Early Childhood Tooth Decay-Is Your Child At Risk?

Glossary of Terms

How Can You Brighten Your Smile?

Improving Your Smile

What Are Porcelain Veneers?

What Is A Composite Resin (White Filling)?

What Is A Dental Emergency?

What Is A Dental Implant?

What Is A Root Canal?

What Is A Sealant?

What is Bruxism?

What Is Gum Disease?

What Is Halitosis?

Why Do I Need X-rays?

 

Early Childhood Tooth Decay - Is Your Child At Risk?
 

The average healthy adult visits the dentist twice a year. The average healthy two-year-old has never been to the dentist. By kindergarten, twenty-five percent of children have never seen a dentist, yet according to the Surgeon General's Oral Health Report 2000, dental decay is the single most common chronic childhood disease in America.

The culprit? A combination of misinformation about when a child should first visit the dentist, when a parent should start caring for a child's teeth and the frequent and long-term exposure of sugary liquids to a child's teeth.

The Academy of General Dentistry recommends a child first visit the dentist six months after the eruption of the first tooth. During this first exam, the dentist can teach parents the best way to guard against early childhood tooth decay by wiping down the teeth with a damp cloth once a day and remind parents to limit sugary beverages.

Frequent and long-term exposure of a child's teeth to sugary liquids is commonly called baby bottle tooth decay. Most parents and dentists are aware of baby bottle tooth decay however, may not know that the long-term and regular consumption of sugary liquids in a bottle or cup puts children's growing teeth at increased risk for decay.

According to the American Academy of Pediatrics, fruit juice causes tooth decay if children are allowed to hold a bottle, cup or box of juice in their mouth through the day.

If left untreated, baby bottle tooth decay can result in pain and infection. Baby teeth are important because they hold the place for permanent teeth and help guide them into correct position. Severely decayed teeth may need to be extracted which could effect the development of permanent teeth, a child's speech and chewing.

Caring for children's teeth beginning in infancy promotes good oral health care habits for a lifetime and increases the chances of a child maintaining healthy permanent teeth.

Tips for Parents to Decrease the Risk of Early Childhood Tooth Decay:

     
    
  • When a child from the bottle or breast by age one.
     
  • Use spill-proof cups as a transitional step in the development of children, not a long-term solution.
     
  • Don't allow children to use spill-proof cups throughout the day. Save spill-proof cups for snack and mealtimes when increased salivary activity helps clean teeth.
     
  • Drink sugary beverages through a straw. The best spill-proof cups to protect against decay are those with collapsible rubber straws.
     
  • Introduce oral health care habits early. Wipe children's teeth with a damp cloth once a day. Introduce brushing with a soft-bristle brush and fluoridated toothpaste by age two under the supervision of a parent.

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    How Can You Brighten Your Smile?

    Your wedding is coming up and you want your smile to be it’s brightest. Or maybe you have an important speaking engagement. Whatever the reason, tooth bleaching isn't just for the movie stars, and it isn't just for one day. Many people have had their teeth bleached, and probably millions more are thinking about it. The desire for a brighter smile with whiter teeth is very strong, and tooth bleaching safely lightens the color of the teeth, lasting for up to five years. The most effective and safest method of tooth bleaching is dentist-supervised.
                                                     


    Is bleaching for you?

    Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by fluorosis, smoking or tetracycline are lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

    What's involved?
    First, the dentist will determine whether you are a candidate for tooth bleaching and what type of bleaching system would provide the best results.

    If you're in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. We will use either an in-office bleaching system or laser bleaching while you sit in the dental chair. However, most patients choose dentist-supervised at-home bleaching, which is more economical and provides the same results.

    At the next appointment if you don't choose laser bleaching, the dentist or hygienist will make impressions of your teeth to fabricate a mouth guard appliance for you. The mouth guard is custom made for your mouth and is lightweight so that it can be worn comfortably while you are awake or sleeping. The mouth guard is so thin that you should even be able to talk and work while wearing your mouth guard. Along with the mouth guard, you'll receive the bleaching materials. You'll be given instructions on how to wear the mouth guard.

    Some bleaching systems recommend bleaching your teeth from two to four hours a day. Other systems recommend bleaching at night while you sleep. This type of system usually requires only 10-14 days to complete.

    How long does it last?
    Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea. At this point you may choose to get a touch up. This procedure may not be as costly because you can probably still use the same mouth guard. The retreatment time also is much shorter than the original treatment time.

    How does it work?
    The active ingredient in most of the whitening agents is carbamide peroxide (CH4N2O2), also known as urea peroxide; when water contacts this white crystal, the release of hydrogen peroxide lightens the teeth.

    Is it safe? Any side effects?
    Several studies, during the past five years, have proven bleaching to be safe and effective. The American Dental Association has granted its seal of approval to some tooth bleaching products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

    What are realistic expectations?
    No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement as seen on a dentist's shade guide. The success rate depends upon the type of stain involved and your compliance. Bleaching can only provide a shift in color from gray to a lighter shade of gray, for example. Bleaching does not lighten artificial materials such as resins, silicants, or porcelains.

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    Improving Your Smile

    Can we improve my smile?
    From subtle changes to major repairs, we can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discolored, chipped, misshapen or missing. We can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include bleaching, bonding, caps, crowns, veneers, and reshaping and contouring.

    These improvements are not always cosmetic. Many of these treatments can improve oral problems, such as your bite.

    Bleaching
    Bleaching is a common and popular chemical process used to whiten teeth. Some people get their teeth bleached to make stains disappear, while other just want a whiter shade.

    Discoloration occurs in the enamel and can be caused by medication, coffee, tea and cigarettes. Discoloration also can be caused by your genetic make-up or simply getting older.

    Bleaching can be performed in our office or at home. Many patients enjoy bleaching at home because it is more convenient. Treatment begins when we create a custom mouthpiece to ensure the correct amount of whitening solution-10 percent to 20 percent carbamide peroxide-is used and that your teeth are properly exposed. Typically, whitening at home takes two or three weeks, depending on the desired shade you wish to achieve.

    Bonding
    Bonding is tooth-colored material used to fill in gaps or change the color of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities and broken or chipped surfaces. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape.

    Veneers
    Veneers are placed over the front teeth to change color or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth. Little or no anesthesia is needed. Veneers are used to treat some of the same problems as bonding.

    This treatment is an alternative to crowns, which are more expensive. The procedure requires your dentist to take an impression of your tooth. Before the custom-made veneer is glued directly onto the tooth, your dentist will lightly buff the tooth to compensate for the added thickness of the veneer. Once the cement is between the veneer and your tooth, a light beam is used to harden it. Porcelain veneers require more than one visit because they are fabricated in a laboratory. Veneers have a longer life expectancy and color stability than bonding.

    Contouring and reshaping
    Tooth reshaping and contouring, is a procedure to correct crooked teeth, chipped teeth, cracked teeth or even overlapping teeth in a single session. Tooth reshaping and dental contouring, is commonly used to alter the length, shape or position of your teeth. Contouring teeth may also help correct small problems with bite. It is common for bonding to be combined with tooth reshaping.

    This procedure is ideal for candidates with normal healthy teeth, but who want subtle changes to their smile. Your dentist will take X-rays to evaluate the size and location of the pulp of each tooth to ensure that there's enough bone between the teeth to support them.

    Which procedure is right for me?
    We can answer many of the questions you may have about techniques used to improve your smile. The condition of your teeth and desired result you want often dictates the best procedure. If you are considering a treatment, there are a few questions you can ask us before deciding if a particular procedure is right for you.

    • What will the changes look like?
    • What should I expect through the course of treatment?
    • What type of maintenance will be required?

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    What Are Porcelain Veneers?

    Porcelain veneers are ultra-thin shells of ceramic material, which are bonded to the front of teeth. This procedure requires little or no anesthesia, and can be the ideal choice for improving the appearance of the front teeth. Porcelain veneers are placed to mask discolorations, to brighten teeth, and to improve a smile. Highly resistant to permanent staining from coffee, tea, or even cigarette smoking, the wafer-thin porcelain veneers can achieve a tenacious bond to the tooth, resulting in an esthetically pleasing naturalness that is unsurpassed by other restorative options.

    Why a porcelain veneer?
    Porcelain veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth's color, size, or shape. Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.

    What happens during the procedure?
    Patients need three appointments for the entire procedure: diagnosis and treatment planning, preparation, and bonding.

    Diagnosis and treatment planning: It's critical that you take an active role in the smile design. Spend time in the decision-making and planning of the smile. Understand the corrective limitations of the procedure. Have more than one consultation, if necessary, to feel comfortable that we understand your objectives.

    Preparation of teeth: This appointment will take from one to two hours. To prepare the teeth for the porcelain veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which may require a local anesthetic. At this appointment, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This can take about one to two weeks.

    Bonding of veneers: This appointment will take about one or two hours. First, we place the veneers with water or glycerin on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, view the esthetic results, and pay particular attention to the color. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. The color cannot be altered after veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once special cement is sandwiched between the veneer and tooth, a visible light beam initiates the release of a catalyst to harden the cement.

    How about maintenance?
    For about a week or two, you will go through a period of adjustment as you get used to your "new" teeth that have been changed in size and shape. Brush and floss daily. After one or two weeks, you'll return for a follow-up appointment. Keep in mind that a veneer's color cannot be changed after it is placed. So if you plan to whiten your teeth, you should do it before getting veneers, as the porcelain's color cannot be altered through bleaching.

    Veneers are great for:

    • Closing spaces between teeth
    • Restoring broken or chipped teeth
    • Covering stained teeth or visible fillings
    • Correcting uneven or crooked teeth

    They are custom-made from a model of your teeth to fit precisely and look completely natural. Veneers are easily color-matched to your teeth, and they have uncanny enamel-like qualities that defy detection, making your smile beautiful and natural.

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    What Is A Composite Resin (White Filling)?

    A composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide). Introduced in the 1960s, dental composites were confined to the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth. Since then, composites have been significantly improved and can be successfully placed in the back teeth as well. Composites are not only used to restore decayed areas, but are also used for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

    How is a composite placed?
    Following preparation, the dentist places the composite in layers, using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.

    How long does it take to place a composite?
    It takes the dentist about 10-20 minutes longer to place a composite than a silver filling. Placement time depends on the size and location of the cavity-the larger the size, the longer it will take.

    What is the cost?
    Prices vary, but composites average about one-and-a-half to two times the price of a silver filling. Most dental insurance plans cover the cost of the composite up to the price of a silver filling, with the patient paying the difference. As composites continue to improve, insurance companies are more likely to increase their coverage of composites.

    What are the advantages of composites?
    Esthetics are the main advantage, since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

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    What Is A Dental Emergency?

    What Is A Dental Emergency?
    Injuries to the mouth may include teeth that are knocked out (avulsed), forced out of position and loosened (extruded) or fractured. In addition, lips, gums or cheeks are often cut. Oral injuries are often painful and should be treated by a dentist as soon as possible.

    How soon should I been seen by your office?
    Immediately. Getting to a dentist within 30 minutes can make the difference between saving or losing a tooth.

    When a tooth is knocked out:

    • Immediately call our practice for an emergency appointment.
    • Handle the tooth by the crown, not the root. Touching the root (the part of the tooth below the gum) can damage cells necessary for bone re-attachment.
    • Gently rinse the tooth in water to remove dirt. Do not scrub.
    • Place the clean tooth in your mouth between the cheek and gum to keep it moist. It is important not to let the tooth dry out.
    • If it is not possible to store the tooth in the mouth of the injured person, wrap the tooth in a clean cloth or gauze and immerse in milk.

    When a tooth is pushed out of position:

    • Attempt to reposition the tooth to its normal alignment using very light finger pressure, but do not force the tooth.
    • Bite down to keep the tooth from moving.
    • It may be necessary to splint the tooth in place to the two healthy teeth next to the loose tooth.

    When a tooth is fractured:

    • Rinse mouth with warm water.
    • Use an ice pack or cold compress to reduce swelling.
    • Use ibuprofen, not aspirin, for pain.
    • Immediately call our office, we will determine treatment based on how badly the tooth is broken. Only a dentist can tell how bad the break is.
    • Minor fracture: Minor fractures can be smoothed with a sandpaper disc or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days.
    • Moderate fracture: Moderate fractures include damage to the enamel, dentin and/or pulp. If the pulp is not permanently damaged, the tooth may be restored with a full permanent crown. If pulpal damage does occur, further dental treatment will be required.
    • Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery.

    When tissue is injured:
    Injuries to the inside of the mouth include tears, puncture wounds and lacerations to the cheek, lips or tongue. The wound should be cleaned right away with warm water, and the injured person taken to a hospital emergency room for the necessary care. Bleeding from a tongue laceration can be reduced by pulling the tongue forward and using gauze to place pressure on the wound.

    What can I do to be prepared?
    Pack an emergency dental care kit, including:

    • Our office phone numbers
    • Saline solution
    • Handkerchief
    • Gauze
    • Small container with lid
    • Ibuprofen (Not aspirin. Aspirin is an anti-coagulant, which may cause excessive bleeding in a dental emergency.)

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    What Is A Dental Implant?

    A dental implant is an artificial tooth root (synthetic material) that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support, they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth.

    Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jawbone, like natural tooth roots; the second is used when the jaw structure is limited; therefore, a custom-made metal framework fits directly on the existing bone.

    How do they work?
    Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

    Can anyone receive dental implants?
    We would be happy to talk about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

    What can I expect during this procedure?
    The dentist must perform surgery to anchor the "artificial root" into or on your jawbone. The procedure is done in the dental office with local anesthesia. Medications may be prescribed for soreness.

    How long does the process take?
    The process can take up to nine months to complete. Technology, however, is trying to decrease the healing time involved. Each patient heals differently, so times will vary. After the screws and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months.

    What is the success rate of implants?
    The success rate for implants depends on the tooth's purpose and location in the mouth. The success rate is about 95 percent for those placed in the front of the lower jaw and 85 percent for those placed in the sides and rear of the upper jaw.

    How do I care for implants?
    Your overall health may affect the success rate of dental implants. Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day, without metal objects. We will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

    What is the cost of implants?
    Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. Our staff can help you with this process.

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    What Is A Root Canal?

    Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.

    Why do I feel pain?
    When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

    Why do I need root canal therapy?
    Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall-out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it's always best to keep your original teeth.

    What is a root canal procedure?
    A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with gutta percha, a rubber like material, to prevent recontamination of the tooth. The tooth is then permanently sealed with possibly a post and/or a gold or porcelain crown. This enables patients to keep the original tooth.

    What is involved in root canal therapy?
    Treatment usually involves one to two appointments.

    First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, a gap is drilled from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp and reshaped. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or we may go right ahead and fill the canals.

    If you're given a temporary filling, usually on the next visit it's removed and the pulp chamber and canal(s) are filled with rubber like gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.

    What are the risks and complications?
    More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal-filing instrument used-both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

    What happens after treatment?
    Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods on the treated tooth, and us regularly.

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    What Is A Sealant?

    A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research 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.

    How effective are sealants?
    Scientific studies have proven that properly applied sealants are 100 percent effective in protecting the tooth surfaces from caries. Because sealants act as a physical barrier to decay, protection is determined by the sealants' ability to adhere to the tooth. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. 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. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

    How are sealants applied?
    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. Other sealants are applied and allowed to harden much the same way nail polish is applied to fingernails. Sealant treatment is painless and could take anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

    How long will a sealant last?
    Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental check-ups are necessary to monitor the sealants' bond to the tooth.

    Who should receive sealant treatment?
    Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities and the least benefited by fluoride. Surveys show that approximately two-thirds of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

    Are sealants covered by insurance?
    Although insurance benefits for sealant procedures have increased considerably, coverage is still minimal. The trend is toward expanded coverage of this benefit, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

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    What is Bruxism?

    Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren't diagnosed with bruxism until it is too late because so many people don't realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.

    Can bruxism cause harm?
    People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

    What are the signs?
    When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth, which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ)-the jaw-which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching.

    What can be done about it?
    During regular dental visits, we would automatically check for physical signs of bruxism. If the signs of bruxism are noticed, the condition may be observed over several visits to be sure of the problem before recommending and starting therapy.

    The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that's worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient's destructive behavior.

    Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.

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    What Is Gum Disease?

    Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

    What causes gum disease?
    Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

    Are there other factors?
    Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control.

    What are the warning signs of gum disease?
    Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

    What does periodontal treatment involve?
    In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

    How do you prevent gum disease?
    Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. We can design a personalized program of home oral care to meet your needs. Children also should be examined.

    Is maintenance important?
    Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy. Patients should visit the dentist every 3-4 months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily, and brush their tongue. Proxy brushes (small, narrow brushes) are the best way to clean in between the recesses in the teeth, and should be used once a day. Wooden tooth picks and rubber tips should only be used if recommended by us.

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    What Is Halitosis?

    More than 90 million people suffer from chronic halitosis or bad breath. In most cases it originates from the gums and tongue. The odor is caused by bacteria from the decay of food particles, other debris in your mouth, and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

    What causes bad breath and what can be done about it?
    Bad breath is primarily caused by poor oral hygiene, but can also can be caused by retained food particles or gum disease. Proper brushing including brushing the tongue, cheeks, and the roof of the mouth will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. Mouth rinses are effective in temporary relief of bad breath. Consult with us and/or physician if the condition persists.

    Does bad breath come from other sources than the mouth?
    Bad breath also may occur in people who have a medical infection, gum disease, diabetes, kidney failure, or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate post-nasal drip. This is where the mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor. Bad breath originating in the stomach, however, is considered to be extremely rare.

    Why is saliva so important in the fight against bad breath?
    Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware because the odor may reappear even if you've brushed your teeth.

    Do certain foods cause bad breath?
    Very spicy foods, such as onions and garlic, and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.

    How do I control bad breath?
    It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. To alleviate the odor, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control the odor. If you have dentures or a removable appliance, such as a retainer or mouth guard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouth rinses, deodorizing sprays or tablets, talk with your dentist because these products only mask the odor temporarily, and some products work better than others.

    What is my dentist's role?
    Visit your dentist regularly because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, we can help determine its source. We may ask you to schedule a separate appointment to find the source of the odor. Or, if we believe that the problem is caused from a systemic source (internal), such as an infection, we may refer you to your family physician or a specialist to help remedy the cause of the problem.

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    Why Do I Need X-rays?

    Radiographic or X-ray examinations provide us with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

    Do all patients have X-rays taken every six months?
    No. Your radiographic schedule is based on our assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

    What kind of X-rays does my dentist usually take?
    Typically, most dental patients have "periapical" or "bitewing" radiographs taken. These require patients to hold or bite down on a piece of plastic with X-ray film in the center. Bitewing X-rays typically determine the presence of decay in between teeth, while periapical X-rays show root structure, bone levels, cysts and abscesses.

    My dentist has prescribed a "panoramic radiograph." What is that?
    Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

    Why do I need both types of X-rays?
    What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray cannot show. On the other hand, periapical or bitewing X- rays show a highly detailed image of a smaller area, making it easier for your dentist to see decay or cavities between your teeth. X-rays are not prescribed indiscriminately. We have a need for the different information that each radiograph can provide to formulate a diagnosis.

    Should I be concerned about exposure to radiation?
    All health care providers are sensitive to patients' concerns about exposure to radiation. We have been trained to prescribe radiographs when they are appropriate and to tailor radiographic schedules to each patient's individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, we know which techniques, procedures and X-ray films can minimize your exposure to radiation. Our office utilizes digital radiography which greatly reduces your exposure to radiation as compared with older film-type X-rays.

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    Glossary of Terms

     

    Bonding (Adhesion)
    Adhering tooth-colored resin materials to tooth surface to create a bond.

    Bonding (Composite Resin)
    Process by which enamel-like resin is bonded to a tooth's surface, sculpted to an ideal shape, hardened, and polished.

    Bridge
    Fixed or removable dental appliance that replaces lost teeth.

    Composite Resin
    Tooth-colored filling material made of resin reinforced with silica or porcelain particles.

    Cosmetic Contouring
    Reshaping the natural teeth to make them straighter or more youthful in appearance.

    Cosmetic Dentistry
    The field of dentistry dedicated to the art and science of enhancing a person's smile, overall appearance, and oral health.

    Crown
    A cap, cover, or restoration to replace the missing portion of a tooth. (This procedure can also correct general bite with individual teeth or replace missing teeth.)

    Dentin
    The layer of tooth structure under the enamel.

    Diastema
    The space between two teeth.

    Enamel
    The hard, white outer layer of the tooth that covers and protects the dentin.

    Fixed Bridge
    A fixed dental appliance (used to replace a missing tooth/teeth) cemented or bonded to adjacent teeth that have been prepared to provide anchor supports.

    Gingiva
    Gum tissue.

    High Lip line
    Where the widest smile meets the gum tissue above the teeth.

    Incisor
    The central or lateral front teeth with cutting edges (4 upper and 4 lower).

    Inlay
    A porcelain, resin, or gold filling (made to fit a prepared cavity) cemented or bonded in place to help restore a decayed or broken tooth.

    Implant
    A fixed dental appliance used to replace missing teeth.

    Laminate Veneer
    A thin porcelain resin shell that is bonded to the enamel of front teeth.

    Laminating
    The process of applying a thin porcelain or composite resin veneer to a tooth.

    Low Lip line
    Where the widest smile barely reveals the bottom edges of the upper front teeth.

    Malocclusion
    A bad bite caused by incorrect positions of the upper or lower teeth.

    Midline
    An imaginary vertical line that divides the face into equal parts.

    Onlay
    A porcelain, resin, or gold filling that protects a tooth by covering the chewing surface.

    Partial Denture
    A removable dental appliance that replaces missing natural teeth.

    Porcelain
    A ceramic, tooth-colored material that fuses at high temperatures to form a hard, enamel-like substance.

    Posterior-bonded Composite Resin
    Tooth-colored fillings primarily used for back teeth.

    Resin-bonded Bridge
    A thin metal or glass fiber-reinforced bridge which requires slight or no reduction of anchor teeth.

    Rubber Dam
    A thin rubber sheet applied to teeth to control moisture during dental procedures.

    Veneers (Porcelain or Composite)
    Ultra-thin, custom-made laminates bonded to teeth, especially effective for repairing chipped, cracked, or worn teeth.

    Walking Bleach
    A method used to lighten a tooth that has darkened after root canal treatment.

    Whitening
    The process of brightening stained, discolored, or dull teeth with in-office power method or dentist-supervised, at-home whitening systems.

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