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Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

Oral Health Topics

Introduction

Does mercury in the silver fillings in your mouth pose any long-term health risks? Does fluoride, in spite of everything we’ve been told since childhood, actually cause more harm than good? What does the latest research reveal about tobacco use on your overall oral health?

This section is dedicated to the latest information about these and other oral health topics, pulled from authoritative sources such as the American Dental Association.

Click here for the latest news from the American Dental Association.

Fluoride

Does mercury in the silver fillings in your mouth pose any long-term health risks? Does fluoride, in spite of everything we’ve been told since childhood, actually cause more harm than good? What does the latest research reveal about tobacco use on your overall oral health?

This section is dedicated to the latest information about these and other oral health topics, pulled from authoritative sources such as the American Dental Association.

Click here for the latest news from the American Dental Association.

The Preventive Program

Both natural teeth and teeth with restorations survive best in an oral environment that is clean and where the intake of harmful foods is controlled. Our program is designed to help prevent new cavities, preserve teeth that have been restored and manage periodontal disease. At the initial visit oral hygiene instructions are reviewed and are reinforced at subsequent recall visits. The following are helpful recommendations:

 

  • Brush your teeth twice a day in a circular motion with a soft bristled toothbrush aimed at the gum.
  • Floss every night in an up-and-down motion while keeping the floss in a U-shape and against the tooth surface.
  • Avoid smoking.
  • Avoid sticky sugary foods.
  • Eat a balanced diet.
  • Use antiseptic and fluoride rinses as directed.
  • Have sealants placed on young permanent teeth.
Fillings
Frequently asked questions: dental fillings

Are dental amalgams safe? Is it possible to have an allergic reaction to amalgam? Is it true that dental amalgams have been banned in other countries? Is there a filling material that matches tooth color? If my tooth doesn’t hurt and my filling is still in place, why would the filling need to be replaced? Read this interesting and informative discussion from the American Dental Association.

FDA consumer update: dental amalgams

The Food and Drug Administration and other organizations of the U.S. Public Health Service (USPHS) continue to investigate the safety of amalgams used in dental restorations (fillings). However, no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergic reactions.

ATSDR – public health statements: mercury

The Centers for Disease Control and Prevention offers some scientific background on mercury (contained within silver-colored fillings), and whether it believes the substance presents any health hazards.

Analysis reveals significant drop in children’s tooth decay

Children have significantly less tooth decay in their primary (baby) and permanent teeth today than they did in the early 1970s, according to the Journal of the American Dental Association (JADA). The analysis reveals that among children between the ages of six and 18 years, the percentage of decayed permanent teeth decreased by 57.2 percent over a 20-year period. In addition, children between the ages of two and 10 years experienced a drop of nearly 40 percent in diseased or decayed primary teeth.

Alternative Materials

Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural-looking smiles. Researchers are continuing their often decades-long work developing esthetic materials, such as ceramic and plastic compounds that mimic the appearance of natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials used to repair missing, worn, damaged or decayed teeth.

The advent of these new materials has not eliminated the usefulness of more traditional dental restoratives, which include gold, base metal alloys and dental amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.

Alternatives to amalgam, such as cast gold restorations, porcelain, and composite resins are more expensive. Gold and porcelain restorations take longer to make and can require two appointments. Composite resins, or white fillings, are esthetically appealing, but require a longer time to place.

Here’s a look at some of the more common kinds of alternatives to silver amalgam:

  • Composite fillings – Composite fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth-colored restoration. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be “bonded” or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth. In teeth where chewing loads are high, composite fillings are less resistant to wear than silver amalgams. It also takes longer to place a composite filling.
  • Ionomers – Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for non-load bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.
  • Porcelain (ceramic) dental materials – All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. Their strength depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.
Sealants

Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

Sealants were developed in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity.

Sealants act as a barrier to prevent bacteria and food from collecting and sitting on the grooves and pits of teeth. Sealants are best suited for permanent first molars, which erupt around the age of 6, and second molars, which erupt around the age of 12.

Sealants are most effective when applied as soon as the tooth has fully come in. Because of this, children derive the greatest benefit from sealants because of the newness of their teeth. Research has shown that more than 65% of all cavities occur in the narrow pits and grooves of a child`s newly erupted teeth because of trapped food particles and bacteria.

Application

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light.

Sealants normally last about five years. Sealants should always be examined at the child`s regular checkup. Sealants are extremely effective in preventing decay in the chewing surfaces of the back teeth.

Insurance coverage for sealant procedures is increasing, but still minimal. Many dentists expect this trend to change as insurers become more convinced that sealants can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

Infection Control
Standards and Best Practice

With all of the increased media attention on infection outbreaks such as AIDS and multi-drug resistant strains of viruses, it’s no wonder people have heightened concerns about infection control during a medical procedure.

Gloves, gowns and masks are required to be worn in all dentist offices today—a far cry from just a few decades ago—when fewer than one-third of all dentists even wore such personal protective equipment, or PPE.  After each patient visit, disposable PPE-such as gloves, drapes, needles, and scalpel blades-are thrown away, hands are washed, and a new pair of gloves used for the next patient.

All hand instruments used on patients are washed, disinfected and/or sterilized with chemicals or steam after each use.

One of the most effective methods for preventing disease transmission—washing one’s hands—is practiced in our office.  It is routine procedure to wash hands at the beginning of the day, before and after glove use, and after touching any surfaces that may have become contaminated.

Water Quality and Biofilms

Concerns about the quality of water used in a dentist’s office are unfounded, provided the dentist follows the infection control guidelines of the Centers for Disease Control and the American Dental Association.

Some health “experts” in recent years have called into question the risks associated with so-called “biofilms,” which are thin layers of microscopic germs that collect on virtually any surface. Essentially, these bacteria and fungi occur everywhere, including faucets in your home; your body is no less accustomed to being exposed to them than in any other situations.

In fact, no scientific evidence has linked biofilms with disease. If you have a compromised or weakened immune system, you are susceptible to germs everywhere. Consequently, let our office know if you have such a condition so additional precautions, if any, can be taken.

Medication and Heart Disease

Certain kinds of medications can have an adverse effect on your teeth.

Long ago, children exposed to tetracycline developed tooth problems, including discoloration, later in life. The medication fell out of use, however, and is not an issue today.

The best precaution is to ask your family physician if any medications he or she has prescribed can have a detrimental effect on your teeth or other oral structures.

A condition called dry mouth is commonly associated with certain medications, including antihistamines, diuretics, decongestants and pain killers. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems. Garlic and tobacco use are other known culprits.

Dry mouth occurs when saliva production drops. Saliva is one of your body’s natural defenses against plaque because it acts to rinse your mouth of cavity-causing bacteria and other harmful materials.

Some of the less alarming results of dry mouth include bad breath. But dry mouth can lead to more serious problems, including burning tongue syndrome, a painful condition caused by lack of moisture on the tongue.

If dry mouth isn’t readily apparent, you may experience other conditions that dry mouth can cause, including an overly sensitive tongue, chronic thirst or even difficulty in speaking.

Heart Disease

Poor dental hygiene can cause a host of problems outside your mouth—including your heart.

Medical research has uncovered a definitive link between heart disease and certain kinds of oral infections such as periodontal disease. Some have even suggested that gum disease may be as dangerous as or more dangerous than other factors such as tobacco use.

A condition called chronic periodontitis, or persistent gum disease, has been linked to cardiovascular problems by medical researchers.

In short, infections and harmful bacteria in your mouth can spread through the bloodstream to your liver, which produces harmful proteins that can lead to systemic cardiac problems. That’s why it’s critical to practice good oral hygiene to keep infections at bay—this includes a daily regimen of brushing, flossing and rinsing.

Antibiotic Prophylaxis

In some cases, patients with compromised immune systems or who fear an infection from a dental procedure may take antibiotics before visiting the dentist.

It is possible for bacteria from your mouth to enter your bloodstream during a dental procedure in which tissues are cut or bleeding occurs. A healthy immune system will normally fight such bacteria before they result in an infection.

However, certain cardiovascular conditions in patients with weakened hearts could be at risk for an infection or heart muscle inflammation (bacterial endocarditis) resulting from a dental procedure.

Patients with heart conditions (including weakened heart valves) are strongly advised to inform our office before undergoing any dental procedure. The proper antibiotic will prevent any unnecessary complications.

Latex Allergy

Naturally occurring latex has been linked in recent years to allergic reactions in people who use such products as latex gloves. The proteins in the latex, which can also become airborne, can cause problems in vulnerable people such as breathing problems and contact dermatitis. Some allergic reactions, including anaphylactic shock, have been more severe.

Many health experts have rightly attributed the dramatic increase of allergic reactions to latex in the health care community to the increased use of gloves and other personal protection equipment in light of the AIDS epidemic.

Latex is a pervasive substance in many household items—from toys and balloons to rubber bands and condoms.

Latex allergies could cause the following symptoms:

  • Dry skin
  • Hives
  • Low blood pressure
  • Nausea
  • Respiratory problems
  • Tingling sensations

People with high-risk factors for latex allergy include those who have undergone multiple surgical operations, have spina bifida, or are persistently exposed to latex products.

If you are vulnerable to latex or have allergies related to it, please notify our office and, by all means, seek medical attention from your family physician.

Age and Oral Health
Oral changes with age

Is tooth loss inevitable in your later years? How much should adults be concerned about cavities? Here you will find helpful answers to some frequently asked questions about oral health questions you may have as you get older.

National survey reveals baby boomers miss links between oral and overall health

Baby boomers looking for the warning signs of adult-onset diseases may be overlooking key symptoms in their mouth that should signal alarms about their overall health. According to a survey commissioned by the Academy of General Dentistry, 63 percent of baby boomers (ages 45-64) with an oral symptom considered to be a key indicator of a more serious health condition, were unaware of the symptom`s link to the condition. Boomers` failure to recognize that oral health holds valuable clues could negatively impact their overall health.

Tobacco
Dentistry health care that works: tobacco

The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.

Frequently asked questions: tobacco products

What effects can smoking have on my oral health? Are cigars a safe alternative to cigarettes? Are smokeless tobacco products safe? The American Dental Association has some alarming news that you should know.

Smoking and Implants

Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking.

Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.

Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.

Tobacco
Dentistry health care that works: tobacco

The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.

Frequently asked questions: tobacco products

What effects can smoking have on my oral health? Are cigars a safe alternative to cigarettes? Are smokeless tobacco products safe? The American Dental Association has some alarming news that you should know.

Smoking and Implants

Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking.

Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.

Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.

General Dentistry

The first line of defense against oral health problems

In general dentistry, the dentist is the primary care provider for patients of all ages and is responsible for the prevention, diagnosis and treatment of a wide variety of conditions, disorders and diseases affecting the teeth, gums and maxillofacial (jaw and face) parts of the body. Even though general dentists primarily provide preventative care and minor restorative therapy, they are often able to perform a wide array of other dental procedures, including some minor cosmetic treatments.

The American Dental Association (ADA) recommends that patients visit their general dentist at least once every six months to ensure proper oral health and functionality. Regular oral health check-ups and maintenance help to prevent the development of serious dental problems that may require more extensive and costly treatments. General dentists are highly educated and trained in multiple facets of dentistry, providing a variety of different services for you and your family including:

  • Crowns and bridges
  • Dentures
  • Dental implants
  • Gum disease (Periodontal) treatment
  • Orthodontics
  • Root canal therapy
  • Teeth cleanings
  • Bonding
  • Dental fillings

General dentists who do not perform a certain treatment will provide you with a specialist referral.

Tooth Care

What is Tooth Decay?

Plaque is an insidious substance—a colorless, sticky film—that blankets your teeth and creates an environment in which bacteria erode tooth enamel, cause gum irritation, infection in inner structures such as pulp and the roots, and in extreme cases, tooth loss.

Some of the biggest culprits causing plaque are foods rich in sugar and carbohydrates, including soda beverages, some juices, candy and many kinds of pasta, breads and cereals.

Plaque also can attack fillings and other restorations in your mouth, which can lead to more costly treatment down the road.

Plaque is the main cause of tooth decay.  It can also cause your gums to become irritated, inflamed, and bleed. Over time, the plaque underneath your gums may cause periodontal disease, which can lead to bone loss and eventual tooth loss.

Inside your teeth, decay can gradually destroy the inner layer, or dentin.  It can also destroy the pulp, which contains blood vessels, nerves and other tissues, as well as the root.

Periodontal disease is advanced gum disease. This serious condition occurs when the structures that support your teeth—the gums and bone—break down from the infection.  Pain, hypersensitivity and bleeding are some of the signs of periodontal disease.

Simple Preventative Measures

The two best defenses against tooth decay and gum disease are a healthy, well-balanced diet and good oral hygiene, including daily brushing with fluoride toothpaste, flossing and rinsing. Most public drinking water contains fluoride, but if you are unsure of your water supply, then use a good quality mouth rinse containing fluoride.

A good way to help your oral health between brushing is chewing sugarless gum; this stimulates your body’s production of saliva, a powerful chemical that actually neutralizes plaque formation and rinses decay-causing food particles and debris from your mouth.

In some cases, our office can prescribe anti-cavity rinses or apply special anti-cavity varnishes or sealants to help fight decay.

Brushing

Brushing is the most effective method for removing harmful plaque from your teeth and gums. Getting the debris off your teeth and gums in a timely manner prevents bacteria in the food you eat from turning into harmful, cavity causing acids.

Most dentists agree that brushing three times a day is the minimum; if you use a fluoride toothpaste in the morning and before bed at night, you can get away without using toothpaste during the middle of the day. A simple brushing with plain water or rinsing your mouth with water for 30 seconds after lunch will generally do the job.

Brushing techniques

Since everyone’s teeth are different, see me first before choosing a brushing technique. Here are some popular techniques that work:

  • Use a circular motion to brush only two or three teeth at a time, gradually covering the entire mouth.
  • Place your toothbrush next to your teeth at a 45-degree angle and gently brush in a circular motion, not up and down. This kind of motion wears down your tooth structure and can lead to receding gums, or expose the root of your tooth. You should brush all surfaces of your teeth – front, back, top, and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
  • Don’t forget the other surfaces of your mouth that are covered in bacteria – including the gums, the roof and floor of your mouth, and most importantly, your tongue. Brushing your tongue not only removes trapped bacteria and other disease-causing germs, but it also freshens your breath.
  • Remember to replace your brush when the bristles begin to spread because a worn toothbrush will not properly clean your teeth.
  • Effective brushing usually takes about three minutes. Believe it or not, studies have shown that most people rush during tooth brushing.
Flossing
What is flossing?

Flossing is a method for removing bacteria and other debris that cannot be reached by a toothbrush. It generally entails a very thin piece of synthetic cord you insert and move up and down between the sides of two adjoining teeth.

Why is flossing important?

Many dentists believe that flossing is the single most important weapon against plaque. In any event, daily flossing is an excellent and proven method for complementing your brushing routine and helping to prevent cavities, periodontal disease, and other dental problems later in life. It also increases blood circulation in your gums. Floss removes plaque and debris that stick to your teeth and gums.

How often to floss

Floss at least once every day. Like brushing, flossing should take about three minutes and can easily be done while doing another activity, such as watching television. Do not attempt to floss your teeth while operating a motor vehicle or other machinery.

Flossing techniques

There are two common methods for flossing, the “spool method” and the “loop method”.

The spool method is the most popular for those who do not have problems with stiff joints or fingers. The spool method works like this: Break off about 18 inches of floss and wind most of it around your middle finger. Wind the rest of the floss similarly around the middle finger of your other hand. This finger takes up the floss as it becomes soiled or frayed. Move the floss between your teeth with your index fingers and thumbs. Maneuver the floss up and down several times forming a “C” shape around the tooth. While doing this, make sure you go below the gum line, where bacteria are known to collect heavily.

The loop method is often effective for children or adults with dexterity problems like arthritis. The loop method works like this: Break off about 18 inches of floss and form it into a circle. Tie it securely with two or three knots. Place all of your fingers, except the thumb, within the loop. Use your index fingers to guide the floss through your lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gum line and forming a “C” on the side of the tooth.

With either method of flossing, never “snap” the floss because this can cut your gums. Make sure that you gently scrape the side of each tooth with the floss.

Your gums may be tender or even bleed for the first few days after flossing – a condition that generally heals within a few days.

Fluoride Facts

For decades, fluoride has been held in high regard by the dental community as an important mineral that is absorbed into and strengthens tooth enamel, thereby helping to prevent decay of tooth structures.

In nearly every U.S. community, public drinking supplies are supplemented with sodium fluoride because the practice is acknowledged as safe and effective in fighting cavities.

Some private wells may contain naturally fluoridated water.

What Is Fluoride?

Fluoride is a compound of the element fluorine, which can found throughout nature in water, soil, air and food.  By adding fluoride into our drinking water, it can be absorbed easily into tooth enamel, especially in children’s growing teeth, which helps to reduce tooth decay.

Why Is Fluoride Important To Teeth?

Fluoride is absorbed into structures, such as bones and teeth, making them stronger and more resistant to fractures and decay. A process in your body called “remineralization” uses fluoride to repair damage caused by decay.

How Do I Get Fluoride?

Just drinking public water will provide a certain measure of fluoride protection. But for years, health professionals have endorsed the practice of supplementing our intake with certain dietary products, and topical fluorides in many toothpastes and some kinds of rinses. Certain beverages such as tea and soda may also contain fluoride. Certain kinds of dental varnishes and gels may also be applied directly to teeth to boost fluoride intake.

Fluoride Safety

It is generally NOT safe to swallow toothpastes, rinses, or other products containing topical fluoride. In rare cases, some people may be overexposed to high concentrations of fluoride, resulting in a relatively harmless condition called fluorosis, which leaves dark enamel stains on teeth.

Mouth Rinses

The Food and Drug Administration classifies mouth rinses into two categories – therapeutic and cosmetic.

In general, therapeutic rinses with fluoride have been shown to actually fight cavities, plaque and gingivitis.

On the other hand, cosmetic rinses merely treat breath odor, reduce bacteria and/or remove food particles in the mouth. They do nothing to treat or prevent gingivitis.

People who have difficulty brushing (because of physical difficulties such as arthritis) can benefit from a good therapeutic mouth rinse.

Caution: Even rinses that are indicated to treat plaque or cavities are only moderately effective. In fact, regular rinsing with water and use of good quality fluoride toothpaste are just as or more effective.

Sealants

Sealants are liquid coatings that harden on the chewing surfaces of teeth and are showing a great deal of effectiveness in preventing cavities—even on teeth where decay has begun.

The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses these intricate structures on the chewing surfaces of your teeth.

The sealants are applied to the chewing surfaces and are designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of teeth.

Sealants actually were developed about 50 years ago, but didn’t become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants (especially on molars) because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.

Application

Sealants are applied by first cleaning the tooth surface. The procedure is followed by “etching” the tooth with a chemical substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.

X-Rays

When X-rays pass through your mouth during a dental exam, more X-rays are absorbed by the denser parts (such as teeth and bone) than by soft tissues (such as cheeks and gums) before striking the film. This creates an image on the radiograph. Teeth appear lighter because fewer X-rays penetrate to reach the film. Cavities and gum disease appear darker because of more X-ray penetration. The interpretation of these X-rays allows the dentist to safely and accurately detect hidden abnormalities.

How often dental X-rays (radiographs) should be taken depends on the patient`s individual health needs. It is important to recognize that just as each patient is different from the next, so should the scheduling of X-ray exams be individualized for each patient. Your medical and dental history will be reviewed and your mouth examined before a decision is made to take X-rays of your teeth.

The schedule for needing radiographs at recall visits varies according to your age, risk for disease and signs and symptoms. Recent films may be needed to detect new cavities, or to determine the status of gum disease or for evaluation of growth and development. Children may need X-rays more often than adults. This is because their teeth and jaws are still developing and because their teeth are more likely to be affected by tooth decay than those of adults.

Denture Care

Dentures today are made from very advanced materials designed to give you a natural appearance.

However, keep in mind that just like your teeth, dentures should be cared for with the same diligence. This means daily brushing and regular visits to your dentist.

Regular visits to your dentist are critical. Your dentist also can make minor adjustments that ensure that your dentures continue fitting naturally and comfortably.

Just like natural teeth, dentures need to be cleansed of plaque, food particles and other debris. Keeping your dentures in top shape will also help keep the soft tissues of your mouth healthy; an unclean or malformed denture can cause infections and irritation.

Cleaning Techniques

Remember to rinse and brush your dentures after every meal, and soak them in denture solution overnight. This also allows your gums to breathe while you sleep.

Here are some simple techniques for keeping your dentures clean:

  • People can brush their dentures in a variety of ways. Some people use soap and water or a slightly abrasive toothpaste. Popular denture pastes and creams also can be used.
  • Avoid using highly abrasive chemicals or pastes, or vigorously brushing with hard bristled toothbrushes. These can scratch or even crack dentures.
  • Hold your dentures gently to avoid loosening a tooth.
  • Clean your dentures with cool or tepid water over a water-filled sink. Hot water may warp a denture. A small washcloth placed in the bottom of the bowl will ensure that your denture isn’t damaged if it falls.
  • Soak your dentures overnight in any commercially available product like Efferdent or Polident, and remember to rinse your dentures before placing them back in your mouth.
  • Remember to use a separate toothbrush to clean your own natural teeth, as well as all of your gum tissues. In lieu of a toothbrush, a soft washcloth may be used to wipe your gums.

Over time, even daily care of your dentures may require them to be cleaned by the dentist. A powerful ultrasonic cleaner may be used to remove hard accumulations of tartar and other substances.

Emergency Care

A knocked out tooth or bitten tongue can cause panic in any parent, but quick thinking and staying calm are the best ways to approach such common dental emergencies and prevent additional unnecessary damage and costly dental restoration. This includes taking measures such as application of cold compresses to reduce swelling, and of course, contacting our office as soon as possible.

Prevention Tips for Children
Infants

Infants should be seen by our office after the first six months of age, and at least by the child’s first birthday. By this time, the baby’s first teeth, or primary teeth, are beginning to erupt and it is a critical time to spot any problems before they become big concerns.

Conditions like gum irritation and thumb-sucking could create problems later on. Babies who suck their thumbs may be setting the stage for malformed teeth and bite relationships.

Another problem that can be spotted early is a condition called “baby bottle tooth decay,” which is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby’s mouth.

If left untreated, this can lead to premature decay of your baby’s future primary teeth, which can later hamper the proper formation of permanent teeth.

One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Avoid dipping pacifiers in sweet substances such as honey, because this only encourages early decay in the baby’s mouth. Encouraging your young child to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.

Teething, Pacifiers and Thumb-Sucking

Teething is a sign that your child’s gums are sore. This is perfectly normal. You can help relieve this by allowing the baby to suck on a teething ring, or gently rubbing your baby’s gums with the back of a small spoon, a piece of wet gauze, or even your finger.

For babies under the age of 4, teething rings and pacifiers can be safely used to facilitate the child’s oral needs for relieving gum pain and for suckling. After the age of 4, pacifiers are generally discouraged because they may interfere with the development of your child’s teeth.

Moreover, thumb-sucking should be strongly discouraged because it can lead to malformed teeth that become crooked and crowded.

Primary and Permanent Teeth

Every child grows 20 primary teeth, usually by the age of 3. These teeth are gradually replaced by the age of 12 or so with a full set of 28 permanent teeth, and later on, four molars called “wisdom teeth.”

It is essential that a child’s primary teeth are healthy, because their development sets the stage for permanent teeth. If primary teeth become diseased or do not grow in properly, chances are greater that their permanent replacements will suffer the same fate. For example, poorly formed primary teeth that don’t erupt properly could crowd out spaces reserved for other teeth. Space maintainers can sometimes be used to correct this condition, if it is spotted early enough.

Brushing

Babies’ gums and teeth can be gently cleaned with special infant toothbrushes that fit over your finger. Water is suitable in lieu of toothpaste (because the baby may swallow the toothpaste). Parents are advised to avoid fluoride toothpastes on children under the age of 2.

Primary teeth can be cleansed with child-sized, soft-bristled toothbrushes. Remember to use small portions of toothpaste (a pea-sized portion is suitable), and teach your child to spit out, not swallow, the toothpaste when finished.

Fluoride

Fluoride is generally present in most public drinking water systems. If you are unsure about your community’s water and its fluoride content, or learn that it has an unacceptable level of fluoride in it, there are fluoride supplements your dentist can prescribe. Your child may not be getting enough fluoride just by using fluoride toothpaste.

Toothaches

Toothaches can be common in young children. Sometimes, toothaches are caused by erupting teeth, but they also could indicate a serious problem.

You can safely relieve a small child’s toothache without the aid of medication by rinsing the mouth with a solution of warm water and table salt. If the pain doesn’t subside, acetaminophen may be used. If such medications don’t help, contact your dentist immediately.

Injuries

You can help your child prevent oral injuries by closely supervising him during play and not allowing the child to put foreign objects in the mouth.

For younger children involved in physical activities and sports, mouth guards are strongly encouraged, and can prevent a whole host of injuries to the teeth, gums, lips and other oral structures.

Mouth guards are generally small plastic appliances that safely fit around your child’s teeth. Many mouth guards are soft and pliable when opened, and mold to the child’s teeth when first inserted.

If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see our office.  Remember to hold the dislocated tooth by the crown—not the root. If you cannot relocate the tooth, place it in a container of cold milk, saline or the victim’s own saliva. Place the tooth in the solution.

First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.

For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.

If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.

If a child’s primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.

Irritation caused by retainers or braces can sometimes be relieved by placing a tiny piece of cotton or gauze on the tip of the wire or other protruding object. If an injury occurs from a piece of the retainer or braces lodging into a soft tissue, contact our office immediately and avoid dislodging it yourself.

Sealants

Sealants fill in the little ridges on the chewing part of your teeth to protect and seal the tooth from food and plaque. The application is easy to apply and typically last for several years.

Women and Tooth Care

Women have special needs when it comes to their oral health. That’s because the physical changes they undergo through life—menstruation, pregnancy and childbirth, breast-feeding and menopause—cause many changes in the body, some harmful to teeth and gums.

Lesions and ulcers, dry sockets, as well as swollen gums, can sometimes occur during surges in a woman’s hormone levels. These periods would be a prime time to visit the dentist. Birth control pills have been shown to increase the risk of gingivitis, and hormone replacement therapy has been shown to cause bleeding and swollen gums. Gum disease can also present a higher risk for premature births.

Some research has shown that women may be more likely to develop dry mouth, eating disorders, jaw problems such as temporomandibular joint disorders, and facial pain—all of which can be difficult from a physical and emotional standpoint.

Taking care of your mouth with proper oral health care is essential, and can go a long way to helping you face the physical changes in your body over the years.

Seniors and Oral Health

More and more people are avoiding the need for dentures as they grow older, going against the notion that false teeth are a normal part of growing older.

In fact, there’s usually no reason for you NOT to keep your teeth your entire life, providing you maintain a healthy balanced diet and practice good oral hygiene.

Another desirable side effect of good oral hygiene: avoiding more serious problems such as hypertension, cardiovascular disease, diabetes, and even stroke. Indeed, medical research is beginning to show that a healthy mouth equates to a healthy body and a longer life.

Dexterity and Arthritis

People who suffer from arthritis or other problems of dexterity may find it difficult and painful to practice good oral hygiene.

Thankfully, industry has responded with ergonomically designed devices such as toothbrushes and floss holders that make it easier to grasp and control.

You can also use items around the house to help you. Inserting the handle of your toothbrush into a small rubber ball, or extending the handle by attaching a small piece of plastic or Popsicle stick may also do the trick.

Floss can also be tied into a tiny loop on either side, making it easier to grasp and control the floss with your fingers.

Nutrition and Your Teeth

It has long been known that good nutrition and a well-balanced diet is one of the best defenses for your oral health. Providing your body with the right amounts of vitamins and minerals helps your teeth and gums—as well as your immune system—stay strong and ward off infection, decay and disease.

Harmful acids and bacteria in your mouth are left behind from eating foods high in sugar and carbohydrates. These include carbonated beverages, some kinds of fruit juices, and many kinds of starch foods like pasta, bread and cereal.

Children’s Nutrition and Teeth

Good eating habits that begin in early childhood can go a long way to ensuring a lifetime of good oral health.

Children should eat foods rich in calcium and other kinds of minerals, as well as a healthy balance of the essential food groups like vegetables, fruits, dairy products, poultry and meat. Fluoride supplements may be helpful if you live in a community without fluoridated water, but consult with our office first. (Be aware that sugars are even found in some kinds of condiments, as well as fruits and even milk.)

Allowing your children to eat excessive amounts of junk food (starches and sugars)—including potato chips, cookies, crackers, soda, artificial fruit rollups and granola bars—only places them at risk for serious health problems, including obesity, osteoporosis and diabetes. The carbonation found in soda, for example, can actually erode tooth enamel. Encourage your child to use a straw when drinking soda; this will help keep at least some of the carbonated beverage away from the teeth.

Adult Nutrition and Teeth

There’s no discounting the importance of continuing a healthy balanced diet throughout your adult life.

Periodontal Exams

Periodontal exams are vital in the maintenance of your oral health as they are used to assess the health of your gums and teeth. They can help your dentist diagnose gum diseases, gingivitis and periodontitis. These exams can also reveal receding gums, exposed roots, tooth grinding and other problems, making periodontal exams vital to maintaining proper oral health. Regular dental exams are important as they can reveal evidence of gum disease in its early stages.

During your periodontal examination, your dentist will check:

  • For any lumps or abnormal areas in the mouth
  • Whether any of your teeth are missing or loose
  • The color, texture, size and shape of your gums
  • Whether you have fillings, crowns, bridges, dentures or implants
  • How much plaque is on your teeth
  • The depth of the space between your tooth and gum

Gingivitis is the first stage of periodontal disease that causes inflammation of the gums. Dental x-rays can determine if the inflammation has spread to the supporting structures on the teeth so treatment can be started to correct the problem. Periodontitis occurs when gingivitis goes untreated, which makes periodontal exams vital to preventing and putting an end to gum diseases.

Your dentist will complete a periodontal exam with each visit, emphasizing the importance of regular, routine visits to your dentist’s office.

Dental Problems

Treatment of an abscessed tooth

An abscessed tooth is a pocket of pus, usually caused by some kind of infection and the spread of bacteria from the root of the tooth to the tissue just below or near the tooth.

In general, a tooth that has become abscessed is one whose underlying pulp (the tooth’s soft core) has become infected or swollen. The pulp contains nerves, blood vessels and connective tissue, and lies within the tooth. It extends from the crown of the tooth, to the tip of the root, in the bone of the jaws.

An abscessed tooth can be an extremely painful condition.

In some cases, antibiotics are administered in an attempt to kill an infection. If antibiotics are ineffective and an abscess is shown to be damaging the pulp or lower bony structures, a root canal procedure may be needed to remove the dead pulp and restore the tooth to a healthy state.

Bad Breath (halitosis)

Brushing is the most effective method for removing harmful plaque from your teeth and gums. Getting the debris off your teeth and gums in a timely manner prevents bacteria in the food you eat from turning into harmful, cavity causing acids.

Most dentists agree that brushing three times a day is the minimum; if you use a fluoride toothpaste in the morning and before bed at night, you can get away without using toothpaste during the middle of the day. A simple brushing with plain water or rinsing your mouth with water for 30 seconds after lunch will generally do the job.

Brushing techniques

Since everyone’s teeth are different, see me first before choosing a brushing technique. Here are some popular techniques that work:

  • Use a circular motion to brush only two or three teeth at a time, gradually covering the entire mouth.
  • Place your toothbrush next to your teeth at a 45-degree angle and gently brush in a circular motion, not up and down. This kind of motion wears down your tooth structure and can lead to receding gums, or expose the root of your tooth. You should brush all surfaces of your teeth – front, back, top, and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
  • Don’t forget the other surfaces of your mouth that are covered in bacteria – including the gums, the roof and floor of your mouth, and most importantly, your tongue. Brushing your tongue not only removes trapped bacteria and other disease-causing germs, but it also freshens your breath.
  • Remember to replace your brush when the bristles begin to spread because a worn toothbrush will not properly clean your teeth.
  • Effective brushing usually takes about three minutes. Believe it or not, studies have shown that most people rush during tooth brushing.
Flossing

An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have “chronic halitosis,” which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.

Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.

What causes bad breath?

Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth – on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Gum disease is caused by plaque – the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

    • Diabetes – acetone, fruity
    • Liver failure – sweetish, musty
    • Acute rheumatic fever – acid, sweet
    • Lung abscess – foul, putrefactive
    • Blood dyscrasias – resembling decomposed blood
    • Liver cirrhosis – resembling decayed blood
    • Uremia – ammonia or urine
    • Hand-Schuller-Christian disease – fetid breath and unpleasant taste
    • Scurvy – foul breath from stomach inflammation
    • Wegner`s granulomatosis – Necrotic, putrefactive
    • Kidney failure – ammonia or urine
    • Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis – extremely foul, fetid odor
  • Syphilis – fetid

 

Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Caring for bad breath

Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don’t forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue’s surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.

Controlling periodontal disease and maintaining good oral health helps to reduce bad breath.  If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.

If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.

Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.

Bulimia Nervosa

People with eating disorders can suffer from oral health problems as well. This is because many of the behaviors associated with anorexia nervosa and bulimia nervosa—such as binge eating, self-induced vomiting, and use of diuretics or laxatives—cause changes in the mouth.

For example, repeated episodes of vomiting, which is common in people with bulimia, release harmful stomach acids that pass through the mouth and can erode tooth enamel, causing cavities, discoloration and tooth loss.  Other problems, such as poorly fitting fillings and braces, are another byproduct of such eating disorders.

Brushing after episodic vomiting is actually more harmful than one would think. The best practice is to rinse thoroughly with a neutral solution such as baking soda and water.

Canker/Cold Sores

People sometimes confuse canker sores and cold sores, but they are completely unrelated. Both can be painful, but knowing the differences can help you keep them in check.

A canker sore is typically one that occurs on the delicate tissues inside your mouth. It is usually light-colored at its base and can have a red exterior border.

A cold sore or fever blister, on the other hand, usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.

In most cases, patience is the best medicine for treating canker sores. A healthy diet and good oral hygiene are usually the best remedy, but some special rinses and anesthetics can help. Cold sores can be treated effectively with some over-the-counter topical creams; sometimes, an antiviral medication will be prescribed by your doctor.

Cavities and Tooth Decay
What Is Tooth Decay?

Tooth decay is caused by a variety of things; in medical terms, cavities are called caries, which are caused by long-term destructive forces acting on tooth structures such as enamel and the tooth’s inner dentin material.

These destructive forces include frequent exposure to foods rich in sugar and carbohydrates. Soda, candy, ice cream—even milk—are common culprits.  Left inside your mouth from non-brushing and flossing, these materials break down quickly, allowing bacteria to do their dirty work in the form of a harmful, colorless sticky substance called plaque.

The plaque works in concert with leftover food particles in your mouth to form harmful acids that destroy enamel and other tooth structures.

If cavities aren’t treated early enough, they can lead to more serious problems requiring treatments such as root canal therapy.

Preventing Cavities

The best defense against cavities is good oral hygiene, including brushing with a fluoride toothpaste, flossing and rinsing. Your body’s own saliva is also an excellent cavity fighter, because it contains special chemicals that rinse away many harmful materials. Chewing a good sugarless gum will stimulate saliva production between brushing.

Special sealants and varnishes can also be applied to stave off cavities from forming.

If you have any of the following symptoms, you may have a cavity:

  • Unusual sensitivity to hot and cold water or foods.
  • A localized pain in your tooth or near the gum line.
  • Teeth that change color.
Baby Bottle Tooth Decay

Baby bottle tooth decay is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby’s mouth.

If left untreated, this can lead to premature decay of your baby’s future primary teeth, which can later hamper the proper formation of permanent teeth.

One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Encouraging your toddler to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.

Toothaches

Simple toothaches can often be relieved by rinsing the mouth to clear it of debris and other matter. Sometimes, a toothache can be caused or aggravated by a piece of debris lodged between the tooth and another tooth. Avoid placing an aspirin between your tooth and gum to relieve pain, because the dissolving aspirin can actually harm your gum tissue.

Broken, Fractured, or Displaced Tooth

A broken, fractured or displaced tooth is usually not a cause for alarm, as long as decisive, quick action is taken.

If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see your dentist.

First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.

If you cannot locate the tooth back in its socket, hold the dislocated tooth by the crown – not the root. Next, place it in a container of warm milk, saline or the victim’s own saliva and keep it in the solution until you arrive at the emergency room or dentist’s office.

For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.

If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.

If a child’s primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.

Diabetes

People living with diabetes are vulnerable to a host of systemic problems in their entire body. Unfortunately, the mouth and teeth are not immune from such problems, and many diabetics with oral problems go undiagnosed until conditions become advanced.

Infections and other problems such as receding gums and gum disease, or periodontal disease, are common afflictions among diabetics for many reasons; for instance, diabetics often are plagued by diminished saliva production, which can hamper the proper cleansing of cavity-causing debris and bacteria from the mouth. In addition, blood sugar levels that are out of balance could lead to problems that promote cavities and gum disease.

As with any condition, good oral hygiene, including regular brushing, flossing and rinsing, as well as the proper diabetic diet, will go a long way in preventing needless problems.

Dry Mouth

Saliva is one of your body’s natural defenses against plaque because it acts to rinse your mouth of cavity-causing bacteria and other harmful materials. Dry mouth (also called Xerostomia) is a fairly common condition that is caused by diminished saliva production. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Eating foods such as garlic, tobacco use, and some kinds of medications, including treatments such as cancer therapy can diminish the body’s production of saliva, leading to dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems.

Some of the less alarming results of dry mouth include bad breath. But dry mouth can lead to more serious problems, including burning tongue syndrome, a painful condition caused by lack of moisture on the tongue.

If dry mouth isn’t readily apparent, you may experience other conditions that dry mouth can cause, including an overly-sensitive tongue, chronic thirst or even difficulty in speaking.

If you don’t have a medical condition that causes it, dry mouth can be minimized by sipping water regularly, chewing sugarless gum and avoiding smoking. Of course, there is no substitute for regular checkups and good oral hygiene.

Fluorosis

Fluorosis is a condition in which your body has been exposed to too much fluoride. In normal doses (typically found in a safe drinking water system and an ADA-approved toothpaste), fluoride is a healthy compound that promotes strong teeth, which has the ability to fight cavities and other problems.

But sometimes, fluorosis occurs when fluoride-containing toothpastes or rinses are swallowed, instead of expelled.

Fluorosis causes a number of aesthetic problems, including abnormally darkened or stained teeth. While such problems are generally harmless to your health, they can create concerns with your appearance.

Gum Disease (Gingivitis)

Gingivitis is the medical term for early gum disease, or periodontal disease. In general, gum disease can be caused by long-term exposure to plaque, the sticky but colorless film on teeth that forms after eating or sleeping.

Gum disease originates in the gums, where infections form from harmful bacteria and other materials left behind from eating. Early warning signs include chronic bad breath, tender or painful swollen gums and minor bleeding after brushing or flossing. In many cases, however, gingivitis can go unnoticed. The infections can eventually cause the gums to separate from the teeth, creating even greater opportunities for infection and decay.

Although gum disease is the major cause of tooth loss in adults, in many cases it is avoidable.

If gingivitis goes untreated, more serious problems such as abscesses, bone loss or periodontitis can occur.

Periodontitis is treated in a number of ways. One method, called root planing, involved cleaning and scraping below the gum line to smooth the roots. If effective, this procedure helps the gums reattach themselves to the tooth structure.  However, not all instances of scaling and root planing successfully reattach the tooth to the gums.  Additional measures may be needed if the periodontal pockets persist after scaling and root planing

Pregnancy has also been known to cause a form of gingivitis. This has been linked to hormonal changes in the woman’s body that promote plaque production.

Lacerations and Cuts

Any kind of cut to your face and the delicate soft tissues inside your mouth should be addressed immediately in order to prevent further tissue damage and infection.

If a traumatic injury involves a broken facial bone such as the jaw, nose, chin or cheek, maxillofacial surgery may be required.

With jaw surgery, rubber bands, tiny wires, metal braces, screws or plates are often used to keep a fractured jaw in place following surgery. This allows the bone to heal and stay in proper alignment. Dental splints or dentures may also be required to supplement the healing process following jaw surgery.

Oral Cancer

Oral cancer is one of the most common cancers today and has one of the lowest survival rates, with thousands of new cases being reported each year. Fewer than half of all people diagnosed with oral cancer are ever cured.

Moreover, people with many forms of cancer can develop complications—some of them chronic and painful—from their cancer treatment.  These include dry mouth and overly sensitive teeth, as well as accelerated tooth decay.

If oral cancer is not treated in time, it could spread to other facial and neck tissues, leading to disfigurement and pain.

Older adults over the age of 40 (especially men) are most susceptible to developing oral cancer, but people of all ages are at risk.

Oral cancer can occur anywhere in the mouth, but the tongue appears to be the most common location. Other oral structures could include the lips, gums and other soft palate tissues in the mouth.

Warning Signs

In general, early signs of oral cancer usually occur in the form of lumps, patchy areas and lesions, or breaks, in the tissues of the mouth. In many cases, these abnormalities are not painful in the early stages, making even self-diagnosis difficult.

Here are some additional warning signs:

  • Hoarseness or difficulty swallowing.
  • Unusual bleeding or persistent sores in the mouth that won’t heal.
  • Lumps or growths in other nearby areas, such as the throat or neck.

If a tumor is found, surgery will generally be required to remove it. Some facial disfigurement could also result.

Prevention

Prevention is the key to staving off oral cancer. One of the biggest culprits is tobacco and alcohol use. Certain kinds of foods and even overexposure to the sun have also been linked to oral cancer. Some experts believe certain oral cancer risk factors are also hereditary.

A diet rich in fruits and vegetables is one of the best defenses against oral cancer. Maintaining good oral hygiene, and regular dental checkups, are highly recommended.

Plaque

Plaque is a film of bacteria that forms on your teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods such as bread, crackers, and cereal.

Tooth decay, commonly known as cavities, occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to ‘eat away’ at the surfaces of your teeth and gums.  Ironically, the areas surrounding restored portions of teeth (where fillings, or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.

Plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque. This gradual degeneration can often cause gums to pull away from teeth. This condition is called receding gums.

Long-term plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.

Sensitive Teeth

If you wince with pain after sipping a hot cup of coffee or chewing a piece of ice, chances are that you suffer from “dentin hypersensitivity,” or more commonly, sensitive teeth.

Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits.

At least 45 million adults in the United States suffer at some time from sensitive teeth.

Sensitive teeth result when the underlying layer of your teeth (the dentin) becomes exposed. This can happen on the chewing surface of the tooth as well as at the gum line. In some cases, sensitive teeth are the result of gum disease, years of unconsciously clenching or grinding your teeth, or improper or too vigorous brushing (if the bristles of your toothbrush are pointing in multiple directions, you’re brushing too hard).

Abrasive toothpastes are sometimes the culprit of sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes, may increase tooth sensitivity.

In some cases, desensitizing toothpaste, sealants, desensitizing ionization and filling materials including fluoride, and decreasing the intake of acid-containing foods can alleviate some of the pain associated with sensitive teeth.

Sometimes, a sensitive tooth may be confused by a patient for a cavity or abscess that is not yet visible.

In any case, contact your dentist if you notice any change in your teeth’s sensitivity to temperature.

Teeth Grinding (Bruxism)

Teeth grinding, also called bruxism, is often viewed as a harmless, though annoying, habit. Some people develop bruxism from an inability to deal with stress or anxiety.

However, teeth grinding can literally transform your bite relationship and worse, severely damage your teeth and jaws over long periods of time.

Teeth grinding can cause abrasion to the chewing surfaces of your teeth. This abnormal wear and tear will prematurely age and loosen your teeth, and open them to problems such as hypersensitivity (from the small cracks that form, exposing your dentin). Bruxism can also lead to chronic jaw and facial pain, as well as headaches.

If no one has told you that you grind your teeth, here are a few clues that you may suffer from bruxism:

  • Your jaw is often sore, or you hear popping sounds when you open and close your mouth.
  • Your teeth look abnormally short or worn down.
  • You notice small dents in your tongue.

Bruxism is somewhat treatable. A common therapy involves use of a special appliance worn while sleeping. Less intrusive, though just as effective methods could involve biofeedback, and behavior modification, such as tongue exercises and learning how to properly align your tongue, teeth and lips.

Jaw Disorders

People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth. One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.

People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.

Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.

Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint.

Treatment

Braces (Orthodontia)

Braces are applied to teeth for various reasons, including poorly aligned jaws, crooked, crowded and missing teeth, or a bad bite (also called malocclusion).

Various things can cause teeth to become crooked or jaws misaligned, including thumb-sucking or a traumatic injury. Some conditions are inherited.

Children between the ages of 7 and 14 are typical candidates for braces because their facial structures are still developing. Adult braces usually entail additional procedures because their faces have already fully developed.

About Braces

Orthodontics is a field of dentistry that deals with corrections involving jaw and teeth alignment.

Braces employ the use of wires and are usually one of three types:

  • Old-fashioned, conventional braces, which employ the use of metal strips, or bands.
  • Metal or plastic brackets that are cemented or bonded to teeth.
  • Brackets that attach to the back teeth (also called lingual braces).
Procedures

Orthodontic procedures, also called orthodontia, are complex processes.

In most cases, a dentist will need to make a plaster cast of the individual’s teeth and perform full X-rays of the head and mouth.

After orthodontic appliances are placed, they need to be adjusted from time to time to ensure that they continue to move the teeth into their correct position.

Retainers are used following braces to ensure that teeth remain in position.

Aesthetic and Comfort Issues

Advances in technology have vastly improved appearance issues with orthodontia.

Braces today are made from extremely lightweight and natural-colored materials. The materials that braces attach to-brackets-are bonded to the surfaces of teeth but can be later removed.

People can expect to wear braces for about two years—less or more in some cases. Adults are usually required to wear braces for longer periods of time.

Because orthodontic appliances need to be adjusted from time to time to ensure they continue to move the teeth into their correct position, they can create pressure on the teeth and jaws. This mild discomfort usually subsides following each orthodontia adjustment.

Hygiene issues

People who wear braces must be diligent in ensuring that food particles and other debris do not get trapped in the network of brackets and wires. In addition, brackets can leave stains on enamel if the area surrounding them is not cleaned on a daily basis.

Daily oral hygiene such as brushing, flossing and rinsing are a necessity. Some people with orthodontic appliances can benefit from using water picks, which emit small pressurized bursts of water that can effectively rinse away such debris.

Another caveat: Braces and sticky foods don’t mix. Crunchy snacks and chewy substances should be avoided at all costs because they can cause orthodontia to be loosened or damaged.

Space Maintainers

Space maintainers are helpful dental devices that can help teeth grow in normally following premature tooth loss, injury or other problems.

The devices can help ensure that proper spaces are maintained to allow future permanent teeth to erupt.

If your child loses a baby tooth early through decay or injury, his or her other teeth could shift and begin to fill the vacant space. When your child’s permanent teeth emerge, there’s not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.

Sealants

The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses some of these intricate structures on the chewing surfaces of your teeth.

Enter sealants, which are thin coatings applied to the chewing surfaces designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of your teeth.

Sealants actually were developed about 50 years ago, but didn’t become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.

Sealants are applied by first cleaning the tooth surface. The procedure is followed by etching the tooth with an abrasive substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.

Missing Teeth

Fixed bridges and implants are often used to replace missing teeth and to correct some kinds of bite problems.

Crowns and bridges are the most effective procedure for replacing missing teeth or bite problems.

Bridges

Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.

There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges.  Some bridges are removable and can be cleaned by the wearer; others need to be removed by a dentist.

Porcelain, gold alloys or combinations of materials are usually used to make bridge appliances.

Appliances called implant bridges are attached to an area below the gum tissue, or the bone.

Crowns

Crowns are synthetic caps, usually made of a material like porcelain, placed on the top of a tooth.

Crowns are typically used to restore a tooth’s function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth must usually be reduced in size to accommodate a crown. A cast is made of the existing tooth and an impression is made. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.

Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.

Caring For Your Crowns

With proper care, a good quality crown could last up to eight years or longer. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.

Certain behaviors such as jaw clenching or bruxism (teeth grinding) significantly shorten the life of a crown. Moreover, eating brittle foods, ice or hard candy can compromise the adhesion of the crown, or even damage the crown.

Root Canal Therapy

Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root.

All teeth have between one and four root canals.

Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.

A diseased inner tooth brings a host of problems including pain and sensitivity as the first indications of a problem.  However, inside a spreading infection can cause small pockets of pus to develop, which can lead to an abscess.

Root canal therapy is a remarkable treatment with a very high rate of success, and involves removing the diseased tissue, halting the spread of infection and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.

Procedure

Root canal therapy usually entails one to three visits. During the first visit, a small hole is drilled through the top of the tooth and into the inner chamber. Diseased tissue is removed, the inner chamber cleansed and disinfected, and the tiny canals reshaped. The cleansed chamber and canals are filled with an elastic material and medication designed to prevent infection. If necessary, the drilled hole is temporarily filled until a permanent seal is made with a crown.

Most patients who have root canal experience little or no discomfort or pain, and enjoy a restored tooth that can last almost as long as its healthy original.

Extractions
General Procedure

When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, it may need to be pulled, or extracted.

Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has tooth pulled experiences little or no discomfort, and only minor bleeding.

Before a tooth is extracted, the area surrounding the tooth is numbed with a topical/and or injectable anesthetic such as Novocaine.

Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn’t occur.

Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.

Wisdom Teeth

Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.

If wisdom teeth are causing a problem, this could mean that they are impacted.  Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: severe discomfort, inflammation, and some kinds of infections.

Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one’s ability to properly bite down, speak or eat.

If you experience any of the following symptoms, you may have an impacted wisdom tooth:

  • Facial swelling
  • Infection
  • Pain
  • Gum swelling
Scaling and Root Planing

Some cases of acute periodontal (gum) disease that do not respond to more conventional treatment and self-care such as flossing may require a special kind of cleaning called scaling and root planing.

The procedure begins with administration of a local anesthetic to reduce any discomfort. Then, a small instrument called a “scaler,” or an ultrasonic cleaner, is used to clean beneath your gum line to remove plaque and tartar.

The root surfaces on the tooth are then planed and smoothed. If effective, scaling and root planing helps the gums reattach themselves to the tooth structure.  Additional measures may be needed if the periodontal pockets persist after scaling and root planing.

Flap Surgery

Your bone and gum tissue should fit snugly around your teeth like a turtleneck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to thrive and wreak havoc.

As bacteria accumulate and advance under the gum tissue in these deep pockets, additional bone and tissue loss follows. Eventually, if too much bone is lost, the teeth will need to be extracted.

Flap surgery is sometimes performed to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for you or your dental professional to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.

A pocket reduction procedure is recommended if daily at-home oral hygiene and a professional care routine cannot effectively reach these deep pockets.

In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Dentures

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.

Types of dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called “conventional” or “immediate” according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient`s jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Partials with precision attachments generally cost more than those with metal clasps.

How are dentures made?

The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a “try-in” is placed to assure proper color, shape and fit; and the patient`s final denture is placed, following any minor adjustments.

First, an impression of your jaw is made using special materials. In addition, measurements are made to show how your jaws relate to one another and how much space is between them (bite relationship). The color or shade of your natural teeth will also be determined. The impression, bite and shade are given to the dental laboratory so a denture can be custom-made for your mouth.

The dental laboratory makes a mold or model of your jaw, places the teeth in a wax base, and carves the wax to the exact form wanted in the finished denture. Usually a “wax try-in” of the denture will be done at the dentist`s office so any adjustments can be done before the denture is completed.

The denture is completed at the dental laboratory using the “lost wax” technique. A mold of the wax-up denture is made, the wax is removed and the remaining space is filled with pink plastic in dough form. The mold is then heated to harden the plastic. The denture is then polished and ready for wear.

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Your denture should easily fit into place. Never force the partial denture into position by biting down. This could bend or break the clasps.

At first, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your denture can be adjusted to fit more comfortably. After making adjustments, you may need to take the denture out of your mouth before going to bed and replace it in the morning.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum.

Care of your denture

It’s best to stand over a folded towel or a sink of water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance. Pay special attention to cleaning teeth that fit under the denture`s metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay.

Hand soap or mild dishwashing liquid to clean dentures is also acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution.

Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.

Adjustments

Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over the counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear.

Common concerns

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing.

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures “click” while you`re talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.

Jaw/TMJ

People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth.

One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.

People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.

Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.

Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint. Traumatic injuries also can cause jaw dislocation.

In these cases, jaw surgery may be required to correct the condition. Some jaw surgery can be performed arthroscopically.

Maxillofacial Surgery

When facial reconstruction, including procedures involving the oral cavity, is called for, a specialist is needed. Surgical procedures of the neck and head area are performed by a maxillofacial surgeon.

Common maxillofacial procedures include denture-related procedures and jaw surgery.

Jaw Correction

Protruding chins, crooked or buck teeth or misaligned teeth are good candidates for maxillofacial surgery.

In some people, jaws do not grow at the same rate; one may come in larger than the other, or simply not be aligned properly with other bony structures in the skull. This can cause problems other than appearance issues; an improperly aligned jaw can cause problems with the tongue and lips, and speech and chewing problems as well. Jaw surgery can move jaws into their proper place.

Other kinds of maxillofacial surgery can correct problems with upper facial features such as the nose and cheek.

In addition to correcting jaw problems surgically, orthodontic appliances such as braces may be needed to restore bite relationship and ensure continued proper alignment of the jaw. In some cases, tiny wires or small rubber bands may be needed to keep the jaws in place and promote faster healing. In other cases, small “fixation” screws or plates may need to be inserted in the jaws to facilitate easy movement of the jaws following surgery.

Denture Fatigue

People who have worn dentures for a long time can sometimes experience loss of gum tissue and even bone, mostly from the wear and tear of the appliance on the soft tissues of their mouth.

In extreme cases, maxillofacial surgery, including bone grafts, manipulation of soft tissues or even jaw realignment, may be performed to correct such problems.

Cosmetic Dentistry
Overview

People choose esthetic dental procedures/surgery for various reasons—to repair a defect such as a malformed bite or crooked teeth, treat an injury, or just improve their overall appearance.  Whatever the reason, the ultimate goal is to restore a beautiful smile.

For these and many other reasons, esthetic dentistry has become a vital and important part of the dental profession.

Common esthetic dental procedures can be performed to correct misshaped, discolored, chipped or missing teeth. They also can be used to change the overall shape of teeth—from teeth that are too long or short, have gaps, or simply need to be reshaped.

Some of the more common procedures involve:

  • Bonding – A procedure in which tooth-colored material is used to close gaps or change tooth color.
  • Contouring and reshaping – A procedure that straightens crooked, chipped, cracked or overlapping teeth.
  • Veneers – A procedure in which ultra-thin coatings are placed over the front teeth. Veneers can change the color or shape of your teeth. For example, veneers have been used to correct unevenly spaced, crooked, chipped, oddly shaped or discolored teeth.
  • Whitening and bleaching – As the term implies, whitening and bleaching, a rapidly increasing procedure, are used to make teeth whiter.

Which techniques should be used to improve your smile? A dental exam will take many factors into consideration, including your overall oral health.

Pain Management

Overview

Pain can occur in any number of places in your mouth: teeth, gums, roots, the palate, tongue and jaw.

Cavities are a common culprit causing pain. Untreated cavities can impact nerves because of infections of the tooth and gums. Impacted and abscessed teeth and sore jaws from teeth grinding are other common causes of pain.

Improper bite relationships and jaw disorders can also cause pain. Other sources of pain include sleep disorders, and headaches and neck aches.

Special splints can sometimes be applied to stabilize a bite. Bites can also be corrected with special orthodontic procedures, appliances and restoration techniques.

Managing Pain

There are many methods for relieving oral pain. They include:

  • Ice packs on the affected area.
  • Avoiding hard candy or ice.
  • Avoiding sleeping on your stomach.

Dentists use a wide array of pain management tools, including:

  • Anesthetics such as Novocaine.
  • Analgesics such as aspirin or ibuprofen.
  • Sedatives, including a procedure known as “conscious sedation” or general sedation (also known as “deep sedation”).
Anesthesia

Dentistry has advanced to the point in which pain is almost a thing of the past.

Powerful pain-killing medications known as anesthetics not only help a patient avoid discomfort during a procedure, but post-operatively as well.

Some patients, especially children, may require higher doses of anesthetic than others.

Types of pain-killing medications include:

  • Analgesics – These are also called pain relievers and include common non-narcotic medications such as ibuprofen and aspirin. Analgesics are usually used for mild cases of discomfort, and are typically prescribed following such procedures as a root canal or tooth extraction.
  • Anesthetics – Anesthetics can either be topically applied, injected or swallowed. Dentists often apply topical anesthetics with a cotton swab to an area of the mouth where a procedure such as a restoration will be performed. This numbs the affected area. Topical anesthetics are used in many dental procedures such as tooth restoration. Topical anesthetics also are used to prepare an area for injection of an anesthetic. Novocaine and Lidocaine are the most common kind of injectable anesthetics. Such medications block the nerves from transmitting signals and are used for more major types of procedures, such as fillings and root canals.
  • Sedatives – Sedatives are medications designed to help a patient relax. This can be a powerful tool in avoiding pain. Sedatives are sometimes used in combination with other types of pain relievers and pain-killers. Nitrous oxide, or laughing gas, is a form of sedative. Conscious sedation involves administering a sedative while the patient is alert and awake. Deep sedation or general anesthesia involves administering a medication that places a patient in a state of monitored and controlled unconsciousness.

Types of sedatives include:

  • Intravenous (IV) sedation – Usually in the form of a tranquilizing agent; patients given IV sedation are often awake, but very relaxed.
  • Inhalation sedation – a form of sedation in which nitrous oxide is administered through a special mask.
Air Abrasion

Many people associate the high-pitched whirring of a dental drill with pain. Just the sound alone can make many people wince.

A relatively new technique called air abrasion uses powerful particles of aluminum oxide to remove debris and decay. The most exciting thing for patients is that air abrasion is painless and, in some cases, doesn’t require an anesthetic.

Air abrasion leaves behind a gritty feeling in your mouth, which is simply rinsed away almost instantaneously using a small suction device.

Tiny cracks and imperfections on a tooth can be fixed using air abrasion. Although air abrasion is not suitable for work on crowns and bridges, it is often used for bonding procedures, and on tooth restorations involving composite, or tooth-colored fillings.

Medications

Some dental procedures, such as tooth extractions and oral surgery, may call for our office to prescribe medications before or after a procedure. These medications are used to prevent or fight an infection, or to relieve any post-operative discomfort and pain.

For these reasons, it is extremely important that you share your entire medical history – including any medications you are currently taking – with our office. Some medications used in dentistry, and other medical practices, could interact with those medications in a detrimental way.  In addition, if you have any allergic reactions to certain medications, it is important for our office to know beforehand.

Finally, if you are prescribed any medication by our office, follow the dosage instructions very carefully, and if instructed, finish your entire prescription even if you are no longer feeling pain.

Patient Information

Your First Dental Visit

Your first dental visit promises to be a pleasant experience.

Making sound decisions about your dental care and oral health is an easy thing to do with the right preparation beforehand:

  • Make a list of questions to ask our office, so you don’t forget anything on the day of your appointment. This includes any concerns you have, or oral problems you’ve been experiencing.
  • If you have dental insurance, remember to bring your insurance card with you.
Dental Emergencies

A knocked out tooth or bitten tongue can cause panic in any parent, but quick thinking and staying calm are the best ways to approach such common dental emergencies and prevent additional unnecessary damage and costly dental restoration. This includes taking measures such as application of cold compresses to reduce swelling, and of course, contacting our office as soon as possible.

Product Reviews

Oral Health Products

Visit any pharmacy or the health and beauty section of a supermarket today, and you are faced with a large, and many say confusing, array of over-the-counter remedies and devices designed to help you tend to your hygiene and health-care needs.

There are many high-quality products on the market today. There also are many products of dubious value.

Whatever over-the-counter dental product you buy, it is strongly advised that you ensure it has the American Dental Association’s Seal of Acceptance.

Over-the-counter dental instruments are fraught with danger. These include scaling devices and picks. Use of the products, even when following the instructions, can put your teeth and the soft tissue of your mouth at risk of tearing, bruising and other injury. You also may accidentally chip a tooth.

It is best to consult our office instead of trying to do a repair job yourself.

Choosing a Toothbrush

Never before has there been such a dizzying array of toothbrushes on the market. Consumers are inundated with new designs, materials, attachments, and colors. Whatever toothbrush design you choose, the most important thing is that you use the toothbrush at least 2-3 times a day. Moreover, how long you spend brushing your teeth is as critical as how often you brush.  This ensures complete plaque removal in hard to reach areas.

Mechanical and manual toothbrushes

Our dental team highly recommends a mechanical (electric) toothbrush. The pulsations break up plaque efficiently. Many models now have timers to remind you to brush longer.

It is always nice to have a backup manual toothbrush. When choosing a manual toothbrush, look for a compact head with very soft, rounded bristles.

Types of Floss

Dental floss comes in a variety of colors, materials and even flavors. Waxed varieties slide through the teeth, allowing people with extremely tight spaces to floss more easily. Popular flavors of floss include wintergreen and cinnamon. Waxed floss does tend to fray more than unwaxed floss.

A type of material called dental tape can be effective for people with large spaces between their teeth, or for people with bridge work.

Floss can be purchased in small self-dispensing boxes. Floss can also be purchased in special, single-use holders, which are useful for people who have a hard time wrapping floss around their fingers, including those with dexterity problems or arthritis.

Water Picks

There is never a suitable substitute for daily brushing and flossing.

While some products, including water irrigation devices (or “water picks”), may be useful for specific applications, they may not be as effective as traditional flossing in the removal of plaque.

Water picks use powerful tiny bursts of water to blast away food particles and other debris in hard-to-reach areas of your mouth. Dentists use professional-grade water picks when preparing a tooth for restoration, or in general cleaning and exams.

People with painful gum disease or highly sensitive gums may find water picks useful for supplementing their brushing regimen. People with orthodontia, including braces, have found water picks quite useful because toothbrush bristles often get stuck.

Mouth Guards

Anyone who participates in a sport that carries a significant risk of injury should wear a mouth protector. Sports like basketball, baseball, gymnastics, and volleyball all pose risks to your gum tissues, as well as your teeth. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.

A helmet can prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by helping to avoid situations where the lower jaw gets jammed into the upper jaw.   Mouth guards are effective in moving soft tissue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks, especially for those who wear orthodontic appliances.

Mouth protectors, which typically cover the upper teeth, can cushion a blow to the face, minimizing the risk of broken teeth and injuries to the soft tissues of the mouth. If you wear braces or another fixed dental appliance on your lower jaw, a mouth protector is available for these teeth as well.

A properly fitted mouth protector may be especially important for people who wear braces or have fixed bridge work. A blow to the face could damage the brackets or other fixed orthodontic appliances. A mouth protector also provides a barrier between the braces and your cheek or lips, limiting the risk of soft tissue injuries. Although mouth protectors typically only cover the upper teeth, your dentist or orthodontist may suggest that you use a mouth protector on the lower teeth if you have braces on these teeth too. If you have a retainer or other removable appliance, do not wear it during any contact sports.

Types of mouth guards

There are three types of mouth protectors:

  • Stock – Inexpensive and come pre-formed, ready to wear. Unfortunately, they often don’t fit very well. They can be bulky and can make breathing and talking difficult.
  • Boil and bite – Can be bought at many sporting goods stores and may offer a better fit than stock mouth protectors. They should be softened in water, then inserted and allowed to adapt to the shape of your mouth. If you don’t follow the directions carefully you can wind up with a poor-fitting mouth protector.
  • Custom-fitted – Made by your dentist for you personally. They are more expensive than the other versions, but because they are customized, they can offer a better fit than anything you can buy off the shelf.

Glossary

A

Amalgam – Material made from mercury and other alloy mixtures used to restore a drilled portion of a tooth.
Anesthesia – Medications used to relieve pain.
Anterior teeth – Front teeth. Also called incisors and cuspids.
Arch – The upper or lower jaw.

B

Baby bottle tooth decay – Caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby’s mouth.
Bicuspids -A premolar tooth; tooth with two cusps, which are pointed or rounded eminences on or near the masticating surface of a tooth.
Bitewings – X-rays that help a dentist diagnose cavities.
Bonding – Application of tooth-colored resin materials to the surface of the teeth.
Bridge – A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements.
Bruxism – Teeth grinding.

C

Calculus – A hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.
Canal – The narrow chamber inside the tooth’s root.
Canines – Also called cuspids.
Canker sore – One that occurs on the delicate tissues inside your mouth. A canker sore is usually light-colored at its base and can have a red exterior border.
Caries – A commonly used term for tooth decay, or cavities.
Cold sore – Usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.
Composite filling – Tooth colored restorations, also known as resin fillings.
Composite resin – A tooth colored resin combined with silica or porcelain and used as a restoration material.
Contouring – The process of reshaping teeth.
Crown – An artificial tooth replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure. It is also placed on a dental implant.
Cusps – The pointed parts on top of the back teeth’s chewing surface.
Cuspids – Front teeth that typically have a protruding edge.

D

Dentin – The tooth layer underneath the enamel.
Denture – A removable set of teeth.

E

Endodontics – A form of dentistry that addresses problems affecting the tooth’s root or nerve.

F

Fluoride – A harmless over-exposure to fluoride resulting in tooth discoloration.
Fluorosis – A harmless over-exposure to fluoride and resulting sometimes in tooth discoloration.

G

Gingiva – Another word for gum tissue.
Gingivitis – A minor disease of the gums caused by plaque.
Gum disease – An infection of the gum tissues. Also called periodontal disease.

I

Impacted teeth – A condition in which a tooth fails to erupt or only partially erupts.
Implant – A permanent appliance used to replace a missing tooth.
Incisor – Front teeth with cutting edges; located in the center or on the sides near the front.
Inlay – An artificial filling made of various materials, including porcelain, resin, or gold.

L

Laminate veneer – A shell that is bonded to the enamel of a front tooth. The shell is usually thin and made from porcelain resin.

M

Malocclusion – Bad bite relationship.
Mandible – The lower jaw.
Maxilla – The upper jaw.
Molar – Usually the largest teeth, near the rear of the mouth. Molars have large chewing surfaces.

N

Neuromuscular Dentistry – Addresses more than the aches and pains felt in and around the neck and head that are associated with your teeth and jaw.

O

Onlay – A filling designed to protect the chewing surface of a tooth.
Orthodontics – A field of dentistry that deals with tooth and jaw alignment.
Overdenture – A non-fixed dental appliance applied to a small number of natural teeth or implants.

P

Palate – Roof of the mouth.
Partial denture – A removable appliance that replaces missing teeth.
Pediatric Dentistry – A field of dentistry that deals with children’s teeth
Perio pocket – An opening formed by receding gums.
Periodontal disease – Infection of the gum tissues. Also called gum disease.
Periodontist – A dentist who treats diseases of the gums.
Permanent teeth – The teeth that erupt after primary teeth. Also called adult teeth.
Plaque – A sticky, colorless substance that covers the teeth after sleep or periods between brushing.
Posterior teeth – The bicuspids and molars. Also called the back teeth.
Primary teeth – A person’s first set of teeth. Also called baby teeth or temporary teeth.
Prophylaxis – The act of cleaning the teeth.
Prosthodontics – The field of dentistry that deals with artificial dental appliances.
Pulp – The inner tissues of the tooth containing blood, nerves and connective tissue.

R

Receding gum – A condition in which the gums separate from the tooth, allowing bacteria and other substances to attack the tooth’s enamel and surrounding bone.
Resin filling – An artificial filling used to restore teeth. Also called a composite filling.
Root canal – A procedure in which a tooth’s nerve is removed and an inner canal cleansed and later filled.
Root planing – Scraping or cleansing of teeth to remove heavy buildup of tartar below the gum line.

S

Sealant – A synthetic material placed on the tooth’s surface that protects the enamel and chewing surfaces.

T

TMJ – Temporomandibular joint disorder. Health problems related to the jaw joint just in front of the ear.
Tarter – A hardened substance (also called calculus) that sticks to the tooth’s surface.

W

Whitening – A process that employs special bleaching agents for restoring the color of teeth.
Wisdom tooth – Third set of molars that erupt last in adolescence.

V

Veneer – A laminate applied or bonded to the tooth.

New Patient

During the first visit, we make sure to obtain important background information and give you time to get to know your doctor.

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