FAQs

Please review the list of frequently asked questions below. If need additional assistance, please contact our office.

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 us 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.

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.

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.

Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic radiograph allows us 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.

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give us a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray can not show. On the other hand, periapical or bitewing X- rays show a highly-detailed image of a smaller area, making it easier for us 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.

Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic radiograph allows us 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.

Brushing

Brushing with toothpaste (also called a ‘dentifrice’) is important for several reasons. First and foremost, a toothpaste and a correct brushing action work to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes caries, gum disease, and eventual tooth loss if not controlled. Second, the toothpaste contains fluoride, which makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage can even be seen. Third, special ingredients in the dentifrice help to clean and polish the teeth and remove stains over time. Fourth, toothpastes help freshen breath and leave your mouth with a clean feeling.

As long as your toothpaste contains fluoride, the brand you buy really does not matter, whether or not it is in paste, gel, or even powder form, or containing a certain flavor. All fluoride dentifrices work effectively to fight plaque and cavities and clean and polish tooth enamel. Your dentifrice brand should also bear the ADA (American Dental Association) seal of approval on the container, which means that adequate evidence of safety and efficacy have been demonstrated in controlled, clinical trials.

If your teeth are hypersensitive to hot or cold, consider trying a toothpaste designed for sensitive teeth. Dentifrices containing baking soda and/or hydrogen peroxide (which are both good cleansing agents) give the teeth and mouth a clean, fresh, pleasant feeling that can offer an incentive to brush more, but fluoride is the true active ingredient at work protecting your teeth. Some prefer a tartar control toothpaste containing pyrophosphates to prevent the buildup of soft calculus deposits on their teeth. New pastes offer advanced whitening formulas aimed at safely removing stains to make teeth brighter and shinier, although they can’t nearly match the effectiveness of a professional whitening formula administered or prescribed by a dentist.

Contrary to what toothpaste commercials show, the amount of paste or gel needed on your brush for effective cleaning does not have to be a heaping amount. Simply squeeze on a pea-sized dab of paste on the top half of your brush. If you brush correctly, holding the toothbrush at a 45-degree angle and brush inside, outside and between your teeth, the paste should foam enough to cover all of your teeth. Children under six, however, should be given a very small, baby pea-sized dab of dentifrice on their brush.

No. Although brushing thoroughly after each meal helps, flossing your teeth every day to remove plaque and food particles between teeth and at the gumline is just as important. Studies show that plaque will regrow on teeth that are completely clean within 3 to 4 hours of brushing.

TMJ

The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side and base of the skull) and the mandible (lower jaw). Mastication (chewing) muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways, and open and close.

The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. Temporo-mandibular Disorder (TMD) may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

Normal function for this muscle group includes chewing, swallowing, speech and communication. Most experts suggest that certain tasks, either mental or physical, cause or aggravate TMD, such as strenuous physical tasks or stressful situations. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth (bruxism). These excessive habits tire the jaw muscles and lead to discomfort, such as headaches or neck pain. Additionally, abnormal function can lead to worn or sensitive teeth, traumatized soft tissues, muscle soreness, jaw discomfort when eating, and temporal (side) headaches.

  • An earache without an infection
  • Jaw pain or soreness that is more prevalent in the morning or late afternoon
  • Jaw pain when you chew, bite or yawn
  • Clicking when opening and closing your mouth
  • Difficulty opening and closing your mouth
  • Locked or stiff jaw when you talk, yawn or eat
  • Sensitive teeth when no dental problems can be found

The majority of cases can be treated by unloading (resting) the joint, taking a non-aspirin pain reliever and practicing stress management and relaxation techniques. It’s important to break bad habits to ease the symptoms. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. If you still experience pain, you may be grinding or clenching your teeth at night. You may need a nighttime mouthguard.

Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint). Eating soft foods and avoiding chewing gum also help relax the muscles.

Tooth sensitivity is caused by the stimulation of cells within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp). When the hard enamel is worn down or gums have receded-causing the tiny tube surfaces to be exposed-pain can be caused by eating or drinking food and beverages that are hot or cold; touching your teeth; or exposing them to cold air.

The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment, by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis.

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. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth.

Sensitive teeth is one of the most common complaints among dental patients. At least 45 million adults in the United States and 5 million Canadians, suffer at some time from sensitive teeth.

Some toothpastes contain abrasive ingredients that may be too harsh for people who have 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.

Tooth sensitivity can be reduced by using desensitizing toothpaste, applying sealants and other desensitizing ionization and filling materials including fluoride, and decreasing the intake of acid-containing foods. Tartar control toothpastes will sometimes cause teeth to be sensitive as well as drinking diet soft drinks throughout the day.

Avoid using hard bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth’s root surface and expose sensitive spots. The way to find out if you’re brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you’re brushing too hard.

If a tooth is highly sensitive for more than three or four days, and reacts to hot and cold temperatures, it’s best to get a diagnostic evaluation from us to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that’s not yet visible.

Sensitivity may be defined as a short sharp pain, which is usually initiated by hot or cold foods or exposure to cold air. Aching often follows. Because sensitivity may mean different things to a patient and dental professional, be sure to clarify exactly what you feel when you discuss the condition with us. Be sure to tell us when the pain started and if there is anything, such as the application of a warm compress, that helps eliminate the pain.

Toothpastes for sensitive teeth usually contain a desensitizing agent that protects the exposed dentin by blocking the tubes in the teeth that are connected to nerves. In most cases, these products must be used on a regular basis for at least a month before any therapeutic benefits may be noticed.

We have a variety of regimens to manage tooth hypersensitivity, including both in-office treatments and patient-applied products for home use. If you are diagnosed with dentin hypersensitivity, we may apply a desensitizing agent or a protective coating. You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride. These ingredients help block transmission of sensation from the tooth to the nerve. It also might help to massage the special paste onto your gums with your finger after brushing.

Listen closely to our instructions. We will advise you not to eat or drink for a short period of time, to eliminate all sources of irritation, such as acidic foods or medication, highly concentrated foods or flavored toothpastes. You will also be instructed to change oral hygiene habits that are likely to cause abrasion or use a daily fluoride application (a rinse or brush-on gel.)

Sealants

A dental sealant is a thin plastic film painted on the chewing surfaces of molars. Sealants have been shown to be highly effective in the prevention of cavities. They act as a barrier to prevent bacteria and small food particles from penetrating into a tooth. Sealants are most commonly used on newly erupted molar teeth. Molars typically erupt at age six and twelve. Sealants can be beneficial at any age.

Orthodontics

Your family general dentist is responsible for coordinating your dental treatment, and this could encompass any orthodontic treatment plan, including diagnosis, examinations and some orthodontic procedures. We may, however, refer you to an “orthodontist”- a specialist trained in the development, prevention and correction of irregularities of the teeth, bite and jaws and related facial abnormalities.

With braces, oral hygiene is more important than ever. Braces have tiny spaces where food particles and plaque get trapped. Brush carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush. Rinse thoroughly and check your teeth in the mirror to make sure they’re clean. Take time to floss between braces and under wires with the help of a floss threader. Have your teeth cleaned every six months to keep your gums and teeth healthy. Insufficient cleaning while wearing braces can cause enamel staining around brackets or bands.

Yes. Cut down on sweets, chips and pop. Sugary and starchy foods generate acids and plaque that can cause tooth decay and promote gum disease.

Cut healthy, hard foods like carrots or apples into smaller pieces. Sticky, chewy sweets like caramel can cause wire damage and loosen brackets. Avoid hard and crunchy snacks that can break braces, including popcorn, nuts and hard candy. More dont’s: ice cube chewing, thumb sucking, excessive mouth breathing, lip biting and pushing your tongue against your teeth.

The interconnecting wires are tightened at each visit, bearing mild pressure on the brackets or bands to shift teeth or jaws gradually into a desired position. Your teeth and jaws may feel slightly sore after each visit, but the discomfort is brief. Keep in mind also that some teeth may need to be extracted to make room for teeth being shifted with braces and for proper jaw alignment.

That depends upon your treatment plan. The more complicated your spacing or bite problem is, and the older you are, the longer the period of treatment, usually. Most patients can count on wearing full braces between 18 and 30 months, followed by the continued use of a retainer.

The orthodontist will know what appliance is best for your particular problem, but the patient often has a choice. Braces generally come in three varieties: The most popular type are brackets, metal or plastic, that are bonded to teeth and are far less noticeable. The “lingual” type of braces are brackets that attach to the back of teeth, hidden from view. Bands are the old-fashioned type that cover most of your teeth with metal bands that wrap around the teeth. All use wires to move the teeth to the desired position.

Patients with orthodontic problems can benefit from treatment at nearly any age. An ideal time for placement of braces is between 10 and 14 years of age, while the head and mouth are still growing and teeth are more accessible to straightening. However, because any adjustments in facial appearance can be traumatic to a child during these sensitive years, parents should discuss the matter with their children before braces are applied.

And braces aren’t just for kids. More and more adults are also wearing braces to correct minor problems and to improve their smiles.

Orthodontics is a special discipline of dentistry concerned with aligning the teeth and jaws to improve one’s smile and oral health. “Ortho” means correct or straight, and “Odont” means tooth.

A dentist usually recommends braces to improve the patient’s physical “orofacial” appearance. Through orthodontic treatment, problems like crooked or crowded teeth, overbites or underbites, incorrect jaw position and disorders of the jaw joints are corrected.

Occlusal Guard

Two appointments are needed to make an occlusal guard. At the first visit, molds of your teeth are made. The molds are sent to a dental laboratory. Acrylic is used to cover the tops of your teeth. At the second visit, the acrylic guard is checked for fit. The way you bite on the guard is adjusted so that any jaw pain will be minimized.

Ideally, they should be worn every night. The guard will keep your teeth from wearing. They will also decrease the pain associated with TMJ. They work by helping the chewing muscles to relax – the usual source of TMJ pain. They are also suggested to protect extensive dental work.

Oral Cancer

Oral cancer, the sixth most common cancer, accounts for about 3.6 percent of all cancers diagnosed, with roughly 40,000 new cases of oral cancer reported annually in the United States. The vast majority of oral cancers occur in people older than 45 years, with men being twice as likely as women to develop the disease. The most frequent oral cancer sites are the tongue, the floor of the mouth, soft palate tissues in back of the tongue, lips, and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery, and even death. We perform a thorough oral cancer screening at each visit.

Scientists aren’t sure of the exact cause of oral cancer. However, the carcinogens in tobacco products, alcohol and certain foods, as well as excessive exposure to the sun have been found to increase the risk of developing oral cancer. Risk factors for oral cancer may also be genetically inherited.

Oral cancer-represented by red, white or discolored lesions, patches or lumps in or around the mouth-is typically painless in its early stages. As the malignant cancer spreads and destroys healthy oral tissue, the lesions or lumps become more painful. However, oral cancer is sometimes difficult to self-diagnose so routine dental exams are recommended. See us immediately if you observe: any sore that persists longer than two weeks; a swelling, growth or lump anywhere in or about the mouth or neck; white or red patches in the mouth or on the lips; repeated bleeding from the mouth or throat; difficulty swallowing or persistent hoarseness.

We screen for oral cancer during routine checkups. We feel for lumps or irregular tissue changes in your neck, head, cheeks and oral cavity, and thoroughly examine the soft tissues in your mouth, specifically looking for any sores or discolored tissues.

If we suspect oral cancer, a biopsy of the lesion is required to confirm the diagnosis. Surgery is required to remove the tumors, which may cause disfiguration. Radiation therapy may be used as part of the treatment.

Oral cancer accounts for roughly 9,000 deaths annually (about 3 percent of all cancer-caused deaths). Of all major cancers, oral cancer has the worst five-year survival rate at about 54 percent. Because oral cancer is usually not diagnosed in its early stages, less than half of all oral cancer patients are cured. You can help prevent oral cancer by not smoking, using spit tobacco or drinking excessive alcohol. When tobacco use and alcohol use are combined, the risk of oral cancer increases 15 times more than non-users of tobacco and alcohol products. Research suggests that eating plenty of fruits and vegetables may safeguard against oral cancer. Because successful treatment and rehabilitation are dependent on early detection, it is extremely important to see us for an oral cancer screening and regular checkup at least every six months. Survival rates greatly increase the earlier oral cancer is discovered and treated.

Rinses

Rinses are generally classified by the U.S. Food and Drug Administration (FDA) as either cosmetic or therapeutic, or a combination of the two. Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste. Therapeutic rinses have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases. Therapeutic rinses are regulated by the FDA and are voluntarily approved by the American Dental Association (ADA). Therapeutic rinses also can be categorized into types according to use: antiplaque/ antigingivitis rinses and anticavity fluoride rinses.

That depends upon your needs. Most rinses are, at the very least, effective oral antiseptics that freshen the mouth and curb bad breath for up to three hours. Their success in preventing tooth decay, gingivitis (inflammation of the gingival gum tissue) and periodontal disease is limited, however. Rinses are not considered substitutes for regular dental examinations and proper home care. Dentists consider a regimen of brushing with a fluoride toothpaste followed by flossing, along with routine trips to the dentist, sufficient in fighting tooth decay and periodontal disease.

Again, that depends upon your needs. While further testing is needed, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics aren’t much more effective against plaque and periodontal disease than rinsing with plain water. Most dentists are skeptical about the value of these antiplaque products, and studies point to only a 20 to 25 percent effectiveness, at best, in reducing the plaque that causes gingivitis.

Many dentists consider the use of fluoride toothpaste alone to be more than adequate protection against cavities. Dentists will prescribe certain rinses for patients with more severe oral problems such as caries, periodontal disease, gum inflammation and xerostomia (dry mouth). Patients who’ve recently undergone periodontal surgery are often prescribed these types of rinses. Likewise, many therapeutic rinses are strongly recommended for those who can’t brush due to physical impairments or medical reasons.

Anticavity rinses with fluoride have been clinically proven to fight up to 50% more of the bacteria that cause cavities. However, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics are not much more effective against plaque and gum disease than rinsing with water. Most rinses are effective in curbing bad breath and freshening the mouth for up to three hours.

If it’s an anticavity rinse, dentists suggest the following steps, practiced after every meal: brush, floss, then rinse. Teeth should be as clean as possible before applying an anticavity rinse to reap the full preventive benefits of the liquid fluoride. The same steps can be followed for antiplaque rinses, although Plax brand recommends rinsing before brushing to loosen more plaque and debris, a measure which has not been clinically proven to be effective. If ever in doubt, consult us or follow the instructions on the bottle or container. Be sure to heed all precautions listed.

First, take the proper amount of liquid as specified on the container or as instructed by we into your mouth. Next, with the lips closed and the teeth kept slightly apart, swish the liquid around with as much force as possible using the tongue, lips, and sucking action of the cheeks. Be sure to swish the front and sides of the mouth equally. Many rinses suggest swishing for 30 seconds. Finally, rinse the liquid from your mouth thoroughly.

Yes, and they vary depending on the type of rinse. Habitual use of antiseptic mouthwashes containing high levels of alcohol (ranging from 18 to 26 percent) may produce a burning sensation in the cheeks, teeth and gums. Many prescribed rinses with more concentrated formulas can lead to ulcers, sodium retention, root sensitivity, stains, soreness, numbness, changes in taste sensation and painful mucosal erosions. Most anticavity rinses contain sodium fluoride, which if taken excessively or swallowed, can lead over time to fluoride toxicity. Because children tend to accidentally swallow mouthwash, they should only use rinses under adult supervision.

Infection Control

Infection control is a set of recommended safety precautions that dentists implement to protect their patients and staff in the office. Strict infection control is required to prevent the spread of disease, since many dental procedures involve direct contact with blood and saliva. Improved infection control procedures with heightened awareness of the dangers of infection mean that the instruments and supplies we use in your mouth are either heat sterilized, or they are disposable items intended for one-time use.

In 1986, less than 30 percent of dentists wore gloves, masks or gowns. Today, these infection control tools are required in all dental practices. To fight the spread of diseases, such as HIV, Hepatitis B (HBV), syphilis and herpes viruses, we have strict procedures and may use a variety of measures to ensure that instruments used during dental procedures are sterile. As an extra precaution, we have been vaccinated for Hepatitis B, to prevent us from potentially passing it on to patients. Sterilizing dental instruments, a process that destroys all forms of microbial life, is also an important part of infection control in a dental office.

When you first sit in the dental chair, chances are the first thing you’ll see is one of us washing or disinfecting our hands. Hands are washed at the start of the day, before putting on gloves and after touching any potentially contaminated surface.

We may use a variety of protective items that are used once and then thrown away, including gloves, masks, paper drapes, suction/water tube tips and needles. Dentists and their assistants can use different kinds of protective gloves. Latex or vinyl gloves are used for patient examinations and procedures and are worn whenever skin could be in contact with body fluids. Between patients, the gloves are thrown away, the hands washed and a new set of gloves is used to treat the next patient.

For cleaning and sterilizing instruments, heavy rubber utility gloves are used. If you are allergic to rubber or latex, we can wear nitrile gloves, which do not contain any latex rubber proteins.

Universal precautions, used for every patient, are safety procedures established by the Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA). These precautions require all dental staff involved in patient care to use appropriate protective wear, such as gloves, masks and eyewear. For more information on CDC Infection Control guidelines, please visit www.cdc.gov.

Before you enter the examination room, all surfaces, such as the dental chair, drawer handles and countertops are disinfected. To sterilize equipment that can’t be moved, such as X-ray units and countertops, disinfectant is applied after each patient to ensure a germ-free environment. Some offices may drape this equipment with protective covers, which are replaced after each patient. Disposable sharp items such as needles that cannot be sterilized are disposed of in puncture-resistant biohazard containers. Anything contaminated with blood or saliva is disposed of in special containers with safety lids.

Dentists sterilize handpieces and other instruments between patients to prevent the transmission of diseases. Dental offices follow and monitor specific heat sterilization procedures, which are outlined by the CDC and the ADA. Most dental instruments are sterilized in special machines; it takes much more than just soap and water to make sure instruments are free of bacteria. Recommended sterilization methods include placing these tools into an autoclave (steam under pressure), a dry heat oven, or chemical vapor (commonly called a chemiclave). Typically, this equipment is kept in the office away from a patient’s view. Ask us to show you how and where instruments are sterilized.

Fluoride

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and in most foods. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children’s growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible.

“Topical” fluoride is found in products containing strong concentrations of fluoride to fight tooth decay. These products, including toothpastes and mouthrinses, are applied directly to the teeth and are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.

Professionally-administered topical fluorides such as gels or varnishes are applied and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of dental caries, we may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

“Systemic” fluoride is ingested when added to public and private water supplies, soft drinks and teas, and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

Fluoridated water protects against cavities and root caries-a progressive erosion of adult root surfaces caused by gum recession-and helps remineralize early carious lesions. Thanks to these preventive benefits, public water fluoridation is considered the most efficient and cost-effective dental caries prevention measure available. More than 144 million United States residents in more than 10,000 communities drink fluoridated water, most from public water supplies with sodium fluoride added artificially. A small percentage get water from private wells with naturally fluoridated water.

The Environmental Protection Agency has determined that the accepted “optimal” amount of fluoride in water is 0.7 parts per million (ppm) or mg per liter. Backed by results from more than 140 documented studies undertaken in 20 different countries over the past several decades, fluoridated water adhering to these standards has been scientifically established as safe for drinking. Water fluoridation is endorsed by nearly every major health and safety-related organization. Fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay and to improve oral health for a lifetime.

In general, the use of fluoride is considered safe unless it’s misused or over-concentrated. Drinking excessively fluoridated water can cause dental fluorosis, a harmless cosmetic discoloring or mottling of the enamel, visible by chalky white specks and lines or pitted and brown stained enamel on developing teeth.

Avoid swallowing toothpaste, mouthrinses or other topical supplements, check with us on proper dosage, and be careful not to accidentally take too much. If you are concerned about the fluoride levels in your drinking water, call the local public water department. If the source is a private well, request a fluoride content analysis taken via a water sample through your local or county health department.

Children are more vulnerable to dental fluorosis because their developing teeth are sensitive to higher fluoride levels. They are at greater risk if they swallow or use too much toothpaste and fluoride supplements, or regularly drink water containing excessive fluoride levels.

Flossing

Some people loop. Some people spool. Others simply refuse. The verdict is in: Flossing is one of the best things you can ever do to take care of your teeth.
“Flossing every 24 hours to break up plaque is imperative for good oral health,” says Gordon Isbell, DMD, MAGD, spokesperson for the Academy of General Dentistry (AGD).

An article in the October 2005 issue of AGD Impact, AGD’s monthly newsmagazine, describes how floss is the single most important factor in preventing periodontal disease, which affects more than 50 percent of adults.
Flossing, which is just as important as brushing, helps remove the plaque and debris that stick to teeth and gums in between the teeth. It also helps polish the tooth’s surface and control bad breath.

Dental floss can be waxed or unwaxed, flavored and unflavored, wide and regular. All floss helps clean and remove plaque. Wider floss, also known as dental tape, may help people with a lot of bridgework and is usually recommended when the spaces between teeth are wide. Waxed floss can be easier to slide between teeth with very little space between. Unwaxed floss makes a squeaking sound which let the user know their teeth are clean.

Recently, electric flossers have entered the scene, but most dentists contend there is no substitute for manually flossing one’s teeth.

“Electric flossing is no substitute, but if someone has a disability (and can’t manually floss,) it is better than nothing,” says Dr. Isbell.

Similarly, dentists say that waterpicks should not be used as a substitute for brushing and flossing because they don’t remove plaque. Dentists do recommend waterpicks for people with gum disease who have trouble flossing because of pain.

Benefits of flossing:
•         Decreased risk of gum disease
•         Better breath
•         Removes plaque in between teeth
•         Polishes tooth surfaces

Cold Sores

Like cold sores, canker sores–also known as aphthous ulcers–can be quite painful and often recur. While cold sores are caused by a virus, the formation of a canker sore may be triggered by multiple factors such as stress, food allergies or a weakened immune system. A canker sore forms in the soft tissues of your the mouth and is typically not contagious whereas a cold sore usually appears around the lip area outside the mouth and is highly contagious. If a cold sore appears inside the mouth, usually it appears on the non-movable parts such as the roof, rather than the tongue or soft-palate.

Cold sores, also known as fever blisters, are tiny, clear, fluid-filled blisters that form around the mouth and are caused by the herpes simplex virus (HSV1) living inside your nerve tissue. Cold sores usually do not last longer than two weeks. However, the sores are highly contagious and tend to recur when the virus is reactivated by a trigger such as stress, sunlight, fever or illness.

Most people get HSV1 infections during infancy or childhood and usually catch the virus from an infected family member or friend. Only an estimated 10 percent of those infected actually develop the characteristic blisters. If sores do develop, they can appear anywhere from two to 20 days after exposure to an infected person. Other persons with a primary infection may have flu-like symptoms such as a high fever, sore throat, swollen neck glands and mouth soreness.

Day 1: Prodrome (tingle) stage – Before a cold sore has formed, you may feel a tingling, itching or burning sensation beneath the skin, usually around the mouth or the base of the nose. Applying anti-viral medications during this stage can help alleviate cold sore symptoms.

Days 2 to 3: Blister stage – An outbreak of fluid-filled blisters is the first visible sign of cold sore formation.

Day 4: Ulcer or weeping stage – Typically, the most contagious and painful stage of cold sores is when blisters rupture, leaving a shallow reddish open sore.

Days 5 to 8: Crusting stage – After a few days, the blisters dry up and form a yellow or brownish crust, which eventually falls off. During this stage, it is important to care for the scab, which can crack or break.

Days 9 to 12: Healing stage – Usually a series of scabs will form on the lesion, which eventually flake off. Each new scab will be smaller than the previous one, until the cold sore heals completely, usually without scarring

•         Eat foods high in lysine (an amino acid found in red meats, fish, and dairy products) or take supplements.
•         Apply sunscreen to the face and lips before going outdoors.
•         Shave with a disposable razor during an outbreak.
•         Replace your toothbrush.
•         Engage in relaxing activities to reduce stress.

Topical anti-viral medications can reduce the duration and severity of an outbreak if used early. Antiviral drugs may also be prescribed.

Over-the-counter creams containing docosanol can inhibit the herpes virus. Medications with a numbing agent, such as benzyl alcohol, can help alleviate a cold sore’s burning, itching and pain. Emollients can reduce cracking and soften scabs. Applying aloe vera balm three times a day to the cold sore also can help fight the infection and enhance healing.

If over-the-counter remedies don’t help, ask us for a prescription. We can accurately diagnose cold sores and base treatment on important factors such as your age, overall health, medical history and tolerance for specific medications.

There may be long periods when the herpes virus remains inactive. The following factors can trigger cold sores:
•         Illness, such as cold or flu
•         Dental treatment
•         Physical stress or fatigue
•         Menstruation or pregnancy
•         Mouth trauma
•         An immune system deficiency
•         Injury to the lips caused by sunlight exposure or ultraviolet lamps
•         Food allergies

Dental Emergency Information

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.

Immediately. Getting to a dentist with 30 minutes can make the difference between saving or losing a tooth.

•         Immediately call us 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.

•         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.
•         We may splint the tooth in place to the two healthy teeth next to the loose tooth.

•         Rinse mouth with warm water.
•         Use an ice pack or cold compress to reduce swelling.
•         Use ibuprofen, not aspirin, for pain.
•         Immediately get to us, 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 crown. If pupal damage does occur, further dental treatment will be required.
•         Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery.

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.

Pack an emergency dental care kit, including:
•         Dental Office: 603-694-6300,  After Hours Voicemail:603-498-6428
•         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.)

Tooth Decay

Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body’s natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.

If you are at medium to high risk for cavities, we may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. We may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for recurrent cavities.

The best way to combat cavities is to follow three simple steps:

Cut down on sweets and between-meal snacks. Remember, it’s these sugary and starchy treats that put your teeth at extra risk.

Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits-the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child’s developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.

See us at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect, thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

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.

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.

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.

Stress and certain personality types are at the root of bruxism. For as long as humankind has existed, bruxism has affected people with nervous tension. Anger, pain and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.

During regular dental visits, we automatically check for physical signs of bruxism. If 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, we 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 a night.

Baby Bottle Tooth Decay

Baby bottle tooth decay is caused by the frequent and long-term exposure of a child’s teeth to liquids containing sugars. Among these liquids are milk, formula, fruit juice, sodas, and other sweetened drinks. The sugars in these liquids pool around the infant’s teeth and gums, feeding the bacteria that cause plaque. Every time a child consumes a sugary liquid, acid attacks the teeth and gums. After numerous attacks, tooth decay can begin.

The condition also is associated with breast-fed infants who have prolonged feeding habits or with children whose pacifiers are frequently dipped in honey, sugar or syrup. The sweet fluids left in the mouth increases the chances of cavities while the infant is sleeping.

Never allow children to fall asleep with a bottle containing milk, formula, juice or other sweetened liquids. Clean and massage the baby’s gums to help establish healthy teeth and to aid in teething. Wrap a moistened gauze square or washcloth around the finger and gently massage the gums and gingival tissues. This should be done once a day.

Plaque removal activities should begin upon eruption of the first baby tooth. When brushing a child’s teeth, use a soft toothbrush and a pea-shaped amount of fluoride toothpaste. Parents should first bring their child to the dentist around age 3.

Preventing baby bottle tooth decay involves changes in a child’s diet. A series of small changes over a period of time is usually easier, and eventually leads to better oral health.

To incorporate these changes:

•         Gradually dilute the bottle contents with water over a period of 2-3 weeks.
•         Once that period is over, if you give a child a bottle, fill it with water or give the child a clean pacifier recommended by a dentist. The only safe liquid to put in a bottle to prevent baby bottle tooth decay is water.
•         Decrease consumption of sugar, especially between meals.

Children should be weaned from the bottle as soon as they can drink from a cup, but the bottle should not be taken away too soon, since the sucking motion aids in the development of facial muscles, as well as the tongue.

Giving an infant a sugary drink at nap or nighttime is harmful because during sleep, the flow of saliva decreases, allowing the sugary liquids to linger on the child’s teeth for an extended period of time. If left untreated, pain and infection can result. Severely decayed teeth may need to be extracted. If teeth are infected or lost too early due to baby bottle tooth decay, your child may develop poor eating habits, speech problems, crooked teeth, and damaged adult teeth. Healthy baby teeth will usually result in healthy permanent teeth.

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