Click on topic to learn more about various dental health topics and procedures by clicking on any topic of interest.
There are a few basic steps to follow for oral hygiene. The first step is to brush twice a day, after breakfast and right before you go to bed. Flossing before going to bed is a very important part of home care. You can also supplement these steps with mouth rinses. There are mouth rinses specific for gum health or cavity control. Rinse after brushing and flossing. To help fight gingivitis and periodontal disease use a product like Listerine (has alcohol) or Crest Pro Health. To help fight cavities, use a product like ACT (has alcohol) fluoride rinse. Alcohol can dry your mouth, be careful. There are products available that don’t contain alcohol. It is also important when brushing your teeth to brush your tongue and use a soft bristle brush.
In addition to appropriate oral hygiene at home, it is necessary to get your teeth cleaned at least every six months. Brushing, flossing, and rinsing help, but a professional cleaning will get the areas that you are missing. It will also clean the areas that you are unable to clean, the deeper gum pockets that develop over time. During the cleaning, your hygienist will also inform you on how to take good care of your teeth, answer questions, and inform you on products available that are specific to your needs. During the cleaning, bitewing x-rays (those that look at the top of your teeth) should be taken once a year. A full mouth set of x-rays should be taken at least every five years. The dentist should do an exam every six months. This can help catch cavities early and correct any problems before they worsen.
Whitening teeth is a very popular procedure. There are many methods available to the patient. There are over the counter products. A patient may see results from some of these products, but they are generally slower than methods available at your dental office. In the dental office, they offer stronger concentrations of the active ingredient and therefore, faster results. Tray whitening is a very effective method. Plastic trays are made to fit your teeth. At your convenience, a gel is loaded into the tray and worn for a couple of hours. You can control how white you want your teeth to get. “Power Whitening” is done in the office. It is intended for very fast results, usually an hour. A high concentration gel is applied to the teeth and sometimes a light is used. Whitening can cause teeth sensitivity. Ask your dentist what is best for you and your teeth to help prevent sensitivity and get the results you want.
Sealants are plastic covers that are bonded to the top of adult teeth, usually molars. Cavities on the top of the teeth are the most common kind of cavity. They typically occur in young people. Molars start erupting into a child’s mouth at age 6. At this age, children usually have poor home care and enjoy sweets. These two factors cause cavities that can be prevented with sealants, which is a short and very simple procedure
Veneers are a very popular treatment to correct discoloration or little imperfections in teeth. Veneers are considered a cosmetic procedure and have received great press from all of the makeover reality shows on television. Veneers are bonded restorations which require little or no tooth preparation in some cases. They can be either porcelain or composite and are bonded into place. It is important to talk your dentist about what material is right for you. Usually the veneer appointment sequence involves sitting down with your dentist and doing a thorough exam to determine if they are right for you. The bite needs to be examined and followed by a discussion about what corrections the patient wants and expects. Sometimes whitening of the teeth is done next. This appointment is followed by the preparation appointment where the fronts of the anterior teeth are shaved down and an impression is taken. From the impression a lab will fabricate the veneers (if they are porcelain). They are usually very thin, about half the width of a dime. While the permanent veneers are being made, the patient will have temporary veneers on. They will look and feel similar to the veneers that are being made in the lab. At the following appointment, the dentist will bond the veneers into place. In some cases, the dentist will recommend doing composite veneers. They look and feel very similar to porcelain with the advantages being less cost and only one appointment in most cases. There are many things to be considered in this treatment and that is why it is important to have an open dialog with your dentist about your needs.
Bonding refers to any dental procedure that involves using composite to “stick” a restoration to the tooth. Composite is glue and very small pieces of plastic. The procedure involves using a mild acid to clean the tooth. Next, an unfilled (less plastic and more glue) resin is painted on the tooth and acts as the glue. The filled resin or composite is dispensed into the tooth and a light is shined on it to set the filling. The composite is then polished and adjusted to your bite. White fillings in the front teeth have been bonded for a couple of decades. More recently, posterior teeth have been filled using bonding to replace amalgam (silver) fillings. There are other procedures that involve bonding, including veneers and sealants. Bonding allows more conservation of tooth structure and it is esthetically pleasing.
A crown, or cap as some people call it, is a tooth restoration for many purposes. A crown is a tooth-like restoration that is used to cover up the tooth. The existing tooth is smoothed down on the top and sides to make room for a crown to fit. The dentist then takes an impression or model of the tooth. It is then mailed to a lab where the crown is made. In the meantime, the patient goes home with a temporary crown that looks and feels like the final crown. At a second appointment, typically two weeks later, the crown is cemented to the existing tooth. Crowns can be all porcelain, porcelain fused to metal, or gold. It is important to talk to your dentist to find out what is best for your mouth.
Crowns are recommended for a number of reasons. Broken teeth, misaligned teeth, root canal treated teeth, teeth badly worn, and enamel defects can all be corrected. The most common reason for a crown is for a tooth that breaks because of a large existing filling. When a large filling is placed, it compromises the strength of the tooth. To prevent it from breaking, a crown is placed that will protect the tooth. Crowns have been a common procedure for many years and they last a very long time with good home care and professional cleanings.
A bridge is used to replace one or more missing teeth in a patient’s mouth. A bridge is an extension of a crown because the procedure is a lot the same. A tooth on each side of the missing tooth space is smoothed down on the tops and side. An impression is taken from which a model is fabricated. The model is then used by the dental lab to fabricate the bridge. In the meantime, the patient is sent home with a temporary bridge. It is possible to replace numerous missing teeth, but the dentist needs to do a thorough exam to determine what the best option is.
A removable denture is used to replace missing teeth in a patient’s mouth. The difference between a denture and a bridge is that a denture can be removed while a bridge is cemented in. Removable dentures are made of pink acrylic as a base and plastic teeth. The denture acrylic is very natural looking and the teeth used come in many different shades and shapes. Your dentist is trained to pick teeth that will be very unnoticeable. A denture can replace a couple teeth or all your teeth. Sometimes a fixed bridge is not an option because there is not a tooth available on each side of the area where teeth are missing. This is where a removable denture is a treatment option. There are two kinds of removable dentures, a partial or full denture.
A partial removable denture uses the existing teeth to help hold the denture into place. Metal arms are fabricated that hold onto the existing teeth to make it stable. The metal arms are hidden so that other people do not notice. If they can’t be hidden, there are techniques that can be employed to hide them so that no one knows you are wearing a denture.
A full removable denture is used when there are no existing teeth available. It stays in by using suction. The same acrylic and teeth used in a partial denture are used in a full denture. Typically, upper full dentures fit well because they suction to the palate. Lower dentures don’t fit as well because the tongue always pushes the denture around. Another contributing factor to the fit is the remaining bone. The more bone that remains creates more surface area for the acrylic of the denture to suction into place. If the denture doesn’t fit real well, sometimes adhesives can be used. If these don’t work, implants can be used to help hold the denture into place. It is very important to sit down with your dentist and discuss what the best treatment plan is for you.
Implants are an amazing treatment option to replace missing teeth. A titanium post is placed into the bone and fuses into place. A crown is then placed on top of the post. It looks exactly like a real tooth and nobody will notice the difference. It also functions like a real tooth and you will never notice the difference. The great thing about implants is there success rate. They are truly the best treatment option when it comes to replacing a missing tooth. They don’t involve cutting on the adjacent teeth like a bridge. They also have a longer life span than a fixed bridge.
Another use for implants is to anchor a denture into place. Sometimes dentures have poor retention due to a lack of bone present to retain them. In these cases, implants are placed into the bone. Special attachments are screwed into the implant. These attachments match attachment units on the denture to help anchor the denture. They help give stability to the denture so that they function better.
Root Canal Treatments
A root canal is a procedure typically performed to alleviate a toothache. For this reason, they have a bad reputation. What causes the pain is pressure from a bacterial infection. To get rid of the infection, a root canal is done to begin the healing. They are a very common procedure that involves removing the nerve from the inside of the tooth root and replacing it with a filling material. Root canals can be performed by your dentist or an endodontist. An endodontist is a specialist who limits their practice to performing root canals. During the procedure, the dentist gets the patient very numb and then makes a small hole in the top of the tooth. The nerve is removed using a series of files that clean the root out and kill the bacteria. A filling is then placed inside the root that seals the tooth from getting reinfected. It is a longer procedure but very effective.
Gum disease is the most common cause of tooth loss. To prevent this, periodontal surgeries can be done. There are different levels of periodontal procedures performed in the dental office. The simplest is scaling and root planing. The patient is given anesthetic, and then a deep gum cleaning is performed. It involves the hygienist or dentist using their instruments to get rid of unhealthy tissue and hardened inorganic plaque material. The gum tissue typically responds very well to treatment with good home care and more frequent recall cleanings.
Sometimes further treatment of a deep gum pocket is needed to get the tissue healthy. This usually involves lowering the gums on the tooth. It turns a deep gum pocket into a shallower one that is easier for the patient to clean. There are other times when an antibiotic can be placed in an area of an infected gum pocket. It is important to talk to your dentist about which treatment options are available and the expected outcomes.
Braces are used to straighten teeth and fix problems with a patients bite. They can be done on adults or children. The treatment usually takes 18-24 months, but it can vary a lot. Timing depends on how much correction needs to be done. If there is a lot of crowding present, some teeth may need to be extracted. This helps create necessary space to alleviate crowding. If there are gaps between the teeth, the spaces can be closed. There are different options available for treatment. Metal braces can be used. There are also porcelain brackets with metal wires that are a little less noticeable. In cases that require minimal tooth movement, sequences of clear plastic trays are made that are very unnoticeable and can be removed. There are also a number other treatments involved in tooth movement that can be employed. It is usually recommended for younger patients to see their dentist or orthodontist around nine years of age to assess growth and spacing. Talking to your dentist is important for assessment to see if braces are right for you.
Wisdom Tooth Extraction
Wisdom tooth (third molar) extraction is a very important preventive procedure. In many patients, there is not enough room for wisdom teeth to fit into their mouth. Even if they fit part of the way, they will give the patient problems. For these reasons, we recommend wisdom tooth extraction, especially in younger patients. Wisdom teeth are very hard for the patient to clean and very hard for the dentist to work on. For these reasons, they are very susceptible to cavities and gum disease. They also are believed to shift around other teeth. Usually, to eliminate these problems before they can even start, we have wisdom teeth removed at a young age when healing times are very quick and the roots haven’t fully formed on the wisdom teeth. This keeps them from contacting nerves on the bottom and the nasal sinus on the top that can lead to further complications. Sometimes your dentist can remove your wisdom teeth, but, typically, an oral surgeon will remove them under general anesthesia. A frequent question that occurs with wisdom tooth extraction is “Why should I have them pulled if they are not bothering me?” We very rarely see a case where an older adult is able to maintain their wisdom teeth. There is always one or two of them that are problematic. The advantage of getting them out at a younger age is rapid healing, fewer complications, and less interruption of normal activities as compared to adult life. Another common question is “Why can’t I just get the one taken out?” We usually tell our patients that if they get one out, they might as well get them all out. The reasons are because it is expensive to pay for general anesthesia, so just pay for it once. The other reason is just have the one healing time and not worry about it again.
Water fluoridation was an important advancement in public health. Cities were required to add fluoride to the drinking water supply. By doing this, fewer cavities occurred and people were more likely to maintain their teeth better. Fluoride helps to keep bacteria from breaking down the tooth and causing cavities. Fluoridation of water occurs naturally in many areas, usually too little or too much. People who drink well water, use water purification systems, or drink bottle water, may not be getting fluoride. We usually see more cavities in these groups of people. Many school aged children are fine because they drink enough water in school. Also, Americans typically have a diet that includes many processed foods. Many of these foods are processed in cities that have water fluoridation and when we consume these foods, we get the benefit. If a patient is at high risk for cavities, there are different sources of fluoride that can be used. Consult with your dentist to find out if you are getting enough fluoride.
Drinking Water Fluoride
An optimal level of fluoride in drinking water is .7-1.2 ppm. City drinking water has fluoride added at this level. Today, many people receive most of their drinking water from alternative sources. Most bottled waters do not contain fluoride. Water purification systems often remove fluoride that was added. Other people drink well water. Well water may or may not have an optimal level of fluoride. It is important to have well water tested to determine the amount of fluoride. Many companies that sell water purification systems can test the levels of fluoride. If fluoride is suboptimal whether because of bottled water, well water, or a water purification system, it needs to be supplemented back into the diet. For children, fluoride pills can be prescribed. As teenagers or adults, fluoride rinses can be used to help prevent cavities. There are also some bottled water companies and water purification systems that have fluoride. It is important to talk to your dentist about which sources your family is receiving fluoride from and assessing cavity risk. If fluoride is low and cavity risk is high, fluoride needs to be received from other sources.
Facial pain can present in many different ways and have many different sources. The first step is to determine the true source of the pain. Tooth pain, gum disease, temporamandibular joint pain, wisdom teeth, sinus infection, muscles of chewing or other sources can cause facial pain. Pain can radiate and present in a location secondary to the site of the pain. All of these sources of pain demonstrate how important it is to have a thorough exam done to get to the true source of the pain. Treatment usually involves many steps. If it is muscle or joint pain, then it is important not to overuse the area. Avoid gum chewing, chewy food, or any other oral habits. Sometimes a piece of plastic formed to your teeth (splint) is used if you are grinding or clenching your teeth. Sometimes a series of exercises are used or even drug therapy.