Question: What can happen as a result of avoiding Dental care?

Answer: What starts as a small cavity can become very serious if left untreated. Some people wait until the pain they have is enough to exceed their avoidance tendency. This fear of pain is one of the major reasons why patients fail to seek help from a dentist until their emergency becomes to severe. At that point, what should have been a simple cavity now becomes a more involved root canal or extraction. Additionally, a patient who avoids routine dental cleanings and gum maintenance can wind up with severe gum disease ( Periodontal Disease), which causes gum recession, bone loss, tooth mobility and the eventual loss of teeth. Swellings and infections may result from neglecting these cavities and gum tissues, and what would have been unnecessary costs and procedures will now be necessary to restore the mouth back to a better state of health and function.

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Question: What causes a toothache?

Answer: A toothache occurs when the nerve within the tooth gets damaged or inflamed. This is usually caused by bacteria from the tooth decay communicating with the nerve of the tooth. These cavities are usually brought about by a combination of poor oral hygiene coupled with eating a lot of sticky, sugary and starchy foods. This bacteria feeds on the sugars and starch left over from poor brushing and flossing. As a result acids are produced that will slowly eat away at the good tooth structure until the nerve becomes damaged, causing the toothache. Another way the nerve can get damage is from dental trauma (i.e. sports injury, rough play or fights, severe teeth grinding, or extensive dental work on hypersensitive teeth).

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Question: What are Veneers ( aka porcelain veneers, laminates )?

Answer: Veneers are thin pieces of porcelain or resin material that gets bonded (glued) to the front of your teeth. For teeth that are chipped, severely discolored, crowded, spaced, rotated or misshaped in any way, these veneers can create a durable and pleasing smile for many years to come. Veneers are difficult to stain, making them popular for people seeking a perfect smile.

There are two types of veneers:

Porcelain (indirect) veneers, which must first be created to custom fit your teeth in a dental laboratory and require two visits to your dentist. Porcelain veneers may vary from $900-2,500 per tooth and last from 10-15 years or more. While more expensive than other other alternatives, porcelain veneers usually offer a more precise, realistic color to match your surrounding teeth

Composite (direct) veneers, in which composite resins are bonded to your tooth in a single visit. Composite veneers cost significantly less, around $250-400 per tooth, but usually need to be maintained or replaced sooner than the porcelain version.

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Question: What is Implant Dentistry?

Answer: The introduction of implant dentistry has laid the foundation for a new level of the care and service that accomplishes today what was thought impossible only a few years ago. It is the most advanced therapy available to replace missing or lost teeth. Dental implants not only enable one to regain their confidence and psychologically be able to enjoy and active lifestyle, but they can improve your smile, help you once again enjoy chewing all the foods you like and help to restore your facial structure and youthful appearance. Implant dentistry and bone regeneration are among the recent miracles of modern medicine. Their impact on the field of dentistry ranks up there with the introduction of the local anesthetic Novocain ( developed in in 1904), and the air-driven turbine drill (introduced in 1957). With adequate time ad proper planning great things can be accomplished.

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What should I expect for my root canal? What happens during root canal treatment?

First, an examination, including radiographs (x-rays), will be performed. A local anesthetic will be given, if necessary. A sheet of latex, called “rubber dam”, will be placed around the tooth to isolate the area and keep it clean and dry during the procedure. Complete treatment consists of the following five basic steps:

1. An opening is made to access the affected nerve tissue (pulp)
2. The pulp is removed from within the canals of the roots. Tiny instruments called files are used to clean the root canals and shape them to a form that will ensure they will be well sealed. If the root canal is not completed in one visit, then a temporary filling would be placed to seal the opening and protect the tooth between visits.
3. The root canals are filled and sealed with a material that prevents bacteria from re-entering. The opening in the crown of the tooth is sealed with a temporary filling. Radiographs are made before, during and after treatment.
4. Your dentist will later remove the temporary filling (ideally within 4 weeks of treatment), and replace it with a more permanent material, to be followed with a permanent restoration of crwon.
5. The root canal, permanent filling, and/or crown are evaluated for healing at periodic intervals called recall appointments.

You should then see your general dentist for the permanent crown or restoration. Ideally, the tooth should be permanently restored within a few weeks to prevent the tooth from developing a fracture and to prevent the temporary filling from loosening and leaking, which in turn could cause the root canal treatment to fail, necessitating re-treatment.

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Root Canal Therapy is when the Endodontist removes the inflamed or infected pulp (nerve), carefully cleans and shapes the nerve canals of the tooth’s root and then seals the prepared space. Most treatment is performed in one or two appointments ranging from 30-90 minutes each (depending on the number of canals). Once treatment is completed, you may be instructed to return to your dentist for a more permanent restoration. This restoration of the tooth is an important part of the treatment because it seals the cleaned canals from the oral environment, protects the tooth and restores it to function.

Root Canal Therapy (Endodontic treatment) is necessary when the nerve (pulp) becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities, repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

There are several indications for a need for treatment including prolonged sensitivity to heat or cold, spontaneous pain, discoloration of the tooth, and swelling or tenderness of the tooth or adjacent gums. Transient sensitivity to cold may just be due to exposed root surfaces or heavy teeth grinding. If the cold sensation lingers, and radiates up to give you a headache, chances are there has been irreversible damage to the nerve.

Sometimes there are no symptoms, and diagnosis is made from a routine x-ray. Other times root canal treatment is recommended as a result of the bacteria from the decay extending into the nerve (pulp) of the tooth.

Question: What should I do if there is a dental emergency

The most important thing you should do is to try and remain calm. Understand that injuries to the mouth, teeth and face do happen frequently with both adults and children. In order to minimize the traumatic situation and comfort the injured person you must remain calm and take the appropriate prompt action.

The next thing you should do is assess whether or not the accident involved hitting the head or causing them to lose consciousness at all. If consciousness was lost, even briefly, then you should contact a physician immediately, and then focus on the teeth once everything is stabilized.

If there is any beeding, use a clean towel or gauze, and then check around you for any broken or missing teeth. It is possible broken fragments may have entered parts of the lip. If any teeth are missing, you should look for them in case they can be utilized.

Accidents can happen to anyone but many traumatic injuries occur from 18 to 40 months of age. This is due to the fact that this is a time where your uncoordinated toddler is learning to walk and run. The risk for dental injuries for you and your child can be greatly reduced by doing the following:

• Make sure that protective athletic gear, including a sports mouth guard, is worn to prevent sever injuries to the mouth.
• Check to see that you and your child are properly secured in the car, using the appropriate car seat, booster, or seat belt.
• Be aware of your surroundings, and prevent unnecessary injuries at home by taking precautions and child-proofing the house for younger kids.
• Advise your children to avoid rough play and to not run fast in confined or slippery spaces.

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Question: How can a patient overcome their fear of dentistry?

Numerous studies have shown that the critical element is that the patient believes he or she has some sort of control over the potential threat. Therefore, if the dentist can convince the patient through words or actions that he or she can terminate the procedure if they feel the need (raising the hand), then less fear and less pain will likely be experienced. If the patient feels that they have no means of influencing treatment, then they may develop a perception of helplessness and lack of control, which fuels their fear.

Some apprehensive patients need to be told everything that is going to be done, so they know what to expect. (i.e. Warnings when they may feel pressure or vibration, what they are likely to experience next, etc.) A lack of information may result in fear. By developing a sense of trust with their dentist, a once fearful patient can become the most dedicated and loyal patient.

Once in the dental chair, one can cope with their fear and anxiety with certain techniques. Coping skills include learning to relax and breathe properly, utilizing distraction techniques, and asking questions to gain control. Sometimes candles, waterfalls, relaxation music, headphones, TV, movies, etc will enable the patient to relax more. Additional ways of controlling fear and anxiety is by administering Nitrous Oxide (laughing gas), Oral Premedications (i.e. Valium, Ambien, and Xanax), IV sedation, and giving pain free injections after using a strong topical numbing agent. Of course, having a dentist and staff that is patient, understanding and comforting is the most important factor in helping to cope with one’s fears and anxieties.

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Happy New Year! Start this year off on the right foot with some helpful tips on keeping your teeth their best.

Proper Home Care involves the combination of having an adequate diet, exercising proper brushing and flossing techniques, and utilizing additional adjuncts such as tongue scraping and rinses. A summary of these various facets of home care is summarized below:

Diet

Any food or snack that can become trapped within pits and groves of your teeth or between your teeth can become harmful if not cleaned properly. Chewy candy (i.e. Taffies, caramels, jellybeans, and licorice) are among the biggest cavity culprits. However, you may be surprised to know that nuts, raisins and dried fruits can also cause a lot of damage, since they too get readily stuck in and around the teeth.

The complex carbohydrates such as pretzels and potato chips get broken down into the same sugars that are found in cakes and cookies. Any food debris left on the tooth creates an acid attack in the mouth to break it down. The less likely the food is to dissolve or rinse away, the longer the acid attacks will be. Chocolate, which is full of sugar, is actually not as bad for your teeth as dried fruit and nuts, because chocolate dissolves quickly. However, you can prolong any acid attack by eating or drinking things slowly over a longer period of time.

Additionally, if you can’t get to a brush right away, you should rinse well with water, and can chew sugar-free gum for 5 minutes to help neutralize the acids in your mouth and lift out the debris from within the grooves of your teeth. This is especially important in those individuals with a dry mouth.

Brushing

It is recommended that everyone brush at least twice each day with a soft-bristled brush or electric brush. The first time should be in the morning, after breakfast, so your child’s teeth are clean before leaving for school. It defeats the purpose of brushing if you give your child their sugary vitamin after they brush, or give them their breakfast to nibble on the bus, because these substances will stay lodged in the top grooves of their molars and in between their teeth for hours to come, contributing to the formation of cavities.

The most important time to brush is right before you go to sleep at night so that nothing is left on or in between your teeth when you are sleeping. The reason is that when you are awake, your saliva helps to bathe and rinse your teeth, but while asleep, you do not salivate that much, and your teeth are more susceptible to developing cavities from the debris left on them.

Additionally, if you have the chance to brush after other meals or snacks, it would be advisable. And don’t forget to brush their teeth after they are given medicine, as the acids contained in medicines may break down the tooth enamel.

An electric brush has a few advantages over a manual brush. First it generates more brush strokes per second; making it more effective for the amount of time it is being used. Keep in mind that while it is recommended to brush for 2 minutes, the average person only brushes for 30 seconds. With an electric brush it is easier to clean behind the back teeth. Many of these electric brushes have certain extra bells and whistles such as a digital timer so you know when 2 minutes is up, and an indicator light to show if you are pressing too hard. There is usually less trauma to the gums and teeth when brushing with an electric brush since many over-zealous manual toothbrush users bang into their gums with the wrong technique, or scrub too hard.

A manual toothbrush can be very effective with the right technique, and conversely, an electric toothbrush can be virtually useless with the wrong technique. If using a manual brush, use small, vibratory strokes on a 45 degree angle so that the bristles get in the pockets between the teeth and gums. Avoid the up and down or circular motion, as that can just traumatize the gums. If you are using an electric brush, try to spend at least 2 full seconds on each tooth surface (inside, outside and top), making sure to angle the brush between the teeth and having the bristles go between the tooth and the gums. Spin brushes are just a watered down version of an electric brush the may attract the attention of your child with its various themed versions.

Whether you use a manual brush or an electric, make sure you always change your brush or brush head every three months, or sooner if you just had a cold so you don’t reinfect yourself.

Flossing

It is very important to floss your teeth at least once per day (preferably before you go to sleep) to remove food debris and plaque from in between your teeth where your toothbrush couldn’t reach. Plaque causes tooth decay and can lead to gum disease. Another great reason to floss is that recent studies have shown that flossing helps to prevent a heart attack or stroke.

When flossing, be sure to take out a piece about 18 inches long, and gently wrap it around your middle fingers so that you have full control and dexterity holding the floss between your thumb and index finger. Then, starting at the base of the gums, work the floss in a circular motion scrapping the plaque away from the gums. Don’t forget to wrap the floss around the corner line angles of the tooth where plaque builds up.

Toothpastes

Toothpastes coupled with the proper brushing action is an effective way to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes cavities, gum disease, and eventual tooth loss if not controlled. Tooth pastes also contain fluoride, which makes the entire tooth structure more resistant to tooth decay. Toothpastes also help to remove superficial stains and help to leave your mouth with a clean, fresh feeling. It doesn’t matter what kind of toothpaste you use, as long as it contains fluoride.

Other Dental Aids

Other dental aids that work very well are pre-brushing rinses, such as Plax, and post brushing antiseptic mouthwashes designed to help kill germs between your teeth. Water Jet Irrigators, such as Waterpiks, are effective for cleaning in between teeth, especially when one does not have the dexterity for flossing properly. Proxybrushes (brushes designed to remove plaque and debris in open areas between the teeth) and Stimudents (very thin wooden toothpick made of orange-wood) are also great adjuncts to removing debris that gets trapped between the teeth.

Tongue scraping

Your tongue is the most retentive surface in your mouth, and is quite adept at harboring bacteria within its Velcro-like surface. It is the anaerobic bacteria and volatile sulfur compounds trapped in these surfaces that give off the oral malodor.

Tooth brushing alone does not clean our mouths, and mouth rinses only mask the bad breath for a short period of time. It has been found that 90% of halitosis (bad breath) originates from the mouth, with 80% coming from the posterior third of the tongue. Brushing the posterior of the tongue will stimulate a gag reflex. The only definite way to remove those volatile sulfur compounds is to scrape the tongue with a tongue scraper designed to reach that area.

Time to ring in the New Year with a smile! Whether you want to whiten your teeth for that big night out or if you want to keep it going for rest of the year, here is an answer for a common teeth whitening question.

Question: Which is a better way to whiten your teeth using an In-Office or At-Home whitening system?

Answer:In-Office whitening (i.e. Zoom! or Britesmile) is a faster alternative for achieving that brighter smile, with a high degree of predictability. This method has been very popular with anyone whose free time is limited to who just wants instant gratification. Many times patients do the In-Office whitening in combination with custom home trays. The home trays, when used beforehand, can be used to help condition the teeth for more dramatic In-Office results. They can also be used for a period of time after an In-Office session in order to continue the whitening process, or to help lock the shade that was achieved. It is recommended to keep your custom trays for periodic touch ups either before a big event, or to use a couple of times per year to maintain the shade you attained. In-Office whitening procedures allow the dentist to whiten their patient’s teeth up to 15 shades in about an hour (the average shade change being 8 shades). Some individuals may choose not to wear custom tray if they are more hypersensitive or prone to a gag reflex.