What X-rays should be taken and why?
Bite wings are recommended every 12-18 months and are taken to radiographically diagnose the presence of interproximal caries (i.e. cavities between teeth). A full mouth or panoramic x-ray should be taken every 36 months. This x-ray is diagnostic, in that it shows the entire mouth, and any anomalies / pathology of the hard tissues that may exist. Once identified, appropriate treatment can be rendered. It also provides the clinician a means to evaluate the level of bone, any abscesses, or abnormalities which should ordinarily not be present.
Am I getting too much radiation from dental X-rays?
No. The equipment that is used these days is so efficient, and the film speed so fast, that excessive radiation exposure is no longer of any significance. This by no means indicates or suggests that x-rays should be randomly taken without indication or merit.
Is chewing gum good for me?
Sugar-free gum has been shown to clinically reduce the incidence of caries, when chewed immediately following meals.
Using an electric rotary toothbrush is far more efficient and effective in overall plaque removal and massaging of the gums. The one we recommend and dispense to patients (at a substantial discount) is the Braun Oral B Ultra 4-head with built-in timer.
What kinds of foods should I not be eating?
Foods and drinks that are high in sugar content, sticky foods such as caramels, dates, and graham crackers should be kept to a minimum. Foods that stick to teeth cause more dental disease than similar amounts of sugar in less sticky forms or in liquids. Frequent consumption of sugar rich foods without adequate brushing is a sure request for dental disease.
What are sealants? What teeth should be sealed? Am I too old for sealants?
Sealants are basically resins which are flowed into the grooves of teeth (back teeth) to help reduce the likelihood of cavities. They can be placed on primary and permanent teeth (molars and premolars). The new generation of sealants now has the added benefit of releasing fluoride. Any posterior tooth that has grooves which are deep and has no evidence of caries or an existing filling is a candidate for a sealant. There is no age limit at which a person can have sealants placed. Many insurance companies however, will only pay for sealants through age 14.
What are gingivitis and periodontitis?
Gingivitis is basically inflammation of the gums in response to an irritant. It can be mild, moderate, or severe. All forms of gingivitis are generally reversible with improved oral hygiene and some interceptive treatment. The more advanced cases might require a gingivectomy, which is the surgical excision of the redundant tissue. Causes of gingivitis include lack of good oral hygiene, side effects from drugs, and hormones, just to name a few.
Periodontitis, on the other hand, involves bone loss. It too can be mild, moderate, or severe. The worse the condition, generally the worse the prognosis. Bone-loss is non-reversible, at least not naturally. Surgical placement of synthetic bone to correct periodontal defects can be performed for moderate to severe cases.
Words of Wisdom: “Be true to your teeth, or your teeth will be false to you!” â€”Anonymous
What are TMJ and TMD?
TMJ stands for Temporomandibular Joint and TMD stands for Temporomandibular Dysfunction. The causes for TMD are numerous and patients suffering from TMD or chronic facial pain should consult with a dentist immediately for treatment.
What are implants? When can they be used? Are they permanent?
Implants are basically root forms that are placed inside your jaw bone by an oral surgeon or periodontist. The patient must first be evaluated radiographically and clinically by both the general dentist and the surgeon to see if he or she is a candidate for implants. The determining factors are the patient’s pre-existing medical conditions, the amount of bone present (both quality and quantity), the patient’s oral hygiene status, etc. If all these criteria are satisfied, then success of the implant, both now and long-term, can be realistically appreciated. Once placed, they generally stay undisturbed for a period of six months to a year to achieve osseointegration, which is the interweaving of the bone matrix and implant. Once sufficient osseointegration is achieved, the restorative phase can be undertaken. Implants can be for single tooth replacement, for bridges, and for partial or complete dentures. Each of these applications requires a specific type of implant.
What causes discolored teeth?
Many conditions may cause the teeth to be discolored (brown, gray, yellow, orange, black, etc.) Some of the causes include foods, chemicals ingested during the early years of life (ex: Tetracycline), injury to the primary teeth affecting the permanent developing tooth follicle, excessive fluoride ingestion during the first few years of life, genetic conditions, childhood diseases, external stains due to foods, smoking, etc.
What is the treatment for grinding and clenching?
Grinding and clenching these days is unfortunately, all too common. It appears to be a stress induced response, and one which is invariably treatable by utilization of a simple splint. Grinding is referred to as bruxism and is more a nocturnal habit that occurs during sleep.
Clenching, on the other hand, is a diurnal habit, meaning it happens during the day. Once the cause has been established, a splint is custom made for the patient to wear (day or night) to help reduce the deleterious effects that this parafunctional habit causes. Two of the best splints available these days for this condition are the “Brux-eze” and the “Reme-deze”. Usually this modality of treatment is sufficient in obtaining a favorable result. If unsuccessful, then other regimens can be utilized.
What are some of the causes of bad breath? What can I do about it?
Unpleasant mouth odor is scientifically referred to as halitosis. It can be the result of many conditions, such as periodontal breakdown, ill-fitting restorations (fillings or crowns), digestive system problems, sinus infections, nose disorders, and certain foods, especially those high in sulfur content, just to name a few. Food which is trapped under defective crowns or bridges, or in-between teeth with ill-fitting broken restorations, decomposes and ferments, sometimes also in the presence of pus, and illicit a very foul taste and smell. Treatment measures should include improved oral hygiene, a comprehensive oral examination with x-rays, evaluation of existing restorations, and replacement of defective restorations. Effective mouth rinses (TriOral) are available at the office for purchase. These eliminate the volatile sulfur compounds that cause halitosis.
My teeth are becoming increasingly sensitive. What can I do to help reduce the sensitivity?
When the gums start to recede, either due to periodontal disease or physiologically as one grows older, nerve endings which are housed in the cementumâ€”the covering of the rootâ€”become exposed and, when stimulated, illicit a response. They are generally sensitive to cold, sweet, or acidic foods. There are a number of treatment modalities that can be used to help reduce or eliminate the discomfort. The simplest method would be to use a desensitizing toothpaste like Sensodyne, Crest Sensitive, Aquafresh Sensitive, or any other sensitive formulation. Regular usage twice a day for 8-12 weeks should show signs of improvement. If that doesn’t work, then prescription desensitizing medicaments can be topically applied in the office and a prescription given for home use. They are generally quite effective and offer immediate results. If the area of cervical erosion is too deep at the gum line, then a tooth colored restoration can be bonded to eliminate both the sensitivity as well as the tooth defect.
I see a gray band around the crown on my front tooth. What can I do about it?
The most common crowns, even today, are made from porcelain fused to metal. The substructure is metal, onto which is baked an “opaquer,” which is then topped with porcelain. The thinner gum tissue at the margin allows the collar of the crown to be visible, which is why you can see the gray outline of the crown. There are numerous specialty crowns that are available today which are nearly as strong as conventional porcelain-metal crowns, but have a better aesthetic. There is no comparison in the aesthetic component of these specialty crowns, but again these are not crowns that insurance companies allocate benefits for. Crowns of this classification include Occlusal Glass, IPS Empress, Wolceram, Captek, Procera, and Occlusal Gold, to name just a few.
What can I do about my front teeth which are fractured, irregularly shaped, or worn down? What can I do about the spaces between my front teeth?
There are a range of cosmetic procedures which serve as treatment options to correct the appearance of teeth with any of the above conditions. These treatments range from inexpensive, like bondings, to expensive, like veneers.
My mouth is always dry. What causes dry mouth?
Xerostomia (dry mouth) can be a result of aging, salivary gland problems, certain pre-existing medical conditions like Sjogrens, numerous medications, and many more causes. This condition can influence speech and can cause an increase in the incidence of caries (decay). Saliva substitutes (prescription and OTC) should be used frequently, and treatment to reduce or eliminate the causative agent should be sought.
Does a tooth which has had a root canal always need a crown?
No, not always. If a large amount of tooth structure is lost due to decay, then yes the tooth should be protected with an onlay or a crown, which is generically referred to as a “cap.” If the tooth has an excessively large filling with evidence of fracture lines in the remaining natural tooth structure and it is in a stress bearing area of the mouth, that too is an indication for a crown or onlay. Invariably, teeth in the front of the mouth do not need crowns even after root canals. If they radically discolor, other options such as bleaching or veneering might be treatment possibilities.
How do I know if my tooth is dead? When do I need a root canal? Are they guaranteed to work? What if they fail? Are they very painful?
Sometimes it’s hard to know that a problem exists because the patient is asymptomatic, meaning they have no complaints of any pain. Upon clinical examination, a discolored tooth is generally a pretty good indication that the tooth is non-vital (dead). Upon vitality testing of any suspicious teeth, an electric current is passed through the tooth. A tooth which is alive will respond immediately. One which is almost dead might barely respond, and one which is dead will be non-responsive. A tooth which has a large carious lesion (decay) that is approximating the pulpal chamber (nerve) might also be a candidate for a root canal.
Root canals, if performed properly, enjoy a very high success rate. There is no guarantee that every root canal will succeed. Sometimes they fail for no apparent reason, even if it seemed to be the best kind of text-book case. After a failed root canal, treatment options can include retreatment of the root canal using a microsurgical procedure known as an apicoectomy. The patient can also elect to have the tooth extracted. In terms of pain, root canals cover a very broad spectrum of pain, from absolutely painless to outrageously painful. We always tell our patients not to wait for the pain, despite all the horror stories they have heard. If it’s present, it will hopefully be very short-lived, and the pain-medications will help lessen the pain.
Why is a bone graft sometimes recommended when I am having an extraction?
Recently, bone replacement therapy has become increasingly popular in extraction situations. Two of the best systems, which are the ones we use at our practice, are “Perio Glass” (Block Drug Company) and Bioplant HTR Polymer (Septodont). Bone replacement therapy helps prevent the bone loss which occurs naturally whenever a tooth is extracted. By replacing the bone immediately at the time of extraction, we eliminate having to undergo a future surgery for bone augmentation, and accomplish a strong and secure foundation for future dental implants, crowns, bridges, and dentures. When a tooth is extracted and the site is not appropriately addressed, bone loss occurs and can be in excess of 60%. When this bone resorption occurs over the years, food can start collecting under bridges, dentures can become loose, and this situation which could have been prevented or lessened, is now a reality. Placing bone in an empty socket (especially in lower wisdom teeth situations) can often significantly reduce an exceedingly painful post-operative condition referred to as a “Dry Socket” (Acute Alveolar Osteitis). For what it costs and what it offers in return, it is truly one of the biggest bargains that dentistry has to offer.
If I have teeth missing in the back of my mouth, why do I need to replace them if nobody sees them?
Though it may be true that nobody sees your back teeth, your mouth was not made to function without them. Teeth like to have adjacent and opposing teeth to keep them in sync. When a tooth is prematurely lost, some sort of replacement should be considered by the patient to be inserted four to six months post-extraction. This limits the amount of drifting, tilting, rotation, extrusion, etc., which will result the longer that space exists. The replacement can be as simple as a space maintainer or as elaborate as an implant. They can be removable, like a denture, or fixed, like a bridge.
I’ve heard that dentures are ugly, and that they might fall into my soup while I’m eating. Are these things true? Will everyone know I have dentures?
These are some of the most common concerns patients have. Dentures, if well made, are very retentive and do not present any of these problems. A whole new generation of thermoplastic dentures is now available, and they are what we almost exclusively utilize. They are the most aesthetic, most comfortable, and most natural looking dentures available. They do not have any visible metal whatsoever, so you can smile away and nobody will know that you are wearing dentures. These are a group of what we call specialty dentures, and are not the dentures that insurance companies allocate benefits for. Dentures of this classification include Valplast, Virginia Partials, Flexite, and Valplast to Vitallium.
How should I select a dentist?
Do not choose a dentist solely on fees, or because my insurance company says I have to see Dr. X, Y, or Z. Find out something about the dentist; ask for a tour of the facility; ask to speak with the dentist; and ask other patients who see the dentist about the quality of care they are receiving.
Patients seeking low dental fees can usually find them, but the fees are usually low for a reasonâ€”cheap materials, old equipment, inadequate sterilization techniques, and antiquated clinical techniques often equate to low quality and less complete service. This can invariably lead to irreparable situations, premature tooth loss, and expensive future treatment or re-treatment. Similarly, high fees do not necessarily mean quality care either. Therefore, don’t select a dentist based solely on fees.
How often should I see the dentist?
The American Dental Association (ADA) recommends a routine check-up once every six months (exam & cleaning). X-rays should be taken as needed.
Is taking too much fluoride bad for me or my teeth?
Yes. Fluoride, if consumed in concentrations greater than 1 PPM (part per million) for extended periods of time, can result in a dental condition known as Fluorosis. Fluorosis can, in severe cases, result in the deformation of the tooth enamel, making it appear mottled with brown pits.
Should my child be taking supplemental fluoride?
Fluoride seems almost ubiquitous in today’s environment. If, however, you live in an area where you use well water, or the water is non-fluoridated, then supplemental fluoride should be prescribed for the child. Consult your dentist or physician for a prescription and appropriate dosage. If your water supply is fluoridated, then you do not require supplemental fluoride for your child.
When should my child get his or her first cleaning and check up?
The ADA recommends that a child’s first checkup be at age 3.
What is a deep cleaning and why do I need it?
A deep cleaning is properly termed “Periodontal Scaling and Root Planning.” Instead of cleaning from the gumline up onto the tooth, a periodontal scaling and root planning procedure is done under anesthesia. This is because it starts at the gumline and extends beneath the gum onto the surface of the root. It is a procedure which is recommended when the calcified deposits present in the mouth are heavy supra and subgingivally; the gums appear irritated and bleeding in response to the presence of these accretions; is radiographically evident; and is more than a routine cleaning can accomplish. Typically there is also “pocketing,” the extent of which is measured using a periodontal probe. After the deep cleaning is performed, with patient compliance and improved oral hygiene, the patient should experience a significant difference in his/her oral health.