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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

If you would like more information about dental implants, please call us or schedule an appointment. You can also read more by reading the Dear Doctor magazine article “Dental Implant Maintenance.”

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 youâ??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.

Contact us today to schedule an appointment or to discuss any questions that you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening.”

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.

Contact us today to schedule an appointment to discuss your questions about dentures. You can also learn more by reading the Dear Doctor magazine article “Removable Full Dentures.”

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:

1. 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.
2. 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.
3. Sealing above the root canal filling: This step is critical to prevent the bleach from leaking into the root canal space.
4. Applying the bleach: To obtain the whitening needed, it typically requires between one and four office visits for additional bleaching.
5. 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.

1. Are you a loud habitual snorer?
2. Has anyone ever witnessed you holding your breath, gasping for air or even choking while asleep?
3. Do you regularly feel un-refreshed or tired even after waking from eight or more hours of sleep?
4. Do you find yourself easily falling asleep throughout your day at work or at home?
5. Do you suffer from poor concentration or judgment, memory loss, irritability and/or depression from lack of sleep?
6. 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.

Learn More

Learn more about the signs, symptoms, and treatment options when you read “Snoring & Sleep Apnea.” Contact us today to discuss your questions or to schedule a consultation.

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:

• Gold
• Porcelain-Fused-to Metal (PFM)
• All porcelain

To learn more on this topic, read the Dear Doctor article, “Porcelain Crowns & Veneers.” You can also contact us to discuss your questions or to schedule a consultation.

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.

Contact us today to schedule an appointment to discuss your questions about fluoride. You can also learn more by reading the Dear Doctor magazine article “Fluoride & Fluoridation in Dentistry.”