Frequently Asked Questions

Prevention

Are adult fluoride treatments effective?

Yes. We tend to think that children are more prone to decay, however adults still get cavities. People are keeping their teeth longer, and as a result root decay is a condition that is more likely to occur as they age. Topical applications of fluoride increase the level of fluoride in the outermost layer of the tooth, no mater what the age. Ideally, multiple applications of fluoride in toothpaste, home fluoride gel, and/or in-office treatments should be used. We will determine your risk and recommend the appropriate level of therapy.

Are electric toothbrushes better than manual ones?

What a great question. Research studies show that electric toothbrushes do provide advantages over manual brushes. The reason is that most people tend to rush while brushing with manual toothbrushes, instead of spending the recommended 2-3 minutes brushing. Those with electric toothbrushes do not rush brushing and spend extra time doing so. Power brushes use the same consistent level of movement which allows for less tooth wear and gum irritation. Oftentimes, patients over-brush or brush too hard in certain areas of their mouth and cause tooth wear. Studies have also shown that electric toothbrushes reduce the amount of plaque on teeth when compared to manual toothbrushes, and the less plaque there is on teeth the better! Manual brushes require more manual dexterity than electric ones and this is important for children and elderly persons who may not have enough to properly clean their teeth. If you are in the market for an electric toothbrush, make sure you find one that is comfortable for you. That is, make sure the size of the toothbrush head is not too big. Timers are often helpful and brushes on which the speed can be adjusted are useful. If you have any questions on electric toothbrushes be sure to ask us.

When should children have their first dental appointment?

Parents should not wait until their children have cavities or a toothache to see the dentist. The first few appointments should be fun and foster a trusting relationship with the hygienist, doctor and staff. Generally speaking, there are far fewer difficulties with children who know that the dentist is there to help them before they need dental work. The goal is to have your child's first few dental experiences be positive ones. The child should accompany a parent to a routine cleaning appointment to become acquainted with the office. He/She can take a ride in the dental chair and watch mommy or daddy while they get their teeth cleaned. A good time to have their first dental exam is when all of their baby teeth are present unless a problem is noticed beforehand. The first cleaning and checkup can follow a few months later depending on the child's maturity and his/her readiness to accept treatment. Contact us if you have a question about the timing of your child's first dental appointment.

What are dental sealants and why are they placed?

The term "dental sealant" refers to a plastic coating which a dental professional bonds into the grooves of the chewing surface of a tooth, as a means of helping to prevent the formation of a cavity. The white film that forms on a person's teeth causes tooth decay. Dentists refer to this film as "plaque". The longer plaque remains on a tooth's surface, the more likely it will be able to create a cavity. The reason we brush our teeth is to scrub off the plaque that has accumulated on the tooth's surface. Some teeth however, because of the way they are shaped, are harder to effectively clean than others. Generally, molars are difficult for a person to clean because the grooves in the chewing part of the tooth are deep and narrow. Even though the person brushes they can not clean the plaque off adequately because the bristles of their toothbrush are too large to reach the bottom of the tooth's grooves. Because some plaque is not cleaned off a cavity can develop. A dentist can combat this situation by bonding plastic (the dental sealant) into the grooves of a tooth, resulting in surfaces that are flatter and smoother. There are no longer any places on the chewing part of the tooth that the bristles of a toothbrush can't reach and clean. Since plaque can be removed more easily and effectively, there is much less chance that decay will start. Read more about sealants.

Is it true that cavities can now be detected with lasers?

Yes it is true. A machine called DIAGNOdent aids in the early detection of cavities. This machine measures the density of the tooth, on one that may be visually clear of discoloration or decay. Now we are able to find cavities much earlier, and as a result, the sizes of the fillings are much smaller. Tooth structure is being saved because less of the tooth has to be removed due to decay. By running a small laser-like light over the top of the tooth surface, the DIAGNOdent registers number readings that indicate the severity of the decay. Clean healthy tooth structure register very low readings on the display. Carious or decayed tooth structure will register readings proportionate to the degree of decay. It is important to note that it can be used on all natural or unrestored tooth surfaces. Our dental hygienists will use it on patients during the teeth cleaning, and then alert the doctor of any problem areas to evaluate. Read more about preventative care and DIAGNOdent.

What is laughing gas?

Laughing gas, also known as nitrous oxide, is a safe, effective technique to calm children and adult's fear of the dental visit. It is a blend of two gases, oxygen and nitrous oxide. When inhaled, it is absorbed by the body and has a calming effect. Normal breathing eliminates the nitrous oxide from the body. While the patient is breathing it, he/she will smell a sweet, pleasant aroma and experience a sense of relaxation. Nitrous oxide is perhaps the safest sedative in dentistry. It is mild, non-addictive, easily taken, and then quickly eliminated by the body. The patient remains fully conscious and keeps all natural reflexes, but is simply more relaxed and less anxious. If you feel anxious about dental treatment, let us know and we can offer you a means of relaxation.

What is sedation dentistry?

Sedation dentistry uses oral medication to help patients relax during dental procedures. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it's usually taken about an hour before the procedure. There are however a few other sedatives that may be given in combination to allow the treatment time to be longer. The pill will make you drowsy, although you'll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure though they can be awakened with a gentle shake. Learn more about sedation dentistry.

Is fluoride in the water really that important?

Absolutely! Fluoridated drinking water contains a fluoride concentration effective for preventing dental cavities; this concentration can occur naturally or be reached through water fluoridation, which is the controlled addition of fluoride to a public water supply. When fluoridated water is the main source of drinking water, a low concentration of fluoride is routinely introduced into the mouth thereby reducing the chances of getting a cavity.

Many persons drink bottled water, replacing tap water partially or completely as a source of drinking water. Although some bottled waters contain an optimal concentration of fluoride (approximately 1.0 ppm), most contain <0.3 ppm fluoride. Thus, a person substituting bottled water with a low fluoride concentration for fluoridated community water might not receive the full benefits of water fluoridation. For water bottled in the United States, current FDA regulations require that fluoride be listed on the label only if the bottler adds fluoride during processing; the concentration of fluoride is regulated but does not have to be stated on the label. Few bottled water brands have labels listing the fluoride concentration.

All persons should know whether the fluoride concentration in their primary source of drinking water is below optimal, optimal, or above optimal. Currently, an optimal amount of fluoride in community/tap water ranges from 0.7-1.2 ppm. This knowledge is the basis for all individual and professional decisions regarding use of other fluoride modalities (e.g., mouth rinse or supplements). Parents and caregivers of children, especially children aged <6 years, must know the fluoride concentration in their child's drinking water when considering whether to alter the child's fluoride intake. For example, in nonfluoridated areas where the natural fluoride concentration is below optimal, fluoride supplements might be considered, whereas in areas where the natural fluoride concentration is >2 ppm, children should use alternative sources of drinking water. When in doubt, ask your dentist about the appropriate amount of fluoride you or your child should receive.

If I drink bottled water, am I getting enough fluoride?

Not necessarily. If bottled water is your primary source of drinking water, you may not be getting enough fluoride. While fluoride is added to public water supplies in much of the U.S. to reduce tooth decay, the majority of bottled waters on the market do not contain optimal levels (0.7-1.2 part per million) of fluoride. A number of factors affect whether or not you're getting enough fluoride, including: 1) the fluoride level in your bottled water, which can vary greatly by brand. If the fluoride content does not appear on the label, contact the company and ask. 2) the amount of bottled water you drink during the day. 3) whether you use bottled water for drinking, cooking or reconstituting soups, juices and other drinks and 4) whether you also drink fluoridated water at school, work or elsewhere. If you drink mostly bottled water, you should talk to your dentist about whether you need supplemental fluoride treatments- especially if you have children. Your dentist may recommend fluoride drops or tablets if he or she feels your child is not receiving adequate levels of fluoride.

What are the most frequent types of sports injuries to the mouth region?

Two of the most frequent injuries to the mouth include avulsion and fractured teeth.

Avulsion occurs when the entire tooth (root and all) becomes dislodged from the mouth. If you or someone you know has an avulsed tooth, do not pick up or hold the tooth by the root. Hold it by the crown, or top part, of the tooth. If the tooth is clean or undamaged, an attempt to replant the tooth should be made. However, only permanent teeth should be replanted, never baby teeth. If the tooth is dirty, damaged, or contaminated place it in one of these solutions for transportation to the dentist's office: cold whole milk, saliva (place in cheek of the patient), salt water, or tap water (only as a last resort). Most importantly, never try to clean off the root of a tooth as it may cause permanent damage! If a tooth is cracked, broken, or partially knocked out by a blow to the face, attempt to find the broken or missing pieces. Try to stop bleeding with pressure. A bag of crushed ice in a towel will help to reduce pain and swelling. Call your dentist right away to determine if immediate treatment is required. The tooth may or may not require splinting, and root canal may be necessary depending on the severity. To prevent these types of injuries from happening, contact your dentist to have a custom made mouthguard fabricated.

Is it okay for my child to use a sippy cup?

Sippy cup use is okay as long as the parent realizes that there are limitations. Cavities can occur as soon as baby teeth appear. One of the risk factors for childhood decay, also known as baby bottle tooth decay, is frequent and prolonged exposure of a baby's teeth to liquids containing sugar such as milk, formula, and juice. When giving your child a sippy cup be very careful about what kind of cup you use, what goes in the cup, and how frequently it is used. When shopping for a cup, choose one that does not have a no-spill valve. These are nothing more than baby bottles in disguise. Make sure that the cup has a snap-on or screw-on lid with a spout. Don't let your child constantly sip sugared liquids because that encourages cavities. Offer these liquids only at mealtimes and if your child is thirsty between meals offer water instead. Once your child has learned how to sip, the cup has achieved its purpose and can be set aside. If you have questions about sippy cup use be sure to ask your dentist.

My child is starting basketball. Should I get him a mouth guard?

Absolutely. A sports guard, or mouth guard, is a device worn over the teeth that protects them from blows to the face and head. Mouth guards are an important piece of athletic equipment for anyone participating in a sport that involves falls, body contact or flying equipment. This includes football, basketball, baseball, soccer, hockey, skateboarding, gymnastics, mountain biking - any activity that might result in an injury to the mouth.

Mouth guards typically cover the upper teeth, and are designed to protect against broken and knocked out teeth, cut lips and other damage to your mouth. There are several types of mouth guards including stock mouth guards, boil and bite mouth guards, and custom mouth guards. Custom made mouth guards are likely to provide the most comfortable fit and best protection. Your dentist makes an impression of your teeth and then constructs the mouth guard over a model of them. Because they fit and feel better, most athletes prefer customized mouth guards. Contact your dentist to have a mouth guard made for your child.

What causes bad breath?

Bad breath, also called halitosis, can be caused by several factors. Certain foods, such as garlic and onions, contribute to breath odor. Brushing at least twice a day and flossing once a day only mask the odor. Odors continue until the body eliminates the food. If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which causes bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving a bad odor. Additionally, bad breath can be caused by having a dry mouth. Saliva is necessary to cleanse the mouth and wash away particles that may be causing the odor. Dry mouth may be caused by various medications, salivary gland dysfunction, or mouth breathing. Tobacco products cause bad breath too. If you are a smoker, ask your dentist for tips on kicking the habit. Finally, bad breath may be the sign of a medical disorder such as chronic sinus problems, diabetes, or gastrointestinal problems. If your dentist feels that your mouth is healthy, he/she may refer you to your medical doctor to determine the cause of bad breath. Schedule regular dental visits for professional cleanings and checkups. Keep your mouth as clean as possible by brushing and flossing daily.

Restoration

I think I have a cracked tooth. What does that mean?

If you bite down and feel sharp pain that quickly disappears you may have a cracked tooth. A tooth may crack due to numerous factors including chewing hard objects like ice, hard candy, or nuts. In addition, an accident such as a blow to the mouth, grinding/clenching your teeth, and large fillings can all cause a crack in a tooth. A cracked tooth may appear as a hairline fracture, running vertically along the tooth though often it is invisible to the naked eye. You can help us determine which tooth is causing the problem by noting when and where you have sensitivity to heat or cold and where the pain is when you are chewing. A cracked tooth may hurt because the pressure of biting causes the crack to open. When you stop biting, the pressure is released and a sharp pain results as the crack closes. If the crack irritates the nerve inside the tooth and becomes damaged or diseased, root canal treatment may be necessary to save the tooth. A severely cracked tooth may need extraction. If you have a cracked tooth, we will determine the best treatment for you.

What is a root canal and will it be painful?

A root canal is a procedure designed to relieve pain and infection from a diseased tooth. It is generally performed using a local anesthetic and should not be painful, regardless of what you may have heard. Once the tooth is profoundly numb, the entire nerve is removed through a small opening in the top of the tooth and a filling is placed in the space where the nerve was previously present. After the procedure, no sensation or feeling is present in the tooth and the infection is eliminated. A root canal is really an amazing service allowing you to keep your tooth instead of having it extracted in order to eliminate the pain and infection present. Since the nerve and blood supply has been removed, your tooth will dry out and become brittle and could fracture, so a crown will be needed to protect it. Pain should only be a concern for you if you delay in getting this procedure done and allow your infection to get out of hand.

Can cavities be treated without 'the drill'?

Yes they can with a technique called air abrasion. Air Abrasion is a fine, gentle spray of an air-and-powder mix that removes decay and enables Dr. Marilyn to target only the decay, leaving healthy tooth structure intact. This technique is capable of painless and atraumatic care. It does not require anesthesia, and that means no needles and no "fat lip." There is no vibration, no sound, no smell, and no water spray. Unfortunately, however, it is not suitable for all cavities. Deep cavities still require more conventional treatment. Air abrasion is best for early decay and for sealing the deep grooves on the biting surfaces of teeth. Read more about Air Abrasion.

What are dental implants?

Dental implants are metal posts that are surgically placed in the bone under your gums. During a healing phase, the bone grows around the implant and they become fused together. Then a replacement tooth, or crown, is attached to the metal post. This gives you a restoration that looks like a natural tooth. Implants can be used to replace a single tooth or multiple teeth as in a bridge or denture. Patients who have a history of a loose lower denture are oftentimes candidates for an implant supported denture. Because implants fuse to the jawbone, they offer a secure base and the denture is no longer loose. Oftentimes, implant supported teeth look and feel more like natural teeth. It is important to note that healthy gums and bone are necessary to support dental implants. Patients who want to have implants must commit to a meticulous oral hygiene routine, including brushing, flossing, and regular dental visits to help protect the supporting tissues from any disease. Read more about dental implants.

Why does my filling need replacing?

There is no perfect substitute for a healthy tooth without a filling. Fillings may last many years before it needs to be replaced. However, fillings undergo constant stress from chewing and clenching or grinding your teeth. These can cause a filling to gradually wear away, chip, crack, or fall out. Additionally, a filling may eventually wear around the edges. It may pull away from the surrounding tooth structure leaving a small space between the tooth and the filling. This space allows for bacteria to enter and may cause decay around the border of the filling. Regular dental exams are important because problems with existing fillings generally can be detected in the early stages and can simply be replaced. Worn fillings should be replaced promptly. Do not wait until you have a toothache or the filling and/or tooth break. This can complicate your treatment and make it more costly. Read more about fillings.

Health

Why do I need antibiotics before my dental appointment?

During dental treatment, bleeding sometimes occurs. As a result, bacteria from the mouth can possibly enter the bloodstream and work their way to the heart. This presents a risk for some patients with cardiac abnormalities because the bacteria may cause bacterial endocarditis, a serious inflammation of the heart valves or tissues. Antibiotics reduce this risk. Certain heart conditions are more often associated with endocarditis than others. To determine if an existing heart condition poses a risk, we require a thorough medical history on your Health History Form. The form should also include the name and address of your family physician or cardiologist as well as the names and dosages of all medications that you take. Heart conditions for which antibiotics are required prior to dental treatment include: heart surgery within past six months, pacemaker, vascular surgery (replaced artery) within past six months, artificial heart valve, history of rheumatic fever, history of heart murmur (mitral valve prolapse with regurgitation), previous bacterial endocarditis, systemic pulmonary shunt, congenital heart defect, and acquired valvular dysfunction. In addition, bacteria in the bloodstream can settle in an artificial joint. This increases your risk of contracting an infection. For the first two years following a total joint placement, antibiotic prophylaxis is recommended for everyone. After two years, only high-risk patients may need to receive antibiotics for high-risk procedures.

What are impacted wisdom teeth?

Wisdom teeth, a.k.a third molars, usually will try to grow into the mouth at around age 18 to 20 years of age. They are no different than any other tooth except that they are the last teeth to erupt, or grow into the mouth. They are just as useful as any other tooth if they grow in properly, have a proper bite relationship, and have healthy gum tissue around them. Unfortunately, this does not always happen. When wisdom teeth are prevented from erupting into the mouth properly, they are referred to as impacted. Teeth that have not erupted are not necessarily impacted. It may be that it is still too early in someone's dental development, and if time passes they might grow in properly. A dentist must examine a patient's mouth and his or her x-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems including infection, decay of adjacent teeth, gum disease or formation of a cyst or tumor. Many dentists recommend removal of impacted wisdom teeth to prevent potential problems your wisdom teeth.

I think I have gum disease. What does this mean exactly?

When gums are healthy, they fit snugly around the teeth. Gum disease is an infection of the tissues that support the teeth. Gum disease is usually caused by plaque, a sticky film of bacteria that constantly forms on teeth. If plaque is not removed with thorough daily brushing and flossing, gums become irritated and swollen. The irritated, swollen gums can separate from the teeth and form spaces called pockets. Bacteria move into the pockets where they continue to promote irritation. If left untreated, the process can continue until bone and other tooth-supporting tissues are destroyed. Unfortunately, you may not even be aware that you have gum disease because often there is no pain. However, there are warning signs that you should be aware of: gums that bleed during brushing; red, swollen or tender gums; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums; loose or separating teeth; a change in the way your teeth fit together when you bite; a change in the fit of partial dentures. Current research suggests that there is a link between gum disease and other health concerns including heart problems, stroke, diabetes, and increased risk during pregnancy. You can help prevent gum disease by brushing twice a day and flossing daily. In addition, avoiding tobacco use and eating a balanced diet are important in preventing gum disease. Regular checkups are important to monitor the pockets around each tooth to ensure your teeth and gums are healthy.

Why is smoking bad for your teeth and gums?

Use of any tobacco product (cigarettes, cigars, smokeless tobacco) can increase your risk of developing oral cancer and gum disease (periodontal disease). Tobacco products can damage your gums by affecting the attachment of bone and soft tissue to your teeth. The attachment can decrease thereby causing receding gums. Now part of the tooth that used to be covered by gum tissue is directly exposed to air and the oral environment. This increases your risk of developing a sensitivity to hot and cold, or tooth decay in these unprotected areas. Additionally, smoking can delay healing after a tooth extraction or other oral surgery. Smoking can contribute to bad breath, stains on your teeth and tongue, and a build-up of tartar on your teeth. Several signs and symptoms that could indicate oral cancer include: irritation or burning or a sore that will not heal; pain or tenderness; development of a lump, or leathery, wrinkled patch inside your mouth; color changes or your gums (gray, red, or white spots) rather than a healthy pink color; and difficulty chewing or swallowing. By keeping your teeth clean with thorough brushing and flossing and seeing a dentist on a regular basis, you may be able to stop or prevent any of the above changes from taking place.

How does having cancer affect my mouth?

Patients who undergo cancer treatment sometimes are unaware that it can affect the teeth, gums, and salivary glands. Chemotherapy and radiation treatments can cause several oral side effects: inflammation and ulceration of the mucous membranes; painful mouth and gums; dry mouth; severe tooth decay; burning, peeling or swelling of the tongue; change in ability to taste; poor diet due to problems with eating; increase in the risk of developing oral and systemic infections. If possible, have a thorough dental checkup at least two weeks before treatment begins. During treatment, you should continue to brush teeth twice a day using a fluoridated toothpaste and floss once a day. We may recommend a mouth rinse in addition to daily brushing. Fluoride gel may also be indicated for home use to reduce the likelihood of tooth decay. If dry mouth develops we may recommend a saliva replacement, sucking sugar-free candy, or frequent sips of water. Soft moist foods like cooked cereals, mashed potatoes and scrambled eggs may be suitable if your mouth is sore. Additionally, it is recommended that you avoid alcohol and tobacco. Contact us if you have questions about the affects your cancer treatment is having on your mouth.

Can putting my child to bed at night with a bottle cause dental problems?

Yes. It's called baby bottle tooth decay and it's very important for parents and caregivers to understand what it is and how to prevent it. A baby's teeth are susceptible to decay as soon as they appear in the mouth. Baby bottle tooth decay is a dental condition that occurs when a child's teeth are continuously exposed to sugary liquids such as formula, fruit juice, and milk. And, it's not only what your child drinks, but also how often and how long their teeth are exposed to decay-causing acids. During sleep, salivary flow decreases, allowing sugary liquids from a bottle to form on your child's teeth. This greatly increases your baby's risk of decay. The teeth most likely to be damaged are the upper front teeth; however, other teeth can be damaged, too. Primary teeth are important because they help your baby chew food and speak. Parents, who repeatedly offer a child a bottle containing sugary liquids either as a pacifier or at bedtime, can do serious harm to their child's dental health. If your baby needs a comforter between regular feedings, give him or her a bottle of water instead.

What is gingival recession?

Gingival recession is a pathological movement of the gum margin away from the tooth. This causes the root surface of the tooth to be exposed. Exposed root surface causes pain upon exposure to cold and hot liquids and foods, and can be very sensitive to tooth brushing. Gingival recession is also unaesthetic, especially if the tooth is located in the front of the mouth when the person speaks or smiles. Some people have a very wide smile and show many teeth when they smile. An uneven gum line can be distracting and even compromise a beautiful, pleasing smile. Recession can be caused by a variety of reasons including: brushing too hard with a toothbrush, prominent roots, orthodontic treatment, muscle attachments, and periodontal disease. Treatment for recession depends on the cause and how much of a problem it is causing the patient.

What is xerostomia?

Xerostomia refers to a sensation of a dry mouth. Dry mouth may be caused by a number of factors including salivary gland dysfunction, aging, smoking, mouth breathing, radiation therapy to the head region, and HIV infection. Additionally, a wide variety of medications may produce dry mouth as a side effect. Xerostomia affects women more frequently than men and it is also more common in the elderly. This dryness may be caused by decreasing salivary gland secretions due to increasing age, but this is often difficult to prove because so many older patients take medications that may induce xerostomia. Treatment of dry mouth is difficult and often unsatisfactory. Artificial salivas are available and may help make the patient more comfortable. In addition, continuous sips of water throughout the day and sugarless candy can be used in an effort to stimulate salivary flow. If the dryness is due to the patient's medication, consult with the patient's physician to either discontinue the drug, modify the dosage, or try a different drug. Because of the increased potential for dental decay, frequent dental visits are recommended. Daily home fluoride applications can be used to help prevent decay and prescription mouth rinses can be used to minimize plaque buildup.

I am thinking about getting my tongue pierced. Can this be bad for my health?

Many young people don't realize that there are numerous alarming side effects that could happen to them if they get an oral piercing. Because your mouth contains millions of bacteria, infection is a common complication of oral piercing. Other side effects include pain, nerve damage, an increased flow of saliva and injuries to the gum tissue. If a blood vessel was in the path of the needle during the piercing, severe and difficult-to-control bleeding can result. For some, blood poisoning or even blood clots can occur. For many, the swelling of the tongue is a common side effect. And in extreme cases, a severely swollen tongue can actually close off the airway and prevent breathing. The jewelry itself also presents some hazards. You can choke on any studs, barbells or hoops that come loose in your mouth, and contact with the jewelry can chip or crack your teeth. So, skip the mouth jewelry and let your healthy smile make your fashion statement.

How does smoking affect my mouth?

Most of us know that smoking is bad for our health, but did you know that smoking is also a major factor in many dental problems? The link to dental problems and smoking includes all forms of tobacco use such as cigarettes, cigars, and smokeless tobacco. Tobacco use greatly increases the risk for oral cancer, a disease that progresses rapidly and can be deadly if not diagnosed and treated early. Tobacco use also increases the risk of gum disease, which is one of the leading causes of tooth loss in adults. Smoking can slow down healing after having a tooth pulled or other oral surgery procedures. Tobacco use can damage gum tissue and cause receding gums, leaving the roots of the teeth exposed. This could increase the risk of tooth decay and cause sensitivity to hot and cold. Any form of tobacco use can cause bad breath, stains on teeth that can't be removed from regular brushing, and a build up of tartar, which could require more frequent dental cleanings. Tobacco use causes the sense of smell and taste to be affected. Quitting smoking and/or other forms of tobacco right now can provide long term health benefits. If you would like to quit but don't know how, talk to your dentist about how he/she can help.

I heard that having poor oral hygiene can increase your risk of cancer. Is this true?

Yes. According to an article recently published in the "Journal of the National Cancer Institute," men with poor oral health have a significantly increased risk of developing pancreatic cancer over those with good oral health. Researchers from Massachusetts and Puerto Rico recently conducted a clinical study to evaluate the potential association between oral health and the development of pancreatic cancer. This study included over 50,000 male health professionals between the ages of 40-75 years who were followed for 16 years. Results indicated that a history of periodontal (gum) disease increased the risk of developing pancreatic cancer by 64%. Pancreatic cancer is the fourth leading cause of cancer deaths in the United States and usually causes no symptoms until it has spread to other sites in the body. This study shows that having great oral hygiene and seeing your dentist for cleanings and checkups can have an affect on your overall health.

How prevalent is oral cancer?

34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 34,000 newly diagnosed individuals, only half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cervical cancer, Hodgkin's disease, cancer of the brain, liver, testes, kidney, or skin cancer (malignant melanoma). The death rate associated with this cancer is particularly high due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location. Oral cancer is particularly dangerous because it has a high risk of producing second, primary tumors. This means that patients, who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for 5 to 10 years after the first occurrence. The demographics of those who develop this cancer have been consistent for some time. While the majority of people are over the age of 40 at the time of discovery, it does occur in those under this age. There are links to young men and women who use chewing or spit tobacco. The human papilloma virus has now been shown to be sexually transmitted between partners, and is implicated in the increasing incidence of young non-smoking oral cancer patients. This is the same virus that is the causative agent in more than 90% of all cervical cancers. From a gender perspective, for decades this has been a cancer which affected 6 men for every woman. That ratio has now become 2 men to each woman. Tobacco use in all its forms is number one on the list of risk factors. At least 75% of those diagnosed are tobacco users. When you combine tobacco with heavy use of alcohol, your risk is significantly increased, as the two act synergistically. Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others. Learn more about oral cancer screening.

What is "meth mouth?"

Meth (methamphetamine) addicts have a combination of drug induced symptoms and behavior patterns that cause severe tooth decay and gum disease. The drug induced symptoms are dry mouth, increased body temperature, muscular hyperactivity, and violent, self destructive behavior patterns. The dry mouth and increased body temperature produce a ferocious thirst. The increased body temperature combined with the increased hyperactivity produce a physical need for quick energy and a huge appetite for sugar. Soda, (especially Mountain Dew) is a cheap, ever-present source of both fluid and sugar and many meth addicts eat and drink little else. The dry mouth produced by the methamphetamine tends to exacerbate the severity of the decay, and the increased muscular activity produces relentless bruxing (grinding and clenching) which causes the decay weakened teeth to break. Meth also produces violent and self destructive behavior which directs the addict's attention away from looking after his or her own well-being. Consequently, little attention is paid to personal hygiene, including oral hygiene.

How does being diabetic affect my oral health?

The most common oral health problems associated with diabetes are: tooth decay; gum disease; salivary gland dysfunction; infection and delayed healing; fungal infections; and taste impairment. Thus, it is important to keep you medical records current. Make sure your dentist knows: if you have been diagnosed with diabetes; if the disease is under control, and the names of all prescription and over-the-counter drugs you are taking. When diabetes is not controlled properly, high glucose levels in saliva may help bacteria thrive. Because diabetes reduces the body's resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold your teeth in place. Patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than do people who have good control over their diabetes. Fungal infections, especially in denture wearers, occur more frequently among people with diabetes. These infections produce white (or sometimes red) patches in the mouth that are sore. When on the tongue, they can cause a painful, burning sensation. It can also cause difficulty swallowing and compromise the ability to taste. Watch for signs and symptoms of oral disease and contact your dentist when problems arise. Practice good oral hygiene, follow your physician's instructions regarding diet and medications, and schedule regular dental checkups to maintain a healthy smile.

Does having acid reflux affect my teeth?

Yes. Gastroesophageal reflux disease, or GERD, is an involuntary muscle relaxing of the upper esophageal sphincter, which allows stomach acid to move upward though the esophagus and into the oral cavity, resulting in enamel erosion. Symptoms such as belching, unexplained sour taste or heartburn usually alert the patient to the condition. However, in silent GERD, these symptoms do not occur, and enamel erosion of the back teeth may be the first indication of the disease. Enamel or dental erosion is an irreversible process involving mineral loss and chemical dissolution of tooth structure resulting in tooth sensitivity and improper tooth-to-tooth relationships (how you bite). If a dentist is suspicious that a patient may have gastric reflux, he/she will refer the patient for further medical evaluation, because successful treatment of this medical condition is necessary before dental treatment can be initiated successfully.

What's the difference between a canker sore and a cold sore?

Canker sores are often confused with cold sores. An easy way to distinguish between the two is to remember that canker sores occur inside the mouth, and cold sores usually occur outside the mouth.

A canker sore (also called aphthous ulcers) is a small ulcer with a white or gray base and red border. There can be one or a number of sores in the mouth. Canker sores are very common and often recur.

A cold sore, which is also called fever blister or herpes simplex, is composed of groups of painful, fluid-filled blisters that often erupt around the lips and sometime under the nose or under the chin. Cold sores are usually caused by herpes virus type I and are very contagious.

Canker sores usually heal in about a week or two. Rinsing with antimicrobial mouth rinses may help reduce the irritation. Over-the-counter topical anesthetics can also provide relief. Cold sores usually heal in about a week. Over-the-counter topical anesthetics can provide temporary relief and prescription antiviral drugs may reduce these kinds of viral infections.

Cosmetic

What is a veneer?

Porcelain veneers, often alternatively termed dental veneers or dental porcelain laminates, are wafer-thin shells of porcelain which are bonded onto the front side of teeth so to make a cosmetic improvement in their appearance. Porcelain veneers are routinely used to improve the looks of teeth that are discolored, worn, chipped, or misaligned. They can be used to repair minor tooth imperfections and defects, cover existing stained fillings, make color changes in teeth that are permanently discolored, and sometimes be used as an alternative to orthodontic treatment.

Are there any side effects to bleaching your teeth?

Yes. Bleaching or whitening gel usually causes some degree of tooth sensitivity. This is sensitivity to hot/cold fluids and even air can cause discomfort. If this happens to you, discontinue use for a couple of days and the discomfort will usually dissipate within 24-48 hours. Don't be concerned as bleaching does not need to be done consecutively. You will get to the same whitening point, only it will take a little longer. You can also use a toothpaste specifically designed for sensitive teeth such as Sensodyne or Crest for sensitive teeth. The active ingredient, potassium nitrate, will cut down on the sensitivity. Your dentist may offer a desensitizing gel for you to use at home to eliminate the bleaching discomfort as well. Read more about professional tooth whitening.

When I was a child, I was given tetracycline for an infection. Some of my permanent teeth are badly stained as a result of this. Will whitening my teeth take care of the discoloration? If not, what other options do I have?

It is a fact that if children are given the antibiotic tetracycline during the formation of their permanent dentition (age 3-14 yrs), that this medicine will permanently stain the teeth a dark color. The colors can range from grayish, to brownish to greenish, or a variation of these colors. The normal ways to whiten teeth, (in-office power whitening or home whitening trays) usually do not work very well with this deep intrinsic type of staining. Other procedures such as porcelain veneers or composite bonding may be considered to esthetically restore these hard to lighten teeth. Talk to your dentist if you have further questions about enhancing your smile. Learn about professional tooth whitening.

My son's upper lateral incisors (the teeth next to the front teeth) just erupted and they seem much smaller than those of other kids his age. Is this normal and what can be done to correct this?

Except for the third molars (wisdom teeth), the maxillary lateral is the tooth with the most anomalies (extreme variations from the norm). The most frequent is the peg lateral. This is a diminutive or small, peg-shaped crown with a smooth surface lacking contact on both sides with the adjacent teeth. Fortunately for your son, the maxillary laterals are just smaller in size because sometimes they are congenitally missing. This can cause many problems later of not treated. To correct the small size, direct bonding can be done thereby making the tooth appear larger. The dentist directly bonds white filling material to the tooth and shapes it so it appears more normal in size. Alternatively, these teeth can be restored with porcelain veneers to obtain a more natural and esthetic appearance. I would wait to do porcelain veneers on him though until he has undergone orthodontics, if needed, or until he is older. Read more about bonding.

I have an older crown on a front tooth and when I smile I see a gray line near my gums. What can be done to get rid of the gray color?

This is a common problem when porcelain fused to metal crowns are used to restore front teeth. With age, sometimes people develop recession where the gum tissue pulls away from the tooth slightly and the tooth now appears longer. A margin of a crown that used to be covered by gum tissue is now exposed. Sometimes the metal margin can cause the nearby gum tissue to appear gray. To get the best cosmetically pleasing result, a new crown is generally indicated. A crown can be constructed without metal and therefore the gray line will not be a problem. In some cases, the gray gingiva may need to be recontoured to eliminate the gray appearance as well. Lastly, Lumineers™ porcelain can easily be placed on top of older crowns and bridgework, with absolutely no pain, drilling, or removing sensitive tooth structure (provided that clinically the crown is sound and the margin is free of decay). If you are bothered by this "gray line," talk to your dentist during your next checkup appointment.

What are Lumineers™?

Lumineers are porcelain veneers that do not require removal of painful tooth structure. Lumineers™ by Cerinate are a wonderful cosmetic solution for permanently stained, chipped, discolored, or malaligned teeth. Lumineers can even be placed over old crowns and bridgework. They can be made as thin as a contact lens and are placed over your teeth without requiring removal of sensitive tooth structure. And yes, this means that there is no painful anesthesia! You read this correctly — no numbing! This is unlike traditional veneers. Lumineers can only be made from patented Cerinate porcelain. In just two or three visits, Lumineers can provide a custom-made smile for you. Contact your dentist to see if he/she provides Lumineers in his/her office. Read more about Lumineers.

Dentures/Partials

I am unable to wear a partial denture with a metal base. Is there another type of partial denture that I may be able to tolerate?

Yes. One of the most recent advances in dental materials has been the application of nylon-like materials to the fabrication of partial dentures. This material (the most common name brand is Valplast) can replace the metal and the pink acrylic denture material used to build the framework for standard removable partial dentures. It is nearly unbreakable, is colored pink like the gums, can be built quite thin, and can form not only the denture base, but the clasps as well. In fact, the clasps are built to curl around the necks of the teeth and are practically indistinguishable from the gums that normally surround the teeth. Even though this denture does not rest on the natural teeth like the metal variety, the clasps rest on the gums surrounding the natural teeth. This tissue, unlike the gums over extraction sites, is stable and does not tend to change over time which keeps these RPD's stable and unchanging similar to the cast metal variety. This type of partial denture is extremely stable and retentive, and the elasticity of the flexible plastic clasps keeps them that way indefinitely. Read more about partial dentures.

My dentures are loose... what should I do?

As the years pass, the tissue and bone may shrink slightly. As this happens your dentures will then loosen. Also, as you lose or gain weight, you may notice that the denture may loosen. If your denture is loose you can get it relined, which involves a new impression under your existing denture, and then the tissue side of your denture is replaced but the teeth are not. This will help your denture fit snug again. However, if their bases are too far gone, you may need to get a new denture. If your denture is more than a year or two old and you are using Fixodent everyday... your dentures are too loose and you could benefit from a reline. Relines are can usually be done in the same day and should be done every couple of years. Read more about dentures.

Why do my dentures need to be replaced?

The American Dental Association recommends that you replace your dentures every five years. Many people believe that dentures last for 20 years or more. This is absolutely not true! A denture is made of a hard, rigid material. Your face, mouth and jaw, on the other hand, change over the years. Because it cannot adapt to these changes and because artificial teeth wear down with time, a denture cannot do its job effectively for more than about five to seven years. Old dentures cause headaches, ear aches, joint problems, dietary problems, etc. Recently, a new technique has been developed that can practically mimic the looks of an existing/old denture. By using the Celara Denture System, your new denture will fit and look better, and you'll have fewer appointments and adjustments. With this system, your existing dentures are used as a reference point. This enables you and your dentist to keep the attributes you want from your existing denture while effectively communicating any changes that need to be incorporated into your new set of dentures in as little as three appointments. Read more about dentures.

Temporomandibular Joint (TMJ)

I often wake in the morning with a headache and jaw pain. What causes this?

If you find yourself waking up with sore jaw muscles or a headache, you may be suffering from bruxism - the grinding and clenching of teeth. Bruxism can cause teeth to become painful or loose, and sometimes parts of the teeth are literally ground away. It can also lead to problems involving the jaw joint, such as temporomandibular joint syndrome (TMJ). For many people, bruxism is an unconscious habit. They may not even realize they're doing it until someone comments that they make a horrible grinding sound while sleeping. For others, a routine dental checkup is when they discover their teeth are worn or their tooth enamel is fractured. Other potential signs of bruxism include aching in the face, head and neck. The appropriate treatment for you will depend on what is causing the problem. Based on the amount of tooth damage and its likely cause, your dentist may suggest: 1) Wearing an appliance while sleeping - custom-made by your dentist to fit your teeth, the appliance slips over the upper teeth and protects them from grinding against the lower teeth. While an appliance is a good way to manage bruxism, it is not a cure. 2) Also, applying a warm, wet washcloth to the side of your face can help relax muscles sore from clenching. 3) Reducing the "high spots" of one or more teeth to even your bite - An abnormal bite, one in which teeth do not fit well together, may also be corrected with new fillings, crowns or orthodontics.