determine the underlying cause.
There are two reasons for loose teeth, and most often, this looseness is actually a late symptom of gum (periodontal) disease. If left untreated, this disease destroys the supporting structure of your teeth, including the bone. As bone loss progresses, teeth gradually become looser, and if you do not seek treatment, this can ultimately result in tooth loss.
Another less common reason for loose teeth is excessive biting forces, including clenching or grinding of the teeth. These biting forces are outside the normal range of functional pressures and can stretch the periodontal ligaments that join the teeth to the supporting bone, resulting in loose teeth.
In both cases, this condition can be classified as “occlusal (bite) trauma.” When we examine you, we will determine the type of occlusal trauma that you have.
- If the amount of bone supporting your teeth is normal and excessive force is causing your loose teeth, it then is referred to as primary occlusal trauma. Our treatment approach will focus on reducing the biting forces. We may recommend minor bite adjustments and/or custom mouthguards.
- Secondary occlusal trauma occurs when gum disease has caused excessive bone loss. In this instance, even normal biting forces can be damaging. We will work with you to treat the gum disease and improve your oral hygiene efficiency to heal your gums. Once the gum tissue heals and the inflammation is reduced, it is likely that there will be some tightening of the teeth. We will then adjust the biting surfaces of your teeth. This is accomplished by carefully reshaping (by drilling) small amounts of your tooth's surface enamel to change the way upper and lower teeth contact each other, thus redirecting forces. Secondary occlusal trauma may also require splinting or joining teeth together, so that they can handle biting pressures. The need for this additional procedure will be determined by your response to treatment and how much mobility of the teeth remains after the inflammation is resolved.
If you would like more information about loose teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Loose Teeth: Biting Forces Can Loosen Teeth.”
Advancements in dentistry have created an abundant source of treatments for restoring health and vitality to diseased teeth and gums. Unfortunately, not all of these treatment options may be in your financial reach. Fortunately, there are some affordable restorative options, as well as cost-effective treatments that could buy you time until you can afford a more permanent solution.
Your first step is a dental examination to evaluate your current oral health and possible future treatment needs. If you’re not already showing symptoms of tooth decay or gum disease, we would evaluate your probable risk for future disease development. Risk assessment enables us to recommend a prevention strategy that is relatively inexpensive and may save you on more expensive dental procedures in the future.
If the examination reveals some current problems, it may be necessary to prioritize. Painful or abscessed teeth are a dental emergency and should be treated as soon as possible. Other conditions, like mild gum disease would be next in line; however, a word of warning: the longer you postpone treatment for many of these conditions, the greater the likelihood of subsequent bone and tooth loss, which will lead to more extensive — and expensive — treatment.
There are also new alternatives to traditional treatments that are less costly but still have many of the benefits. For example, less-costly glass — or resin-based fillers are becoming a popular option for restoring decayed or damaged teeth. Though not quite as durable as more expensive options, these new materials are life-like in appearance and work well on repair sites on non-biting surfaces.
You should also look to one other resource for managing the costs of dental care — us, your dental team. While we want your teeth and gums to be as healthy as possible, we also understand “wallet” issues. We can work with you on financial matters to ensure you’re getting the effective care you need, including payment plans for more expensive treatment processes, working with your dental insurance plan, and recommending affordable treatment options.
The key is to develop a long-term care plan targeted to your individual dental needs. Knowing where we need to go — and adapting treatment strategies that match your resources — will help you get the best dental care you can afford.
If you would like more information on dental care treatment options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cost-Saving Treatment Alternatives.”
Your children’s health is a major concern for you, even before they’re born. That concern should include their dental health and, yes, even before they’re born — a baby’s primary teeth are already forming just a few weeks into pregnancy.
Here, then, are some important tips for keeping your child’s dental health, before and after birth, on track.
Eat healthy during pregnancy. Your baby’s teeth actually begin to mineralize around the third or fourth month of your pregnancy. You can aid this process by eating a diet rich in calcium, phosphorous and protein.
Fight tooth decay by limiting sugar. Sugar is a major contributor to tooth decay, especially in primary teeth. To reduce this risk, limit sugary snacks as much as possible, and avoid bottles filled with sugar-filled liquids (including breast milk) during your baby’s sleeping hours.
Begin good hygiene early. When teeth first appear in the mouth you should begin to wipe around the teeth and gums with a water-soaked gauze pad right after feeding. As teeth develop, begin to gently brush them with a soft-bristled brush with just a smear of fluoridated toothpaste. Teach your child beginning around age 2 to brush for themselves with a pea-sized amount of paste on the brush. By age 6, they should be able to brush on their own and ready to learn flossing.
Schedule regular dental visits and cleanings. Dental checkups should begin around their first birthday and continue semi-annually. Your dentist is a key resource in monitoring tooth development, preventing disease and developing future treatment strategies.
Make your home “tooth-friendly.” Your home environment can be a danger to your child’s mouth. Check for hard or sharp surfaces your child could fall on and eliminate the danger — it’s estimated half of dental injuries to children under seven occur near home furniture. Check your drinking water as well — does your system add fluoride, a proven cavity fighter, or do you need to find other sources?
Taking a few precautions and establishing good life-long dental habits will help ensure your child’s teeth and gums remain healthy right into adulthood.
If you would like more information on oral health for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Top 10 Oral Health Tips for Children.”
Q: What is sleep apnea, and how common is it?
A: Obstructive sleep apnea is a type of sleep-related breathing disorder (SRBD) in which the airflow to the lungs is restricted — or even cut off completely — during sleep. This condition is usually caused by the collapse of soft tissues in the back of the throat, and is potentially deadly. Sleep disorders, including SRBD, are thought to affect tens of millions of people in the United States. They have been blamed for several catastrophic accidents, including the 2014 Metro-North train crash in New York, and the 1989 Exxon Valdez oil spill in Alaska.
Q: How can I tell if I might have sleep apnea?
A: Everyone has trouble sleeping sometimes. But if you constantly snore, wake up feeling irritable, and experience sleepiness and diminished performance during the day, it may mean you suffer from this condition. After a while, SRBDs can trigger depression, confusion, memory loss, and other personality changes. Medical professionals note that a person with SRBD tends to be obese; to show enlargement of the tongue, tonsils, or uvula; to have nasal polyps or congestion; and possibly, to exhibit other signs.
Q: How is sleep apnea treated?
A: There are various treatments for sleep apnea, depending on the severity of the problem and its likely cause. These include oral appliance therapy (wearing a retainer-like device in the mouth at night); orthodontic treatment and/or oral surgery; and using a CPAP (constant positive airway pressure) machine to help facilitate breathing at night. Each has advantages and disadvantages that should be discussed with a healthcare provider who has experience in the area of sleep disorders.
Q: What does all this have to do with dentistry?
A: Dentists are, of course, extremely familiar with the anatomy of the mouth. We sometimes notice signs of potential sleep problems before they become life-threatening. What’s more, we may be able to successfully treat the problem with oral appliance therapy. We can properly fabricate, fit and adjust an oral device that helps keep your airway open at night. Because it is inexpensive, removable, and relatively comfortable, an oral appliance may be a good remedy to try before moving on to more complex treatments, such as a CPAP machine or surgery. So if you think you might have SRBD, maybe it’s time to make an appointment and talk to us about it.
It can happen in an instant — your child takes a hard hit to the mouth while playing football, basketball or some other contact sport. Suddenly, he or she faces the severest of dental injuries: a knocked out tooth.
There's both good and bad news about this situation. First, the good news: the knocked out tooth can be reinserted into its socket and take root again. The bad news, though, is that the tooth has only the slimmest of chances for long-term survival — and those chances diminish drastically if the reinsertion doesn't take place within the first five minutes of the injury.
Outside of the five-minute window, it's almost inevitable that the tooth root won't reattach properly with the tiny fibers of the periodontal ligament, the sling-like tissue that normally holds the tooth in place to the jawbone. Instead, the root may fuse directly with the bone rather than via the ligament, forming what is called ankylosis. This will ultimately cause the root to melt away, a process known as resorption, and result in loss of the tooth.
Of course, the resorption process will vary with each individual — for some, tooth loss may occur in just a few years, while for others the process could linger for decades. The best estimate would be four to seven years, but only if the tooth receives a root canal treatment to remove any dead tissue from the tooth pulp and seal it from possible infection. Over time the tooth may darken significantly and require whitening treatment. Because the tooth may be fused directly to the jawbone it can't grow normally as its neighbor teeth will and thus may appear uneven in the smile line. From a cosmetic point of view, it may be best at that time to remove the tooth and replace it with an implant or other cosmetic solution.
In many ways the longevity of the tooth post-injury really depends on time — the time it takes to reinsert the knocked out tooth into its socket. The quicker you take action, the better the chances the tooth will survive.
If you would like more information on treating a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth: How Long Will a Tooth Last After Replantation?”
When children begin losing their primary (“baby”) teeth, it’s a rite of passage — a sign that childhood is transitioning to future adulthood. And while it’s a normal part of dental development, it does bear watching for abnormalities.
Primary teeth are like deciduous tree leaves in that it’s their nature to shed and give way for new growth. They serve a purpose not only in providing children a means to bite and chew food, but also as guides for the permanent teeth that will soon erupt in their place.
As it reaches the end of its development within the jaw, the permanent tooth will begin to exert pressure on the primary tooth. This stimulates a process known as resorption where the primary’s roots begin to dissolve. This weakens its attachment to the jaw and the tooth becomes loose to the touch. At the end of this process, it doesn’t take much coaxing for the tooth to finally come out of its socket, with occasional minor bleeding and tenderness around the site. You will notice if you look at the bottom of the lost tooth that the roots have completely dissolved, leaving only a small indention.
This natural process, however, can run into complications. In their roles as permanent teeth guides, there’s a natural sequence for the loss of primary teeth; the permanent teeth develop along this sequence, which helps them erupt in the proper position. If a primary tooth is lost early and out of sequence (notably because of decay), the premature space can cause misalignment of the permanent teeth as they erupt.
That’s why it’s important for your child to have regular dental checkups, beginning sometime around their first birthday. This allows us to monitor primary tooth loss to make sure its progressing normally, as well as treat any condition such as tooth decay that could lead to premature loss. Regular checkups along with good oral hygiene practices will help ensure that the transition from primary to permanent teeth goes just as nature intended.
If you would like more information on the process of losing primary teeth in children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Losing a Baby Tooth.”
If you’ve come in to our office lately, chances are you’ve been asked to fill out a form or answer a question about what medications — both prescription and non-prescription — you are currently using. Of course, if you’re taking a blood-pressure drug or a pill to help control your cholesterol, you wouldn’t hesitate to put it on the list. But how about those vitamins and herbal supplements you take — do you really have to list those too?
The answer is a definite yes — and some of the reasons why may surprise you. Did you know that many “natural” dietary supplements can have potentially serious interactions with other drugs you may be prescribed? For example, herbal preparations made from the plant called St. John’s Wort are often used by people seeking relief from depression or anxiety. However, the active chemical compounds in this herb can interfere with some anesthetic drugs, and may make it harder for you to recover from the effects of anesthesia. Ginkgo biloba and some other commonly used herbs have a similar effect.
Even some vitamins have the potential to cause negative interactions. Large doses of Vitamin E, for example, can increase the risk of internal bleeding in people who are taking blood thinners or non-steroidal anti-inflammatory medications (NSAIDS), such as aspirin and ibuprofen. These medications are commonly prescribed for pain relief after minor dental procedures.
Does that mean you have to stop taking vitamins and herbal supplements if you may need a dental or medical procedure? Not necessarily. Vitamins are indeed vital to your health, and a deficiency in one or more of these important substances can result in serious diseases — like scurvy, which formerly plagued sailors lacking access to fresh fruits and vegetables. If you’ve been told you have a vitamin deficiency, taking vitamin pills is a must.
But the best way to get the proper amount of vitamins is through a healthy, well-balanced diet rich in fruits, vegetables, and whole grains. Not only does consuming these foods give you the most “natural” source of vitamins — it also provides you with other essential micronutrients and fiber, and it is low in fat and cholesterol.
No nutritional supplement is a substitute for a healthy diet — and that’s something we’d like everyone to remember. We’d also like to remind you to tell us about ALL the medications and supplements you’re taking, especially if you’re going to have a procedure. Giving us complete information will help ensure that you’ll remain as healthy and safe as possible.
If you have questions about dietary supplements, nutrition and your teeth, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine article “Vitamins & Dietary Supplements: What Every Consumer Should Know.”
It is sometimes hard to believe all of the features and characteristics that we inherit from our parents. Whether you're tall, short, blue-eyed or blonde, you can usually attribute some of these features to your mother and father. Of course, the downside of genetics is that diseases and disorders are also linked to genes.
Well, you can add gum tissue to that list as well! Genetics actually determines whether you have what we call “thin” or “thick” gum tissue. How does this work? Well, the type of gum tissue you have relies heavily on the shape of your tooth, which indeed is genetically-coded. If you have a triangular tooth shape, you'll likely have thin gums. If you have a squarer tooth shape, you'll usually have thick gums.
So, what can you expect from each tissue type?
If you have a thin gum tissue type, you are more likely to have gum recession. Watch out for the following signs of gum recession:
- Sensitivity to hot or cold, even without the presence of dental decay
- If you have crowns on your teeth, you may see a dark gray line at the gum line from the metal casting beneath the crown
- Small dark triangular spaces between teeth
On the other hand, if you have a thicker tissue type, your gums are more vulnerable to dental disease through a condition called “pocketing.” This happens when bacterial plaque causes your tissue to become inflamed, lose its attachment to the teeth and develop a pocket. Pocketing can result in bone loss, and, in worst-case scenarios, tooth loss.
It's important to note that while we use these terms to categorize different tissue types for treatment decisions, your tissue may also fall somewhere in between the two varieties.
So, how can you prevent gum disease? Daily oral hygiene is the best way to ensure proper care of your gums, no matter what type you have. Be sure to brush twice daily (use a soft toothbrush) and floss regularly at night. Floss gently until you hear a squeak, but watch out for your gum line. And of course, continue to visit us two times a year, so that we can assess whether you are in danger of developing gum disease.
If you would like more information about genetics and gum disease, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Genetics and Gum Tissue Types.”
When your baby’s first teeth erupt in the mouth, it’s a big step in their development. Unfortunately, you may not have much opportunity to celebrate — you’re too busy tending to your infant whose experience is anything but pleasant.
Commonly known as teething, the eruption process usually begins between six and nine months of age, although some children may begin as early as three months or as late as twelve. Not all teeth come in at the same time: it usually begins with the two lower front teeth, then the two upper front teeth, followed by the molars and then the canines (eye teeth). By age three, most children have all twenty of their primary teeth.
Each child’s teething experience is different and may vary in length of time and intensity. The usual signs are heightened irritability, biting and gnawing accompanied by gum swelling, ear rubbing, drooling and sometimes facial rashes. Babies also may have disturbed sleeping patterns and a decreased appetite. Occasionally, this discomfort can be intense.
There are some things you can do to ease this discomfort. Provide your baby a clean, chilled (not frozen) rubber teething ring, chilled pacifier or wet washcloth to gnaw on. Cold foods, like popsicles for older children can also be soothing, though you should limit sugary foods to lower the risk of tooth decay. You can also finger massage swollen gums to counteract the pressure coming from the erupting tooth, or administer pain relievers like baby acetaminophen or ibuprofen. You can use products with Benzocaine®, a numbing agent, for children two years or older — but you should never use alcohol for children of any age for inflamed gums.
Be sure to also set up a Year One dental examination around their first birthday. This is an important first step in your child’s long-term dental care, and a good opportunity to check their teething progress. And, by all means, if you have concerns about your child’s experience with teething, don’t hesitate to call our office.
Teething is a normal part of your child’s development. There’s much you can do to help make it as comfortable and pain-free as possible.
If you would like more information on teething, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teething Troubles.”
It’s a recognized goal of modern dentistry to help you keep your natural teeth clean and disease-free, so you’ll be able to enjoy them for your whole life. But dentists can’t accomplish that goal by ourselves — we need your help! Maintaining good oral hygiene is the best way to ensure that your smile stays as healthy as it should be. Here are a few simple tips that can make a big difference in your dental health.
- Use the right brush, and change it as needed. What’s the right brush? Generally speaking, it’s one with soft bristles that’s small enough to fit your mouth comfortably. However, if you have trouble using a manual brush effectively (because of arthritis, for example), consider getting a good-quality electric brush. Change your brush when its bristles begin to stiffen or wear out. Ask us about proper brushing technique if you have any questions — and, of course, make sure to use a toothpaste with fluoride.
- Floss — every day. Because no matter how hard you try, you simply can’t reach all the areas in between your teeth with a brush alone — and that’s where many cavities get started. Plus, when it comes to preventing periodontal (gum) disease, flossing may be even more important than brushing, since it can actually remove plaque (a bacterial film) from under the gums. So no more excuses — OK?
- Stay away from sugary drinks and between-meal snacks. That includes sodas, cookies, and so-called “energy” drinks, which often pack a damaging one-two punch of sugar and caffeine. If you eat sugary treats at all, do so only after a meal. This will give your mouth plenty of “free time” to neutralize the acids that result when sugar is processed by oral bacteria. It’s these acids that are the primary cause of tooth decay.
- Avoid bad oral-health habits. Some you already know: smoking (or using tobacco products of any kind); excessive consumption of alcohol; chewing on pencils, fingernails, or anything else that doesn’t belong in your mouth. But some you may not know: A clenching or grinding habit at night can cause serious tooth damage without you even realizing it. Getting an oral piercing increases your chance of chipping a tooth, and can lead to other problems. And playing sports without a mouthguard is risky business.
- See your dentist regularly. You can do plenty on your own to keep up your oral health — but it’s also important to see us regularly. When you come in for an office visit, we will check you for early signs of problems, and take care of any that we find… before they get bigger and harder to treat. We’ll also make sure you leave with a sparkling smile that has been thoroughly and professionally cleaned.
If you would like to learn more about maintaining good oral hygiene, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine articles on “How to Help Your Child Develop the Best Habits for Oral Health” and “Oral Hygiene Behavior.”
Although they may appear inert, teeth are anything but — they grow and change like other bodily tissues until complete maturation. Teeth roots are especially adaptable; teeth with multiple roots develop much like forks in a road as each root takes a different path toward the jawbone.
This fork where they separate is called a furcation. It’s normal for lower molars and premolars to have two furcations, while upper molars traditionally have three. Furcations pose difficulties for teeth cleaning and maintenance. If bone loss has occurred around them, a condition called a furcation invasion has occurred. This loss is most likely due to periodontal (gum) disease, an inflammation arising from bacterial plaque on the teeth that hasn’t been removed through proper oral hygiene.
We identify furcation invasions through x-ray imaging and tactile probing. They’re classified in three stages of development: Class I describes early onset in which marginal bone loss has occurred, exposing a groove that leads to the beginning of the furcation; Class II is moderate bone loss where a space of two or more millimeters has developed horizontally into the furcation; and, Class III, advanced bone loss whereby the bone loss has extended from one side of the tooth to the other, or “through and through furcation.”
Our first step in treatment is to remove any detectable plaque and calculus on the tooth surface, including the roots (known as scaling and root planing). These areas can be difficult to access, especially near furcations, and requires special instruments known as scalers or curettes. We may also employ ultrasonic scalers that use high-frequency vibrations coupled with water to break up and flush out the plaque and calculus.
We then apply antimicrobial or antibiotic medicines to further disinfect the area and inhibit bacterial growth while the affected tissues heal. As the infection and inflammation subsides, we then turn our attention during subsequent visits to address the bone loss around the furcation. This may involve surgical procedures to aid in re-growing gum tissue and bone and to create better access for cleaning and maintaining the area.
Finally, it’s important to establish good oral hygiene habits and regular checkups and cleanings to prevent further complications or a reoccurrence of the disease. Maintaining these habits will help you avoid tooth loss and other problems with your oral health.
If you would like more information on furcations, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “What are Furcations?”
If you’ve been reviewing tooth replacement options, you probably already know the superior benefits of dental implants: their durability, functionality and life-like quality could provide you with years, even decades of satisfying service.
If you take this option, however, you should be prepared for a slightly longer process than a couple of office visits. From concept to permanent crown placement, it will require several months of preparation, expertise and teamwork. The more you know about this process, the better prepared you’ll be to handle it.
After careful preparation, which may include extracting the tooth being replaced, the process begins in earnest with the surgical placement of the implant’s titanium post into the jawbone. The surgeon uses a guide based on your bite and mouth structure to precisely implant the post in a pre-planned location: this ensures that the permanent crown will be affixed in the right location for best appearance and functionality.
While a temporary crown can sometimes be attached immediately after implantation, the permanent crown must wait until the bone grows and attaches around the titanium post (osseointegration). Once this has occurred, usually over several months, the implant can fully support the permanent crown and its function.
This last element, the permanent crown, is in many ways a work of art. Taking into consideration the patient’s facial features and shape, the type of tooth replaced and the tooth coloring natural to the patient which is transmitted this information to the dental technician who will manufacture the crown. The goal is to produce a life-like replica that will look natural and perform well.
It may seem quite involved, but all these stages are necessary for a successful outcome. Although dental implants take careful attention and time, the outcome is worth it. In the end you’ll not only recover lost function, you’ll also have a new, transformed smile.
If you would like more information on the procedures for placing dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: Evaluating Your Professional Options for Care.”
You may have heard the expression: “If you just ignore your teeth, they will go away.” That may be true — but by practicing good oral hygiene, more and more people are now able to keep their natural teeth in good condition for their entire life. So we prefer to put a more positive spin on that old saw: “Take care of your teeth and they will take care of you — always.” What’s the best way to do that? Here are our top five tips:
- Brush and floss every day. You knew this was going to be number one, right? Simply put, tooth decay and gum disease are your teeth’s number one enemies. Effective brushing and flossing can help control both of these diseases. Using a soft-bristle brush with fluoride toothpaste and getting the floss into the spaces between teeth (and a little under the gum line) are the keys to successful at-home tooth cleaning and plaque removal.
- Don’t smoke, or use any form of tobacco. Statistically speaking, smokers are about twice as likely to lose their teeth as non-smokers. And “smokeless” tobacco causes tooth discoloration, gum irritation, an increased risk for cavities, and a higher incidence of oral cancers. Of course, smoking also shortens your life expectancy — so do yourself a favor, and quit (or better yet, don’t start).
- Eat smart for better oral (and general) health. This means avoiding sugary between-meal snacks, staying away from sodas (and so-called “energy” or “sports” drinks), and limiting sweet, sticky candies and other smile-spoiling treats. It also means enjoying a balanced diet that’s rich in foods like whole grains, fruits and vegetables. This type of diet incorporates what’s best for your whole body — including your teeth.
- Wear a mouthguard when playing sports. An active lifestyle has many well-recognized health benefits. But if you enjoy playing basketball, bicycling, skiing or surfing — or any other sport where the possibility of a blow to the face exists — then you should consider a custom-fitted mouthguard an essential part of your gear. Research shows that athletes wearing mouthguards are 60 times less likely to suffer tooth damage in an accident than those who aren’t protected — so why take chances with your teeth?
- See your dentist regularly. When it comes to keeping your smile sparkling and your mouth healthy, we’re your plaque-fighting partners. We’ll check you for early signs of gum disease or tooth decay — plus many other potential issues — and treat any problems we find before they become serious. We’ll also help you develop healthy habits that will give you the best chance of keeping your teeth in good shape for your whole life.
If you would like to learn more about keeping your teeth healthy for life, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine articles “Tooth Decay — The World’s Oldest & Most Widespread Disease” and “Dentistry & Oral Health For Children.”
If you’re missing a tooth, you’re not alone; in fact 35 million Americans are missing all of their teeth in at least one jaw! Whether it’s one tooth or many, it’s important to replace what’s missing. Depending on the number of teeth lost, the potential drawbacks to doing nothing may become hard to ignore: impediments to eating, interference with speech, and unaesthetic appearance, for example.
Traditional bridges and dentures are the most affordable options for replacing teeth. Tooth implants — tiny titanium, screw-like substitutes for a tooth’s natural root to which natural-looking dental crowns are attached — are pricier but offer an important extra benefit. In addition to addressing the common problems previously mentioned, by acting like the original tooth root, an implant can maintain or stimulate “remodeling,” of the jawbone below. Without a tooth root to provide stimulation, mature bone cells will continue to be removed, or resorbed, but no new bone cells will regenerate to replace them, leading to a progressive loss of bone width, height and density. The more teeth are lost, and with less bone structure to support it, the whole shape of the face can change.
Unfortunately, when greater numbers of teeth must be replaced, implants can become financially unrealistic for some people. But in appropriate cases there is a third option: a bridge or denture/implant hybrid. In the case of a bridge intended to fill a gap when multiple teeth are missing, an implant can be used on either side of the gap to support the bridge, leaving the natural teeth undisturbed. Strategically placed implants can be used to support a removable denture, too.
If you would like more information about dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: Your Best Option For Replacing Teeth.”
Your dental care would be much more limited without our ability to see “below the surface” with x-ray imaging. But since x-rays passing through the body are a form of radiation, could your exposure from them be hazardous to your health?
It depends on exposure dosages and, of course, the amount you have been exposed to over your lifetime. But, decades of research have demonstrated that exposure to dental x-rays during your regular office visits are only a fraction of the radiation you normally encounter from the natural environment every year.
X-rays have the ability to pass through body tissues, but at different rates for soft tissue like skin and muscle and hard tissue like bone. This effect creates shadows on exposed film; the differentiation is in such detail that a trained technician can interpret not only internal structures, but defects such as fractured bone or, in the case of dentistry, signs of tooth decay and bone loss from gum disease.
But like other energy sources in our environment, x-rays do emit radiation that in high doses can be dangerous to living tissue. The amount of exposure is measured in millisieverts (mSv), a unit that allows for comparison of doses from different sources of radiation. Scientists have calculated that we’re normally exposed to between 2 and 4.5 mSv every year.
By contrast, a single digital periapical image taken of a tooth is equal to 1 microsievert (μSv), or one thousandth of an mSv; a full mouth series (between 18 and 20 images) creates an exposure of 85 μSv, or 85/1000 of one mSv. In addition, advances in technology have further reduced the radiation exposure from x-ray imaging. For example, digital imaging has reduced exposure during full mouth x-rays from seven to ten days of equal exposure from normal background radiation to half a day, and with no loss in image quality.
In effect, dental x-rays pose little to no risk for patients. Still, understanding that x-ray imaging does expose patients to radiation, dentists follow certain protocols and safety precautions. For example, dentists will place a lead apron around their patients’ chest area during an x-ray exposure.
As your dentist, we’re happy to address any concerns you may have about x-ray radiation exposure. But rest assured, the x-ray devices used in your dental care, so necessary in the fight against tooth decay and other diseases, are safe and reliable.
If you would like more information on the use of x-ray technology and safety, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “X-Ray Frequency and Safety.”
Have you been avoiding seeing a dentist because you are afraid that the visit might be unpleasant or painful? Are you unhappy with the appearance of your teeth and the health of your mouth, even envious of others who are able to visit their dentist without hesitation?
If you've answered yes to these questions, you are not alone. Many people experience some anxiety about visiting their dentist. Some fears are based on past negative experiences, indirectly influenced by family members or friends, or even by images seen in the movies. Regardless of the origin of your fear, we will work with you to turn negative perceptions or experiences into positive ones. The most important thing to remember is that allowing dental problems to remain untreated can have bad consequences, including toothache, infection, poor appearance and even general health complications.
We will listen to you and even encourage you to express your feelings. Tell us the details of your fear and anxiety. You won't be judged but, instead, we want to understand exactly what troubles you, so that together we help you overcome what is preventing you from getting the care you want and need.
You will be in control at all times and we will never rush you. First we'll spend the time necessary to get you comfortable, before we even do any dentistry. After all, attempting to rush through a procedure may only incite more anxiety, and that is the last thing we want to do! We want you to leave our office with the feeling that you can more comfortably see us again building on your last positive experience.
If you would like to talk to us about what's bothering you and begin working together towards a solution, please call us today to schedule a consultation. To learn more about how patients and dentists can work together to eradicate dental fear, read the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”
Did you know that you probably do at least one thing during the course of an average day that puts your healthy smile at risk? These are some of the more common offenders:
Coffee, Soda, and Sports Drink Consumption
If you really can’t give them up, try to consume these beverages with restraint. Their high acidity and/or sugar content can erode protective tooth enamel, making your pearly whites more prone to staining and decay. Even natural fruit juices should be consumed in moderation as they tend to be high in sugar and sometimes acidity (e.g. orange juice). Your best bet? Water, of course. It won’t damage your teeth and thanks to fluoridation may even help remineralize and fortify your enamel.
Brushing Immediately After Eating
If you were told to brush after every meal, forget it. Acids in foods and beverages can soften your enamel, and brushing may actually accelerate erosion. Wait at least an hour to brush, which is the time it generally takes for your oral pH to normalize and your tooth enamel to reharden. However, it is advisable after eating to floss and rinse out your mouth with plain water or a mineralized dental wash to help wash away food particles.
Jaw Clenching, Tooth Grinding, Pencil Chewing
These and similar “parafunctional” behaviors — outside the uses for which teeth are designed — can cause undue tooth wear and exert stresses that can cause chips and fractures. They can affect other parts of the oral system, too, potentially resulting in jaw joint pain and muscle spasms, headaches and other head and neck ailments.
It’s hard to cut out all high-sugar/high-acid foods and beverages, so where complete elimination isn’t possible, focus on moderation and try to consume them only during mealtime. Jaw clenching and other parafunctional behaviors are often subconscious and may be harder to control; in such cases an unobtrusive device like a clear occlusal (bite) guard can alleviate the problem.
If you would like more information about tooth damage and prevention please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Tooth Decay” and “Stress & Tooth Habits.”
Root canal treatments are an important method for stopping the disease process within an infected tooth and ultimately saving it. However, one of the few side effects could have an aesthetic impact on your smile. Leftover blood pigments or the filling materials themselves can cause a darkening of the tooth — the tooth could eventually stand out in an unsightly way from surrounding teeth.
There is, however, one possible solution: a whitening technique known as internal or non-vital bleaching can lighten a darkened, non-vital tooth. For this procedure, we would insert a bleaching mix (usually sodium perborate mixed with hydrogen peroxide) into the pulp chamber of the darkened tooth for a short period of time. The chemical reaction of the mix whitens the tooth from within.
Our first step is to make sure by x-rays that the root canal filling in the tooth is still intact and still has a good seal. We then create a small opening in the rear of the tooth just above the root canal filling, irrigate it with water to remove any debris, and then add a special cement at the point where the root canal filling begins to seal it from any leakage of the bleaching solution into the root canal filling.
We then insert the bleaching solution into the empty pulp chamber. This is covered with a cotton pellet, which is then sealed in with a temporary filling. We repeat this application over a number of days until we see a noticeable change in the tooth color (normally after one to four visits). At this point, we would remove any residual solution and apply a permanent filling to seal the tooth.
This procedure can be performed instead of more extensive procedures such as veneers and crowns as a cover for the discolored tooth, or as a way to lighten teeth before applying a veneer or crown to help prevent discoloration from showing through. Either way, non-vital bleaching can help remove unsightly discoloration and restore vibrancy to your smile.
If you would like more information on internal or non-vital bleaching, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”
If you think you'd rather wrestle a pack of porcupines than go to the dentist for a root canal treatment — then maybe it's time to think again! This common procedure has been the butt of jokes for a long time. Let's set the record straight by answering some common questions about the much-maligned procedure.
Q: What is a root canal?
A: Coursing through the central part of each root is a hollow space or canal, which contains the pulp tissue. The pulp tissue contains the nerves which respond to temperature changes transmitted through the tooth. When the temperatures are extreme the nerves signal sensitivity and pain. It's also shorthand for the dental procedure that is performed when the pulp tissue that fills these canals develops a disease.
Q: Why do I need to get a root canal?
A: Because an infection or inflammation has developed deep inside one or more of your teeth. When the living pulp tissue — which contains nerves and blood vessels — becomes inflamed or infected, it can cause intense pain. It also releases bacterial toxins, which can lead to further problems.
Q: What happens if I don't get a root canal?
A: Your acute pain may temporarily go away, but the infection won't. It will eventually travel through the tooth's roots into the surrounding tissues. If left untreated, it may result in an abscess or even a systemic infection. That's why you need to take care of it now.
Q: Will it be painful?
A: Generally, a root canal procedure is no more painful than getting a filling. In fact, it starts the same way: An anesthetic is given to numb the tooth and the surrounding area. Then a small hole is made through the tooth's chewing surface and down into the canal. Diseased pulp tissue is removed through the hole via a set of tiny instruments. Finally, the root canal is cleaned, disinfected, filled with inert biocompatible material and sealed up.
Q: What happens after that?
A: Your tooth may be sensitive for a few days after the treatment, but the acute pain will be gone. Over-the-counter pain relievers generally work well for pain relief at this point. To restore your tooth to its fully-functioning state, a crown or other restoration is usually needed after root canal treatment. Properly done, the restored tooth can last as long as any of your natural teeth.
Q: Is there an alternative?
A: Yes. You can relieve the pain by having the tooth removed. But you don't want to go there. Tooth loss can lead to unwanted side effects, like migration of teeth, bone loss and eventually the inability to chew properly. It's far better to save your natural teeth when you can.
If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”
You have a toothache… or do you? That's not a facetious question — sometimes it's difficult to determine if it's your tooth that hurts, your gums or both. It's even difficult at times to pinpoint which tooth may be hurting.
This is because the pain can originate from a variety of causes. Determining the cause is the first step to not only alleviating the pain, but also treating the underlying condition. Those causes generally follow one of two paths: either the problem originates within a tooth and spreads to the gums and other tissue, or it begins with infected gum tissues and can spread to the teeth.
We refer to the first path as endodontic, meaning it originates from within a tooth. Most likely the tooth has decayed (also referred to as a cavity), which if untreated can progress, allowing bacteria to infect the tooth pulp (living tissue inside the tooth that contains nerve fibers). Pain results as the nerves become inflamed and sensitive, though often varying in quality (sharp or dull) or frequency (constant or intermittent); outside stimuli, like temperature or pressure, may also trigger pain.
Although likely originating with one tooth, it may be difficult to pinpoint which one is actually causing it; you might even feel pain in your sinus cavity radiating upward from the tooth. An untreated infection will continue to spread to surrounding soft tissue, or result in a painful abscess, an infected pocket of bacteria between the tooth and gums.
The other path is periodontal, meaning the infection originates in the gum tissues. A thin layer of dental plaque known as biofilm develops and sticks to teeth at the gum line, which can lead to infection of the gum tissue, which then becomes inflamed and painfully sensitive. The untreated infection can then progress along the tooth and invade the pulp through the accessory root canals.
Knowing the source of an ache will determine the best course of treatment, whether a root canal, root planing, or a combination of these or other procedures. It's also the best, most efficient way to relieve you of that unpleasant mouth pain.
If you would like more information on the various causes of tooth pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Confusing Tooth Pain.”
Your mouth’s biting and chewing function is an intricate interplay of your teeth, jaws, lips, cheeks and tongue. Most of the time everything works in orderly fashion, but occasionally the soft tissues of the tongue or cheeks get in the way and are accidentally bitten. The resultant wound creates a traumatic fibroma, an overgrowth of tissue that develops to cover the affected area.
A fibroma consists of fibrous tissue made up of the protein collagen; this traumatized tissue functions much like a callous on a tender spot of skin by binding together the new tissues forming as the wound heals. But because the fibroma is raised on the surface of the cheek more than normal tissue, the chances are high it will be bitten again and reinjured, even multiple times. If this occurs the fibroma becomes tougher and more pronounced.
As it becomes raised and hardened in this way, it becomes more noticeable. More than likely, though, it poses no danger other than as an inconvenience. If it becomes too much of a nuisance, or you have concerns that it’s more than a benign growth, it can be removed with a simple fifteen-minute procedure. An oral surgeon, periodontist or dentist with surgical training will first anesthetize the area with a local anesthetic; the fibroma is then completely excised (removed) and the wound opening sutured with two or three small sutures. Any post-procedure discomfort should be mild and easily managed by pain medication like aspirin or ibuprofen.
Although it’s highly unlikely the fibroma is cancerous, the excised tissue should then be sent for biopsy. Viewing the tissue microscopically is the only definitive way to determine the true nature of the tissue and confirm any diagnosis that the tissue is benign. This is no cause for alarm as it’s a standard healthcare procedure to biopsy this particular kind of excised tissue.
“Bumps and lumps” are common occurrences in the mouth. It’s a good idea to point them out to us during your regular checkups or at any time if you have a concern. In either case, this bothersome problem can be easily treated.
If you would like more information on traumatic fibromas, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Common Lumps and Bumps in the Mouth.”
Perhaps you or someone you know has been told they will need root canal treatment. Maybe you're experiencing some unexplained tooth pain, and you think you might need to have this procedure done. Nervous? You shouldn't be! A good understanding of this common and relatively pain-free dental treatment can go a long way toward relieving your anxiety.
What's a root canal? It's the small, branching hollow space or canal, deep within the root of the tooth. Like an iceberg in the ocean, a tooth shows only part of its structure above the gum line: That's the part you see when you smile. But about two-thirds of the tooth — the part called the root — lies below the gum. A healthy root canal is filled with living pulp tissue, which contains tiny blood vessels, nerves and more.
A “root canal” is also shorthand for the endodontic treatment that's called for when problems develop with this tissue. For a variety of reasons — deep tooth decay or impact trauma, for example — the pulp tissue may become inflamed or infected. When this happens, the best solution is to remove the dead and dying tissue, disinfect the canals, and seal them up to prevent future infection.
How is this done? The start of the procedure is not unlike getting a filling. A local anesthetic is administered to numb the tooth and the nearby area. Then, a small opening is made through the chewing surface of the tooth, giving access to the pulp. A set of tiny instruments is used to remove the diseased tissue, and to re-shape and clean out the canals. Finally, the cleared canals are filled with a biocompatible material and sealed with strong adhesive cement.
After root canal treatment, it's important to get a final restoration or crown on the tooth. This will bring your tooth back to its full function, and protect it from further injury such as fracture. A tooth that has had a root canal followed by a proper restoration can last just as long as any other natural tooth. And that's a long time.
If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”
Your toothbrush serves the invaluable purpose of minimizing bacterial buildup (plaque) that can irritate gums and lead to periodontal disease, infection of the bone and tissues supporting your teeth. Brushing also helps dislodge food particles that certain oral bacteria would otherwise feed on, producing acids in the process that can eat through protective tooth enamel and the vulnerable dentin below. Given its importance to your oral health, you can maximize your toothbrush’s effectiveness by using and storing it properly, and replacing it (or the brush head if you have a powered model) regularly.
Using and Storing Your Brush
All that’s needed to dislodge plaque from oral surfaces is a relaxed grip and a gentle jiggling motion. Too much pressure can wear away tooth enamel, cause gum tissue to recede, and shorten the life of your brush head.
When you’re done using your brush:
- Thoroughly rinse it to remove any remaining tooth paste, food particles, etc.
- If you’re super-vigilant, you also can disinfect your brush by soaking it in mouthwash, brush-sanitizing rinse, or a half water/half hydrogen peroxide solution, or dipping it in boiling water for 5 to 10 seconds.
- Air dry in an upright position and do not routinely cover your toothbrush or store it in a closed container. A dark, moist environment is more conducive to the growth of microorganisms.
Replacing and Recycling Your Toothbrush
Even with the best of care, toothbrush bristles become frayed and worn and their cleaning effectiveness diminishes after 3 or 4 months, according to the American Dental Association, though it could be sooner depending on factors unique to each patient. Besides checking the bristles regularly, a good way of keeping track is to write the date you start using your toothbrush in permanent pen on a big-enough spot on the handle (or doing it on masking tape applied to the base of a power brush).
Once your brush has passed its useful life for oral hygiene, you can still get plenty of mileage out of it. You’ll find plenty of ideas on the internet for cleaning grout between tiles and grime-filled spots around taps and toilet lid hinges; removing mud from boot treads; scrubbing off corrosion from around car battery terminals and more!
If you would like more information about oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Toothbrush Lifespan” and “Manual vs Powered Toothbrushes.”
Dental implants are a popular and effective restoration for lost teeth, if there’s enough bone present to support the implant. That might not be the case, however, because without the stimulation of the lost tooth, the bone may dissolve (resorb) over time. It’s possible, however, that you may need to re-grow bone in the back area of the upper jaw where your upper (maxillary) sinus is located.
Sinuses are air space cavities located throughout the skull. This feature allows your head to be light enough to be supported by your neck muscles. Inside each sinus is a membrane that lines your sinus cavities, nasal passages and other spaces. The maxillary sinus is located on each side of the face just below the eyes. Pyramidal in shape, the floor of the pyramid lies just above the upper back teeth.
A surgeon approaches the sinus through the mouth, with the objective of moving the sinus membrane up from the floor of the sinus. This is accomplished by placing bone-grafting material in the area. Over time the body uses the grafting material as a scaffold to produce new bone that then replaces the grafting material. The resulting new bone becomes the support for the implant.
If enough bone exists to stabilize an implant but not anchor it, then the surgeon can approach the sinus from the same opening that’s used for the intended implant site, insert the grafting material, and install the implant during the same procedure. If not, the surgeon creates a small “window” laterally over the teeth to access the sinus and insert the graft. The implant is installed a few months later after the new bone is created.
The procedure usually requires only a local anesthetic, although some patients may require additional sedation or anti-anxiety medication. After the surgery, you normally experience mild to moderate swelling and discomfort, about the same as having a tooth removed. All these symptoms can be managed with non-steroidal, anti-inflammatory pain medication and a decongestant for minor congestion in the sinus. We might also prescribe an antibiotic to help prevent infection.
Although this procedure adds another step and possibly more waiting time to implantation, it gives you an option you wouldn’t otherwise have — a life-like, effective replacement of your back teeth with dental implants.
If you would like more information on bone regeneration for implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sinus Surgery.”
You may be suffering from an uncomfortable cracking of the skin at the corners of the mouth. This condition is known as perleche (or angular cheilitis). From the French word “lecher” (“to lick”), it derives its name from the tendency of sufferers to lick the affected areas.
There are a number of causes for perleche. It’s found most often in children who drool during sleep, or in teenagers or young adults wearing braces. Older adults develop perleche due to the wrinkling of skin caused by aging; and anyone can develop the condition from environmental factors like cold, dry weather. Conditions from within the mouth may also be a cause: inadequate saliva flow; inflammation caused by dentures; or tooth loss that diminishes facial support and puts pressure on the skin at the corners of the mouth. Systemic conditions such as anemia, diabetes or cancer can dry out oral tissues and membranes, which may lead to perleche.
Our first priority is to treat any underlying infection. Cracked mouth corners are easily infected, most commonly from yeast called candida albicans. The infection may range from minor discomfort localized in the affected area to painful infections that involve the entire mouth and possibly the throat. Any of these can be treated with an oral or topical anti-fungal medication, including anti-fungal ointments applied directly to the corners of the mouth until the infection clears up. Chlorhexidine mouth rinses can also be used to treat minor yeast infections.
As for healing the cracked skin, a steroid ointment for control of inflammation combined with a zinc oxide paste or ointment will serve as an antifungal barrier while the tissues heal. If the condition is related to missing teeth or dentures, we can take steps to replace those teeth or ensure the dentures are fitting properly. Good oral health also goes a long way in preventing further reoccurrence of perleche, as well as dermatological techniques to remove deep wrinkles due to aging.
If you would like more information on perleche and other mouth sore issues, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Corners of the Mouth.”
As life spans have increased over the last century so has the importance of maintaining good oral health. Teeth are such a critical component in good nutrition and disease protection, it’s important we do all we can to preserve them for a lifetime.
Through advances in dentistry and oral hygiene, two of teeth’s greatest enemies, dental caries (tooth decay) and periodontal (gum) disease, are not only quite treatable but even preventable. The fact remains, though, that like the rest of our body, our teeth are still subject to aging. The irreplaceable outer layer known as enamel is especially susceptible to wear over time.
The normal wearing down of teeth occurs because of occlusal (bite) activity. As our upper and lower teeth interact with each other through constant biting and chewing activities, some of the enamel surface naturally wears away as we age. Our biggest concern shouldn’t be the wear itself but the rate of wear — whether it’s exceeded the normal range.
Habits that increase the frequency and rate of biting forces are the most common reason for excessive enamel erosion. Such habits include excessive tooth-to-tooth contact as when we clench or grind our teeth and tooth-to-foreign object, the chronic habit of holding hard objects (nails, pencils, pins, etc.) tightly between the teeth. Many of these habits are a response to psychological stress that can even carry over into our sleep.
The key is to minimize these effects on the normal process of wear, and to protect teeth for as long as possible. How to accomplish that goal depends on your individual circumstance: treatments could include such things as orthodontics to correct bite problems that contribute to abnormal wear, considering restoring worn teeth with new crowns or fillings, or reducing grinding or clenching with nocturnal mouth guards or some form of stress-relief therapy.
In cases where abnormal wear has passed the point where it doesn’t make sense to repair your natural teeth, all is not lost — restorations such as dental implants can help restore lost function and inhibit further erosion. Advances over the last thirty years in restoration techniques can, in effect, extend a new lease on life for your teeth. What’s more, we can also restore form — to bring back that smile from your younger years.
If you would like more information on tooth erosion and aging, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How and Why Teeth Wear.”
The old saying, “If it ain't broke, don't fix it,” doesn't really apply when discussing your wisdom teeth. It's great if they are not bothering you, but don't wait for problems to develop before you take action. This may seem counter-intuitive, but you should know that the best time to have your wisdom teeth removed is when they are not causing problems.
Why do wisdom teeth cause problems?
Wisdom teeth are so-called because they appear at ages 17 to 25, the age of supposedly attaining wisdom. They are also known as third molars and are farthest back in your jaws. For some people they come through the gum-line only partially, or they may not erupt into the mouth at all. Unerupted they have the potential to cause problems associated with the neighboring teeth and surrounding gums.
You may have heard of “impacted” wisdom teeth. This means that they are impacted or forced against neighboring structures, teeth or bone that prevent them from coming into the mouth in correct biting position. Since they are your last teeth to come in, space for them may be severely limited. They may push into the teeth that are already in place, becoming stuck as they try to erupt. When wisdom teeth are trapped like this below the gum line and are pushing against neighboring teeth, these molars can cause problems such as infections, cysts, or gum disease.
My wisdom teeth seem OK, so why remove them?
The dilemma is that if you wait until you feel pain connected with your wisdom teeth, their neighboring teeth may already be in trouble.
Another reason to remove these back teeth before they cause problems is that it's a good idea to have your surgery while you are young. Younger, healthy patients with no infections at the site have the best chance of having their wisdom teeth extracted without complications, with an easier recovery and uneventful healing.
Of course, each situation is different. Make an appointment with us for an examination and a consultation to discuss the risks and benefits of removing your wisdom teeth. For more information read the article “Removing Wisdom Teeth” in Dear Doctor magazine.
Our smiles are our “calling cards” for first impressions. When our front teeth are missing, chipped or otherwise damaged, it will certainly make an impression — and not a positive one.
The good news is many aesthetic problems with front teeth can be remedied with the use of composite resins. This cost-effective treatment choice not only minimizes a negative appearance, but can actually create a positive smile transformation.
Composite resins are tooth-colored materials made up of two or more polymer substances. We call materials like these biomimetic, meaning something non-living that’s fashioned to appear or “mimic” something living. Composite resins are made of substances that aren’t teeth, but fashioned to look and function like teeth.
Composite resin restorations are bonded to the outside of the tooth with dental adhesive, with little to no preparation of the enamel surface of the tooth. They’re best suited for teeth with minor to moderate damage from decay or trauma, but where the majority of the structure is still viable and intact.
These restorations require skill and an artistic eye to achieve the most life-like result. One of the most important considerations is tooth color. The natural color of your teeth is actually a combination of color from the inner core of the tooth, the dentin, and the outer enamel layer. Much of the color comes from the dentin as it shows through the translucence of the enamel. The intensity and hue also changes along the length of the tooth — there are subtle zones of color that run vertically along the length of the crown (the visible portion of the tooth). Our aim is to replicate this variety of color in the restoration and affix it in such a way that it blends with the natural color of surrounding teeth.
Composite resins aren’t the best option for all situations; depending on the tooth’s condition and location, a porcelain veneer may be the better choice. After a thorough dental examination, we can make the best recommendation for your situation. If conditions are right, a composite resin restoration could transform your smile and your life.
If you would like more information on front teeth repair options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Artistic Repair of Front Teeth With Composite Resin.”
Do you clench your jaw or grind your teeth? Bite your nails? Chew on pencils or toothpicks? Or, heaven forbid, unscrew hard-to-open bottle caps using your precious pearly whites?
Over time, habits such as these — referred to in dentistry as “parafunctional” (para – outside; functional – normal) or beyond the range of what nature intended — can inflict excessive wear and tear on your teeth. Besides the impact damaged teeth can have on your smile, so called “tooth to tooth” and “tooth to foreign object” behaviors can cause physical problems, such as jaw joint and muscle pain, headaches, earaches, and even neck and back pain.
Use of Excessive Force
Parafunctional behaviors exert an abnormal amount of force on your teeth — up to 10 times the amount used for biting and chewing. Tooth grinding or “bruxism” (from the Greek word brykein – “gnash the teeth”) is particularly detrimental and is commonly seen in individuals who are experiencing a stressful time in their life. Some medications can also trigger it. Since bruxism often occurs while people sleep, it's possible to be unaware of it unless a partner comments (it can be noisy!) or a dental professional points out the tell-tale signs of wear.
To counter the adverse effects of nocturnal tooth grinding our office can create a customized night or occlusal (bite) guard. Typically fashioned from a hard, clear “processed acrylic” (wear-resistant plastic), this type of guard is amazingly inconspicuous. It is made to fit over the biting surfaces of the upper teeth only and is thinner than a dime. When it is worn, the lower teeth easily glide over the upper teeth rather than chomping into and gnashing with them, which minimizes the likelihood of erosion, chipping and uneven or excessive wear of the biting surface of the teeth. The guard is so unobtrusive, that some people even wear it as they go about their daily activities.
Remember: In addition to proper dental hygiene, you can help keep your teeth healthy by using them wisely!
If you would like more information about parafunctional habits like bruxism and ways to protect your teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Stress & Tooth Habits” and “How And Why Teeth Wear.”
Not only can orthodontic treatment transform your smile, it can also restore function to your teeth and mouth that will improve both your oral and general health. But any treatment to straighten misaligned teeth requires careful planning. Depending on the exact nature of your misalignment, there may be some additional steps we would need to perform before undertaking orthodontic treatment.
One common need is space to help relieve overcrowding. To make room for tooth movement, often a tooth may need to be removed if the crowding is excessive. The most likely candidates are the first bicuspids, teeth located between the cuspids (or eyeteeth, located in line under the eyes) and the second premolar located in front of the molar teeth. The removal of these first premolars won't have a great effect on future form or function. Under the gentle pressure exerted by the braces, neighboring teeth will move and fill in the open space. Today's orthodontist goes to great lengths to avoid removing any teeth; in severe overcrowding, though, this is an acceptable way to create needed space.
Damaged teeth in need of replacement may also be removed before orthodontics and certainly more desirable — if any tooth needed to be removed, you would always choose a damaged tooth first. The object is to first preserve the underlying bone and close the space to avoid replacing that tooth or, if not possible, maintain the correct amount of space for any future restoration.
As living tissue, bone constantly reshapes in response to its environment. If it no longer senses a tooth (or the forces exerted by a tooth when biting or chewing), the bone will slowly disappear through a process known as bone resorption. To counteract this process, we may graft material (like processed donor bone) into the socket to encourage and maintain bone growth. This creates a platform for future tooth replacements like implants or bridgework after orthodontic treatment.
After orthodontics, it may also be necessary to install some type of “placeholder” (temporary bridgework or partial denture) in the area of missing teeth. Keeping the teeth from migrating into the space will improve the chances that any permanent restoration like an implant or fixed bridgework will look natural — as if it belonged there the entire time.
A complete dental examination will indicate whether any teeth need to be removed before undergoing orthodontic treatment. If necessary, taking this strategic step will help ensure we achieve the best result — a winning smile.
If you would like more information on tooth removal and other options to enhance orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Removal for Orthodontic Reasons.”
Everyone's heard the jokes about root canals. Now, let's go beyond the myths and get to the “root” of the matter. Here are a few things everyone should know about this relatively painless and beneficial procedure.
1) If you experience discomfort after eating hot or cold foods, sharp pain when biting down, swelling of the gum tissue, or acute tooth pain, you may need root canal treatment.
All of the above are symptoms of disease in the pulp tissue, which lies deep within the roots of teeth, inside tiny canals that go from one end of the root to the other. Pulp tissue can become infected or inflamed for a variety of reasons, such as trauma or deep tooth decay, causing pain and leading to further complications.
2) Diseased pulp tissue in the root canal must be removed to prevent more problems.
The acute pain may go away — but without treatment, the infection in the pulp tissue won't. It will eventually travel through the ends of the tooth's roots and into surrounding areas. This can lead to dental abscesses, and may even cause systemic problems and diseases in other parts of the body.
3) Root canal treatment is effective.
Removing the diseased pulp tissue removes the infection. Pulp tissue itself is a remnant of tooth development which the tooth no longer needs. After the tissue is removed, the root canal is filled with a biocompatible material, and then it is sealed. A crown or other restoration is usually done after root canal treatment to restore the tooth to its full function.
4) Root canal treatment is generally pain-free.
Just like having an ordinary filling, the process begins with an anesthetic administered to numb the tooth and the nearby area. A tiny hole in the tooth's biting surface provides access to the canal, and minute instruments are used for the procedure. Afterwards, over-the-counter pain relievers are typically all that's needed to relieve the sensitivity that may persist for a day or two following the treatment.
5) A properly done root canal preserves your natural teeth.
A tooth that has had appropriate root canal treatment and restoration can last just as long as a natural tooth. That's important, because the other option — removal of the tooth — can lead to issues like unwanted tooth movement and bite problems. Saving your natural teeth should be the first priority in proper dental care.
If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”
You hardly notice the moist environment of your mouth — unless it becomes uncomfortably dry. Some instances of dry mouth are quite normal — when you first wake in the morning after reduced saliva flow during sleep, when you're stressed, or when you're dehydrated and need fluids. But some are not normal — millions of people, in fact, suffer from a chronic inadequacy of saliva production and flow.
Chronic dry mouth (or xerostomia) can have a greater effect on your oral health than discomfort. Saliva performs a number of tasks for the body: its enzymes help break down food before digestion; its antimicrobial properties help reduce harmful bacteria and its buffering ability helps neutralize acid, both of which reduce the risk of tooth decay.
There are a number of causes for chronic dry mouth. One of the most common arises as a side effect of over 500 medications, both prescription and over-the-counter. The major contributors to dry mouth fall into three main types: antihistamines, used to treat allergies; diuretics, prescribed to cardiac patients to drain excess fluid; and antidepressants. Diseases like Diabetes, Parkinson's disease, or AIDS can also cause dry mouth. Some treatments can too — persons undergoing head or neck radiation or chemotherapy may experience dry mouth.
If you've noticed dry mouth over several days, it's a good idea to visit us for an exam. Our first step is to try to determine the extent and cause of the condition. Depending on what we find, we can then recommend a treatment path that includes some changes in habit and prescribed medications. For example, if lack of hydration is contributing to dry mouth, we would recommend drinking an adequate amount of water, as well as cutting back on caffeinated or acidic beverages. We might also prescribe medication to stimulate saliva flow. Consuming foods that contain xylitol, a natural sugar substitute, may also do the same.
It's also important that you maintain a good oral hygiene regimen and regular dental checkups and cleanings. Good oral hygiene and the proper treatment for chronic dry mouth will greatly reduce your risk of tooth decay and other diseases.
If you would like more information on the causes and treatment of dry mouth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dry Mouth.”
If you have noticed that one or more of your teeth have lost some of the surrounding pink gum tissue so that part of the root surface is now uncovered, you are experiencing gum recession. It's a very common problem — in fact millions of Americans have some degree of gum recession. Fortunately, there are very effective methods of treating it.
Gum recession can be unsightly, but there are more serious concerns. Tooth root surfaces exposed by gum recession can become sensitive to temperature and pressure changes and can decay or wear away. In very severe cases, teeth can actually be lost. That's because gum or “gingival” tissue as it is medically known is supposed to encircle and firmly attach to the necks of the teeth and the underlying bone. This forms a protective barrier that is resistant to the abrasive action of foods during eating, biting and chewing.
Gum tissue is largely made of a fibrous protein called collagen, covered by a layer of another very resilient protein called keratin (nails and hair are also made of it). Yet it is still possible for this tough tissue to lose its grip on the teeth it protects. Here are some of the ways this can happen:
- Ineffective oral hygiene — inadequate removal of dental bacterial plaque (biofilm) with daily brushing and flossing.
- Excessive brushing (and flossing) — too hard, or for too long.
- Habits — holding foreign objects between the teeth, such as bobby-pins, nails etc that press on the gum tissues.
- Oral appliances and ornaments — badly fitting removable partial dentures and orthodontic appliances (braces), or tongue bolts and oral piercings can apply pressure to the gums.
Treatment will depend in part on whether the recession is stable or progressive. For example, an older person might have a few areas of gum recession but there are still adequate zones of attached protective gum tissue and the exposed tooth root surfaces are healthy. In this case, there may not be reason to do anything but monitor the situation. On the other hand, a teenager with a history of fairly rapid gum recession (over a period of months) usually requires immediate treatment. The dental specialty of periodontics (“peri” – around; “odont” – tooth) has developed predictable surgical techniques to deal with recession.
Free Gingival Grafting, for example, involves taking a very thin layer of skin from the palate, where the tissue is identical to gum tissue, and transplanting it to the area where gum has been lost. Both sites will heal in a very predictable and uneventful manner. The free gingival graft is so-called because it is “freed” from the donor (original) site completely. It is crucial to make sure individuals with gum recession correct faulty hygiene habits prior to this (or any) treatment so that they will not jeopardize their future results.
If you are concerned about gum recession, please contact us or schedule an appointment for a consultation. You can also learn more about gum recession and gingival grafting by reading the Dear Doctor magazine article “Periodontal Plastic Surgery.”
Loose teeth are an exciting rite of passage in childhood; in adulthood, they're anything but. In fact, a permanent tooth that feels loose is a sign that you need to make an appointment with our office right away. The quicker we act, the better chance we will have of saving the tooth.
What causes loose teeth? In the absence of a traumatic dental injury, the culprit is usually periodontal (gum) disease. This is a bacterial infection of the gum and/or bone tissues that surround and support your teeth. The infection is caused by bacterial plaque that sits on your teeth in the absence of effective oral hygiene. Over time, periodontal disease will cause gum tissue and eventually bone to detach from the teeth. As more of this supporting tissue is lost, the teeth will gradually become loose and (if the disease remains untreated) eventually fall out.
Loose teeth can also be caused by a clenching or grinding habit that generates too much biting force. This force can stretch the periodontal ligaments that join the teeth to the supporting bone, making your teeth looser.
Whether the cause of your tooth looseness is biological (gum disease) or mechanical (too much force), treatments are available here at the dental office. The first step in treating gum disease is a thorough cleaning to remove plaque and harder deposits on the teeth (tartar or calculus); this includes the tooth-root surfaces beneath the gum line. You will also be instructed on effective oral hygiene techniques and products to use at home. This type of therapy will promote healing of the gums that will cause some tightening of the teeth. Additional treatments will probably be necessary to gain the maximum healing response to allow the teeth to be most stable. For example, we may also want to temporarily or permanently splint the loose tooth or teeth to other teeth so that biting forces do not loosen them further.
There are other mechanical approaches we can employ to prevent a loose tooth from receiving too much force. For example, we can reshape the tooth by removing tiny amounts of its surface enamel in order to change the way upper and lower teeth contact each other. We also may suggest a custom-made nightguard to protect your teeth if you have a nighttime grinding habit.
The most important thing to know about loose teeth is that it's crucial to intervene quickly. So if you are experiencing tooth looseness, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Loose Teeth” and “Treatment for Loose Teeth.”
If a glance in the mirror reveals stained or discolored teeth that are detracting from your self-confidence, it's time to do something about it. The first step is to make an appointment for an office visit to find out how we can help you.
External (extrinsic) stains that form on the surfaces of teeth are usually caused by beverages such as red wine, tea, coffee as well as unhealthy habits like tobacco use. Extrinsic stains generally come in shades of browns, black or grays, but may even be orange or green from color producing bacteria.
Internal (intrinsic) stains are part of the structure of the tooth and cannot be removed by polishing. Among their causes are excessive fluoride levels or tetracycline antibiotics given in childhood and during tooth formation. Teeth do become more yellow and discolored as we age. Discoloration of individual teeth may be indicative of tooth decay, or teeth that have had root canal treatment and have literally lost their vitality tend to darken over time. Internal discoloration comes in a variety of shades and hues from yellows, grays, browns, and even some reds or pink.
Five Ways to lighten, whiten and brighten stained or discolored teeth
- Change your habits. Reduce or stop consuming or using foods, drinks or tobacco if they are staining your teeth.
- Improve your daily oral hygiene. Make sure to brush your teeth well, twice a day. Change to a toothpaste that contains a mild abrasive. Some toothpastes also contain tooth whiteners.
- Visit our office for a professional cleaning and polish. Routine scaling and polishing will remove most superficial external stain and discoloration. Sometimes ultrasonic cleaning (by high frequency vibration) and polishing with slightly abrasive pastes may just do the trick.
- Treatment for internal stain and discoloration. Brown colored decaying teeth need to have the decay removed and the teeth restored. Stained old and leaking fillings may also need to be replaced.
- Tooth whitening by bleaching. Bleaching or tooth whitening is a safe and effective way to brighten stained teeth. Internal tooth bleaching can whiten even discolored root canal treated teeth. Ask us for more information about this technique.
If your mirror tells you that your smile needs attention, there's no time like the present to get started. Get back your bright, white smile and your self-confidence as well.
Metal braces are often considered a rite of passage for teenagers whose teeth need straightening. While some teens have no problem with this, others are more self-conscious and would like a less noticeable and less restrictive form of orthodontic treatment (“ortho” – to straighten; “odont” – teeth). After all, traditional braces can sometimes require diet modification, regular tightenings can cause discomfort, and the hardware itself can irritate the inside of the mouth. All of these things can limit a teen's ability to function normally during an already difficult stage of life.
That's why many teens today are opting for removable clear aligners, which have been popular with adults for years. In this system of orthodontic treatment, transparent, flexible, plastic “trays” are custom-made to move an individual's teeth into better alignment in a step-by-step fashion. Each tray moves the teeth a little bit further, according to a precise plan developed with specialized computer software by an orthodontist, or a general dentist who has received special training. It's not available from every dentist, but we are happy to be able to offer it here.
It used to be that clear aligners were not recommended for teens for two main reasons. For one thing, because they are removable rather than attached to the teeth, it was assumed a teenager would not be as conscientious as an adult about wearing them nearly 24 hours a day, which is necessary to achieve the desired results. Now, however, clear aligners for teens have colored “compliance indicators” that fade over time. With this new tool, dentists and parents — and teens themselves — can monitor compliance and progress.
The other main problem in prescribing clear aligners for teens had been that their second molars are still growing into position. This problem, too, has been solved. Clear aligners now have “eruption tabs” that serve as space-holders for teeth that have yet to grow in.
Finally, in recent years, improvements have been made to the whole clear aligner system that allow it to be used for more serious malocclusions (bad bites). So it's actually a viable option for more orthodontic patients in general — teens as well as adults.
If you would like to learn more about clear aligners for your teenager, please contact us or schedule an appointment for a consultation. You can also find out more in the Dear Doctor magazine article “Clear Aligners For Teenagers.”
The weapons in the war against cancer are stronger and more effective than ever. But as in real war, those weapons can inflict harm on innocent bystanders — in the case of cancer treatment, other cells in your body. Your mouth in particular may develop side effects from these treatments.
The basic purpose of common cancer treatments like chemotherapy and radiation is to destroy and inhibit future growth of cancer cells. They're very effective to that end, but they can also destroy healthy cells caught in the “crossfire” with malignant cells or have an adverse effect on the body's immune system and its response to infection. Chemotherapy in particular negatively affects blood cells developing within bone marrow, which leads to lower resistance to infection.
These can have secondary effects on the mouth. Patients undergoing cancer treatment can develop painful ulcers and sores within the mouth cavity, and reduced immunity makes them more susceptible to tooth decay or gum disease (especially if risk factors were present before cancer treatment). Certain treatments may also cause dry mouth in some patients.
If you are being treated for cancer, or about to begin treatment, we can help mitigate these effects on your oral health. The first step is to perform a complete dental examination to identify any issues that may affect or be affected by the cancer treatment. We would then treat those conditions (if possible before cancer treatment begins).
We would also monitor your oral health during the treatment period and treat any complications that arise. Such treatments might include applications of high-potency fluoride to strengthen teeth against decay, anti-bacterial rinses to reduce the risk of bacterial growth, and medications to stimulate saliva if you should encounter dry mouth.
Fighting cancer will be your main priority. You should, however, remain aware of how cancer treatment may affect other aspects of your health. As your dentist, we will partner with you in seeing that your teeth and gums remain as healthy as possible during this process.
If you would like more information on caring for oral health during cancer treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Health During Cancer Treatment.”
A consistently dry mouth is not only uncomfortable and unpleasant but also probably more serious than you think. Dry mouth, medically known as xerostomia (“xero” – dry; “stomia” – mouth) affects millions of people, but few understand why it happens or why it is important.
What Causes Dry Mouth?
It is normal to awaken with a dry mouth because saliva flow decreases at night. But if your mouth is persistently dry throughout the day, it may be a result of habits such as smoking, alcohol or too much coffee drinking or even dehydration. It is also a common side effect of some medications. Xerostomia is not a disease in itself, but it could be a symptom of salivary gland or other systemic (general body) disease.
Why is Saliva Important?
A persistently dry mouth can be a problem. Not only does it feel unpleasant and lead to bad breath, it can also significantly increase your risk for tooth decay. Saliva lubricates your mouth for chewing, eating, digestion and even speaking. Saliva also has important antibacterial activities. Most importantly normal healthy salivary flow neutralizes and buffers acids in the mouth to protect the teeth from the acids produced by bacteria on the teeth that cause decay, and by acids in sodas, sports drinks and juices that can erode tooth enamel.
Not only does saliva neutralize acids but with its high mineral content it can actually reverse de-mineralization — the process by which acids attack enamel and remove calcium from the enamel surface. Healthy saliva actually re-mineralizes the outer layers of tooth enamel, but the process can take 30-60 minutes. That's why it's important not to snack on sugars or drink sodas between meals — one an hour and your mouth is acidic all the time.
Individuals without enough saliva are especially at risk for root decay and fungal infections, and they are also more likely to lose tooth substance through abrasion and erosion.
What Can We Do for a Dry Mouth?
If your mouth is usually dry, make an appointment with us to assess the causes of the problem. However it may be more serious with medical implications. The solution may be as simple as drinking more water and using good daily oral hygiene, or it may necessitate prescription medication to promote more saliva flow.
Contact us today to schedule an appointment to discuss your dry mouth and what we can do to help. For more information read the article in Dear Doctor magazine “Tooth Decay – How To Assess Your Risk.”
Because its symptoms can be easy to overlook, gum disease is sometimes called a “silent” malady. But don't underestimate this problem! Untreated periodontal disease can progress into a serious condition, possibly leading to tooth loss and even systemic (whole-body) health issues. With proper preventive measures and appropriate treatment, however, the disease can be controlled.
The root cause of periodontal disease — actually, a group of related diseases, all of which affect the tissues surrounding the teeth — is the buildup of bacterial plaque (also referred to as biofilm) around the gums. While hundreds of types of bacteria live in the mouth, only a comparatively few are thought to be harmful. But when oral hygiene (namely, brushing and flossing) is inadequate, the environment in the mouth becomes favorable to those harmful types.
The disease often begins with inflammation of the gums called gingivitis. It symptoms include bad breath, bleeding gums, and soreness, redness, or tenderness of the gum tissue. However, in some people these early warning signs are ignored, or masked by the effects of harmful habits like smoking.
Gum disease is chronic; that means, if left alone, it will worsen over time. Periodontitis, as it progresses, causes damage to the ligament that helps hold the tooth in place, as well as bone loss. This may become increasingly severe, and ultimately result in the loss of the tooth. Severe periodontitis is also associated with whole-body (systemic) inflammation, which has been linked to an increased incidence of cardiovascular diseases, like stroke and heart attack.
But there's no reason to allow gum disease to progress to this stage! Prevention — that is, regular daily brushing and flossing as well as regular dental cleanings — is a primary means of keeping this problem at bay. Plus, every time you have a regular dental checkup, your gums are examined for early signs of trouble. Of course, if you notice the symptoms of gum disease, you should come in for a check-up as soon as you can.
There are a number of effective treatments for gum disease. One of the most conservative, routine ways are those regular dental cleanings we referred to earlier, usually called scaling and root planning. Using hand-held and ultrasonic instruments, the buildup of plaque (tartar) is carefully removed, sometimes under local anesthesia. A follow-up evaluation may show that this treatment, carried out on a regular schedule, is all that's needed. Or, it may be time for a more comprehensive therapy.
If you have concerns about gum disease, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Understanding Gum (Periodontal) Disease” and “Warning Signs of Periodontal (Gum) Disease.”
It can be daunting for parents to know just what to do when their child complains of an ache or pain. What if your child tells you their tooth hurts — is that cause for alarm? That's actually not so easy to determine, but there are some things you should do when your child has a toothache.
First, try to determine from your child exactly where the pain is coming from and how long it's been hurting. Look for an apparent cause for the pain: the most common is tooth decay, considered a type of infection caused by bacteria, and normally indicated by brown spots or tiny holes (cavities) on the biting surfaces or between teeth. Look for swelling or tenderness in the gum tissues, a sign of a possible abscess. Debris caught between teeth may also cause pain.
The pain might stem from an injury. Though the lips and outer tissues may appear fine, a blow to the face or other traumatic incident may have damaged the teeth. Without treatment, pulp tissue within a traumatized tooth may die and lead to an infection and potential tooth loss.
If you see any of these signs or symptoms, or the pain keeps your child up at night or continues into the next day, you should contact our office as soon as possible so that we can do a full evaluation of the tooth. In the meantime, there are some things you can do to help lessen the pain. First, clean the teeth to remove any debris. Administer ibuprofen or acetaminophen (in the proper dosage for a child) for pain relief. An ice pack against the jaw may also help, but alternate on and off in five-minute intervals to prevent burning the skin with the ice.
If these steps stop the pain within an hour, you can wait until the next day to make an appointment. If not, this may be indicative of an abscess forming and you should not delay contacting our office. The quicker we can properly diagnose and begin treatment, the less chance your child will suffer from any long-term damage to their teeth.
If you would like more information on caring for a child's toothache, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child's Toothache.”
Even before your infant's first tooth emerges, you can take steps to reduce the risk for cavities!
Cavities occur when decay-causing bacteria living in the mouth digest carbohydrates (sugars) introduced into the mouth via food and beverages. This produces acid, which can eat through the protective enamel surface of teeth and attack the more vulnerable dentin below. Infants aren't born with decay-promoting bacteria; however, they can acquire them from their caregiver(s) through close contact, for example:
- Kissing on the mouth
- Sharing food
- Sharing eating utensils (e.g., a spoon or glass)
- Cleaning off a pacifier by mouth
Tooth decay is the most common chronic childhood disease! It can start as soon as the first tooth erupts — which generally happens around age 6 to 9 months but can be as early as 3 months or as late as 1 year. Besides being potentially painful, severe tooth decay may cause your child to lose the affected primary (baby) tooth before it's due to fall out on its own. That, in turn, can raise the risk of orthodontic problems because primary teeth maintain space for permanent teeth, which also use them as their guide for coming in properly.
It's important to clean your child's teeth regularly once they appear and to refrain from certain feeding activities that have been linked with early tooth decay. For example, use of a sleep-time bottle containing a liquid with natural or added sugars, such as formula or juice, can result in a pattern of severe decay once referred to as “baby bottle tooth decay.” These days, the term early childhood caries (ECC) is more commonly used to also encompass decay linked to continuous sippy-cup use, at-will breast-feeding throughout the night, use of a sweetened pacifier, or routine use of sugar-based oral medicines to treat chronic illness.
We recommend that you schedule a dental visit for your baby upon eruption of his or her first tooth or by age 1. This first visit can include risk assessment for decay, hands-on instruction on teeth cleaning, nutritional/feeding guidance, fluoride recommendations, and even identification of underlying conditions that should be monitored. Your child's smile is a sight to behold; starting early improves the odds of keeping it that way!
If you would like more information about infant dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Age One Dental Visit.”
Americans today can expect to have a longer lifespan than ever before. And, as our population ages, our concern is no longer just longevity… it becomes, in addition, the quality of life. These days, the task of helping an older person — perhaps a parent, relative, or friend — to maintain a good quality of life often falls to adult children or others in the extended family. These caregivers have a crucial role in deciding how best to provide for an older person's care.
Eating a healthful diet, getting moderate exercise and having an invigorating social life are factors that can improve quality of life for a person of any age. But we would propose adding one more item: keeping a healthy smile. By age 74, about one in four people have lost all of their permanent teeth. Many more have failing teeth, or only a few teeth remaining. According to actuarial tables, these folks can expect to live, on average, to age 86 — and some will live much longer. That's a long time to go without good replacement teeth.
The Old School: Bridges and Dentures
What's the best method of tooth replacement? The answer depends on several factors. If just a small number of teeth are missing, the best options available are a fixed bridge (also called a fixed partial denture) or a dental implant. If most or all teeth are failing or lost, either complete or partial removable dentures, or implants, may be considered. We'll come back to implants later, but let's look at other methods first.
The dental bridge is a traditional method of closing a gap in your smile — but it has some drawbacks. It requires crowning or “capping” healthy teeth on either side of the gap, so they can be used to anchor a series of prosthetic teeth. This means a significant amount of tooth material must be removed from “good” teeth, which may leave them more susceptible to decay. Root canal treatment may also be required. A bridge can make gum disease more likely, and it is generally expected to need replacement in about ten years.
Removable dentures, both complete and partial, have been around even longer than bridges — in fact, they go back centuries. Denture problems, too, are legendary: They include problems with chewing and speaking, unpleasant smells and tastes, the inability to eat many favorite foods, and the tendency of dentures to become loose and ill-fitting over time. Many of these problems force a person to make compromises in their lifestyle; the last one, however, points to a serious flaw with dentures.
When teeth are lost, the underlying bone in the jaw begins to be resorbed (melted away) by the body's natural processes. This causes the jawbone to become weaker — and, as support for the facial features is lost, it can result in the appearance of premature aging. Dentures don't stop bone loss, in fact, they accelerate it. When dentures stop fitting properly, it's evidence of the process of bone loss at work.
A Modern Solution: Dental Implants
There's a great way to stop bone loss and restore teeth to full function: the dental implant. Whether it's a single tooth or an entire set of teeth that are missing, dental implants are the new gold standard for tooth replacement. Because of the way they become fused with the living bone tissue of the jaw, implants stop bone loss form occurring. They “feel” and function like natural teeth — and they can be almost impossible to tell from the real thing.
A single missing tooth can be replaced by one dental implant, where a bridge would require a minimum of three prosthetic teeth (one for the missing tooth, and two for the supports). On the other hand, an entire arch (top or bottom row) of replacement teeth can be anchored by just four to six implants. And, with regular care, implants can last a lifetime.
So if you're helping someone choose between different methods of tooth replacement, be sure to consider the advantages of dental implants. It's an investment in quality — both the quality of the implant itself, and the enhanced quality of life it provides. If you would like more information, or wish to schedule a consultation, please call our office. You can learn more in the Dear Doctor magazine articles “Dental Implants” and “Removable Full Dentures.”
Some people are planners, and others just go with the flow. Some spend all winter in the gym, and others try and lose ten pounds right before beach season. Some have every detail of their wedding day planned out months in advance, and others... don't.
No matter which kind of person you are, you'll want to look your best for your wedding day. And that includes sporting a bright, healthy-looking smile. Depending how much time you have beforehand, there's a range of dental treatments that can help you look and feel great — not just that day, but every day. Here's a rundown of what you can do in the time remaining before your big day.
Time Left: Up to two years. If you've planned this far in advance, congratulations! You probably have time for almost any needed dental treatment — including orthodontics, which can straighten misaligned teeth and correct a bad bite. But even if you don't have quite so much time, don't despair: Clear aligners and tooth-colored or tongue-side braces, if recommended, can make orthodontic appliances nearly invisible.
Time Left: Six months to one year. Many dental treatments, like periodontal plastic surgery or tooth implants, can achieve remarkable results in this time. Periodontal surgery can give you a less “gummy” smile and greatly improve the aesthetics of your teeth. Tooth implants are modern dentistry's best option for replacing missing teeth. Natural-looking implants have a success rate of 95%, and can last a lifetime.
Time left: Three or four months. There's plenty you can do! If the roots are intact, a crown can be placed on a damaged tooth to restore its appearance and function. Or, missing teeth can be replaced via bridgework, which supports a false tooth from abutments on either side. Stained or discolored teeth can also be dramatically lightened with veneers, where a porcelain shell replaces the tooth's outermost layer of enamel. Tooth implants are still a possibility, under the right circumstances. We can evaluate your individual situation and come up with the best option to replace missing teeth.
Time left: Six weeks or so. You still have time for some basic, yet effective, treatments. Small chips or discolored fillings can be restored with tooth-colored materials that securely bond to the teeth themselves. You can also brighten your teeth by several shades using the techniques of bleaching. In-office whitening treatments are the fastest, but take-home kits, used under our supervision, offer similar results in a longer time.
Have even less time? At the very least, come in for a thorough cleaning right before the date! This will help remove many surface stains and freshen up your smile. Be sure to call in advance so that you're able to get an appointment. Then, smile for the camera!
If you would like more information about a wedding-day smile makeover, please contact us or schedule an appointment to discuss your treatment options. You can learn more in the Dear Doctor magazine article “Wedding Day Smiles.”
Porcelain laminate veneers are one of the innovative techniques dentistry has developed for restoring teeth to improve their color and shape so that they look as good as or better than the originals.
What are porcelain veneers? Porcelain is a ceramic material that is baked in a high-heat oven until it becomes glass-like. Your grandmother's antique china teacups are probably made of porcelain. Dental porcelains are especially made to perfectly mimic the color, reflectivity and translucency of natural tooth enamel. A veneer is a covering or shell, a false front; dental porcelains can be fashioned into veneers used to restore the enamel surfaces of teeth.
What is a laminate? A laminate is a structure created by uniting two or more layers of material together. Dental porcelain laminate veneers refer to the combination of tooth enamel bonding material and porcelain veneer.
When are porcelain laminate veneers used? Porcelain veneers are used to enhance the color of stained, darkened, decayed and heavily restored teeth. They are also used to: correct spaces between teeth; straighten slightly rotated teeth; correct problems in tooth shape and some bite problems. They can be good solutions for broken teeth or teeth that have been worn by habitual tooth grinding.
What is the process of placing the veneers? Room generally needs to be created to place a veneer; generally requiring about half a millimeter of reduction of tooth enamel. Artistic dental laboratory technicians fabricate veneers. About a week of laboratory time is usually needed to construct your veneers.
How do I know whether I will like the way my new veneers look? Computer imaging can be used to digitally replicate your teeth and create images of the proposed changes. Models of your teeth can be cast and changes can be made in white wax for your preview. Temporary veneers can also be fabricated as a test drive before the final veneers are fabricated.
How long will porcelain veneers last? Veneers can last 20 years or more. They are very strong but like glass, they can break if extreme force is applied to them. You should avoid such activities as opening bottles, cracking nuts, or biting into candy apples with your veneers.
How do I look after my new veneers? Once the veneers are placed, you should continue daily brushing and flossing. There is no higher incidence of decay around them than with your natural teeth. However, the more dental work you have in your mouth, the more vigilant you need to be. Of course, keeping your sugar consumption low helps to protect all of your teeth from decay.
Contact us today to schedule an appointment or to discuss your questions about porcelain laminate veneers. You can also learn more by reading the Dear Doctor magazine article “Smile Design Enhanced with Porcelain Veneers.”
Every pregnant woman knows that her body will go through a series of profound changes as it's making a new life. Along with the alterations in overall size and changes in eating and sleeping patterns, pregnancy also affects the teeth and gums. Here are some answers to common questions women may have about oral health during pregnancy.
1) What's the most important thing I can do for my baby's oral health?
Maintain your own dental and general health! Eat a healthy and balanced diet — it provides the nutrients, vitamins and minerals needed for proper development of your baby's teeth and bones. While food cravings and aversions are common, try to at least limit your intake of sugary snacks to mealtimes. Don't neglect the good habits of brushing, flossing, and seeing your dentist regularly. This will help minimize the possibility of tooth decay or gum disease.
2) Does pregnancy make me more susceptible to gum disease?
Yes. “Pregnancy gingivitis” (“gingival” – gum tissue; “it is” – inflammation of) may develop from the second to the eighth month. This is mostly due to elevated hormone levels. In the presence of gum disease, pregnancy hormones may stimulate the production of prostaglandins, which cause inflammation of gum tissues. Occasionally, benign growths called “pregnancy tumors” may also appear on the gums during the second trimester. If they don't resolve themselves, these may be surgically removed after the baby is born.
3) With all my other concerns right now, why is the health of my teeth and gums so important?
Several studies have shown a link between periodontal (gum) disease, pre-term delivery and low birth weight — conditions which put some newborns at greater risk for health complications. There's also a correlation between more severe periodontal disease and an increased rate of pre-eclampsia, a potentially serious condition. But treating periodontal disease decreases the level of inflammation-causing prostaglandins. That's one reason why you should come into our office for an evaluation as soon as you know you're expecting.
4) Is it safe to get dental treatments while I'm pregnant?
Dental examinations and routine treatment during pregnancy is generally safe for both mom and baby. If you need non-urgent dental care, it may be most comfortable in the first five months of pregnancy. Situations requiring urgent care are managed as they arise, to treat pain and infection and to reduce stress to the developing fetus. Under the watchful eye of your dentist, it's possible to have anesthesia, X-rays and dental medications (if needed) without undue risk. So don't let worries about dental treatments keep you from coming in for a check-up!
If you would like more information about pregnancy and oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Pregnancy and Oral Health,” and “Expectant Mothers.”
One went over the handlebars of his mountain bike. Another got an elbow going for a lay-up. For a third, it was that tricky maneuver on her new snowboard...
These are just a few of the ways that kids' teeth can be injured. (No doubt, parents can think of plenty more.) The good news is that modern dentistry offers more options than ever for treating the injury and restoring the appearance and function of the teeth.
Teeth that are fractured or dislodged are a serious condition that requires immediate, comprehensive treatment. The majority of dental injuries, however, are less severe: most often, they involve chipped teeth. If chips occur in the upper front teeth — as some 80% of dental injuries do — even small flaws can have a big affect on the appearance. And, especially in the teenage years, appearance can mean everything.
In many cases, small chips in the teeth can be repaired effectively using a procedure called “bonding.” In this treatment, we use a tooth-colored material made by mixing a plastic matrix and a glass-like filler, which provides adequate strength and aesthetic qualities similar to the natural teeth. In fact, this composite material can be matched to an individual's tooth color so accurately that it's hard to notice any difference.
Composite resins can be successfully bonded to most healthy teeth — and they offer some advantages over other restoration methods, particularly for children and teenagers. The bonding procedure avoids making tiny “undercuts” in the natural substance of the tooth, while metal fillings need to “lock in” to the tooth's structure. This means that bondings generally require less tooth preparation, which usually makes bonding a quick and relatively easy method of restoration.
It's true that, over time, some bonded restorations may not stand up to the tremendous biting forces of the jaw as well as porcelain restorations — but in young people whose permanent teeth have large pulp (nerve) chambers, the removal of too much tooth structure could compromise the long-term health of the tooth. Later on, we can look at performing a different type of restoration.
If you have questions about cosmetic bonding or sports-related dental injuries, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “An Introduction to Sports Injuries & Dentistry.”
Bad breath, or halitosis, is bad news in any social situation — whether you're having an intimate conversation with a date or simply saying hello as you shake someone's hand. Halitosis, from the Latin halitus (exhalation) and the Greek osis (a condition or disease causing process), can also be a warning that something's amiss healthwise — usually in your mouth (85% to 90% of the time) but sometimes elsewhere in your body.
Most Common Causes of a Malodorous Mouth
Most unpleasant odors emanating from the mouth result from the processing of food remnants by certain strains of bacteria that typically populate the oral environment. As they feed on food particles, these microbes produce nasty-smelling byproducts — mostly volatile sulfur compounds, which have a distinctive “rotten egg” odor. That's why diligent dental care is front and center when it comes to banishing bad breath. Brushing, flossing and routine professional cleanings will help ensure that traces of last night's dinner or your midday candy bar don't stick around for bacteria to dine on.
Especially important, but often overlooked, during routine home oral care is the back of the tongue. This is actually the most common location for mouth-related bad breath to develop. Unlike the front of your tongue, which is bathed in saliva, the back of the tongue is relatively dry and poorly cleansed — an ideal setting in which microbe-laden plaque can form and flourish.
Even if you're industrious when it comes to brushing and flossing, food debris can get trapped and plaque can build up in hard-to-reach places such as between teeth (interdental), under the gums (subgingival) and around faulty dental work (e.g., ill-fitting crowns or veneers) contributing to overall oral odor. Other culprits include unclean dentures and oral disease such as tooth decay, gum disease, and abscesses.
Halitosis may accompany dry mouth, or xerostomia (xero – dry, stomia – mouth), a condition in which the normal flow of saliva, which cleanses the oral environment and keeps odor-producing bacteria in check, is interrupted. Most of us wake up with a temporary case of halitosis or “morning breath” because our salivary glands are less active while we sleep, but it usually disappears after a good brushing. If dry mouth is persistent, other possible triggers include: breathing through your mouth, a medication side effect, fasting or dehydration, or even stress.
Clearly, maintaining or restoring a healthy oral environment is your greatest defense against halitosis. Take care of your teeth and there's no reason your breath should be any less attractive than your smile!
If you would like more information about halitosis and ways to prevent or treat it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bad Breath.”
If you are one of the millions of Americans with missing teeth, then you're probably aware of some of the obvious side effects. You may feel self-conscious during conversations or simply avoid smiling altogether to conceal your dental issue. It is not uncommon for missing teeth to affect your confidence, but did you know that there are other problems that result from tooth loss?
For starters, if you have lost enough teeth, eating may become more difficult, in particular healthy foods, such as fruits and vegetables. This is one of the main reasons that inadequate dental care frequently results in nutritional deficiency.
Another very serious issue that results from missing teeth is bone loss. We sometimes refer to this as a “hidden consequence,” because you may not actually see or feel this issue right away. Did you know that bone is actually living tissue that needs constant stimulation to maintain its form and density? Thus, when a tooth is lost, the bone in the jaw that surrounded and supported that tooth melts away. There is a 25% decrease in width of bone during the first year after tooth loss and an overall 4 millimeters decrease in height over the next few years. The longer you have missing teeth, the greater the loss of bone.
As bone loss continues, it can actually affect the structure of your face. If you lose your teeth early in adulthood, by age 45 you might start to notice sunken cheeks. By age 60, your cheeks and lips will lose their support, resulting in a collapsed and aged look. If your teeth are not replaced, this process will continue, and you will be in danger of losing much of the structural support of your lips and cheeks.
Luckily, we can use dental implants to not only restore your smile, but also to halt this bone loss. Implants look, feel and function like your natural teeth and are made of titanium, which has the unique ability to fuse with your living bone. Among the many benefits of implants, they continue to provide stimulation to your bone, preventing further bone loss.
With a success rate of more than 95%, implants are the best long-term solution for tooth replacement.
If you would like more information about implants and bone loss, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”
Tooth sensitivity is an all too common problem among dental patients. If eating certain foods or simply touching a tooth causes you pain, you should know why this may be happening and what can be done about it.
Tooth sensitivity occurs in most cases because the portion of the tooth known as the dentin has been exposed. The dentin contains nerve fibers that inform and alert the brain about the current environment of the tooth (temperature or pressure changes). The enamel protects the tooth from environmental extremes.
Receding gums are the most common cause for dentin exposure — the enamel only protects the crown of the tooth and is not present on the root of the tooth. Acids in certain foods can then begin to erode the dentin around the roots and expose nerves. Sweet items (mainly sugar) and temperature shifts irritate the nerve endings, causing pain.
While receding gums (most commonly caused by brushing too hard and too often) may be the most common cause for sensitivity, it isn't the only one — tooth decay may also lead to it. Untreated, decay works its way into the tooth pulp and irritates the nerves. Treating the decay and filling the tooth may also cause sensitivity unless the dentist places a lining designed to minimize it temporarily while the area heals.
Alleviating pain from sensitivity begins with how you brush your teeth. Remember: the goal of brushing is to remove plaque, which does not require vigorous action. Brush gently with a soft-bristled brush and not too often. We might even recommend not brushing a very sensitive tooth for a few days to give the tooth a rest. You should also brush with a toothpaste containing fluoride, which will help strengthen the tooth surface against the effects of acids and sweets.
During an office visit, we can also apply a fluoride varnish or use certain filling materials that will serve as a barrier for the sensitive area. For cases where decay has irreversibly damaged the tooth pulp, a root canal may be the best treatment.
Tooth sensitivity isn't necessarily something you have to live with. There are treatments that can relieve or lessen the pain.
If you would like more information on tooth sensitivity and what can be done about it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sensitive Teeth.”
We all know that dentistry can do amazing things these days to give you the smile you've always dreamed of. With the latest cosmetic and restorative dental techniques, it is possible to achieve amazingly natural-looking results. But how do we map out the best route to a better smile? And how do we know that the results will hold up over time?
Every individual has a unique set of conditions in his or her mouth and it is our job to figure out how you have come to your present state, dentally speaking. We need to correct or at least manage any factors that could risk the success of your treatment. These risk factors fall into four basic categories:
Periodontal Risk — This involves the condition of the structures that support your teeth, including your gum and bone tissue. It's important to establish good periodontal health before we perform any restorative or cosmetic procedures.
Biomechanical Risk — This has to do with the structural integrity of your teeth. We will look at whether any tooth structure has been lost due to decay, and take steps to reduce your susceptibility to decay if necessary.
Functional Risk — This relates to your bite: how your teeth, muscles and jaw joints are functioning. For example, do you have excessive tooth wear or joint pain? If so, you are at a higher risk in this category and we need to figure out why.
Aesthetic Risk — This is the most subjective of the categories as beauty is in the eye of the beholder. Still, if you display a lot of your teeth and gums when you smile, any issues you have (gum recession, for example) will be that much more visible and affect your smile more. We will have to take this into account when we plan your treatment.
Only when we have determined how best to minimize your risk in all four of these categories can we restore or enhance your smile in a way that will not only look great but also last as long as possible.
If you have any questions about cosmetic or restorative dental treatment, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Successful Dental Treatment: Getting the Best Possible Results.”
If you've recently had a dental implant placed, congratulations! You have made a good investment in your smile that should last for a lifetime — if you take proper care of it. This is easy to do with a good oral hygiene routine and regular professional cleanings. Here are some important things to keep in mind about implant care:
- Implants can last as long as teeth. A dental implant made of titanium will fuse to the bone surrounding it and function just like a natural tooth. It is a highly successful method of tooth replacement that succeeds more than 95% of the time.
- Implants and natural teeth attach to surrounding bone and gums very differently. A natural tooth does not actually fuse to the bone that surrounds it. Instead, it is held in place by a periodontal ligament (“peri” – around; “odont” – tooth) made up of tiny fibers that insert into the bone on one side and into the tooth on the other. Farther up, these collagen fibers attach the tooth to the gum tissue. Implants and the crowns that go on top of them are not anchored to the gum in this way. An understanding of this biology is important for maintaining good periodontal health when implants are present. We will go over this with you so can care for your implants correctly.
- Infection is the enemy. Bacterial infection is a concern with both natural teeth and implant-supported teeth. A bacterial biofilm (plaque) builds up daily on implant teeth, just as it does on natural teeth. If it is not regularly cleared away, various oral infections can develop. In the case of natural teeth, this might result in tooth decay, gum disease, and the loss of tooth-supporting bone. Implants can't decay, but they can be threatened by a rapidly progressing infection known as peri-implantits (“peri” – around; implant “itis” – inflammation), which can lead to a well-like or dish-shaped loss of bone around the implant. The implant can become loose as greater amounts of bone is lost.
- Good oral hygiene is as important as ever. Daily removal of bacterial biofilm is key to preventing peri-implantitis. You'll want to make sure you brush your teeth twice daily with a soft brush and fluoride toothpaste, and floss gently at least once per day.
- Your dental hygienist has an important role to play. Professional cleanings here at our dental office are also still as necessary as ever, if not more so. Dental hygienists have special instruments they use to clean areas around your implant that can't be reached by your brush or floss — without scratching the surfaces of your implant components.
Do you snore? You can admit it. Most everyone does, from time to time. But if snoring becomes a frequent and disturbing feature of your nighttime routine, it may be more than just an annoyance. Did you know that excessive snoring — when accompanied by irritability and depression, daytime sleepiness and confusion, and/or several other physical and mood problems — is one of the common symptoms of a sleep-related breathing disorder (SRBD)?
SRBDs are potentially serious conditions, with consequences that can range from poor workplace performance to possible cardiovascular and brain damage. One of the most significant of these maladies is called Obstructive Sleep Apnea, or OSA, a condition in which the tongue and surrounding soft tissues fall back into the throat and obstruct air flow. This reduces oxygen levels in the blood, causing the body to wake suddenly — and in severe cases, it can happen up to 50 times an hour, without a person consciously realizing it.
Needless to say, that doesn't make for a good night's sleep. But even if it turns out your snoring problem isn't severe OSA, it can still prevent you (and your partner) from feeling refreshed in the morning. Did you know that we may be able to recommend an oral appliance that has been proven to alleviate problem snoring in many cases? This custom-made device, worn while you're sleeping, helps maintain an open airway in the throat and reduce breathing problems.
If you have this condition, it's critical that you get professional advice. Dentists who have received special training in sleep problems can evaluate you, provide medical referrals when needed, and help determine the type of appliance that may work best for you. Since sleep disorders can be problematic, a thorough evaluation and follow-up monitoring is essential.
Several treatments for SRBDs are available. But oral appliance therapy, when it's recommended, offers some distinct advantages. The small appliances are comfortable, easy to wear, and very portable — unlike more complex medical devices such as CPAP machines. They're a non-invasive and reversible treatment that should be considered before undertaking a more intensive treatment, like surgery. Could an oral appliance benefit you? Why not ask us if we can help you get a good night's sleep.
If you would like more information about oral appliance therapy for sleep problems, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea FAQs.”
You've probably brushed your teeth every day since early childhood when your parents handed you your first toothbrush. But do you really know if you're doing it effectively and removing disease causing bacterial plaque or biofilm? Let's take a look at the basics of tooth brushing.
What is the goal of brushing and flossing your teeth? While it is true that brushing your teeth freshens your breath and removes stains from the surfaces of your teeth, the principal goal of tooth brushing is to remove dental bacterial plaque. This biofilm grows in the nooks and crannies of your teeth, and especially at the gum line — regardless of what you eat or drink. If left on your teeth, this bacterial film can cause gingivitis (inflammation of your gums). It can progress to periodontal disease, affecting the supporting bone of your teeth and even result in tooth loss. This means that flossing should also be an important part of your daily dental hygiene routine to remove plaque from the protected areas between your teeth.
Can you actually brush too much? More is not always better and can be damaging. We advise you to use a soft brush and to brush gently. It does not take force to remove plaque, and using a toothbrush too vigorously can damage your gums and cause them to recede (shrink away from your teeth), causing sensitivity and tooth wear. It takes between 12 and 24 hours for plaque to form on your teeth, so you don't need to brush more than twice a day and floss once a day.
How do you know when you've done a good job? A good test is that your teeth should feel like you've just had a professional cleaning. Your tongue is a great evaluator — just feel for smoothness at the gum line.
Is a powered toothbrush better than a manual one? An evidence-based study comparing all the research available found little difference between power and manual toothbrushes. The conclusion was that some powered toothbrushes with a rotation-oscillation action achieve a modest reduction in plaque and gingivitis compared to manual toothbrushes. But as we say, “it's not the brush, it's the hand that holds it.”
Come to our office for a demonstration. Any brush, whether electric or hand-powered, requires professional demonstration and training so that you know how to remove plaque correctly. Bring your toothbrush with you on your next visit to our office, so we can see your brushing technique and make sure you are doing it correctly for the most efficient plaque removal. And don't be embarrassed — nobody really knows how to brush effectively until they're shown!
Contact us today to schedule an appointment or to discuss your questions about tooth brushing and oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Manual vs Powered Toothbrushes.”
What do burnt eggshells, crushed bones, brick dust and ox-hoof ashes have in common? Are they things you discovered in your kid's pocket? Ingredients in a witches brew? Funky organic compost materials?
It may be hard to believe — but they're all substances that were once used to make toothpaste, from ancient Egyptian concoctions through 18th century British blends. But don't worry: You won't find any broken crockery or ashes inside a modern tube! Today's toothpastes are scientifically formulated to be effective in removing plaque, which helps prevent tooth decay and gum disease (not to mention bad breath.) So what makes them work so well?
One class of ingredients found in all toothpastes is abrasives — also called cleaning and polishing agents. These slightly grainy substances make the mechanical action of brushing more effective. But unlike crushed bones, or the harsh, gritty particles of yore, today's abrasives are designed to remove stains and bacterial films without damaging tooth structure.
Next come detergents, which account for the foam you see when you brush vigorously. Detergents (sometimes called “surfactants”) help to break up and wash away materials that would otherwise be difficult to dissolve. An ingredient called sodium lauryl sulfate, which is also found in many shampoos, is probably the most common detergent used in toothpastes.
Fluoride, first included in toothpaste in 1914, is another common ingredient. In fact, all toothpastes that carry the seal of the American Dental Association contain it, typically in the form of sodium fluoride, stannous fluoride or sodium monofluorophosphate. It has been proven to make tooth enamel stronger and more resistant to decay.
In addition to these primary components, toothpastes generally contain flavorings to make them more palatable, and binders and preservatives to hold them together and keep them from drying out. Special-purpose toothpastes — like those designed to whiten teeth, prevent tartar, or help reduce sensitivity — have added ingredients.
But regardless of what's in your toothpaste, there's one thing you should remember: It's not the paste (or the brush) that keeps your teeth and gums healthy — it's the hand that holds it! Brushing once or twice a day, using a soft brush with the proper technique (and your favorite toothpaste!) is probably the most important thing you can do at home to enhance your overall oral health.
If you have questions about toothpastes or oral hygiene, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “Toothpaste — What's In It?”
A “crown” or a “cap” is the term used to restore a decayed or broken tooth that needs to be completely encased to protect the tooth beneath it. A crown's dual purpose is to restore the tooth's form and function. Decades ago gold was the material of choice for a crown. What we ultimately choose depends on a particular crown's requirements with regard to the tooth's appearance and function, and to some extent what you want.
Gold: Gold crowns last the longest and wear the best (at about the same rate as natural teeth), but they are not used as frequently today, especially if they are visible in a person's smile. Gold crowns are made of cast gold, a technique that has been in use for over a hundred years. They can last for decades, and have been known to last 50 years or more. They tend to cost less per tooth than porcelain or other materials.
All-Porcelain: “All porcelain” crowns have a natural appearance and as technology improves they are gaining popularity. Dental porcelains are composed of ceramic substances that are variations of glass. This gives them their translucent, lifelike appearance — but it makes them brittle and subject to fracture. Therefore all-porcelain crowns may not be a good choice for back teeth because they frequently fail under the biting forces applied during chewing and especially adverse habits like tooth clenching or grinding. Porcelain crowns are made of material that doesn't wear. Consequently, it can cause excessive wear to the teeth they bite against.
Porcelain-Fused-to-Metal (PFM): PFM crowns have been in use for more than 40 years. They combine a substructure of gold or platinum for strength and have porcelain “facings” for the visible surfaces. In some ways they combine the best of both worlds, but they do have some problems; the metal can show through the porcelain, detracting from its life-like appearance. These crowns can have a functional lifespan of about 20 years or more.
New and Future Materials: Newer “pressed-ceramic” restorations and computer-milled ceramics have received good reviews for aesthetics and service. These new materials are being intensively researched. Initial results look good, but we'll have to see how they last over time.
Contact us today to schedule an appointment or to discuss your questions about crowns and other dental restorations. You can also learn more by reading the Dear Doctor magazine article “Gold or Porcelain Crowns?”
Do you have silver dental fillings that you wish you didn't have? Wouldn't it be nice if no one could look in your mouth and see how many cavities you had as a kid? Tooth-colored fillings may offer a solution to the problem of too much metal in your mouth. How much do you really know about non-metallic tooth-colored fillings? Take our quiz and find out.
True or false: Tooth-colored fillings are a radical new technology.
False. A variety of dental porcelains and composite resins have been successfully used in tooth restoration for many years. These materials have been designed to mimic the properties of the two major components of teeth: the hard outer enamel, and the bone-like inner dentin. Our increasing understanding of tooth structure and composition has led to better and more natural-looking filling substances.
True or false: Teeth must remain rigid under the pressure of the bite.
False. At one time, metal amalgam (silver) fillings were preferred because of their extreme hardness. But we now know that the crowns of our teeth actually flex under the forces of the bite. This discovery has spurred the development of new methods and materials to stabilize the restored tooth and reduce the incidence of premature failure.
True or false: It's usually more complicated to put in a tooth-colored filling than a metal one.
False. Regardless of which material is used, the basic process of filling a tooth is the same. The dentist prepares the tooth for treatment, removes decay, and places a filling directly into the tooth. If the filling is moderately deep, a tooth-colored filling may be set in several layers which are successively “cured” or hardened. More extensive restorations may require more than one visit, but the natural-looking results generally justify the extra time.
True or false: Regular metal fillings make the tooth structure stronger.
False. Properly securing an amalgam filling may require the tooth to be “undercut,” meaning that a greater amount of healthy tooth material must be removed. This can weaken the tooth structure, eventually leading it to chip and crack. Non-metallic fillings don't require undercutting, so more tooth structure is left intact. This more conservative treatment can result in a stronger, longer-lasting restoration.
True or false: Non-metallic (tooth-colored) fillings are safer than silver fillings.
False. While each method has advantages and disadvantages, and may not be an appropriate treatment in every situation, both methods have been deemed safe and effective by major U.S. and international science and health organizations. While there have been recent concerns about mercury in amalgam fillings, there is presently no reason to believe that it presents any cause for concern.
If you would like more information about tooth-colored fillings, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Natural Beauty of Tooth-Colored Fillings.”
What does the term “two-implant overdentures” mean?
For more than a century, complete dentures were the only care option for edentulous (toothless) people. As a solution, these left a lot to be desired, particularly for the lower jaw. Now dental technology has developed a better alternative that combines two strategically placed dental implants and a traditional lower denture that has been modified to fit over the two implants — thus the term.
What are the problems with traditional dentures?
The problem is that when you lose teeth, the bone that supported the missing teeth begins to shrink away. This is known as resorption, and it is the reason that dentures fitted too soon after teeth are lost quickly become loose. Bone loss happens most rapidly during the first year and is four times greater in the lower jaw than in the upper.
Why not just use dental adhesives to hold dentures tightly to the lower jaw?
Zinc, a major ingredient in most dental adhesives, has been associated with neurological disorders and may be unsafe. In addition, dental adhesives are expensive and the cost of frequent usage adds up.
Besides dental adhesives, are other health problems associated with dentures?
Yes, edentulism has been related to poor nutrition. Many edentulous people switch to soft foods with high fat content because they find healthier foods like vegetables and proteins difficult to chew.
What are dental implants?
Dental implants are replacements for the roots of teeth, the parts that are below the gumline and anchored in bone. They are usually covered with a crown that shows above the line of the gums.
What are the benefits of implants?
Most importantly, implants reduce the amount of bone resorption. Studies have shown about 75% less resorption in parts of the jaw with implants compared to areas without them. Since most of the bone loss occurs within the first year after tooth loss, it is important to place implants within this time period.
Is a complete set of dental implants a good solution for edentulism?
Yes, it can be a good solution, but it is not for everyone. Some patients, who have lost a great deal of bone support, need another solution for cosmetic reasons that offer more facial support like an implant overdenture. In addition, depending on their resources and insurance, some people require a less expensive solution.
Why does the two-implant overdenture work better for the lower jaw?
Based on differences in bone volume, density and other factors, we think that four to six implants are needed to retain an upper implant overdenture. Thus a two-implant overdenture is a good solution to consider for a lower jaw, but other options might be preferred for an upper jaw.
Contact us today to schedule an appointment to discuss your questions about dentures and implants. You can also learn more by reading the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”
If you don't like your smile when you look in the mirror, or feel self-conscious because your teeth are discolored, there are a variety of whitening procedures that can help you obtain the smile of your dreams.
Choosing the Right White: With strips, trays and toothpastes all claiming to be the best tooth whitening systems, it can be hard to choose how to whiten your teeth. Our office can help you decide the best approach based on your individual needs, time constraints and budget. Whiteners may not correct all types of discolorations.
Whitening in Our Office: This procedure is called chair-side or professional bleaching and may require more than one office visit. Each visit may take from 30 minutes to one hour. We use an in-office whitening gel that is professionally applied to your teeth and activated by a light source, giving you significantly whiter teeth in less than an hour. Typically, teeth with a yellowish hue respond best to whitening.
Whitening Your Teeth at Home: If you are an adult who practices good oral hygiene and doesn't suffer from periodontal disease, our office can help you decide whether an at-home whitening system, or having your teeth whitened in our office best meets your needs. If you decide to go with an at-home system, you will wear a custom-made whitening tray that looks like a thin, transparent night guard. You fill the tray with a mild whitening gel and need to wear the gel filled tray for a specified period of time each day (per our office's instructions). This procedure must be continued over a period of time that generally extends from 2-4 weeks.
Whitening Products Found in Stores: If you are considering over-the-counter whitening products we can also recommend products that will offer you the best results. Whitening toothpastes that have the American Dental Association (ADA) Seal of Acceptance contain special chemical or polishing agents that generally provide some stain removal effect.
Even with modern knowledge about oral health and how to prevent tooth decay and gum disease, more than 25 percent of Americans have lost all their teeth by the time they are 65. Perhaps they did not have access to dental education, quality care or treatment. Whatever the reasons, those who suffer from “edentulism” — the complete loss of all permanent teeth — also suffer from poor self-image, impaired nutrition, and reduced quality of life.
Removable full dentures are often the solution of choice for those suffering from edentulism. Dentures can be made to look good and feel great; but successful denture-wearing demands the collaboration of a skilled dentist and a willing patient.
A set of well-fitting full removable dentures starts with detailed planning. We need to work out where each tooth will be placed and how the upper and lower teeth will meet together. To do this, we make use of photos taken before the teeth were lost, as well as using the facial features as a guide. You as the patient have to decide whether you want your dentures to look much like your natural teeth did, including any gaps and uneven areas, or whether you want to make your new teeth more regular and uniform than the originals.
In addition to the size, spacing and locations of the teeth, decisions must be made regarding the colors and textures of the part of the denture that fits over and looks like gum tissue. Photos can help with this aspect as well. Ridges can be added to the section of the denture behind the upper front teeth to aid in natural speaking and chewing.
The upper and lower dentures must be designed so that in the process of biting they stabilize each other. This is called “balancing the bite.” This is necessary for normal function and speech.
All this careful planning and design are only the beginning. The dentures will be created in a wax form, tested and modified. They are then completed in a dental laboratory, where the new teeth and gums are created out of a special plastic called methyl methacrylate. With careful planning, skill and artistry they are made to look like natural teeth and gums.
At this point the role of the denture wearer becomes vitally important. He or she must relearn how to bite, chew, and speak while wearing the dentures. As the dentures press down on bone and gum tissues, over time some bone will be lost. This will require coming in for frequent checkups and modifications to make sure the dentures continue to fit well and comfortably.
Protecting your children is one of your most important roles as a parent or caregiver. Dental sealants are one way you can protect your children's teeth from the ravages of tooth decay, drilling and fillings — and they can be applied simply, comfortably and quickly right here in our office.
What is a dental sealant?
A dental sealant is a thin, plastic film that is painted onto the tiny grooves on the chewing surfaces of the back teeth (usually the premolars and molars) to prevent caries (cavities) and tooth decay. And by allowing us to use sealants to seal these little nooks and crannies where your child's toothbrush can't reach, you will dramatically reduce their chances for developing tooth decay. This one, simple and quick office visit could save you both money and time with fewer dental visits and healthier, cavity-free teeth.
So will sealants guarantee no (or no more) cavities?
No, just like life, there are few guarantees. Your child's oral hygiene, regular dental visits, fluoride, sugar consumption and genetics are the other important factors that will determine to what degree your child experiences tooth decay. However, research shows that pit and fissure (chewing surface) decay accounts for approximately 43% of all decayed surfaces in children aged 6 to 7, even though the chewing surfaces (of the back or posterior teeth) constitute only 14% of the tooth surfaces at risk. This demonstrates the vulnerability of the chewing surfaces of the posterior teeth to decay. By placing a protective seal over the areas of teeth at risk, you can effectively and proactively protect your children's teeth.
How long do sealants last?
Research has shown that some sealants can last up to 10 years. However, if you opt for sealants for your children's teeth, we will closely monitor them with each office visit to ensure that they are still doing their job. As needed, we can apply more sealant.
Being unhappy with your smile can impact your life in ways that you might not even realize. Are you awkward in social situations that require smiling? Do you shy away from becoming romantically involved? You may even miss out on a better job because you don't want to be forced to endure a live interview for fear of smiling!
If you've decided that the time is right to regain some self-confidence by having your smile redesigned, we can help. We will begin with a consultation, during which we will discuss a number of factors that will influence the process and the final result of your smile makeover including:
- What do you want from a new smile?
- How do you want your new teeth to look?
- How we can use photographs and computer simulations to show you what your new smile will look like before we even start.
- How we work with dental technicians to test shapes, sizes, and colors to personalize teeth so that they closely match your natural teeth.
- How we use “customized temporary restorations” to let you test-drive the look and feel of the final crowns and veneers so that we can guarantee success.
We can even show you “before and after” photos taken of our many patients throughout the course of their makeovers. And, of course, we will discuss the costs to you with respect to both time and money based on the extent and type of work that is necessary to give you your ideal smile.
The tools that are now at our disposal can make the entire smile redesign process an essentially painless and highly creative collaboration that includes constant interaction between you, us, and dental laboratory technicians as we all work together to create your new smile. If you think you are ready to start exploring the possibilities, please call our office to set up a consultation. To learn more about cosmetic dentistry, read the Dear Doctor magazine article “Cosmetic Dentistry: A Time For Change.”
If you are pleased with your smile except for that one front tooth that appears darker, then we have good news for you. Often a tooth appears darker as a result of trauma that may have occurred years ago. Your tooth may need root canal treatment or may have already had root canal treatment in the past. Regardless, you can whiten this tooth via a process called internal bleaching. And as the name suggests, the tooth can be bleached from the inside out. Here's a brief summary of how this entire process works:
- Performing an x-ray exam: The first step is to take a radiograph (x-ray) to make sure that your root canal filling is intact adequately sealing the root canal and the surrounding bone is healthy.
- Making an access hole: To apply the bleaching agent, a small hole will need to be made in the back of your tooth to apply the bleach. However, before doing that, the area must be thoroughly cleaned and irrigated.
- Sealing above the root canal filling: This step is critical to prevent the bleach from leaking into the root canal space.
- Applying the bleach: To obtain the whitening needed, it typically requires between one and four office visits for additional bleaching.
- Applying a permanent restoration: Once your tooth has lightened to the desired color, a permanent filling will be placed over the small hole to seal your tooth's dentin. This is then covered with tooth-colored composite resin (filling material) so that the access hole is undetectable to the naked eye.
To learn more about this procedure and see amazing before and after images, continue reading the Dear Doctor article, “Whitening Traumatized Teeth.” Or, you can contact us to discuss your questions or to schedule an appointment.
Bad breath can have a serious impact on a person's social and business life. Americans are well aware of this fact, and spend nearly $3 billion each year on gums, mints, and mouth rinses in order to make their breath “minty fresh.”
Bad breath or halitosis (from the Latin halitus, meaning exhalation, and the Greek osis, meaning a condition or disease-causing process) can originate from a number of causes; but oral bacteria are the most common source. About 600 types of bacteria grow in the average mouth. If bacteria act on materials that have been trapped in your mouth, many of them produce unpleasant odors.
Most often, bad breath starts on the back of the tongue, the largest place in the mouth for a build-up of bacteria. In this area bacteria can flourish on remnants of food, dead skin cells, and post-nasal drip. As they grow and multiply these bacteria produce chemical products called volatile sulfur compounds or VSCs. These compounds emit smells of decay reminiscent of rotten eggs.
In addition to bacteria on the tongue, halitosis may come from periodontal (gum) disease, tooth decay, or other dental problems. If you have halitosis, it is thus important to have a dental examination and assessment, and to treat any such problems that are found. Treating bacteria on the tongue without treating underlying periodontal disease will only temporarily cure bad breath.
The next step is to take control of tongue bacteria by brushing or scraping your tongue, with possible addition of antiseptic mouth rinses. People who have bad breath have more coating on their tongues than those who don't, and regularly cleaning the surface of the tongue has been demonstrated to reduce bad breath.
Implements have been designed specifically for the purpose of scraping or brushing the surface of the tongue. Using a toothbrush is not as effective because it is designed to clean the hard tooth surface, rather than the spongy surface of the tongue. To keep your breath fresh, you must regularly remove the coating from your tongue. This means acquiring a tongue scraper or brush and using it every day.
Contact us today to schedule an appointment to discuss your questions about tongue cleaning and bad breath. You can also learn more by reading the Dear Doctor magazine articles “Tongue Scraping” and “Bad Breath.”
If you wake yourself by snoring or have been told by others that you snore, you should share this fact with us during your next visit. Why? Many people are shocked to learn that their dentist is a vital resource for treating snoring and Obstructive Sleep Apnea (OSA), a condition that occurs when the upper airway (back of your throat) is blocked or obstructed causing significant airflow disruption or even no airflow whatsoever for 10 seconds or more.
Self Test For Sleep Apnea
While your responses to the following questions are not a diagnosis for OSA, they can be warning signs that you may have OSA or another condition that is impacting your sleep.
- Are you a loud habitual snorer?
- Has anyone ever witnessed you holding your breath, gasping for air or even choking while asleep?
- Do you regularly feel un-refreshed or tired even after waking from eight or more hours of sleep?
- Do you find yourself easily falling asleep throughout your day at work or at home?
- Do you suffer from poor concentration or judgment, memory loss, irritability and/or depression from lack of sleep?
- Are you 15 pounds over the normal weight range for your height and/or does you neck measure more than 17 inches around if you are male and 16 inches if you are female?
If you answered, “yes” to any of the above questions, you should share your responses to all of these questions with both your physician and us so that you can receive a thorough examination to address your sleep concerns. And if you are diagnosed with OSA, we can help with specific oral treatment options that may work best for you.
Dental crowns are excellent tools that we use to restore functionality, color and/or beauty to teeth and your smile. And while many people may have heard of them, often times there are many questions surrounding the process, costs and their maintenance. This is why we have put together this list of some of the questions we are commonly asked on this subject. Our goal is to provide you with straightforward answers so that you have a clearer understanding of the treatment and are comfortable making the decision to go forward with these excellent tooth restorations should they ever be required.
What Is A Crown?
A dental crown is a tooth-shaped “cap” or cover that a dentist places over a tooth that is badly damaged from trauma or decay in order to restore its color, strength, size and functionality. They are also used for cosmetic reasons to improve discolored or misshapen teeth.
Why Can The Cost Of Crowns Vary?
The reason the cost of a crown can vary greatly, even from dentist to dentist is quite simple. The most beautiful crowns require the artistry and years of experience of a team of dental professionals; your dentist and the laboratory technicians that handcraft crowns. To meet higher expectations of some individuals requires more experience, artistry and skill. And great art just tends to cost more. A customized temporary crown may even be used as a preview to see what a final crown will look like. Another critical factor is the choice of materials used. For example, while all porcelain crowns are made from high-quality ceramic (glass) material, they are not equal. It is therefore more expensive in terms of time, skill and expertise to produce the most natural looking results.
How Long Will A Crown Last?
Most dentists expect a crown to last at least 7-10 years with normal wear and proper maintenance. However, depending on the materials used and location of the tooth, they can last upwards of 50 years or more. For example, a gold crown has the longest lifespan because gold is such a durable material that has little to no negative impact on surrounding teeth. On the other hand, porcelain produces a completely natural look but can cause wear to adjacent teeth.
What Materials Are Most Often Used For Crowns?
The three most common materials used to make crowns are as follows:
- Porcelain-Fused-to Metal (PFM)
- All porcelain
Research has revealed that over 12 million Americans suffer from Obstructive Sleep Apnea (OSA), a condition that occurs when the upper airway (tissues at the back of the mouth and throat) collapse causing significant airflow disruption or even no airflow whatsoever for 10 seconds or more. It can leave you feeling tired, depressed, irritable, as well as cause memory loss and poor concentration. But, did you know that we can help treat your sleep apnea?
The primary method dentists who are trained in sleep medicine use to treat OSA is through the use of an oral appliance. Similar in look to an orthodontic retainer or sports mouthguard, oral appliances are designed to maintain an opened, unobstructed, upper airway during sleep. And while there are many different oral appliances available in the marketplace, less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. The key to success is to avoid those over-the-counter (OTC), generic mouthguards and instead use a professionally made and custom-fitted oral appliance, made from a precise models of your teeth and mouth. They are best at keeping your airway open and preventing the muscles and soft tissues from sagging down when relaxed during sleep. Other advantages of custom-fit oral appliances are that they can reposition your lower jaw, tongue, soft palate and uvula (the tissue in the back of the throat that dangles like a punching bag); stabilize your lower jaw and tongue; and increase the muscle tone of your tongue.
But Is Treatment Really That Important?
Absolutely! If undiagnosed and/or left untreated, sleep apnea can be life threatening. It can cause heart attacks, strokes, impotence, irregular heartbeat, high blood pressure, and heart disease — many of which can kill you.
Want To Learn More?
To learn more about sleep apnea, read the Dear Doctor article, “Snoring & Sleep Apnea.” Or if you are ready for a thorough examination and to discuss your snoring, contact us today to schedule an appointment.
Thinking or knowing you have an impacted wisdom tooth can be alarming news for some people. Unfortunately, one of the main reasons for this feeling is due to the mythology surrounding wisdom teeth...and especially impacted wisdom teeth. While an impacted wisdom tooth can cause intense pain, some people are quite shocked to learn that they even have impacted wisdom teeth, as it is causing no pain at all.
By definition, an impacted wisdom tooth is a third (and last) molar that gets jammed against an adjacent tooth or other important structures such as gum, bone nerves, blood vessels. And having an impacted wisdom tooth does have its consequences — even if you are unaware you have one. The most common issue is gum (periodontal) disease. This is the main reason why it is so important to have a problematic wisdom tooth removed early when you are young and before periodontal disease has started. If left untreated, you risk damaging and/or losing the impacted tooth and adjacent teeth.
The key to managing wisdom teeth is to monitor them closely through thorough routine examinations and x-rays between the ages of 17 and 25, the time when wisdom teeth typically appear. This is so vital because it allows us to predict the way your wisdom teeth will erupt (become visible) or come into proper position with useful biting function. We can use these visits and x-rays to monitor development so that we are best equipped to determine if or when wisdom teeth need to be treated or removed.
It is also important to contact us as soon as you think you may have an impacted wisdom tooth that is causing pain, swelling or even infection. We can put your mind at rest with the facts of what needs to be done after we've completed our exam.
If you feel that you or a family member has an impacted wisdom tooth, contact us today to schedule an appointment to discuss your questions. Or you can learn more now about the symptoms and treatment options of impacted wisdom teeth by continuing to read the Dear Doctor magazine article “Wisdom Teeth.”
If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.
Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.
The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.
The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.
Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today to schedule an appointment to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”
The CDC (Centers for Disease Control and Prevention) calls fluoridation of drinking water one of the ten most important public health measures of the 20th century, along with such measures as vaccination and motor-vehicle safety.
A fluoride concentration of about one milligram per liter (1 mg/L), or 1 part per million (1ppm), in the water supply is associated with substantially fewer cavities. This concentration of fluoride (equivalent to a grain of salt in a gallon of water) has been found to have no negative health effects.
The connection between fluoride and oral health was confirmed in the first half of the 20th century, and by 1955 the first clinically proven fluoride toothpaste was launched. Fluoride-containing toothpastes are common today, along with other fluoride-containing products.
Protective Effects of Fluoride
Ongoing studies have shown that fluoride has both a systemic (through the body) effect and a local effect at the tooth surfaces. Tooth decay takes place as part of a kind of active war between de-mineralization and re-mineralization, in which acids produced by bacteria in plaque (a biofilm in your mouth) soften and dissolve the minerals (de-mineralization) in the tooth's surface. At the same time, the saliva bathing the tooth acts to re-harden the tooth's surface by adding minerals back (re-mineralization). If fluoride is present in the biofilm and in the saliva, it protects against de-mineralization.
The fluoride you drink in your water is deposited in your bones. Bone is an active living substance that is constantly broken down and rebuilt as a normal body process. As this happens the fluoride is released into the blood, from which it can enter the saliva and act on the tooth surface. The fluoride in toothpastes and products like rinses is delivered directly to the tooth surface. Fluorides can also be eaten in foods with high fluoride content such as teas, dry infant cereals and processed chicken, fish and seafood products.
Problems with Over-use
Eating or swallowing too much fluoride can contribute to a discoloration of teeth called dental fluorosis, which varies in appearance from small white striations to stained pitting and severe brown mottling of the enamel. To avoid this effect, monitor children's tooth brushing to make sure they use only a small amount of fluoride toothpaste and do not swallow it.
Adding fluoride to water has been controversial because some people believe that it may cause other harmful effects. However, most health experts believe that fluoridated water carries no significant health risks and significantly contributes to public health by preventing tooth decay.
The term TMD means “Temporomandibular Disorder.” But if you suffer from this disorder, it means pain. The pain can be mild or severe, acute or chronic, and it can appear to be centered in different locations, making it difficult to diagnose.
People who clench or grind their teeth because of stress often experience the pain of TMD. They might not even know they are engaging in these habits, because they do them subconsciously, for example when driving in traffic or engaging in vigorous exercise. Another cause of TMD might be an injury such as a blow to the jaw.
You can feel your temporomandibular joints working if you place your fingers in front of your ears and move your lower jaw up and down. On each side the joint is composed of an almond shaped structure at the end of the lower jaw, called the condyle, which fits neatly into a depression in the temporal bone (the bone on the side of your skull near your ear). A small disc between the two bones allows the lower jaw to move forward and sideways. The joints are stabilized by ligaments and moved by muscles.
TMD pain is the result of a process that begins when a stimulus such as psychological stress or an injury to the joint causes spasms (involuntary muscle contractions) in the muscles that move the joint. Blood vessels in the muscle begin to accumulate waste products, causing chemical changes and lactic acid buildup in the muscle. Nerves in the muscle then signal the brain to stop the movement of the jaw by registering pain.
TMD pain can appear to originate from various locations in your jaw, head, or neck. This is why it's important to make an appointment with our office for a professional assessment and diagnosis.
Treatment aims to relieve the symptoms of pain and discomfort and to prevent them from recurring in the future. Treatment can include heat, mild painkillers, muscle relaxants, soft diet, and simple jaw exercises, as well as education regarding the causes of TMD. To prevent further pain you may be provided with a “bite guard,” or referred to relaxation training with a licensed therapist. A bite guard is designed to prevent the lower teeth from biting hard into the upper teeth. It is commonly worn at night, but can also be worn during the day if clenching and grinding are apparent.
If these simpler treatments do not solve the problem, we may recommend more complex procedures such as bite adjustment or, as a last resort, surgical treatment may be needed.
If you asked a room full of parents about their opinions on thumb sucking and pacifiers, the odds are good that you would get a wide variety of opinions. The truth is that this habit is a perfectly normal behavior in babies and young children; however, it is something that parents and caregivers should monitor. This is why we want to share a few basic myths and facts to set the record straight.
So how early does thumb sucking start?
It is interesting to note that thumb sucking for some babies actually starts before birth. This fact is proven quite often when expectant mothers “see” their unborn child sucking fingers or a thumb during a routine mid to later term sonogram. Sucking for babies is absolutely normal; it provides them with a sense of security. It is also a way they test, make contact and learn about their world.
At what age should a parent be concerned if their child still sucks a pacifier, finger or a thumb?
Recent studies have shown that if a sucking habit continues after the age of two, there may be some long-term changes in the mouth that have can have a negative impact on jaw development and/or with the upper front teeth. (It can cause these upper front teeth to become “bucked” or protrude forward towards the lips.) The American Academy of Pediatric Dentistry recommends that parents and caregivers encourage children to cease this habit by about age three.
Do children ever stop this habit on their own?
Absolutely! If left alone, many children will naturally stop sucking their fingers or thumb between the ages of two and four. The main points to remember are that sucking habits are totally natural and should stop on their own. You should not make it a problem unnecessarily. If, however, your child is getting older and still seems dependant upon this habit, feel free to contact us today to schedule an appointment for your child or to discuss your specific questions about pacifiers and finger or thumb sucking. You can also learn more about this topic by continuing to read the Dear Doctor magazine article “Thumb Sucking in Children.”
Wisdom teeth are the third set of molars that erupt in the late teens or early twenties — so-called because they come in around the age of maturity or “wisdom.” While teeth are designed to last a lifetime, wisdom teeth are often problematic requiring early removal because they frequently become impacted, meaning they are not able to erupt fully through the gums to become healthy functioning teeth. However, not all wisdom teeth need to be removed if they are fully erupted and functional.
Prevention: Having a tooth submerged below the gum, pressing on the roots of neighboring teeth can cause damage and decay even though you may not be feeling any discomfort. By the time the tooth becomes painful, significant damage may already have occurred. In addition, the ability of the body to heal following oral surgery tends to decrease with age. A recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation strongly recommends that wisdom teeth be removed in young adulthood in order to prevent future problems and to ensure optimal healing.
Reasons for Removal: If your wisdom teeth are impacted against (pressing on) the roots of other teeth, damage can occur. To prevent infections, gum disease, decay, or damage to other permanent teeth, our office may recommend removal of your wisdom teeth.
What to Expect: If wisdom teeth removal is recommended, it can generally be done in the dental office as a surgical procedure with local anesthesia and conscious sedation (twilight sleep). After the surgery, you may experience some moderate discomfort and swelling depending on the degree of impaction and difficulty. Taking non-steroidal anti-inflammatory medication like ibuprofen, or prescription medication for several days after surgery will provide pain relief and control swelling.
Contact us today to schedule an appointment to discuss any questions you may have regarding removal of your wisdom teeth. Read more about this topic in the Dear Doctor magazine article “Wisdom Teeth: To Be Or Not to Be?”
If you are unhappy with your smile or the way some of your teeth appear, porcelain veneers may be the solution to your concerns. They are a fast, effective, and well-proven method for cosmetically enhancing your smile — and a secret that Hollywood and other celebrities have been taking advantage of for years. To help you determine if they are right for you, here are some questions we typically receive.
What is a veneer?
A veneer is a custom made thin “shell” or thin layer of a dental ceramic material (usually porcelain) used to replace the front, visible surface of the tooth. They are artistically and hand-crafted using a precise model of your mouth and teeth to achieve a natural look.
What can they do for me?
Veneers are the optimal choice for correcting small to medium gaps between teeth; slight rotations of teeth causing them to be misaligned; oddly shaped, chipped, or “short” teeth; as well as teeth that are discolored or unevenly colored. However, veneers have their limitations, too. They cannot correct bite issues, poor tooth position, or profile issues. It is also important to note that if you have this procedure, we will typically need to remove a small amount of enamel from your teeth to accommodate the veneer and produce dramatic improvements to your smile.
How long will they last?
While they can vary widely from person to person, porcelain veneers usually last from 7 to 20 years. Factors that impact this timeline include your oral hygiene habits, diet, lifestyle, as well as how well you protect your veneers during sleep and while playing sports.
Have more questions?
A veneer is a cosmetic dental procedure that we use in some situations to correct discolored teeth, small spaces or gaps between teeth, small chips or oddly shaped teeth, and teeth that are slightly misaligned by placing a thin shell covering over the teeth. They are artistically hand-crafted by lab technicians out of tooth-colored porcelain using precise molds that we have made in our office. We attach veneers to the tooth's surface using a special adhesive that creates a chemical bond. Veneers are often a key component in a smile makeover.
Traditional veneers will require some tooth preparation, a process where we reduce or file down some of the facial (front, visible) portion of your tooth by 0.3 to 0.7 millimeters. For this reason this cosmetic procedure is not reversible.
How Long Do They Last?
Veneers can last from 7 to 20+ years depending on how you care for them. This may include sleeping in a protective, professionally made mouthguard. And while porcelain is a durable material that can withstand a great deal of pressure, you must remember that they are a type of glass. You could possibly shatter a veneer if you bite into anything that requires a hefty amount of twisting movement and biting pressure.
By using the latest technologies and procedures, we will create the naturally beautiful smile of your dreams and we will restore your mouth to full functionality and optimal health. Contact us today to discuss your questions or to schedule a consultation.
Want To Learn More?
Learn more about veneers when you continue reading the exclusive article from Dear Doctor, “Smile Design Enhanced With Porcelain Veneers.”
A veneer is a thin layer of dental ceramic tooth-colored restorative material, usually made of porcelain, which replaces some of the tooth's enamel and is physically bonded to it.
You might want to consider porcelain veneers:
- If your teeth are severely discolored. (For best results we may recommend that your teeth be whitened before veneering them.)
- If your teeth cannot be evenly whitened or matched by other means.
- If your teeth are misshapen or worn, you can change their size or shape for optimum aesthetic appeal.
- If you don't want to have your teeth prepared (drilled), prepless veneers may be an option to change your smile.
- If you want as little natural tooth structure prepared as possible to improve your smile.
- If you would like something temporary first to “test-drive” your new smile, then:
- “Provisional veneers” allow you to try out your new smile and give us feedback before the final permanent veneers are placed.
- If you want to improve your smile for just one tooth or even multiple teeth.
- If you want long-lasting restorations — veneers can last from seven to twenty years or more.
And the top reason is:
- Porcelain laminate veneers are among the most aesthetic ways to create a more beautiful, yet normal, looking smile.
Tell us what you want to change about your current smile, and we can tell you whether veneers are right for you. Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can learn more by reading about porcelain veneers in Dear Doctor magazine.
Your smile is one of the first things people notice, but if your pearly whites have lost their luster, chances are you might be hesitant to show them. As we age, our teeth naturally darken, and certain substances can leave teeth stained or discolored, making you appear older. One easy way to turn back the clock is to have your teeth whitened; a safe, painless, and non-invasive way of achieving a young, healthy-looking smile.
Causes of Tooth Discoloration: Exposure to high-levels of fluoride and taking tetracycline antibiotics during childhood can stain the teeth's structure. Smoking cigarettes and using chewing tobacco can also cause tooth discoloration, as well as foods containing tannins such as red wine, coffee and tea. In addition, poor brushing techniques and not flossing regularly cause bacteria to build on teeth resulting in yellow stains.
The Whitening Process: Our office can help you to achieve a brighter smile using either an in-office procedure or an at-home whitening kit. We can help determine the best treatment for your budget, time frame and individual needs. If you choose to have professional whitening done in our office, we will utilize a prescription strength gel sometimes even activated by a concentrated light source. This procedure offers immediate and long-lasting results in less than an hour. After a single treatment, teeth are typically six to ten shades lighter and with proper maintenance, can last five years or longer.
At-Home Results: For those seeking more gradual results, another option is to use custom-fit trays, which our office will make for you to use at home to whiten your teeth. This is generally less expensive, and is very effective at lightening teeth several shades, although it may take a week or longer to see optimal results.
Choosing the Best Procedure: For some people, teeth whitening may not offer adequate results. If you have thin enamel, chipped, uneven or crooked teeth, we may recommend applying porcelain veneers to restore your damaged teeth. Veneers are bonded to the front of teeth to give your smile a straighter, more uniform appearance.
Contact us today to schedule an appointment to discuss any questions you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter.”
We in dentistry, advise parents to have an orthodontic evaluation some time before your child is 7 years of age. At this time, some of your child's adult teeth have come in and some primary (baby) teeth remain. This is a good time to check for developing problems. Treatment that begins while your child's teeth are coming in is called “interceptive orthodontics.” It provides an opportunity to achieve the best results in orthodontic treatment.
Once this evaluation takes place, it may mean that orthodontic treatment may need to take place in two-stages. A first phase of orthodontic treatment may prevent, intercept or minimize future orthodontic treatment. The first stage may be a process of guiding the growth of the jawbones that support the teeth. This is called “growth modification.” Then when the adult teeth have erupted through the gums, it may be time to do the second and final stage.
If a second phase of treatment is necessary it will probably require braces. These are small metal brackets that are bonded to the teeth. Thin flexible wires are threaded through them, and the wires are designed to push or pull on the teeth to provide a small amount of pressure that makes the teeth slowly reposition themselves within the jawbone. A light and controlled force pulling on a tooth causes new bone and ligament (the fibers that hold teeth in place) to be formed. These are living tissues that are constantly changing and remodeling themselves.
If you wait until your child's permanent (adult) teeth have all come in to start this process, it will be too late to correct some types of orthodontic problems, such as some types of malocclusions (“mal” – bad, “occlusion” – bite). It's better to work together with your child's stages of growth and development in order to have an optimum correction, both in looks and function.
You may be wondering whether a two-stage treatment costs twice as much. In fact, it is likely to be less expensive than a late one-stage treatment would be. Sometimes, the first stage may correct an underlying problem and make further treatment unnecessary. If a second phase is needed, it is likely to be easier and less costly.
Contact us today to schedule an appointment to discuss your questions about orthodontia for your child. You can also learn more by reading the Dear Doctor magazine article “Preventative & Cost Saving Orthodontics.”
Nearly everyone who has ever played a sport, or had a child participate in one, has had that panic-filled moment when they witness an injury. And when you consider that there are more than 22,000 dental injuries each year in children younger than 18 years of age, you see there is fact to backup this concern. This is just one reason why we strongly encourage all of our patients who are involved in activities such as football, soccer, hockey, wrestling, lacrosse, skateboarding, field hockey and more to wear one of our custom-fitted professional mouthguards. It is especially true for basketball and baseball, which are responsible for the largest number of dental injuries.
The following are some key issues to help you understand the importance and advantages mouthguards offer.
Is there a way to determine who is at the highest risk for sports injuries?
Yes there are several. Age, gender, dental anatomy, and the type of sports being played are the four categories used to measure the risks for dental injuries. Young male teens still top the list of most likely to be injured; however, the gap is closing with more females getting involved in sports. Learn which sports or exercise activities made the American Dental AssociationÃ¢Â€Â™s list of recommendations for using a custom mouthguard, when you continue reading “Athletic Mouthguards.”
What's the difference between a “boil and bite” mouthguard and a professionally made mouthguard?
We are often asked this very important question. While some over-the-counter (OTC) mouthguards provide what is advertised as a “custom-fit” to your teeth, it is nowhere near the fit — and thus protection — you receive from our mouthguards that are crafted from precise molds of your teeth. Additionally, because all aspects of our mouthguards are tailored to each specific mouth, they provide much more protection and comfort. This important fact can enhance performance as the athlete can literally breathe easier while wearing one of our mouthguards.
What can I do if I witness a dental injury?
The first important fact to know is that you do not have to be a dental or healthcare professional to assist. However, before jumping in to help out, consult Dear Doctor's Field-Side Guide to Dental Injuries. This pocket-sized, quick-reference guide details what you should do at the scene of a dental injury based on the type of injury. But best of all, it is available to you free of charge from Dear Doctor.
Want to know more?
If your teeth have a worn appearance, it's possible you have a habit you're not even aware of: clenching or grinding your teeth. Also called “bruxism,” this destructive action causes your top and bottom teeth to come together or scrape past each other with a force that's many times what is normal for biting and chewing.
So what's normal? This can be expressed in terms of pounds. An adult usually exerts a force of 13-23 pounds to bite or chew food. But we have the potential to generate as much as 230 pounds of force, or 10 times what's normal. A “parafunctional” force of this magnitude applied repeatedly is bound to stress your teeth and other areas of your oral system. Besides wearing away the enamel of your teeth — and maybe even some of the softer dentin layer underneath — you may experience muscle spasms or pain in your jaw joints. Serious cases of wear can lead to “bite collapse” in which your face actually changes shape as your cheeks and lips lose support. This can make you look prematurely aged.
What can be done? To prevent further wear, we can fabricate for you a thin, plastic mouthguard that will protect your teeth at night or during times of intense stress. We can also recommend ways to temporarily relieve the discomfort that your grinding/clenching habits can cause. Heat and/or anti-inflammatory medication, for example, can be helpful.
If your tooth wear is minor (raggedness along the biting edge of a tooth or teeth) you may not need any restorative work. However, if tooth wear has already caused changes to your teeth and bite that you find aesthetically or functionally unacceptable, we can restore lost tooth structure in a variety of ways. Veneers and crowns are two examples.
If you have any questions about tooth wear or grinding habits, please contact us today to schedule an appointment for a consultation. You can learn more about this topic by reading the Dear Doctor magazine article “How And Why Teeth Wear.”
Of all the of amazing procedures in today's dentistry, surgery that causes new bone to grow — in places where it had previously been lost — is high on the list of the most extraordinary. (When bone is lost or resorbed, it is broken down into its mineral components, which are dissolved into the bloodstream. Resorption of tooth-supporting bone often takes place after teeth are lost.) Dental techniques that cause new bone growth are important because a certain amount of bone is needed to replace lost teeth with dental implants.
Today's dental implants themselves are an amazing innovation. Implants consist of a replacement for the tooth's root, usually made of a metal called titanium. A replacement for the crown, the part of the tooth that is visible above the gums, is attached to the titanium root. Titanium has the remarkable quality of being able to fuse with the bone in which it is anchored. This process, first discovered in the 1950s, is called osseointegration.
In the case of missing upper back teeth, many people who wanted dental implants in the past were told that they did not have enough bone to anchor the implants and that they had to get removable dentures instead.
But now a new surgery called maxillary sinus augmentation can cause your body to regenerate bone where it was lost and is needed to anchor dental implants.
Bone in the upper jaw or maxilla usually supports your upper back teeth. Inside the maxilla, on either side of your upper jaw, are air spaces in the bone, which are lined with a membrane. These spaces, called the maxillary sinuses, are generally shaped like pyramids; but their shape and size is different in each person. The new surgical procedures involve lifting up the sinus membrane in the area where bone is needed and filling the space thus created with a bone grafting material. Your body then creates new bone to fill the space. This usually takes about six months. If you have almost enough bone to stabilize the implants, they can be placed simultaneously with the graft, thus saving time and avoiding a second surgical procedure.
All grafting materials used today are approved by the Food and Drug Administration (FDA) and must be prepared according to their guidelines. They are specially treated to render them completely safe for human use.
After the surgery there is usually no more than mild to moderate swelling and some discomfort, about the same as having a tooth removed.
If you are missing upper back teeth, contact us to schedule an appointment to evaluate your upper jaw. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery.”
Millions of people suffer from mouth dryness, but most people just never talk about it. As your dental care providers, we don't want you to keep it a secret anymore and mouth dryness really can be a problem.
Why? Saliva is a very important fluid that moisturizes, lubricates, and aids in the first stages of chewing and digestion. A normal flow of saliva provides antibacterial benefits that even protect against cavities by buffering the effects of acids. It can also make the surfaces of your teeth more vulnerable to abrasion and erosion. Without enough saliva, you may be especially at risk for not only tooth decay, but even yeast infections.
Causes of dryness include dehydration and even morning breath, both of which are normal. Smoking, alcohol and coffee drinking also cause dryness. It is also a side effect of many medications. Although mouth dryness is not a disease in itself, it could be a symptom of salivary gland or other systemic (general body) disease.
As a first step in the treatment, we will assess your situation by taking a detailed habit, diet, medical, and drug history to properly assess the cause and establish whether this is a local condition affecting only your mouth or an indication of a generalized bodily problem.
It's always helpful to keep yourself well hydrated by simply drinking a sufficient amount of water every day and by using good daily oral hygiene to remove dental bacterial plaque. Chewing gum, especially containing Xylitol, will also help promote saliva flow and keep your mouth moist. Be careful not to suck on candy or mints, because they are likely to cause decay. There are also prescription medications that can be used to promote more saliva flow.
Did you know that the bacteria that cause tooth decay are usually transmitted to children from their parents, through sharing the same spoon or kissing? Once inside the child's mouth, the bacteria live on the teeth in what is called a biofilm. When the child consumes sugary foods or drinks, the bacteria act upon the sugar to produce acids that eat away at the child's teeth, producing tooth decay.
These bacteria thrive on carbohydrates such as bread, sweets, and sodas. Even fruit juices, which offer more vitamins than soda, are filled with sugars that lead to decay. The child's saliva works hard to neutralize the acidity produced from these foods, but if the child often snacks between meals this neutralization process doesnÃ¢Â€Â™t have a chance to occur.
The first sign of decay may be white spots on the teeth, an indication that minerals in the surface enamel have been dissolved in certain locations. Before it goes any farther, this process can be reversed by reducing the exposure to acids and using fluorides to strengthen the tooth surface.
Make sure your child sees a dentist by his first birthday, to provide preventive care and treat any beginning decay.
You can also help your child develop the habit of brushing his teeth with fluoridated toothpaste. It is important to use only a smear of toothpaste on the brush for very young children, and a pea-sized amount on the brush for children over the age of 2. Sometimes small children swallow their toothpaste, and excessive amounts of fluoride can cause staining on the teeth. When your children are very young, you must brush their teeth. As they get older, they can do it themselves, with your supervision. We can also apply fluoride varnish to strengthen the tooth surface and make it resistant to acids.
Brushing twice a day is a good start. But it can't prevent tooth decay when a child is eating carbohydrates all day. One way to reduce the use of sugar is to use xylitol, a naturally occurring sweetener that looks and tastes like table sugar and improves oral health. Studies have shown that use of this sweetener reduces tooth decay in children.
Another good idea is to wean children from bottles and training cups as early as possible. Sometimes children are given bottles filled with milk or sugary beverages at bedtime to help them relax. A better idea for their teeth is to teach them to drink from a regular cup filled with milk — or preferably, with water.
Contact us today to schedule an appointment to discuss your questions about tooth decay in children. You can also learn more by reading the Dear Doctor magazine article “Managing Tooth Decay In Children With Chronic Diseases.” While this article focuses on children with health challenges, it contains excellent advice to help all children prevent tooth decay.
Tooth decay is not trivial. It's a worldwide epidemic, one of the most common of all diseases — second only to the common cold. It affects more than one fourth of U.S. children of ages 2 to 5 and half of those 12 to 15. Among adults, tooth decay affects more than ninety percent of those over age 40.
Prevention of cavities starts with a healthy diet and effective brushing and flossing, but it is much more complex than that. Three strategies for reducing dental caries (tooth decay) include:
Protect with Fluoride and Sealants
This works best when fluoride is applied to the crystalline coating of your child's teeth just after they push through the gums (erupt). The fluoride becomes incorporated into the tooth's surface and acts as a barrier to decay. Studies have shown that low doses of fluoride are safe and effective.
Dental sealants are used as a companion to fluoride because they seal tiny pits and fissures in the tooth's structure, creating an even stronger barrier.
Modify Oral Bacteria
Every mouth contains bacteria, no matter how well you clean your teeth. Not all bacteria cause tooth decay. The problem bacteria are those that produce acid as a byproduct of their life processes. We can identify acid-producing bacteria in your mouth, you can reduce their concentrations using antibacterial mouthrinses such as chlorhexidine, and pH neutralizing agents (substances that reduce the amount of acid).
Reduce Sugars in Your Diet
Bacteria in your mouth ferment sugars and other carbohydrates, producing acids that eat into the mineralized outside structure of your teeth, the enamel. So eating fewer sugars — particularly added sugars such as those in juices, sodas, candy and other sweets — will help prevent decay. Your total sugar intake should be less than fifty grams, or about ten teaspoons, per day. If you begin to read labels showing sugar content of common foods, you may be surprised at the amount you consume without knowing it.
If you must snack between meals, non-sugary snacks like raw vegetables and fresh fruits create a better environment for your teeth.
Xylitol, an “alcohol sugar” used in some chewing gums and dental products, has been shown to reduce decay-producing bacteria.
Try these easy strategies to keep your teeth healthy and functional throughout your lifetime.
The embarrassment of having discolored and/or stained teeth can be monumental and negatively impact your love life, work career, interactions with others, on top of undermining your self-esteem. And it is this reality that urges many people to wonder what teeth whitening could do for their specific needs. However, before obtaining any “fix,” you really should get an understanding of what causes staining of your teeth. This important step will enable you to make the necessary lifestyle and behavioral changes to prevent future issues.
For example, letting us know which of the following common causes for staining teeth apply to you can be an excellent first step towards building an optimal action plan for brightening your smile.
Which of the following questions about discolored teeth apply to you?
- Staining from tobacco use?
- Staining from coffee, tea and/or wine?
- Your teeth have become progressively discolored and yellow with age?
- Staining from red (tomato-based) sauces, sodas/colas and blueberries among other things?
- Other family members have stained teeth so it seems to be genetic?
- Staining from medications such as the antibiotic tetracycline given as a child?
Your honest responses to the above, along with your medical history will enable us to formulate the appropriate therapy for brightening your smile. And for most people this includes bleaching, an inexpensive yet effective method for whitening teeth. It is most often accomplished using a gel that is between 15% and 35% carbamide peroxide, a type of hydrogen peroxide. Years of research have proven that this whitening agent does not damage tooth enamel or the nerves inside the teeth. The only side effect that some people experience is slight tooth sensitivity and irritation of the gum tissues. However, they both are usually temporary, often occuring when you first start bleaching and generally subside after a few days. You can learn more when you continue reading the Dear Doctor article, “Tooth Staining.” Or, you can contact us to discuss your questions or to schedule an appointment.
We tend to think of aspirin as a harmless medication. It is dispensed over the counter and is the most widely used OTC medication in the U.S. We take it without thinking we may be exposing ourselves to risks. But in certain situations aspirin can cause dangerous side effects.
What is aspirin, and how does it work?
The chemical name for aspirin is acetylsalicylic acid. It is used to reduce mild pain, inflammation and fever. When you take an aspirin, it blocks the formation of prostaglandins, substances your body creates that are associated with inflammation. Prostaglandins cause inflamed tissues to become red and swollen, but they also serve protective purposes, such as forming a barrier that protects the stomach from the acid it produces to digest your food. That's why long-term aspirin use can sometimes cause stomach bleeding and ulceration or other health problems.
Why do cardiac patients take aspirin?
Another effect of aspirin is to prevent blood platelets from clumping together. Blood platelets are structures in the blood, smaller than white or red blood cells, that aid clotting by sticking together at the site of an injury. This effect of aspirin can cause prolonged bleeding, but it may be beneficial to people who have cardiovascular (from cardio, meaning heart; and vascular, meaning vessel) disease with narrowed blood vessels.
Aspirin can keep blood flowing in the obstructed vessels and thus prevent heart attacks and strokes; but it can also increase the risk for strokes that are caused by bleeding in the brain. Most physicians attempt to lower such risks by asking their patients to keep their daily aspirin consumption to a low dose 81 mg “baby” aspirin.
How does aspirin affect your teeth and gums?
Be sure to let your medical and dental professionals know you are taking aspirin, and how much you take. Also tell us about other OTC medications you take, including herbal medications and supplements, because they may interact with aspirin to cause side effects.
If you have been told to take aspirin because of a cardiac condition or procedure, be sure to follow your recommended treatment. Do not suddenly discontinue aspirin therapy; doing so can increase your risk for heart attack and stroke. Ask us if you should stop taking aspirin before a major dental or oral surgery, but do not stop taking it on your own. We will consult with your physician about your medical condition and let you know our recommendation. In most cases you can continue your aspirin therapy without causing excessive bleeding during the dental procedure.
Your self-image has a lot to do with how you feel about your appearance — and particularly your smile. If you are unhappy with the way you look, cosmetic dentistry may be the answer to your problems.
- What do we mean by cosmetic dentistry? The word “cosmetic” refers to beneficial changes in appearance. Thus cosmetic dentistry is all dental work that restores or improves a person's appearance.
- What is a cosmetic dentist? Every dentist learns to do procedures in a way that conserves or improves a patient's appearance. Some dentists continue to study and specialize in procedures that are done specifically for the purpose of enhancing a person's appearance.
- What is a smile analysis? The first step to improving your smile, this analysis involves a study of all the elements of your smile — teeth appearance and alignment, gums, jaws — and also your facial features and how they all fit together.
- How can I choose the right cosmetic dentist? Ask your dentist about his or her training and experience. Ask for photos of previous work. You may need to select more than one person, working as a team to take best advantage of each one's experience, skills, and training.
- What can be done to improve a smile using 21st century techniques? We are fortunate to live in times in which numerous options are available. These include making teeth whiter; altering their size, shape, balance, color, and alignment; filling in parts of teeth that are missing because of decay or injury; and even replacing teeth that are missing entirely.
- How can chipped or discolored front teeth be restored? This can often be done by bonding with composite resin.
- How can damaged back teeth be restored? Back teeth with cavities or traumatic injuries can now be repaired with non-metallic tooth-colored material that bonds to the tooth substance.
- What techniques can be used to correct more severe problems? Porcelain veneers, thin layers of porcelain material, can be used to change the appearance of misshapen or undersized teeth. Porcelain crowns can be used to replace the part of the tooth that rises above the gums.
- How can we change the position of teeth that do not meet together well? Orthodontists are dentists who specialize in correcting malocclusions (bad bites). They use traditional braces or clear aligners to move teeth into more attractive and functional positions.
- What if some teeth are missing? A dental implant replaces the root of a missing tooth. A porcelain crown that looks just like a natural tooth can then be connected to the implant.
Contact us today to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”
Designing a better smile sometimes requires a change in the size, shape, or color of your teeth. Porcelain laminate veneers (thin layers of dental ceramic material) enhance your appearance by replacing the natural enamel on the outside of your teeth. A veneer is physically bonded to the surface of a tooth, in essence, becoming part of it.
Traditionally, a small amount of the natural tooth enamel is drilled away to allow room for the veneer. But today, in some circumstances, it is possible to use an approach where enamel reduction or preparation is not necessary because the veneers can be bonded directly onto the tooth's natural surface. These are called “Prepless” or “No-prep” veneers, and are used to create aesthetically pleasing and natural looking restorations. An advantage of the prepless procedure is that the process is reversible so that you can give your new smile a “test drive.”
You may be a good subject for Prepless veneers if:
- Your smile is narrow because the teeth in the sides of your smile are positioned inward and do not show from a frontal view.
- There is spacing between your teeth, and the teeth appear too small.
- You have a fairly common genetic condition in which one or both of the teeth directly next to the two upper front teeth are very small and peg-shaped.
- There is an imbalance between the size of your lips and teeth (large lips and small teeth), which are not in proportion to show off your best smile.
Prepless veneers are probably not for you if:
- Your teeth are not aligned properly in your bite.
- Your teeth are very crowded, resulting in poor facial profile.
- Your teeth are already relatively large or positioned forward.
In these cases you may need to have some form of orthodontic treatment to move your teeth into better position. Sometimes veneers can be used to create an illusion of proper tooth alignment, but some amount of tooth reduction may be required.
We can assess whether prepless veneers are right for you. There is no substitute for an expert dentist's talent and expertise with the various cosmetic techniques available today. These skills combined with a thorough diagnostic evaluation, and a clear understanding of your goals, are the keys to providing you with a successful and beautiful smile.
Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can also learn more about prepless veneers by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”
Three quarters of people surveyed have admitted to having some fear about going to the dentist. About 10% to 15% are so afraid that they never go. Because they put off checkups and treatment they end up with toothaches, infections, and even lost teeth.
You should know that even those who are most afraid of the dentist can learn to reduce their fear and have dental treatment in comfort.
How does fear of the dentist get started?
Fear is learned behavior. People may learn it from stories they have heard from their parents or others, or they may learn it first hand by having a bad dental experience. Once the fear is planted, they avoid going to the dentist, so there is no way for them to learn that a visit can be a positive experience.
If you are among those who fear going to the dentist, the fearful feelings you have can be enough to reinforce themselves. Sweaty palms, rapid heartbeat, and a queasy stomach are not pleasant, and if you experience such feelings they may be your main memories after an appointment, even if the visit was not frightening in itself.
Dental fear can be a subconscious automatic response. This means that you can't control it and make it go away. But there are things you can do to reduce your fear and feel comfortable during your appointment.
Move slowly and get help to conquer your fears.
You need to have new, positive experiences to counteract the bad experiences you had in the past. Realize that you are not alone, many people share this fear. Then talk about your fears with our office. We will start by doing things that cause only mild or no anxiety. You want each visit to be a good experience, so you are able to leave our office with a feeling that this was okay, and you can do it again. It may take a while to train yourself to get over your fears, but we have helped many people accomplish this — and you can, too.
Contact us today to schedule an appointment to discuss your questions about any fears you may have. You can also learn more by reading the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”
Having a whiter, brighter smile can do wonders for improving self-confidence, career opportunities, and interpersonal relationships, as demonstrated in numerous scientific studies. In fact, according to a poll conducted on behalf of the American Academy of Cosmetic Dentistry (AACD), the following was revealed:
- 99.7% of Americans believe a smile is an important social asset.
- 74% feel an unattractive smile can hurt chances for career success.
- 50% of all people polled were unsatisfied with their smile.
These statistics demonstrate why you should have a solid understanding about any cosmetic procedure — even teeth whitening — before making your decision to proceed. To help you ensure that you have the facts, we created the following list of questions.
- Am I a good candidate for tooth whitening?
- How much will the entire process cost?
- Does my insurance cover the cost (or any portion of the cost)?
- How does teeth whitening work?
- Is bleaching teeth safe?
- Will the bleaching agents damage tooth enamel?
- Can whitening treatments make my teeth sensitive?
- How does your professional bleaching differ from home whitening?
- What type of bleach and strength will you use?
- How long can I expect the results to last?
- What will the bleach do to my gums, filings, crowns, veneers, and/or bridgework?
Please note that we may cover most or all of these questions during your initial consultation; however, we encourage you to bring this list with you to ensure you get the answers you need so that you can make the best decision. To learn more now, continue reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....” Or, you can contact us to discuss your questions or to schedule an appointment.
“Impacted wisdom teeth.” The term alone sounds ominous. What are wisdom teeth, why do they become impacted, what is the best way to treat them? These are questions people often ask.
What are “wisdom teeth” anyway?
Your third molars, located in the very back of your jaws, are your wisdom teeth. Most people have four of them.
Why is their name associated with wisdom?
They usually begin to come in when a person is 17 to 25 years old, a time when he or she can be said to begin to reach an age of wisdom.
Doesn't everyone get wisdom teeth?
While some people have more than four, others have fewer, and some have no wisdom teeth at all. Some people have wisdom teeth that can be seen in x-rays but do not erupt (grow up through their gums) and become visible.
What does “impacted” mean?
In normal usage, the term “impact” means “influence or effect.” In dental vocabulary, it means that a tooth is affecting another tooth or a nearby structure such as gums, nerves or blood vessels. Often an impacted wisdom tooth grows sideways into an adjacent tooth instead of growing upwards to come through the gums normally. This may be caused by a lack of room in your jaw for your third molars.
What kinds of problems can impacted wisdom teeth cause?
A wisdom tooth can impact the gum tissues surrounding nearby molars, leading to infection called “periodontal disease” (from the root words for “around” and “tooth.”) They can also cause root resorption in adjacent teeth, a process by which the tooth’s roots are slowly dissolved and eaten away.
What are the symptoms of impacted wisdom teeth?
Sometimes impacted teeth are asymptomatic — you feel nothing, even though damage is being done to gums and teeth surrounding the wisdom teeth. That's why it's a good idea to have regular checkups even if you are feeling no pain. Other times, impacted teeth can lead to acute inflammation and infection in surrounding gum tissues that is very painful.
Should I proactively have my wisdom teeth removed if they are not giving me any trouble?
Not necessarily but your wisdom teeth need to be evaluated. Generally speaking, however, it's better to remove wisdom teeth early, before they begin to cause dental problems. By the time a wisdom tooth starts to hurt, its neighboring teeth may already be in big trouble. In addition, younger people's wisdom teeth have undeveloped roots that make them easier to remove with fewer complications.
If you are dissatisfied with the way your smile looks, and your dentist is unhappy with the way your teeth fit together — but you don't like the idea of wearing braces — clear aligners may be your best solution. How much do you know about this teeth-straightening alternative? Below are some FAQs on the subject.
What do we mean by clear aligners? Clear aligners are a system for straightening teeth that uses clear plastic removable “trays” that fit over your teeth. As the teeth move to fit the trays, new trays are substituted that are designed to continue to move your teeth into the desired position. This system is an alternative to the traditional system of brackets and wires known as braces.
How can teeth be moved to new positions? The connection that holds a tooth in place in your jaws — the periodontal ligament — is not immobile. It constantly changes its position based on the normal forces of your bite. As the ligament is pushed on one side and pulled on the other, the living cells of your mouth respond by depositing bone and cementum (the protective covering of the tooth's root) on one side and dissolving it on the other. Normally this happens in a balance, maintaining your teeth in their position. We can manage these slight changes by applying constant light forces to move teeth in a predictable way.
How long does it take to move teeth to their optimum position using clear aligners? As with braces, the process is gradual. Total treatment time can range from six months to two years.
Do the trays have to be worn all the time? As you move through the sequence of trays, each is worn for 20 hours per day for two weeks. They may occasionally be removed for important social occasions.
How does an orthodontist design the sequential trays that are used? The trays are designed using a computer, based on an assessment and images of your mouth, teeth and jaws.
What kinds of problems can clear aligners correct? This method works well to correct mild to moderate crowding or spacing. If your back teeth already fit together as they should, the system may be ideal. If you have an extreme overbite or underbite, braces might work better.
Are clear aligners an alternative for everyone? Clear aligners are recommended for adults and recently, teenagers. They are not usually recommended for young children.
Why is it important to have your teeth straightened? Besides the obvious benefit of feeling better about yourself and your appearance, straight and well-aligned teeth work better. You will experience a better-functioning bite and can improve your oral health.
Contact us today to schedule an appointment to discuss your questions about orthodontics and clear aligners. You can also learn more by reading the Dear Doctor magazine articles “Clear Orthodontic Aligners” and “Moving Teeth With Orthodontics.”
If you engage in frequent air travel, you have probably experienced pain in your ears and sinuses related to pressure changes. The pain is caused by “barotraumas” (from baro meaning pressure — also the root of the word “barometer” — and trauma meaning injury) and is also called a “squeeze.” Divers also sometimes experience this discomfort or pain.
The cause of barotraumas is air pressure (or water pressure, in the case of divers) on the outside of your body that is not equal to the pressure inside your body. Normally when pressure outside your body changes, your organs such as your blood, bones, and muscles transmit the changes equally from outside to inside. Some structures in your body, such as your middle ear spaces and your sinus cavities (spaces in the facial bones of the skull), don't transmit the pressure as well because they are filled with air and have rigid walls. The maxillary (upper jaw) sinuses are pyramid-shaped spaces in the bone located below your eyes, on either side of your nose.
You have probably tried to stop such pain in your ears by yawning, chewing, or moving your jaw back and forth. These maneuvers, called “clearing,” allow air to move from the back of your throat into your ear canals so that the pressure can equalize. Similarly, your sinuses have small openings near their lower borders, so that you can clear pressure changes within them. If you have a head cold or flu and the membranes lining your sinuses are swollen and inflamed, they may close off the openings and make it difficult to clear these spaces. This can sometimes lead to intense pain.
Because the lower walls of these sinuses are adjacent to your upper back teeth, these teeth share the same nerves as the maxillary sinuses. This sharing sometimes causes pain felt in your back teeth to be perceived as pain in the sinuses, or vice versa. Pain felt a distance from its actual stimulus because of shared nerves is called “referred pain.”
Be sure to make an appointment with us if you experience pain in any of your teeth. Any defect in a filling or tooth can allow air to enter the tooth. It could be referred pain from your sinuses, or the result of pressure changes on trapped air within a filling or a tooth. Such pain, called barodontalgia (from baro meaning pressure, don't meaning tooth, and algia meaning pain) is an early sign of injury in a tooth.
Contact us today to schedule an appointment to discuss your questions about tooth and sinus pain. You can also learn more by reading the Dear Doctor magazine article “Pressure Changes Can Cause Tooth & Sinus Pain.”
If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.
In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.
Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.
When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.
The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.
At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.
Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”
The medical term for dry mouth is xerostomia (“xero” – dry; “stomia” – mouth), something that many of us have experienced at some point in life. However, for some people it can be a chronic condition that is ideal for promoting tooth decay. It can also be a warning sign of a more serious health condition.
Dry mouth occurs when there is an insufficient flow of saliva, the fluid secreted by the salivary glands. Your major salivary glands are located in two places: inside the checks by the back top molars and in the floor of the mouth, with about six hundred tiny glands scattered throughout your mouth. And many people are surprised to learn that when they are functioning normally, saliva glands secret between two and four pints of saliva per day! While this may sound like a lot (and it is), saliva is key for buffering or neutralizing acids in the mouth. Without this powerful protection, tooth decay can increase quickly. This is especially true for older individuals who have exposed tooth root surfaces.
It is also important to note that there are times when mouth dryness is perfectly normal. For example, when you wake, you will probably have a slightly dry mouth because saliva flow slows at night. Another example is if you are dehydrated when it is simply a warning sign that you need to drink more fluids (especially water). Other causes for temporary dry mouth include stress as well as what you consume: coffee, alcohol, onions, and certain spices.
You can also have a dry mouth due to a side effect from an over-the-counter (OTC) or prescription medication. If it turns out that this is the cause in your case, you need to talk to the prescribing physician to see if there is something else you can take to avoid this side effect. If there are no substitutes, one tip you can try is to take several sips of water before taking the medication followed by a full glass of water, or chew gum containing xylitol, which moistens your mouth and decreases the risk of tooth decay.
Another cause of dry mouth is radiation treatment for cancer in the head and neck region. Yes, these treatments are crucial for fighting cancer; however, they can inflame, damage or destroy salivary glands. You can also have dry mouth from certain systemic (general body) or autoimmune (“auto” – self; “immune” – resistance system) diseases, diabetes, Parkinson's disease, cystic fibrosis and AIDS (Acquired Immune Deficiency Syndrome).
Dentists often recommend bone grafting to ensure the success of dental implants. And it is likewise common for people to squirm a bit at the thought. Bone graft? That sounds serious. And maybe a bit, well, unappealing. These feelings are completely understandable. After all, this may be something you've never had to consider before. But there's no reason to worry. HereÃ¢Â€Â™s why:
- Bone grafting is not new or experimental. It is actually a very routine part of the implant process, as well as other types of oral and periodontal surgery. And it is very successful when performed by an experienced doctor.
- Bone grafting materials are processed for safety. The grafts used — whether synthetic or from a natural source, such as cow or human bone — have been specially treated for medical use.
- Only a small amount of this bone-grafting material is needed. Once placed in the site of the missing tooth, it serves as a helpful scaffold your body uses to build more of its own bone in that spot.
- Your implant will be more ideally positioned and may work better. It needs a good, strong foundation with which to fuse. But when teeth are lost, this supporting bone is often lost, too. This loss is often unpredictable and bone grafting limits the change that occurs. In fact that's one of the main benefits of replacing missing teeth with implants: they help prevent bone loss just as a natural tooth does.
- Your implant will look so much better! Think about it: Your original tooth was supported to a certain height by the underlying bone. If that bone is now gone, the replacement tooth is going to be much longer because of the missing bone height. It may not look quite right without that additional support.
So if you want the best-looking and best-functioning implant possible, have no fear of bone grafting. And please contact us to discuss any of your concerns, or schedule an appointment for an implant consultation.
You can read more about this topic in the Dear Doctor magazine article “Can Dentists Rebuild Bone?”
Some of the most important lessons parents and caregivers can give their children involve teaching and demonstrating good oral health habits. The following tips from the Centers for Disease Control and Prevention (CDC) are some ideas for helping you keep your children's teeth healthy.
- Start cleaning teeth early.
As soon as a child's first tooth erupts (appears), you should clean it daily by using a clean, damp cloth. Once several teeth are in, you should switch to a small, soft-bristled toothbrush. As for using toothpaste containing fluoride, you typically should start using it to brush your child's teeth at around 2 years old. However, there are some situations in which we recommend using toothpaste earlier than age 2. It just depends on your childÃ¢Â€Â™s mouth and development.
- Use the right amount of fluoride toothpaste.
Many people are aware that using toothpaste containing fluoride is an important tool for fighting tooth decay. But, many are shocked to discover how much should be used and what could happen if too much is used and swallowed. Because children under the age of 6 may tend to swallow all or some portion of toothpaste, you should only use (and teach them to use) a small amountÃ¢Â€Â”about the size of a pea. Otherwise, they could be at risk for getting white spots on their permanent teeth years later from having swallowed too much fluoride. This is also a key reason for teaching children how to rinse and spit properly after brushing their teeth.
- Supervise brushing.
Because children's abilities and maturity can vary greatly from child to child, you should brush your children's teeth until they have demonstrated the ability to handle the task alone. However, even when you give them the power to self-brush, you need to monitor them closely to ensure they are doing a thorough job, using the correct amount of toothpaste, and not brushing in a way that could damage teeth or gums. Brushing for too long and too hard are bad habits that can be detrimental to teeth and gums.
- Talk to your child's doctor and with our office.
Did you know that your first appointment should be at age one? The age one dental visit can be critical in establishing great communication and trust, and preventing early childhood decay. And having a positive rapport with your dentist and physician is important at any age; however, it is vital for parents and caregivers to develop great communication with their healthcare professionals on behalf of their children from the start of life. Not only does it model good habits for them to observe, but it also helps you stay abreast of the oral and general health needs.
Want to learn more?
Unfortunately, going to the dentist may still be a fear and anxiety provoking experience for some people even with modern dental techniques — an interesting phenomenon given the fact that no one is born with fear. It is either a learned response based on personal experience or one that is literally imagined based upon hearing of another's treatment. However, regardless of how it develops, a person's perception is their reality. The good news is that we are here to both listen and to offer our patients the benefits of oral sedation (sedation dentistry) that allows relaxation of mind and body. Thus you can focus on feeling peaceful rather than anxious.
While research has shown that 75% of all people surveyed have at least a little fear about going to the dentist, 10-15% have a great deal of fear. In fact, some of these people experience so much fear that they will cancel dental appointments or never schedule in the first place. If the latter describes your feelings, we encourage you to ask us about sedation or comfortable dentistry so that you can receive the oral healthcare you need and deserve to maintain optimal dental health.
And this good news gets even better when you understand that oral sedation does not even involve injections (shots)! We typically administer oral sedation in one of two methods: by giving you a pill to swallow whole or by giving you a tablet to place under your tongue (sub-lingually) where it dissolves. Once the prescription medication takes effect, you will remain awake and aware of your surroundings; however, the medication will help you transition from feeling nervous to a more comfortable state of being. Most of our patients describe their experience as “comfortable” or “relaxation” dentistry due to how they feel during their treatment. Simply put, the anti-anxiety (anxiolytic) medication almost literally dissolves away your fears.
Want to learn more?
Getting enough sleep is necessary for good health. We all know how energetic we feel when we are sleeping well at night. Yet, many of us do not feel rested, even after seven or eight hours of sleep. Let's answer some common questions about snoring and sleep apnea, problems that are often called sleep related breathing disorders (SRBD).
What is the purpose of sleep?
Scientists know we need sleep, at a particularly deep level, to be rested, but they are not sure why we need sleep. Sleep may have evolved as a way to conserve energy in the body, to conserve food supplies, or to reduce our risk during darkness. Sleep appears to give the brain a chance to store and organize its information and the body a chance to recuperate. Sleep studies have shown that in order to get the full benefits of sleep we need to sleep long and deeply enough to enter into a series of sleep cycles including Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep.
What kinds of problems get in the way of the type of sleep we need?
There are eight main categories of sleep disorders, but the ones affecting the largest numbers of people are insomnia, SRBD, and Circadian Rhythm Sleep Disorders. SRBDs include snoring and Obstructive Sleep Apnea (OSA), which is a serious health problem.
How do I know if I have OSA or another SRBD?
Often, your bed-partner will tell you that you snore. Chronic loud snoring is an indicator of OSA. To make a diagnosis your physician must take a thorough sleep and medical history. The diagnosis may then be confirmed by a study in a sleep lab.
What causes sleep apnea or OSA?
Snoring and OSA happen when your tongue and other soft tissues in the back of your throat collapse backwards and block airflow through your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stage of sleep your body needs.
What are the treatments for sleep apnea?
Treatments include CPAP therapy, in which patients wear a mask while sleeping. The mask pushes air through the airway, keeping it open. In Oral Appliance Therapy (OAT) patients wear a device that moves the lower jaw forward, allowing more room for air to move down the airway. Oral surgical procedures and orthodontic approaches also have the goal of moving the tongue away from the throat. These are all treatments that can be carried out by a dentist who has training and experience in treatment of sleep disorders.
Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea Frequently Asked Questions.”
Dental professionals agree that effective removal of plaque, the film of bacteria (also called a biofilm) that gathers on everyone's teeth, is the key to good dental health. Daily brushing and flossing are the usual recommendation for plaque removal. It is important to ask us about effective brushing and flossing. At your next appointment, ask us for a demonstration.
Effective brushing removes plaque from the easily accessed surfaces of the teeth. To remove plaque from between the teeth, you must floss.
Some people find it awkward to hold the floss with their fingers as they move it around their teeth. One technique for flossing, suggested by a dentist in Dear Doctor magazine, may make it easier than more traditional methods, although it does take a little practice.
This method requires tearing off a 10 to 12 inch length of floss and tying it to form a circle big enough for your fingers, but not your thumbs, to fit within it. The circle should be knotted with a double knot.
To Clean Teeth and Gums
Keep the floss taut at all times, with about and inch or less between your thumb and index fingers for your upper teeth, or index fingers only for your lower teeth. Curve the floss around each tooth and gently move it up and down until you hear a squeaky clean sound. Extend the downward movement of the floss to just below the surface of the gum, without being too harsh and causing injury. As you move from tooth to tooth, move around the floss circle so that each tooth gets a clean section of floss.
Place all your fingers in the ring, with the floss over your left thumb and right index finger to floss your upper left teeth, and over your right thumb and left index finger to do the other side.
Use both index fingers to floss all your lower teeth.
You may only need to floss once a day before or after brushing to keep your gums health and ward off periodontal (gum) disease. Your dentist will guide you as to how often you may need to floss your teeth. Try this technique and see how it works for you.
If you have a tooth that just doesn't look good because of decay or injury, a porcelain laminate veneer is probably a good way to make it look as good as it ever did — and maybe even better! Dental veneers are composed of thin layers of dental ceramic material. They essentially replace the original tooth enamel and require preparation of the tooth by removing a small amount of enamel to allow room for the placement of the veneer.
Recently, more and more dentists have been using minimal prep or prepless techniques that do not require this preparation. In such cases, the porcelain is bonded directly to the outer layer of the tooth's enamel. Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gum line.
Prepless techniques cannot be used in all situations, but when they are used appropriately the results are beautiful and very stable. Should you get prepless veneers? The following is a list of advantages and disadvantages of prepless veneers.
Advantages of prepless veneers include:
- Tooth preparation or reduction is not needed, leaving the original tooth whole.
- They are not placed under the gum tissue, eliminating the possibility that the restorations negatively impact the gum tissue.
- They can be used to change the appearance of teeth that are too small or misshapen making the teeth look larger and eliminate unwanted spacing.
- They can be used to “lengthen” teeth that have been worn down by grinding.
- Since the underlying tooth has not been reduced, prepless veneers are reversible and practically risk-free.
- There are many cosmetic situations in which they cannot be used, and traditional veneers (requiring preparation) must be used instead.
- Prepless veneers cannot be used in cases in which orthodontic treatment is recommended to move the teeth, such as improper tooth position, poor bite, or a poor facial profile.
- Since they are added on to existing tooth structure, they do not work for teeth that are relatively large or in a forward position in a smile.
- They do not usually work for lower teeth because of space restrictions.
- They cannot replace lost or damaged enamel.
Working with prepless veneers requires special skills and training. Please discuss our credentials and experience with us when you inquire about this technique. We can assess your specific situation and let you know whether restoration without the drill is appropriate for you.
Contact us today to schedule an appointment to discuss your questions about prepless veneers. You can also learn more by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”
Most people think of bone as rock-solid, but it's actually a living tissue that's constantly changing. This has significant implications for your oral health, general health, and appearance — if you are one of the 70% of Americans missing at least one tooth.
Throughout the day, your top and bottom teeth make hundreds of fleeting contacts with each other. These small stresses are transmitted though the periodontal ligament (“peri” – around; “odont” – tooth) that supports each tooth in its socket like a hammock. Think of it as a gentle push on the hammock, which causes the tooth to gently bump the underlying bone. The bone then builds up in the spot that's receiving stress to counteract it. This constant remodeling of bone is what allows bone to stay healthy and strong.
When a tooth is lost, the bone does not receive that gentle stress. It reacts by literally melting away. Sometimes this happens fairly quickly — in a matter of months. After the tooth-supporting bone is lost, the jawbone itself begins the same process of deterioration. This could eventually change the shape of the face, as the distance from nose to chin can decrease — even if only a few back teeth are missing. The results aren't pretty. But the good news is, there's a way to prevent all this.
Dental implants, which function as substitute tooth roots, actually save underlying bone when teeth are lost. They do this because they are made of titanium, which fuses to the bone in which it's set, stabilizing it. The implant is topped by a realistic-looking crown, which replaces the part of the missing tooth that was visible in the mouth. Together, they look and function just as your natural tooth did.
If you are missing a lot of teeth, implants can also be used to anchor bridges or even removable dentures while providing that same bone-saving benefit. And when you consider that they are so durable they should never need replacement, implants are a great investment.
You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”
If you suffer from snoring or think you may have Obstructive Sleep Apnea (OSA), did you know that your dentist could play an important role in treating your condition? For most people this is surprising; however, we can provide both education and some treatment options. And as needed, we will work with your other healthcare professionals to get an accurate diagnosis so that you can improve both your sleep and your health.
Oral Appliance Therapy: These devices may look like orthodontic retainers or sports mouthguards, but they are designed to maintain an open, unobstructed, upper airway (tissues at the back of your throat) during sleep. There are many different oral appliances available but less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. Depending on your specific condition, we may use it alone or in combination with other means of treating your OSA. HereÃ¢Â€Â™s how they work. They reposition the lower jaw, tongue, soft palate and uvula (the tissue in the back of the throat that dangles like a punching bag); stabilize the lower jaw and tongue; and increase the muscle tone of the tongue — unblocking the airway.
Continuous Positive Airway Pressure (CPAP): CPAP bedside machines generate pressurized air delivered through a tube connected to a mask covering the nose and sometimes mouth. Pressurized air opens the airway (windpipe) in the same manner as blowing into a balloon; when air is blown in, the balloon opens and gets wider. This treatment option is generally not used for snoring, but rather for the more serious condition, OSA.
Surgery: Specially trained oral and maxillofacial surgeons may include more complex jaw advancement surgeries. Additionally, an Ear, Nose & Throat (ENT) specialist (otolaryngologist) may consider surgery to remove excess tissues in the throat. It also may be necessary to remove the tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate.
The first step towards getting a great night's sleep if you are a snorer that has never been diagnosed or treated for your condition is to obtain a thorough examination by a physician specifically trained in diagnosing and treating sleep disorders. And depending on the seriousness of your condition, he or she may strongly encourage you to participate in a sleep study. The results from this “study” can provide your dentist and other healthcare professionals with precise data about your snoring, breathing and sleeping habits. This information is key to treating OSA, if you are in fact diagnosed with this condition. Learn more when you read, “Snoring & Sleep Apnea.” Or if you are ready for a thorough examination and to discuss your snoring, contact us today to schedule an appointment.
Do you constantly feel like you are running on empty? Do you snore, feel like napping every day, or even drink multiple cups of coffee just for the caffeine boost? You may have a sleep related breathing disorder (SRBD) or Sleep Apnea (“a” – without; “pnea” – breath) in which your airways become obstructed causing chronic loud snoring. The good news is that we can help both diagnose and treat this disorder, which means you will be able to finally get the rest that you (and your sleeping partner) so desperately need.
The reason that sleep apnea is so disruptive to daily living is that it causes awakening for a few seconds up to 50 times per night, significantly decreasing the amount of deep sleep that is necessary for full rejuvenation. Airway blockage during sleep commonly results from obesity, an enlarged tongue or tonsils, and other factors that can cause your airway to close off when you lie down, all increasing the likelihood that you will suffer from sleep apnea. These conditions are dangerous and impair the brain and heart from receiving adequate oxygen, increasing your risk for both stroke and heart attack.
The study of sleep and its disorders is relatively new. One successful way to treat sleep apnea is with a “CPAP” machine which uses a Continuous Positive Airway Pressure mask overnight to keep air passages open while sleeping. Another more comfortable, less noisy, and unobtrusive method is to use Oral Appliance Therapy, which features an appliance like a retainer that can be custom fitted to your mouth made by a dentist trained in sleep medicine.
And yes, dentists are increasingly being recruited to help study and treat sleep disorders. There are actually several ways in which we can help. Because we see our patients on a regular basis, we are uniquely qualified to diagnose early signs of SRBDs. For example, if you start to snore almost immediately after falling asleep in the dental chair, we will be able to discuss this important warning sign with you. We can also examine the back of your mouth to see if you possess any of the traits that point to SRBDs, including large tonsils and/or an elongated uvula — the tissue in the back of your throat that looks like a little punching bag.
So, if you want to stop snoring and start sleeping well or you think you may have a SRBD, call our office to schedule a basic oral exam and consultation. If you would like to learn more about the link between dentistry and the treatment of sleep disorders, read the Dear Doctor magazine article “Sleep Disorders & Dentistry.”
Nearly everyone has snored at some point in life. However, if your sleeping partner routinely tells you that you suffer from this problem, you really should take action to confirm or deny your suspicions. You may be like one of the 50 to 70 million people in the US alone that suffer from Obstructive Sleep Apnea (OSA), a medical condition in which the upper airway (the back of your throat) collapses during sleep thus limiting your intake of oxygen. And this condition is serious. If left untreated, OSA can lead to a stroke, impotence, an irregular heartbeat, heart attacks, high blood pressure, and other forms of heart disease.
The first and most important step you should take if you snore is to obtain a thorough examination by both your primary-care physician and our office. We have completed specialized training in sleep medicine so that we can not only diagnose but also thoroughly treat your sleep disorders.
If you are diagnosed with this problem, relax. We have many ways we can treat your condition. One of the most common methods is to provide you with oral appliance therapy. This first line of treatment involves our making a customized oral appliance (mouthpiece) that will hold your lower jaw forward. By doing this, we can move your tongue away from the back of your throat so that your airway is less likely to get blocked while you sleep. (It is this blockage that causes the infamous snoring sound.)
Another option we may consider using to treat your sleep apnea if it is moderate to advanced is a Continuous Positive Airway Pressure (CPAP) machine. These machines require you to sleep with a mask over your nose and/or mouth and produce continuous pressure in your windpipe so that your tongue is forced forward away from your airway. Not only can these machines potentially eliminate your snoring, but they can also give you the restful night's sleep that you have been missing.
The last and most permanent solution for treating certain non-responsive cases of sleep apnea is surgery. This option is typically reserved for the most advanced cases to eliminate or reduce an obstruction to the airway.
Contact us today to discuss your questions about sleep apnea or to schedule an appointment. You can also learn more about sleep apnea when you continue reading the Dear Doctor magazine article “Sleep Disorders & Dentistry.”
Ensuring that your children have good oral health is (or should be) the goal of every parent or caregiver. But how confident are you about this topic? The following true/false quiz will help you evaluate your expertise while learning more about keeping your child's teeth healthy.
- All children older than 6 months should receive a fluoride supplement every day.
- Parents should start cleaning their child's teeth as soon as the first tooth appears.
- Parents should start brushing their child's teeth with toothpaste that contains fluoride at age 3.
- Children younger than 6 years should use enough toothpaste with fluoride to cover the toothbrush.
- Parents should brush their child's teeth twice a day until the child can handle the toothbrush alone.
- Young children should always use fluoride mouthrinses after brushing.
- False. Check with your child's physician or dentist about your children's specific fluoride needs. If your drinking water does not have enough fluoride to help prevent cavities, parents of a child older than 6 months should discuss the need for a fluoride supplement with a physician or our office.
- True. Start cleaning as soon as the first tooth appears by wiping the tooth every day with a clean, damp cloth. Once more teeth erupt, switch to a small, soft-bristled toothbrush.
- False. Parents should start using toothpaste with fluoride to brush their childrenÃ¢Â€Â™s teeth at age 2. Only use toothpaste with fluoride earlier than age 2 if the child's doctor or our office recommends it.
- False. Young children should use only a pea-sized amount of fluoride toothpaste. Fluoride is important for fighting cavities, but if children younger than 6 years swallow too much fluoride, their permanent teeth may develop white spots. Using no more than a pea-sized amount of toothpaste with fluoride can help prevent this from happening.
- True. Because children usually do not have the skill to brush their teeth well until around age 4 or 5, parents should brush their young children's teeth thoroughly twice a day. You should continue doing this until the child can demonstrate a proper brushing technique.
- False. Fluoride mouthrinses have a higher concentration of fluoride than toothpaste containing fluoride. Children younger than 6 years of age should not use fluoride mouthrinses unless your child's doctor or our office recommends it. Young children tend to swallow rather than spit it out, and swallowing too much fluoride before age 6 may cause the permanent teeth to have white spots.
If you feel you missed too many of the above questions, read the Dear Doctor article, “Oral Hygiene Behavior.”
Projecting a healthy, radiant smile can help boost self-confidence and lead to increased comfort and success in both personal and career-oriented situations. Yet, many people are unhappy with their less-than-pearly whites, causing them to avoid social interaction and even lose out on opportunities because they are too self-conscious.
Your dissatisfaction with the appearance of your teeth may also be causing you to stifle one of nature's most endearing and intrinsic impulses, simply smiling!
For example, do you:
- Avoid posing for pictures that require a smile?
- Cover your mouth when speaking or laughing in public?
- Avoid dating because you feel unattractive?
- Feel that people think less of you because your smile is flawed?
- Think your smile makes you look older than you are?
If you've answered yes to any of these questions, you are certainly not alone. A poll conducted by the American Academy of Cosmetic Dentistry found that, while a whopping 99.7% of respondents said they considered a good smile to be a highly important social asset, only 50% of those same respondents indicated that they were satisfied with their own smile. In addition, the Academy reported that people between the ages of 31 and 50 are most unhappy with their smile, are most concerned with making a good first impression through a strong smile, and most frequently seek out information on cosmetic dentistry.
The good news is that advances in cosmetic enhancement and restorative dentistry, including treatments like teeth whitening and the application of porcelain veneers to correct tooth crowding, make it possible for anyone to enhance or improve their smile and boost their self-image. And a complete “Smile Makeover” has been shown to positively impact the perception that others have with respect to attractiveness, popularity, and even wealth — all based on the quality of a person's smile.
Our office can work with you to determine just what it will take to improve your smile and self confidence from as little as a minor enhancement to a complete smile makeover — anything that would best match your idea of the perfect smile. To get started, give us a call.
To read about others who have regained their confidence after brightening and whitening their smiles through cosmetic dentistry, read the Dear Doctor magazine article “The Impact of a Smile Makeover.”
A good night's sleep...have you been getting them lately? While everyone knows that sleep is important, did you know that we all spend about one-third of our lives asleep? And did you know that when deprived of sleep, the negative impact is detrimental on both an individual as well as at the societal level? These important facts are just some of the reasons why there has been an increased interest in studying sleep, sleep loss and sleep disorders.
If you have issues with sleep, you might have a sleep disorder — an epidemic problem that impacts approximately 50 to 70 million people in the US alone. Obstructive Sleep Apnea (“a” – without; “pnea” – breath) (OSA) is a medical condition that occurs when your tongue collapses against the back of your throat causing a significant reduction in your intake of air or even total temporary blockage. If left untreated, OSA can lead to an irregular heartbeat, heart attacks, high blood pressure, and other forms of heart disease plus strokes and even impotence.
Please note that while your responses to the questions below do not equate to a diagnosis, sharing them with our office can be extremely beneficial in helping us properly evaluate and treat issues related to poor sleeping habits.
- Do you weigh 15 pounds or more than the normal weight range for your height, sex and age?
- If you are male, is your neck measurement 17 inches or more? Or if you are female, is it 16 inches or more?
- Do sleep partners routinely tell you that you are a loud snorer and/or that during your sleep you choke, gasp for air or briefly stop breathing?
- Do you often wake up still feeling tired after 8 or more hours of sleep?
- Do you often find yourself falling asleep at work or home during periods when you should be awake?
- Do you suffer from irritability, depression, loss of memory, poor judgment and/or concentration?
The first and most important step in treating sleep apnea is to obtain a proper diagnosis. Contact us today to schedule an appointment to discuss your questions about sleep apnea. We can assist in the diagnosis and treatment of sleeping disorder along with a physician trained in this area. And rest assured that we have many treatment options we can use to help you get a great night's sleep. To learn more about sleep apnea, continue reading the Dear Doctor magazine article “If You Snore, You Must Read More!”
Perhaps you've seen Nate Berkus on The Oprah Winfrey Show or watched his television program, The Nate Berkus Show. You may even have read his best-selling book, Home Rules: Transform the Place You Live Into a Place You'll Love. Regardless of where or how you discovered Berkus, you will surely have noticed his dazzling smile.
Berkus recently opened up about the facts behind his trademark smile during an interview with Dear Doctor magazine. First off, his smile is totally natural, as he never wore braces or had any cosmetic work, including porcelain veneers. However, Berkus does give credit to his childhood dentist for the preventative healthcare he received as a young boy. “I'm grateful for having been given fluoride treatments and sealants as a child,” he said. Nate also shared the important flossing advice he learned from his dentist that he still follows today: “Floss the ones you want to keep.” Berkus went on to say that he feels, “healthy habits should start at a young age.”
And we totally agree! For this reason we have put together the following list of facts and oral hygiene tips:
- Over 50% of plaque accumulation occurs in the protected areas between teeth — a place that may be difficult or even impossible to reach with a toothbrush.
- A thorough brushing may take up to two minutes at first, and it may feel awkward as you reach some places in your mouth.
- Remember, more is NOT always better! Brushing or flossing too hard can be damaging to your teeth and gums. And never saw back and forth with your floss.
To learn more about oral hygiene, including brushing and flossing techniques, you can continue reading the Dear Doctor article “Oral Hygiene Behavior - Dental Health For Life.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, review your brushing and flossing techniques, and discuss any questions you have as well as treatment options. As needed, we will work with you to teach you the proper brushing and flossing techniques so that you feel confident before you leave our office. And to read the entire interview with Nate Berkus, please see the Dear Doctor article “Nate Berkus.”
When asked about her dazzling white smile, Cat Cora, the first female iron chef on the hit television series Iron Chef America, freely admits to maintaining the brightness of her smile with professional whitening sessions.
“With what I do, whitening your teeth is like getting your hair done, your nails done and everything else you have to do to be on television,” Cat recently told Dear Doctor magazine. However, she does have her limits. “I want my teeth to be white and healthy looking — but not stark white or looking like they could glow in the dark,” she said with a laugh.
Cat's perceptions and experiences with tooth whitening may accurately describe Hollywood, but through the power of media, celebrities and their respective fan bases, having attractive white teeth has become a goal for most people. This is because white teeth are subconsciously associated with youth and virility.
Here in the dental office, we can use professional-strength “power bleaching” to whiten teeth several shades in a single visit. To prevent irritation to the area surrounding the teeth being treated, we isolate the gums and skin of the mouth with a protective gel or a rubber barrier known as a dental dam. After the whitening solution is placed on the teeth, the process may be supplemented by heat or a light source to activate or enhance peroxide release.
For bleaching teeth at home, our office can make custom-fitted bleaching trays that you fill with a gel form of carbamide peroxide. Sometimes this whitening gel can cause a temporary tooth sensitivity to hot and cold, but this normally lasts for no more than four days after you stop bleaching your teeth.
To learn more about tooth whitening, you can continue reading the Dear Doctor magazine article “Teeth Whitening.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and discuss what treatment options will be best for you. And to read the entire interview with Cat Cora, please see the article “Cat Cora.”
Fracturing back molars is an experience no one ever wants to have. But when a helicopter crashed during a back country ski trip, supermodel Christie Brinkley soon discovered that she had fractured two molars. Fortunately for Christie, her oral health was restored with two dental implants. As she said during an interview with Dear Doctor magazine, “I am grateful for the dental implant technology that feels and looks so natural.”
While Christie's dental implants replaced back teeth, we routinely use them to replace both back and the more visible front teeth. But best of all, we have demonstrated expertise at making dental implant crowns look real. This is where we meld science and artistry.
What drives the most natural and beautiful result is how the crown (the visible, white portion of a tooth) actually emerges through the gum tissues. We also match the adjacent teeth identically in color, appearance, shape and profile. But we can't take all the credit, as it takes an entire “behind-the-scenes” team to produce dazzling results. Choice of materials, the laboratory technician (the person who actually handcrafts the tooth), the expertise we use in placing a dental implant crown and the total quality of care we provide are the ingredients necessary for success.
Another critical factor required is ensuring there is enough bone volume and gum tissue to support an implant. Both of these must also be in the right position to anchor an implant. However, if you do not have adequate bone volume, you may be a candidate for a minor surgical procedure to increase your bone volume through bone grafting or other regenerative surgical techniques.
To learn more about dental implants, continue reading the Dear Doctor magazine article “Matching Teeth & Implants.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, listen to your concerns, answer your questions and discuss treatment options. And if you want to read the entire feature article on Christie Brinkley, continue reading “The Secret Behind Christie Brinkley's Supermodel Smile.”
Athletic activity can boost your health, but many sports also carry some risk — especially to the teeth. This is something NFL wide receiver Jerry Rice well knows.
“Football can be brutal — injuries, including those to the face and mouth, are a common risk for any player,” Rice noted in an interview with Dear Doctor magazine. In fact, Rice himself chipped a couple of teeth, which were repaired with crowns. “There wasn't a lot of focus on protecting your teeth in high school,” Rice recalled.
You don't have to be a legend of the NFL to benefit from the type of high-quality mouthguard a dentist can make for you or your child. Consider that:
- An athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard.
- Mouthguards prevent an estimated 200,000 or more injuries each year.
- Sports-related dental injuries account for more than 600,000 emergency room visits annually.
- Each knocked-out tooth that is not properly preserved or replanted can cause lifetime dental costs of $10,000 to $20,000.
You and/or your child should wear a mouthguard if you participate in sports involving a ball, stick, puck, or physical contact with another player. Mouthguards should be used for practice as well as actual games.
It's also important to be aware that all mouthguards are not created equal. To get the highest level of protection and comfort, you'll want to have one custom-fitted and professionally made. This will involve a visit to our office so that we can make a precise model of your teeth that is used to create a custom guard. A properly fitted mouthguard is protective, comfortable, resilient, tear-resistant, odorless, tasteless and not bulky. It has excellent retention, fit, and sufficient thickness in critical areas.
If you are concerned about dental injuries or interested in learning more about mouthguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Jerry Rice, please see “Jerry Rice.” Dear Doctor also has more on “Athletic Mouthguards.” and “An Introduction to Sports Injuries & Dentistry.”
It is not uncommon to have one or more teeth that are particularly sensitive to heat, cold, or pressure. If you have such a tooth, you probably want to know what caused it and what you can do about it. Here are some frequently asked questions, and their answers.
What causes teeth to become sensitive?
The most common cause of sensitivity is exposure of the tooth's dentin, a layer of the tooth's structure that is just below the outer protective layer (the enamel).
The dentin is sensitive but the enamel layer is not. Why?
The enamel is composed of minerals that are hard and protective. It is not living tissue and has no nerve supply. The dentin layer underneath is bone-like living tissue that does contain nerve fibers. It is protected by enamel above the gum line and by gum tissue in the area of the tooth's root, below the gum line. If the tooth's protective covering is reduced, the nerve fibers in that section of the dentin are exposed to changes in temperature and pressure, which they conduct to the inner pulp layer (nerve) of the tooth. The sensations that reach the tooth's interior pulp layer cause pain.
What causes exposure of the dentin layer in teeth?
Often the dentin is exposed by receding gums, causing areas of the tooth that are normally below the gum surface to be uncovered.
What makes gums recede?
One cause of receding gums is excessive, rough brushing techniques. This is particularly common in individuals who have a family history of thin gum tissues. Removing the film of bacteria called plaque requires only gentle action with a soft brush. This is one reason that we stress the value of learning proper and effective brushing techniques. Gum recession becomes worse after the uncovered dentin of the tooth's root is exposed to erosion from sweet and acidic foods and beverages, such as fruit juices.
Doesn't tooth sensitivity indicate decay?
Decay can also cause tooth sensitivity. As decay destroys a tooth's structure, it eventually invades the inner pulp of the tooth, causing greater and greater pain.
How can you prevent or reduce tooth sensitivity?
As we mentioned above, learn proper brushing techniques; we would be happy to demonstrate them. Use a toothpaste that contains fluoride, which increases the strength of the tooth's protective coating. In more serious cases, we can apply a fluoride varnish or a filling material as a barrier to cover sensitive areas. If you experience long-term tooth sensitivity, make an appointment for an assessment and diagnosis so that we can determine the cause and proper treatment.
Design expert and television celebrity Nate Berkus has definite ideas about how to live. In a recent interview, he explained his ideas on design. He also talked about health, and how he keeps his teeth and mouth healthy.
From an initial design makeover that he did eight years ago on the Oprah Winfrey Show, Berkus has gone on to do 127 such makeovers. He was such a success that he now hosts his own daily talk show. He has also developed a line of home products for the Home Shopping Network and has his own design firm, Nate Berkus Associates. His clients include well-known restaurants and hotels as well as private homes. He has written articles for O Magazine and authored a book on the subject of transforming your home into a place you love.
“I realized many years ago that I wasn't going on Oprah to pick sofa colors and paint chips. I was there to lift people up through the way they live,” he says. His secret to design success is to “go with what you love.” He says, “Don't worry about mixing metals, eras or styles. If you love each item, you'll find a way to make it work.”
His common sense practical attitude continues when it comes to dental health. Berkus is blessed with a healthy mouth and teeth. He doesn't feel anxious when visiting the dentist because he usually has a good report. He has not needed orthodontics or cosmetic dentistry. He thanks his childhood dentist for giving him fluoride treatments and sealants, and for teaching him healthy dental hygiene habits.
Berkus brushes his teeth twice or even three times a day, with a manual or electric toothbrush — depending on whether he is at home or traveling. He also follows his dentist's advice about flossing: “Floss the ones you want to keep!” He says that he tried tooth whitening once, but he felt that the whiteness was “too white.” Now he simply works to maintain his natural tooth color and smile.
Contact us today to schedule an appointment to discuss your questions about maintaining healthy teeth. You can also learn more by reading the Dear Doctor magazine article “Nate Berkus, Helping Others Love the Way They Live.”
Test yourself on your knowledge of this dental procedure.
- A root canal is
- A canal shaped structure in the root of your tooth
- A blood vessel carrying blood from your gum to your tooth
- An instrument used by your dentist in performing dental surgery
- Which of these are symptoms of root canal infection?
- Sharp, acute and intense pain, which is difficult to pinpoint
- Sharp pain when biting down on your tooth or on food
- Lingering pain after eating hot or cold foods
- Dull ache and pressure
- Tenderness (accompanied by swelling) in the nearby gums
- All the above
- If you don't feel any pain you do not have a root canal infection.
- Root canal treatment is a very painful experience.
- Root canal treatment is called endodontic therapy. What does this word mean?
- Bringing the end of your problems
- Inside your tooth
- Fighting gum disease
- You need root canal treatment if
- The inside or pulp of your tooth becomes inflamed or infected
- Your tooth needs to be gently moved in order to correct your bite
- Acid erosion is damaging your tooth
- During root canal treatment the canals in your teeth are cleaned out and sealed off.
- Who is qualified to perform root canal treatment?
- General dentists
- Both of the above
- a. A root canal is a canal shaped space within the root of a tooth that holds the tooth's pulp — which contains the tooth's nerves and blood vessels.
- f. — all of the above
- False. It is possible to have an infection that has stopped hurting but is still present and causing damage.
- False. Root canal treatment doesn't cause pain, it relieves it.
- b. The word comes from roots meaning “inside” and “tooth.”
- True. A small opening is made in the chewing surface of your tooth to gain access to the pulp. Dead and dying tissue is removed and the pulp is cleaned and disinfected. The canals are shaped and then sealed with filling materials to prevent future infection.
- c. All general dentists have received training in endodontic treatment and can perform most endodontic procedures. They often refer people needing complicated root canal treatment to endodontists, who have had specialized training in endodontic diagnosis and treatment.
Periodontal or gum disease is an often silent disease that can cause significant damage to the health of your teeth and body. The reason it is so often classified as a silent disease is because it is chronic or longstanding and often without any symptoms or pain that most people associate with a disease until it may be too late.
If you think you may have gum disease, here is what to look for:
- Bleeding gums — probably one of the most common and overlooked early warning signs that most people ignore is thinking that the bleeding is being caused by brushing their teeth too hard. The truth is that you would have to brush extremely hard to cause healthy gum tissues to bleed.
- Bad breath — something everyone has experienced; however, it can also be a warning sign of periodontal disease. This is especially true for people who hate or refuse to floss their teeth, thereby trapping literally billions of bacteria where they love to collect in the protected areas between the teeth.
- Redness, swelling, and/or receding gums — all signs of gum disease often accompanied by sensitivity of the gum tissues around the teeth.
- Chronic inflammation — long-standing gum inflammation is a sign that your gum tissues are not healing properly. Periodontal disease exhibits periods with bursts of activity followed by periods where the body tries to recover.
- Loose and/or moving teeth — that seem to be drifting into a new position, are visible signs that you are highly likely to have periodontal disease.
- Abscess formation — late stage gum disease is characterized by painful, swollen, red pockets of pus, which denotes an acute localized periodontal infection.
If you have any of these signs, you need to make an appointment for a thorough evaluation. Otherwise, you could end up losing your teeth to the second most common disease known to man after tooth decay. To learn more about gum disease, continue reading, “Warning Signs of Periodontal (Gum) Disease.” Or, contact us today to schedule an appointment.
If you cringe at the appearance of your less than pearly whites when you look in the mirror, you are not alone. A frequently requested cosmetic procedure, teeth whitening is a very successful and relatively inexpensive way to enhance your smile. We can determine which whitening treatment will work best for you after performing a basic oral examination in our office. When will it work and when won't it? Here's some background:
Teeth most commonly become stained or discolored due to surface (extrinsic) changes, the most common of which are dietary and smoking. Foods including red wine, coffee, and tea can cause extrinsic staining. Teeth can also commonly become discolored or stained due to intrinsic (internal) reasons, such as changes in the structure of enamel or dentin or by incorporation of chromogenic (color generating) material into tooth tissue during formation or after eruption.
- Toothpastes that claim to whiten teeth are only effective in removing plaque and other surface stains. Although most of these products contain mild abrasives that remove the plaque, they aren't capable of changing the underlying color of stained teeth.
- Tooth polishing by your dentist or dental hygienist is effective in removing superficial staining, but will not change tooth color.
- Teeth whitening systems work by bleaching, generally with the use of hydrogen peroxide. Using bleaching gels in custom made trays or whitening strips can be done at home, but is slow and the changes are gradual. We can perform quicker and more effective “power bleaching” in our dental office when precautions can be taken to ensure safety due to the higher concentrations of bleaching gels used. Teeth with intrinsic (internal) staining may need internal bleaching to whiten them and this can only be done in the dental office.
- Teeth whitening results fade over time, but optimally last from six months to two years. Taking care of your newly whitened teeth by avoiding the foods, beverages, and habits that cause staining will help them remain whiter for longer.
- If you have had previous cosmetic dentistry performed, including the placement of composite restorations, porcelain veneers, or crowns, teeth whitening may not be for you. Bleaching agents have little to no effect at all on the materials used to create these restorative products.
If you would like to discuss whitening your teeth with us, call today to make an appointment. To learn more about the various teeth whitening procedures, read the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, WhiterÃ¢Â€Â¦”
Some of the most popular smile enhancers on the market today are both over-the-counter (OTC) and professional teeth whitening products. And while studies indicate that bleaching can successfully achieve noticeable increases in whitening of stained teeth, there are some facts you need to know about these products and the results that they can deliver.
- Nearly all bleaching products contain the same basic ingredient, carbamide peroxide or its breakdown product, hydrogen peroxide. However, the products our office uses to professionally whiten your teeth are much stronger without compromising the health and safety of your teeth, gums, and mouth.
- OTC bleaches typically contain no more that 10% carbamide peroxide while professional bleaches can contain between 15% and 35%. And to make professional bleaching even more effective, we may use them in combination with specialized lights or lasers.
- Bleaching is NOT a permanent solution and thus results will diminish over time. The “fade rate” begins to occur 6 to 12 months after treatment.
- While you can't avoid the fading process, you can extend your bleaching results by avoiding foods and drinks that stain your teeth, such as red wine, red (tomato-based) sauces, coffee, tea, sodas/colas, and blueberries to name a few.
- Another method for extending your results is to use a straw when drinking beverages that can stain your teeth so that the liquid does not come in contact with your teeth.
- If you have visible crowns and/or veneers mixed with your natural front teeth, it may be quite difficult for you to bleach your natural teeth so that they perfectly match your veneers or crowns. Remember, tooth whitening is not effective on crowns, veneers, bridgework, or any type of artificial tooth.
- One of the most common side effects of whitening teeth is tooth sensitivity and irritation of the gum tissues. They both are usually temporary and often occur when you start bleaching; however, they generally subside after a few days.
Overall, bleaching your teeth is an effective way to brighten your smile with minimal side effects. If it is something you are interested in pursuing, talk it over with us first — even if you plan to use OTC products — so that you have a clear understanding about your specific options and projected outcomes. Or, learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”
“Smile, and the world smiles with you,” the old saying goes. For people who are afraid to smile because they don't like how their smile looks, the twenty-first century offers a myriad of solutions. Smiling shows your teeth in their various shapes, colors, and sizes, your gums and gum line, your tooth alignment, spacing, and bite all in relation to the rest of your face. Any of these can now be improved.
Through the knowledge, skills, and combined experience of our dental team, it is now possible to make teeth whiter, brighter, and more evenly aligned, to alter tooth shape and size, and to make the teeth and gum line more proportionally balanced. Here are some options for cosmetic dentistry:
- Polish. Remove unwanted stains on outside tooth surfaces by having your teeth polished.
- Teeth Whitening. If teeth are stained or have just lost their luster, whitening is a safe and effective way to lighten a smile.
- Porcelain veneers. Applying a thin layer of dental porcelain restorative material to replace stained or damaged tooth enamel can truly change a smile.
- Porcelain crowns. If teeth are damaged by decay or trauma, porcelain crowns can replace the parts of the teeth that show above the gum line.
- Orthodontics. For teeth that are not in their correct and functional position, a variety of orthodontic techniques can be used including traditional braces, clear aligners and moreÃ¢Â€Â”to improve crooked teeth or a malaligned bite.
- Dental implants. Nothing ruins a smile more than missing teeth. Entire teeth can be replaced, including the roots and the crowns, using dental implants. These are exact replicas of the natural teeth and can be made to match their neighbors exactly.
When it comes to replacing missing teeth, we have numerous options. However, two of the most common treatment options include bridgework and dental implants. See how much you really know about dental implants and bridgework by taking our quick and easy true/false self test.
- When it comes to costs, dental implants may initially cost more than bridgework but are less expensive than bridgework over a lifetime.
True or False
- Both bridgework and dental implants can last a lifetime when properly maintained.
True or False
- Prior to placing a three-unit fixed bridge, if the surrounding teeth have crowns, they must be redone so that the bridge fits and wears properly.
True or False
- Replacing a single tooth with a three-unit bridge, requires removing the enamel on the adjacent teeth even if these teeth are disease-free.
True or False
- In addition to being permanent tooth replacements, another advantage of dental implants is that they don't decay like teeth supporting bridgework.
True or False
- It is not uncommon for root canal treatment to be required to save teeth that support bridgework if they have been subjected to severe decay and their nerves become infected.
True or False
- Placing a dental implant requires more time when compared to placing a three-unit bridge.
True or False
- Both bridgework and dental implants require minor surgery to replace a missing tooth.
True or False
- Dental implants are more desirable than bridgework because placing them does not affect the adjacent teeth.
True or False
- Studies indicate that bridges are only 67% successful at 15 years whereas dental implants have success rates into the 90s.
True or False
Answers: 1) True. This fact shocks many people. 2) False. This is more commonly true for dental implants. 3) True. 4) True. This is one of the disadvantages of bridgework. 5) True. This is just one of the advantages of a dental implant. 6) True. 7) True. 8) False. Dental implants require surgery to be placed. 9) True. This fact is a significant advantage for dental implants. 10) True. Your results may vary; however, this statistic represents what you might expect.
The third molars, called “wisdom teeth” because they usually become visible when a person is 17 to 25 — supposedly the time we achieve wisdom, may have adverse effects on adjacent teeth. Most adults have four wisdom teeth, although some people have more; and some, none at all. The wisest thing to do about wisdom teeth may be to have them removed if they are poorly positioned.
What is an impacted wisdom tooth?
If a wisdom tooth is pushing against gums, other soft tissues, or adjacent teeth at an awkward angle, it is referred to as “impacted.” Usually this occurs when there is not have enough room in the jaws for these last molars to fit next to their adjacent teeth. They can disrupt the gum tissue attachment of their neighboring teeth and the surrounding bone leading to periodontal disease and, ultimately, their loss.
In many cases, impacted teeth are painless, and those who have them have no warning of the problem. Thus it is important to have routine dental exams during the time when the third molars are coming in.
When should wisdom teeth be removed?
It is better to remove wisdom teeth early rather than waiting until periodontal (gum) disease has set in. As individuals age, keeping their wisdom teeth may lead to more serious problems. Periodontal defects tend to get worse in the presence of retained third molars. Furthermore, there is a higher incidence of postoperative symptoms in people over 25.
What are the pros and cons?
Removing impacted third molars can have a negative influence on the periodontal tissues of adjacent second molars. A number of techniques, such as scaling, root planing, and bacterial plaque control, can be used to minimize periodontal problems and promote healthy healing.
Surgical removal of wisdom teeth will involve some mild to moderate post-operative discomfort. Use of aspirin or ibuprofen for a few days after surgery will provide pain relief and control most swelling and symptoms. Antibiotics may be prescribed to ensure infection-free healing. It is important to keep the socket area clean by washing and rinsing with saline or antibacterial rinses. Careful surgery will promote good healing with minimal periodontal consequences to adjacent second molar teeth.
To decide whether your wisdom teeth should be removed, you will need an evaluation to assess the clinical health of the wisdom teeth, the neighboring teeth, and other vital structures. X-ray and digital imaging techniques play an important role in determining the exact position of the wisdom teeth in the jaw. A full assessment and consultation will include all the risks, benefits, likely consequences, and alternative treatment options. This will provide you with the wisdom you need to determine what is best for your wisdom teeth.
To learn more about wisdom teeth, read “To Be or Not to Be: What are the consequences of an impacted wisdom tooth?” Or contact us today to discuss your questions or to schedule an appointment.
When it comes to cosmetic dentistry, we have numerous techniques that we can use to produce a dazzling smile while restoring or helping you maintain optimal oral health. From tooth whitening and gum contouring to bonding and veneers, see how much you really know about cosmetic dentistry by playing our matching game.Words to match:
- Enamel shaping
- Crowns and bridgework
- Gum contouring
- ______ is a minor surgical procedure in which we alter the position of the gum tissue and sometimes even the underlying bone.
- ______ is a treatment option that is not permanent and may require several applications to achieve the desired color results.
- ______ is a restorative technique that involves applying an a tooth colored filling material (composite resin) to a tooth that is color-matched and shaped to restore a decayed or damaged tooth.
- ______ is a treatment option for restoring heavily damaged teeth or replacing missing teeth.
- ______ is a procedure in which small amounts of enamel, a tooth's outer layer, is removed to reshape it to improve the look of a tooth.
- ______ is a minor cosmetic procedure in which we apply a peroxide-based material to bleach out minor stains and discoloration from teeth.
- ______ is a procedure in which we permanently replace a missing tooth by attaching a crown (artificial tooth) to a titanium post that has been surgically placed within the jaw.
- ______ is a treatment option in which teeth are aligned into a proper position giving a more attractive appearance. It is often used in conjunction with other cosmetic procedures.
- ______ is a cosmetic technique where we place a custom-designed, thin shell of tooth-colored material (usually porcelain) to the front surface of a tooth.
- ______ is the most common technique for repairing chipped, broken or decayed teeth. It may also be used to alter the shape of a small or irregular tooth.
Answers: 1) H. 2) A. 3) B. 4) F. 5) C. 6) A. 7) G. 8) D. 9) E. 10) B
To learn more about cosmetic and restorative dentistry, continue reading the Dear Doctor magazine article “Beautiful Smiles by Design.” Or you can contact us today to schedule an appointment to discuss your specific questions.
At Artistic and Family Dental Center, we strive to provide our patients with the most advanced dental treatment available. We offer a full range of services from crowns and bridges to overall smile makeovers – each designed to keep your smile looking beautiful and healthy for a lifetime. For more information about the services and treatments we provide, go to our website, www.artisticdental.com and click “Services Offered.” We are eager to assist you. Thank you for choosing Artistic and Family Dental Center for all your dental needs.
Tired of frown lines, wrinkles on your forehead, or those lines between your eyes. Did you know that we utilize Botox and Dermal Fillers to enhance your smile? You can get rid of wrinkles, and frown lines, and create fuller, more defined lips with these products. Ask us about how Botox treatment and Dermal Fillers can help you keep your youthful appearance.
Welcome to Artistic and Family Dental Center, where our top priority is helping you achieve and maintain a beautiful, healthy smile. We are conveniently located at 3540 South Poplar Street, Suite 301 in Denver. I-25 to Hampden Avenue (East), turn right on Poplar Street. We are in the red brick building on the east side of Poplar, just west of the Whole Foods in Tiffany Plaza. Dr. Wilk is available to see patients Monday through Thursday from 7am until 3pm and Dr. Revoir is available for appointments Tuesday through Thursday from 3pm until 9pm and Friday and Saturday from 8am until 4pm. For more detailed directions to our office, please call 303-758-2980 for a member of our team to assist you.
Whether you are an existing patient or searching for a dentist in the Denver, CO area, we're excited you are here. With the dental industry advancing, we recognize the importance of keeping our patients and visitors up to date with all of the new and exciting things taking place in our practice.
As we move forward with our blog, we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Wilk and his staff.
We hope you find our blog to be helpful, engaging and informational to ensure your best dental health.
As always, feel free to contact us with any dental questions or concerns.
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