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Other Procedures

Other Procedures

At Christina Lawrence, DMD, we offer so many procedures, preventative solutions, and treatments. For more information, find your procedure below.



A-C

Aesthetic Problems

A beautiful straight smile may be marred by a single misaligned tooth. This tooth can be realigned with ease and accuracy by the orthodontist. Alternatively, orthodontists can also work to reshape and restructure the lips, jaw or the face.

Related Topic

Orthodontics

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Anteroposterior Deviations

The discrepancy between a pair of closed jaws is known as an anteroposterior discrepancy or deviation. An example of such a discrepancy would be an overbite (where the upper teeth are further forward than the lower teeth), or an underbite (where the lower teeth are further forward then the upper teeth).

Related Topic

Orthodontics

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Antimicrobial application

Antimicrobial substances have proven effective for eliminating and preventing some strains of harmful oral bacteria. Antimicrobial substances can be combined with water, or used as a stand-alone treatment for successful pocket irrigation.

Related Topic

Pocket Irrigation | Periodontics

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Bone Grafting

Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma. The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth. Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.

A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease or to make the smile appear more aesthetically pleasing.

There are several types of dental bone grafts. The following are the most common:

  • Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth. Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw. If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
  • Allograft – Synthetic bone (man made) can be created in the laboratory and used in the bone grafting procedure. Bone can also be obtained from a bone bank (cadaver bone).
  • Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully for many years. Ample bone can be obtained and no secondary donor site is necessary.

Reasons for bone grafting

There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.

What does bone grafting treatment involve?

Bone grafting is a fairly simple procedure which may be performed under local anesthetic; however if large amounts of bone area need to be grafted, general anesthetic may be required.

Initially, the grafting material needs to either be harvested or prepared for insertion. A small incision is made in the gum tissue and then gently separated from the bone. The bone grafting material is then placed at the affected site.

The bone regeneration process may be aided by:

  • Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material. This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing fibers. This means that bone cells can migrate to the protected area and grow naturally.
  • Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development. Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured. It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur. Tissue stimulating proteins help to create lost support in areas affected by periodontal defects.
  • Platelet-rich growth factors –A high platelet concentration liquid can be used to create a blood clot at the site of a wound. It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

The gum is sutured in place and a follow up appointment will need to be made within 10 days to assess progress. Bone grafting is a highly successful treatment and a good base for further periodontal restorations.

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Braces (Orthodontic Treatment)

The benefits of orthodontic treatment often go beyond the obvious physical changes of an improved bite and straighter teeth; it’s also a great way to improve a person’s overall self-image. While having beautiful straight teeth is important, even more important is the need to alleviate any potential health problems associated with the teeth or jaw. Crooked teeth or jaw problems may contribute to improper cleaning of teeth, leading to tooth decay and, possibly, gum disease or total tooth loss. Orthodontic problems that go untreated can lead to chewing and digestion difficulties, speech impairments, and abnormal wear of tooth surfaces. Over time, excessive strain on gum tissue and the bone that supports the teeth can affect the jaw joints leading to problems such as headaches or face and neck pain.

The American Association of Orthodontics recommends that children get an orthodontic evaluation no later than age 7. Though orthodontic treatment can be done at any age, timely treatment ensures maximum dental health.

With all of the recent advancements in orthodontics, wearing braces has never been easier. State-of-the-art appliances and treatments are now available, from traditional metal braces, to clear and tooth colored brackets, to NASA type wires that are heat activated and require fewer adjustments! Some patients may even be candidates for treatment with Invisalign, a revolutionary way to straighten teeth using clear, retainer type aligners that require no braces or wires!

Reasons for orthodontic treatment (braces) adults & children

  • Breathing or swallowing problems
  • Crossbite
  • Crowding
  • Deep Overbite
  • Disfiguring of the face and mouth
  • Jaw and jaw joint pain
  • Missing or extra teeth
  • Overjet (protruding upper teeth)
  • Self-image
  • Spacing between teeth
  • Speech, chewing or biting problems
  • Underbite (lower jaw protrusion)
  • Finger or thumb sucking
  • Teeth erupting out of position

Treatment

1. Planning Phase – Your first couple of visits may include the following:

  • A medical and dental history evaluation.
  • Castings or “molds” of your teeth.
  • Computer generated photograph of the head and neck that will aid in planning.
  • Photographs of your face and mouth.
  • X-rays of the teeth and jaws.

After careful planning, your orthodontist will design and apply braces or fabricate custom-made appliances for you.

2. Active Phase – Active treatment involves visiting your orthodontist on a regular basis for adjustments and following specific treatment requirements to ensure successful treatment.

3. Retention Phase – When treatment is completed, the braces and/or appliances are removed and a new appliance is made. Usually these retainers are removable and will maintain the changes made to your teeth if worn continuously until the teeth and bone are stabilized in their new positions.

Treatment and retention times vary depending on each individual case. Your orthodontist will ensure you have a successful treatment for a beautiful smile that can last a lifetime.

Types of Braces

Traditional braces – These braces are strong and tend not to stain the teeth. They are comprised of individual brackets which are cemented to each tooth and accompanied by an archwire which constantly asserts gentle pressure on the teeth. Traditional braces are generally metal but are also available in a clear synthetic material and “tooth colored” ceramic. The ceramic brackets are generally more comfortable than the metal alternative, but can become discolored by coffee, wine, smoking and certain foods.

Invisalign®

SureSmile®

Lingual braces – These appliances are usually metal and fixed on the tongue side of the teeth, therefore not seen when a patient smiles. Lingual braces tend to be moderately expensive and in some cases, can interfere with normal speech. If you have any questions about orthodontic braces, please contact our office.

Do Braces Hurt?

One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort. The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious. In most cases, there may be mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.

There are two common types of fixed dental braces used to realign the teeth: Ceramic fixed braces and metal fixed braces. Both types of fixed appliances include brackets which are affixed to each individual tooth, and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment. Elastic or wire ties will be applied to hold the wire in place. Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.

What to expect when getting braces

Placement day – The placement of braces will not be painful in the slightest. It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces. In some cases, the teeth may feel more sensitive than usual. Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.

Two days after placement – The first several days after placement of braces can be slightly uncomfortable. This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands. The orthodontist will provide relief wax to apply over the braces as necessary. Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips. Additionally, over-the-counter pain medication (e.g., Motrin® and Advil®) may be taken as directed to relieve mild soreness.

Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone. The teeth will have gradually acclimated to the braces, and eating should be much easier. Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.

Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces. Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly. The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.

Dealing with discomfort – Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement o braces and orthodontic adjustments. Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.

Related Topics

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Bruxism

Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives. The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home. The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep. The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:

  • Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.
  • NTI-tss device – This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
  • Botox® – Botox® can be injected into the muscles to relax and weaken them. Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent the grinding, but not enough to interfere with everyday functions like chewing and speaking.

Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

Related Topic

Periodontics

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Cavity Prevention

Childhood cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world. There are two main causes of cavities: poor dental hygiene and sugary diets.

Cavities can be incredibly painful, often leading to tooth decay and childhood periodontitis if left untreated. Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually, are all crucial factors for both cavity prevention and excellent oral health.

What causes cavities?

Cavities form when children’s teeth are exposed to sugary foods on a regular basis. Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating. A sticky film (plaque) then forms on the tooth enamel. The oral bacteria within the plaque continually ingest sugar particles and emit acid. Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay. If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.

Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected. It is essential that children brush and floss twice per day (ideally more), and visit the dentist for biannual cleanings. Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.

How will I know if my child has a cavity?

Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all. Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye. Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.

Some of the major symptoms of cavities include:

  • Heightened sensitivity to cool or warm foods
  • Nighttime waking and crying
  • Pain
  • Sensitivity to spicy foods
  • Toothache

If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist. Failure to do so will make the problem worse, leave the child in pain, and could possibly jeopardize a tooth that could have been treated.

How can I prevent cavities at home?

  • Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation. Replace sugary snacks like candy with natural foods where possible, and similarly replace soda with water.
  • Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars. Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water. Make sure they consume enough water to cleanse the teeth.
  • Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months). The small amount of liquid emitted with each sip causes sugary liquid to continually swill around the teeth.
  • Avoid stickiness – Sticky foods (like toffee) form plaque quickly, and are extremely difficult to pry off the teeth. Avoid them where possible.
  • Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby. Rinse a dirty pacifier with running water as opposed to sucking on it, to avoid contaminating the baby’s mouth.
  • Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news. The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities. Ensure the child has a last drink before bedtime, and then brush the teeth.
  • Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child. Do not be tempted to do this. Use a blanket, toy, or hug to calm the child instead.
  • Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old. Before this time, children struggle to brush every area of the mouth effectively.
  • Check on fluoride – When used correctly, fluoride can strengthen tooth enamel and help stave off cavities. Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.
  • Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines. Keep to a regular appointment schedule to create healthy smiles!

Related Topic

Pediatric Dentistry

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Cracked Tooth

Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.

Symptoms of a cracked tooth may include:

  • Unexplained pain when eating.
  • Sensitivity to warm and cold foods.
  • Pain with no obvious cause.
  • Difficulty pinpointing the location of the pain.

What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

  • Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.
  • Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.
  • Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.
  • Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.
  • Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.
  • Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.

When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.

Related Topic

Endodontics

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Crowns (Caps)

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular. They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced. Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.
  • Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

Related Topic

Prosthodontics

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Crown Lengthening

Crown lengthening is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue. Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.

Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

  • Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  • Cosmetic uses – Extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and thus improve the aesthetic appearance of the smile.
  • Dental crowns – Crown lengthening serves to provide more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening involve?

Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend in how many teeth are involved and whether a small amount of bone needs to be removed, in addition to the soft tissue. Any existing dental crowns will be removed prior to the procedure, and replaced immediately afterwards.

The dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown. In other cases, the dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments, and rotary instruments. The rotary instruments roughly resemble the drill that is used in cavity treatment.

When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

The dentist will secure the surgical site using an intraoral (periodontal) bandage, which serves to prevent infection. Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize. The surgical site will be completely healed in approximately two to three months.

Related Topic

Periodontics

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D-G

Dental Anxiety and Fear

The overwhelming fear of dental appointments can be a common cause of anxiety. Many people visualize a drill-wielding man in a white coat just waiting to cause pain and remove teeth. The reality, however, is very different. The comfort, relaxation and happiness of the patient are embedded deep at the heart of any good dental practice. The staff at the practice will do whatever they can to reduce anxiety, allay fears and provide painless, quick treatments.

Recent technological advancements have meant that in many cases, dentists are able to replace noisy drills with painless laser beams. There are also a wide variety of safe anesthetics available to eliminate pain and reduce anxiety during routine appointments.

Here is a list of some of the most common dental fears:

  • Fear of embarrassment about the condition of teeth.
  • Fear of gagging.
  • Fear of injections.
  • Fear of loss of control.
  • Fear of not becoming numb when injected with Novocain.
  • Fear of pain.
  • Fear of the dentist as a person.
  • Fear of the hand piece (or the drill).

How can one overcome dental anxiety?

Dental anxiety and fear can become completely overwhelming. It is estimated that as many as 35 million people do not visit the dental office at all because they are too afraid. Receiving regular dental check ups and cleanings is incredibly important. Having regular routine check ups is the easiest way to maintain excellent oral hygiene and reduce the need for more complex treatments.

Here are some tips to help reduce dental fear and anxiety:

Talk to the dentist – The dentist is not a mind reader. Though it can be hard to talk about irrational fears with a stranger, the dentist can take extra precautions during visits if fears and anxiety are communicated.

Bring a portable music player – Music acts as a relaxant and also drowns out any fear-producing noises. Listening to calming music throughout the appointment will help to reduce anxiety.

Agree on a signal – Many people are afraid that the dentist will not know they are in significant pain during the appointment, and will carry on the procedure regardless. The best way to solve this problem is to agree on a “stop” hand signal with the dentist. Both parties can easily understand signals like raising the hand or tapping on the chair.

Spray the throat – Throat sprays (for example, Vicks® Chloraseptic® Throat Spray) can actually control the gag reflex. Two or three sprays will usually keep the reflex under control for about an hour.

Take a mirror – Not being able to see what is happening can increase anxiety and make the imagination run wild. Watching the procedure can help keep reality at the forefront of the mind.

Sedation – If there is no other way to cope, sedation offers an excellent option for many people. There are several types of sedation, but the general premise behind them is the same: the patient regains their faculties after treatment is complete.

Ask about alternatives – Advances in technology mean that dental microsurgery is now an option. Lasers can be used to prepare teeth for fillings, whiten teeth and remove staining. Discuss all the options with the dentist and decide on one that is effective and produces minimal anxiety.

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Dental Emergencies

Dental emergencies are quite frightening and often painful. Prompt treatment is almost always required to alleviate pain and to ensure the teeth have the best possible chance of survival.

Sometimes teeth become fractured by trauma, grinding or biting on hard objects. In other cases, fillings, crowns and other restorative devices can be damaged or fall out of the mouth completely. If there is severe pain, it is essential to make an appointment with the dentist as quickly as possible. The pain caused by dental emergencies almost always gets worse without treatment, and dental issues can seriously jeopardize physical health.

Types of dental emergency and how to deal with them

Avulsed tooth (tooth knocked out)

If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately. When a tooth exits the mouth, tissues, nerves and blood vessels become damaged. If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.

  1. Call the dentist.
  2. Pick up the tooth by the crown and rinse it under warm water. DO NOT touch the root.
  3. If possible, place it back into its socket – if not tuck it into the cheek pouch.
  4. If the tooth cannot be placed in the mouth, put the tooth into a cup of milk, saliva, or water as a last resort. It is important to keep the tooth from drying out.
  5. Get to the dentist, quickly and safely.

The dentist will try to replace the tooth in its natural socket. In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy may be necessary.


Lost filling or crown

Usually, a crown or filling comes loose while eating. Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes and pressure. Crowns generally become loose because the tooth beneath is decaying. The decay causes shape changes in the teeth – meaning that the crown no longer fits.

If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Keep the crown in a cool, safe place because there is a possibility that the dentist can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.

When the dentist is not immediately accessible, here are the steps to take:

  1. Apply clove oil to the tooth to alleviate pain.
  2. Clean the crown and affix it onto the tooth with dental cement. This can be purchased at the local pharmacy.
  3. If the crown is lost, smear the top of the tooth with dental cement to alleviate discomfort.
  4. DO NOT use any kind of glue to affix the crown.

The dentist will check the crown to see if it still fits. If it does, it will be reattached to the tooth. Where decay is noted, this will be treated and a new crown will be made.


Cracked or broken teeth

The teeth are strong, but they are still prone to fractures, cracks and breaks. Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme. Fractures, cracks and breaks can take several different forms, but are generally caused by trauma, grinding and biting. If a tooth has been fractured or cracked, there is no alternative but to see the dentist as quickly as possible.

Where a segment of tooth has been broken off, here are some steps that can be taken at home:

  1. Call the dentist.
  2. Rinse the tooth fragment and the mouth with lukewarm water.
  3. Apply gauze to the area for ten minutes if there is bleeding.
  4. Place a cold, damp dishtowel on the cheek to minimize swelling and pain.
  5. Cover the affected area with over-the-counter dental cement if there is no way to see the dentist immediately.
  6. Take a topical pain reliever.

The nature of the break or fracture will limit what the dentist is able to do. If a fracture or crack extends into the root, root canal therapy may be the only effective way to retain the tooth. In the case of a complete break, the dentist will usually affix the fragment back onto the tooth as a temporary measure.


Dislodged/loose teeth

When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it. If the tooth remains in the mouth and attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.

It is important to call the dentist immediately to make an appointment. In the meantime, use a cold compress and over-the-counter medications to relieve pain. The dentist will reposition the tooth and add splints to stabilize it. If the tooth fails to heal, root canal therapy may be required.

Related Topics

Cracked Tooth | Root Canal Therapy

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Dental Implants

Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective. If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.

Related Topics

Bone Grafting | Periodontics

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Dentures

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue. They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures - complete and partial dentures. Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain. A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.” A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks. During this time the patient will go without teeth. Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process. Once the tissues shrink and heal, adjustments will have to be made.

Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear. Reasons for dentures:

  • Complete Denture - Loss of all teeth in an arch.
  • Partial Denture - Loss of several teeth in an arch.
  • Enhancing smile and facial tissues.
  • Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks. Highly accurate impressions (molds) and measurements are taken and used to create your custom denture. Several “try-in” appointments may be necessary to ensure proper shape, color, and fit. At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures. Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

Related Topic

Prosthodontics

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Endodontics

Endodontics is a specialized branch of dentistry that deals with the complex structures found inside the teeth. The Greek word “Endodontics” literally means “inside the tooth,” and relates to the tooth pulp, tissues, nerves and arterioles. Endodontists receive additional dental training after completing dental school to enable them to perform both complex and simple procedures, including root canal therapy.

Historically, a tooth with a diseased nerve would be removed immediately, but endodontists are now able to save the natural tooth in most cases. Generally, extracting the inner tooth structures, then sealing the resulting gap with a crown restores health and functionality to damaged teeth.

Signs and symptoms of endodontic problems:

  • Inflammation and tenderness in the gums.
  • Teeth that are sensitive to hot and cold foods.
  • Tenderness when chewing and biting.
  • Tooth discoloration.
  • Unexplained pain in the nearby lymph nodes.

Reasons for endodontic treatment

Endodontic treatment (or root canal therapy) is performed to save the natural tooth. In spite of the many advanced restorations available, most dentists agree that there is no substitute for healthy, natural teeth.

Here are some of the main causes of inner tooth damage:

  • Bacterial infections – Oral bacteria is the most common cause of endodontic problems. Bacteria invade the tooth pulp through tiny fissures in the teeth caused by tooth decay or injury. The resulting inflammation and bacterial infection jeopardize the affected tooth and may cause an abscess to form.
  • Fractures and chips – When a large part of the surface or crown of the tooth has become completely detached, root canal therapy may be required. The removal of the crown portion leaves the pulp exposed, which can be debilitating painful and problematic.
  • Injuries – Injuries to the teeth can be caused by a direct or indirect blow to the mouth area. Some injuries cause a tooth to become luxated, or dislodged from its socket. Root canal therapy is often needed after the endodontist has successfully stabilized the injured tooth.
  • Removals – If a tooth has been knocked clean out of the socket, it is important to rinse it and place it back into the socket as quickly as possible. If this is impossible, place the tooth in special dental solution (available at pharmacies) or in milk. These steps will keep the inner mechanisms of the tooth moist and alive while emergency dental treatment is sought. The tooth will be affixed in its socket using a special splint, and the endodontist will then perform root canal therapy to save the tooth.

What does an endodontic procedure invlove?

Root canal therapy usually takes between one and three visits to complete. Complete X-rays of the teeth will be taken and examined before the treatment begins.

Initially, a local anesthetic will be administered, and a dental dam (protective sheet) will be placed to ensure that the surgical area remains free of saliva during the treatment. An opening will be created in the surface of the tooth, and the pulp will be completely removed using small handheld instruments.

The space will now be shaped, cleaned and filled with gutta-percha. Gutta-percha is a biocompatible material that is somewhat similar to rubber. Cement will be applied on top to ensure that the root canals are completely sealed off. Usually, a temporary filling will be placed to restore functionality to the tooth prior to the permanent restoration procedure. During the final visit, a permanent restoration or crown will be placed.

Related Topics

Cracked Tooth | Root Canal Therapy

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Eruption of Your Child’s Teeth

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year. By the age of three years old most children have a “full” set of twenty primary teeth. The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges. Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits - and the proper spacing and alignment of adult teeth. Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.

In what order do primary teeth emerge?

As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months). Canine teeth can be found next to the lateral incisors, and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth, and are lost between the ages of 10 and 12 years old.

What else is known about primary teeth?

Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both sexes.

Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once. Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone. Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.

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Fixed Bridges

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges. You and your dentist will discuss the best options for your particular case. The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal. This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth. Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

  • Fill space of missing teeth.
  • Maintain facial shape.
  • Prevent remaining teeth from drifting out of position.
  • Restore chewing and speaking ability.
  • Restore your smile.
  • Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Related Topic

Prosthodontics

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Flouride

Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.

How can fluoride prevent tooth decay?

Fluoride fulfills two important dental functions. First, it helps to staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.

When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel - especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.

Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.

How much fluoride is enough?

Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste on a clean toothbrush twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.

The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.

Does my child need fluoride supplements?

The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement may be recommended.

Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.

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Geographic Tongue

Also known as Benign Migratory Glossitis or Erythema Migrans, is a condition where the tongue is missing papillae (small bumps) in different areas, and a map-like appearance can develop. This condition is usually seen as red well defined areas on or around the sides of the tongue. The red patches (which can look like an unsightly rash) may come and go from hours to months at a time and cause increased sensitivity to certain substances

Related Topic

Oral Pathology

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Gum Disease

This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.

Related Topic

Periodontics

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Gum Grafting

A gum graft (also known as a gingival graft or periodontal plastic surgery), is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue.

Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma.

Here are some of the most common types of gum grafting:

  • Free gingival graft – This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.
  • Subepithelial connective tissue graft – This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.
  • Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).

Gum grafting is a common periodontal procedure. Though the name might sound frightening, the procedure is commonly performed with excellent results.

Here are some of the major benefits associated with gum grafting:

  • Reduced sensitivity – When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth. Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.
  • Improved appearance – Periodontal disease is characterized by gum recession and inflammation. Gum recession and root exposure can make the teeth look longer than normal and the smile to appear “toothy.” Gum grafting can make the teeth look shorter, more symmetrical and generally more pleasing to look at. In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.
  • Improved gum health – Periodontal disease can progress and destroy gum tissue very rapidly. If left untreated, a large amount of gum tissue can be lost in a short period of time. Gum grafting can help halt tissue and bone loss; preventing further problems and protecting exposed roots from further decay.

What does gum grafting treatment involve?

Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want perform before gum grafting takes place. First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria. The dentist can also provide literature, advice and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.

The gum grafting procedure is usually performed under local anesthetic. The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank.

Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft. Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.

Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site. Surgical material is used to protect the surgical area during the first week of healing. Uniformity and healing of the gums will be achieved in approximately six weeks.

Related Topic

Periodontics

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Gum Recession

Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated. Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years. Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually. Regular dental check ups will help to prevent gum recession and assess risk factors.

The following symptoms may be indicative of gum recession:

  • Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
  • Visible roots – This is one of the main characteristics of a more severe case of gum recession.
  • Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile. The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.
  • Halitosis, inflammation and bleeding – These symptoms are characteristic of gingivitis or periodontal disease. A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.

Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis. It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem. Once the cause of the gum recession has been determined, surgical and non surgical procedures can be performed to halt the progress of the recession, and prevent it from occurring in the future.

The most common causes of gingival recession are:

  • Overaggressive brushing – Over brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line, and irritate or inflame gum tissue.
  • Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth. The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
  • Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity. Chewing tobacco in particular, aggravates the gingival lining of the mouth and causes gum recession if used continuously.
  • Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes. The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria. The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

Treatment of Gum Recession

Every case of gum recession is slightly different, and therefore many treatments are available. The nature of the problem which caused the recession to begin with needs to be addressed first.

If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used. If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria. In the case of a severe calculus (tartar) build up, scaling and root planing will be performed to heal the gingival inflammation and clean the teeth.

Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature may be recommended. Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing.

Related Topic

Periodontics

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H-L

Hairy Tongue

An overgrowth of bacteria or a yeast infection in the mouth which can cause the tongue to appear hairy and black. This condition is usually a result of poor oral hygiene, chronic or extensive use of antibiotics, or radiation treatments to the head or neck. It is often also seen in HIV positive patients and those who are intravenous drug users. Hairy Tongue may or may not require treatment.

Related Topic

Oral Pathology

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Halitosis

Halitosis (or bad breath) is generally a result of old food particles between the teeth, and tooth decay. A toothbrush or dental scraper alone may not be able to reach into the depths of the gum pockets, but water jets can flush out food particles and help clean above and below the gumline.

Related Topics

Pocket Irrigation | Periodontics

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Headgear

This type of appliance is most useful to treat developmental irregularities. A headgear is a custom-made appliance attached to wire that is worn to aid in tooth movement. A headgear is intended to be worn for 12-20 hours r each day and must be worn as recommended to achieve good results.

Related Topic

Orthodontics

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Infant Oral Health (Perinatal)

Pregnancy is an exciting time. It is also a crucially important time for the unborn child’s oral and overall health. The “perinatal” period begins approximately 20-28 weeks into the pregnancy, and ends 1-4 weeks after the infant is born. With so much to do to prepare for the new arrival, a dental checkup is often the last thing on an expectant mother’s mind.

Research shows, however, that there are links between maternal periodontal disease (gum disease) and premature babies, babies with low birth weight, maternal preeclampsia, and gestational diabetes. It is of paramount importance therefore, for mothers to maintain excellent oral health throughout the entire pregnancy.

Why are perinatal dental checkups important?

Maternal cariogenic bacteria is linked with a wide range of adverse outcomes for infants and young children. For this reason, the American Academy of Pediatric Dentistry (AAPD) advises expectant mothers to get dental checkups and counseling regularly, for the purposes of prevention, intervention, and treatment.

Here are some perinatal oral care tips for expectant mothers:

  • Brush and floss – Be sure to use an ADA approved, fluoridated toothpaste at least twice each day, and floss at least once each day, to eliminate harmful oral bacteria. In addition, an alcohol-free mouthwash should be used on a daily basis.
  • Chew gum – Xylitol, a natural substance, has been shown to reduce infant and toddler caries (cavities) when chewed 3-5 times daily by the expectant mother. When choosing gum, check for the “xylitol” ingredient – no other sugar substitute has proven to be beneficial in clinical studies.
  • Diet evaluation – Maintaining a balanced, nourishing diet is always important, but particularly so during pregnancy. Make a food eating diary and look for ways to cut down on sugary and starchy foods. Sugars and starches provide food for oral bacteria, and also increase the risk of tooth decay.
  • Make regular dental appointments – When seen regularly, the dentist can bolster homecare preventative efforts and provide excellent advice. The dentist is able to check the general condition of teeth and provide strategies for reducing oral bacteria.

How can I care for my infant’s gums and teeth?

Many parents do not realize that cavity-causing (cariogenic) bacteria can be transmitted from the mother or father to the child. This transmission happens via the sharing of eating utensils and the “cleaning” of pacifiers in the parent’s mouth. Parents should endeavor to use different eating utensils from their infants and to rinse pacifiers with warm water as opposed to sucking them.

Parents should also adhere to the following guidelines to enhance infant oral health:

  • Brush – Using a soft-bristled toothbrush and a tiny sliver of ADA approved non-fluoridated toothpaste (for children under two), gently brush the teeth twice each day.
  • Floss – As soon as two adjacent teeth appear in the infant’s mouth, cavities can form between the teeth. Ask the pediatric dentist for advice on the best way to floss the infant’s teeth.
  • Pacifier use – Pacifiers are a soothing tool for infants. If you decide to purchase a pacifier, choose an orthodontically correct model (you can ask the pediatric dentist for recommendations). Be sure not to dip pacifiers in honey or any other sweet liquid.
  • Use drinking glasses – Baby bottles and sippy cups are largely responsible for infant and toddler tooth decay. Both permit a small amount of liquid to repeatedly enter the mouth. Consequently, sugary liquid (milk, soda, juice, formula, breast milk or sweetened water) is constantly swilling around in the infant’s mouth, fostering bacterial growth and expediting tooth decay. Only offer water in sippy cups, and discontinue their use after the infant’s first birthday.
  • Visit the pediatric dentist – Around the age of one, the infant should visit a pediatric dentist for a “well baby” appointment. The pediatric dentist will examine tooth and jaw development, and provide strategies for future oral care.
  • Wipe gums – The infant is at risk for early cavities as soon as the first tooth emerges. For young infants, wipe the gums with a damp cloth after every feeding. This reduces oral bacteria and minimizes the risk of early cavities.

Related Topic

Pediatric Dentistry

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Interdental Cleaning

Pocket irrigators blast plaque, food particles and other debris from between the teeth. The removal of harmful materials and bacteria keep the gum pockets cleaner and shallower; thus helping the gum tissue remain healthy.

Related Topics

Pocket Irrigation | Periodontics

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Invisalign

One of the primary concerns people often have about dental braces is the aesthetic impact of the metalwork on their smile. Especially for adults, the prospect of wearing unattractive metal braces for long periods of time can be very discouraging. Invisalign® offers an almost invisible aligning system that straightens teeth fast and contains no metal.

Invisalign® treatment consists of a series of custom-made aligning trays. The dentist changes the trays every several weeks to fit the new tooth configuration. In addition to the reduced visual impact, Invisalign® aligning trays can be temporarily removed for important occasions – meaning that treatment duration is patient-controlled. A great number of people report complete satisfaction with both the Invisalign® treatment and the stunning results.

What kind of bite problems can Invisalign® correct?

Invisalign® corrects the same dental problems as traditional metal braces; the only difference is that Invisalign® trays are almost invisible to the naked eye, and can be removed at will.

What advantages does Invisalign® offer over traditional braces and veneers?

Traditional dental braces, Invisalign® aligning trays and dental veneers are three different ways to perfect the alignment of the teeth. There are many different considerations to make when considering which treatment will be best, and each of these options works better in certain situations.

Invisalign® differs from traditional braces in that the aligning trays are fully removable. This means that more discipline and commitment is required from the patient. This is not usually a problem since the trays are comfortable and nearly invisible. Almost identical results can be obtained by using either treatment.

Invisalign® is preferable to veneers in many cases because unlike veneers, Invisalign® actually straightens the teeth. Veneers are thin covers that the dentist permanently affixes to the teeth. Teeth must be etched beforehand, meaning that to remove dental veneers, an alternative covering must be constructed. In addition to being somewhat expensive, veneers can break and often last for less than 20 years.

What does Invisalign® treatment involve?

First, the dentist needs to devise an initial treatment plan before creating the special aligning trays. Three-dimensional digital images are taken of the entire jaw. These images allow the dentist to move specific teeth on the screen, view the jaw from different angles, and also foresee what the face might look like in years to come. In essence, this technology can show how Invisalign® trays will change the facial aesthetics.

Once planning is complete, a unique set of aligners is made. The total amount of aligners required varies with each individual case, but 20-29 sets per arch is typical.

What are some considerations when wearing Invisalign® trays?

Life with Invisalign® aligning trays may take several weeks to get used to. The trays should be worn constantly, except when eating and drinking. It is important to remove the trays when consuming food or drink because food can become trapped between the tray and the teeth, causing tooth decay.

Usually, new trays are necessary every two weeks and progress between appointments can be seen with the naked eye. There is no doubt that Invisalign® aligning trays have revolutionized orthodontics. Invisalign® is renowned for being both comfortable and effective.

Related Topic

Orthodontics

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M-P

Malocclusion

A malocclusion is an incorrect relationship between the maxilla (upper arch) and the mandible (lower arch), or a general misalignment of the teeth. Malocclusions are so common that most individuals experience one, to some degree. The poor alignment of the teeth is thought to be a result of genetic factors combined with poor oral habits, or other factors in the early years.

Moderate malocclusion commonly requires treatment by an orthodontist. Orthodontists are dentists who specialize in the treatment of malocclusions and other facial irregularities.

The following are three main classifications of malocclusion:

  • Class I – The occlusion is typical, but there are spacing or overcrowding problems with the other teeth.
  • Class II – The malocclusion is an overbite (the upper teeth are positioned further forward than the lower teeth). This can be caused by the protrusion of anterior teeth or the overlapping of the central teeth by the lateral teeth.
  • Class III – Prognathism (also known as “underbite”) is a malocclusion caused by the lower teeth being positioned further forward than the upper teeth. An underbite usually occurs when the jawbone is large or the maxillary bone is short.

A severe malocclusion may lead to skeletal disharmony of the lower face. In a more extreme case, the orthodontist may work in combination with a maxillofacial dentist to reconstruct the jaw. It is never too late to seek treatment for a malocclusion. Children and adults alike have completed orthodontic realignment procedures and have been delighted with the resulting even, straight smile.

Here are some of the main reasons to seek orthodontic treatment for a malocclusion:

  • Reduced risk of tooth decay – A malocclusion often causes an uneven wear pattern on the teeth. The constant wearing of the same teeth can lead to tooth erosion and decay.
  • Better oral hygiene – A malocclusion can be caused by overcrowding. When too many teeth are competing for too little space, it can be difficult to clean the teeth and gums effectively. It is much easier to clean straight teeth that are properly aligned.
  • Reduced risk of TMJ – Temporomandibular jaw syndrome (TMJ) is thought to be caused by a malocclusion. Headaches, facial pains and grinding teeth during sleep all result from the excessive pressure to the temporomandibular joint. Realigning the teeth reduces pressure, and eliminates these symptoms.

Treatments

Related Topic

Orthodontics

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Median Palatal Cyst

This cyst is of developmental origin and is essentially a fluid filled skin sac. It usually appears in the middle of the palate and may cause substantial discomfort.

Related Topic

Oral Pathology

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Mini Dental Implants

Mini Dental Implants (MDIs) have changed the face of implant placement. Unlike full implant placement where multiple dental visits are required, MDIs eliminate the need for surgery. The development of long term MDIs now allows the dentist to place anchors in the jaw during one noninvasive treatment. The most common use for MDIs is the stabilization of dentures and overdentures. MDIs firmly anchor the dental prosthesis, which means there is no longer any need to suffer with ill-fitting, loose dentures.

MDIs are designed to eliminate bone grafting and expedite treatment. Full implants require significant bone grafting and a recovery period. The latent period allowed the anchor of the implant to properly embed itself into the jawbone. The smaller size of MDIs means that no recovery period is necessary, and the denture can be fitted the same day.

What is the configuration of mini dental implants?

An MDI is a tiny dental implant (similar to a screw) that is designed to act in place of a natural tooth root. MDIs are generally constructed from titanium and are either sprayed with calcium phosphate, or contain it along the length of the screw portion. The design and structure of MDIs promotes quick healing and long lasting results. The head portion of the implant looks very much like a ball. This ball fits firmly into the retaining mechanism and together these structures hold the dentures at a designated level. The dentures sit comfortably on the gum tissue and are able to withstand significant amounts of pressure and natural force.

What are the advantages of MDI placement?

MDIs are a true innovation for people who are reluctant to have invasive dental surgery and for denture wearers. One significant advantage MDIs have over full implants is that they offer a viable treatment choice for patients who have experienced extensive bone loss. Depending on the quality and density of jawbone available at the implant site, four of these mini implants may be implanted at one time. Unlike full implants, MDIs don’t require invasive surgery, which makes MDIs a gentler option. MDIs also minimize cost. Full-sized implants can be expensive to place, especially if many visits are required. The most common use for MDIs is to stabilize a lower denture, however they can be placed anywhere in the mouth.

Here are some of the other advantages associated with MDIs:

  • Better smelling breath.
  • Clearer speech.
  • Easier chewing and biting.
  • Easier cleaning.
  • Firmer denture fit.
  • High success rate. Less discomfort.
  • No cutting or sutures.
  • No need for adhesives or messy bonding agents.
  • No rotting food beneath the denture.
  • No slipping, wobbling or discomfort.
  • Permanent results.
  • Quick treatment time.
  • Reduced costs.

How are mini dental implants placed?

The whole mini dental implant placement procedure takes approximately one hour. Generally, in the case of lower jaw implants, four MDIs will be placed about 5mm apart. Prior to inserting MDIs, the dentist will use many diagnostic and planning tools to find the optimal place to implant them.

Here is a brief overview of the MDI placement procedure:

A mild anesthetic is administered.

A small hole is drilled in the jawbone to situate each MDI.

Each implant is screwed into place and tightened with a winged wrench.

Finally, a ratchet wrench is used to fully stabilize the MDIs.

The denture is measured against the mini implants and marks are made to indicate where the MDIs will fit.

The denture is sent to the laboratory to have holes drilled to accommodate the MDIs.

Once the denture has been fully modified, it can be affixed to the MDIs. The rubber O-ring on each MDI snaps into the designated spot on the denture, and the denture then rests snugly on the gum tissue. MDIs hold the denture comfortably in a tight-fitting way for a lifetime.

In almost all cases, no stitching is required and no real discomfort is felt after the procedure. After the denture placement procedure is complete, light eating can be resumed. The denture can be removed and cleaned at will. MDIs enhance the natural beauty of the smile and restore full functionality to the teeth.

Related Topic

Oral & Maxillofacial Surgery

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Mouth Guards

Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities. Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile. In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.

The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity. Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.

How can mouth guards protect my child?

The majority of sporting organizations now require that participants routinely wear mouth guards. Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain). In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.

Mouth guards also reduce the prevalence of the following injuries:

  • Cheek lesions
  • Concussions
  • Gum and soft tissue injuries
  • Jawbone fractures
  • Lip lesions
  • Neck injuries
  • Tongue lesions
  • Tooth fractures

What type of mouth guard should I purchase for my child?

Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.

Some points to consider when choosing a mouth guard include:

  • How much money is available to spend?
  • How often does the child play sports?
  • What kind of sport does the child play? (Basketball and baseball tend to cause the most oral injuries).

In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:

Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth. The fit is universal (one-size-fits-all), meaning that that the mouth guard doesn’t adjust. Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores. Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.

Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores. First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold. Boil and bite mouth guards are slightly more expensive than stock mouth guards, but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.

Customized mouth guards – These mouth guards offer the greatest degree of protection, and are custom-made by the dentist. First, the dentist makes an impression of the child’s teeth using special material, and then the mouth guard is constructed over the mold. Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.

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Myofascial pain

The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and debilitating headaches.

Related Topic

Bruxism

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Nerve Repositioning

If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required. The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.

Related Topic

Bone Grafting

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Occlusal trauma

The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.

Related Topic

Bruxism

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Oral Cancer

According to research conducted by the American Cancer society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues.

There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including lips, mouth, tongue, salivary glands, oropharyngeal region (throat), gums, and face.

Reasons for oral cancer examinations

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation. When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

The following signs will be investigated during a routine oral cancer exam:

  • Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
  • Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
  • Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems. Oral cancer exams, diagnosis and treatment

The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye. If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.

Related Topic

Oral Pathology | Periodontics

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Oral & Maxillofacial Surgery

Oral & Maxillofacial Surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries. After four years of dental school, an Oral & Maxillofacial Surgeon completes four to six years of additional formal training in treating the craniomaxillofacial complex. This specialty is one of 9 dental specialties recognized internationally and by the American Dental Association (ADA).

An Oral Maxillofacial Surgeon can diagnose and treat a wide variety conditions. The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:

  • TMJ, Facial Pain, & Facial Reconstruction
  • Dental Implants
  • Tooth Extractions & Impacted Teeth
  • Wisdom Teeth
  • Misaligned Jaws
  • Cleft Lip & Palate
  • Apicoectomy
  • Oral Cancers, Tumors, Cysts, & Biopsies
  • Sleep Apnea
  • Facial Cosmetic Surgery

Whether your dentist refers you to our office, you have pain or symptoms causing you concern, or you simply have questions you would like answered, please contact our office today to schedule an appointment. We are here to answer your questions and provide the treatment you deserve!

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Oral Pathology

An oral exam is routinely performed by the dentist during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases pertaining to the maxillofacial and oral regions.

The soft tissue of the mouth is normally lined with mucosa, which is special type of skin that should appear smooth in texture and pink in color. Any alteration of the color or texture of the mucosa may signal the beginning of a pathologic process. These changes may occur on the face, neck, and areas of the mouth (e.g., gums, tongue, lips, etc.). The most serious of these pathologic changes (which may or may not be painful) is oral cancer, but there are also many other common pathologic problems.

Treatment of Pathological Diseases

In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:

  • Antibiotics – In the case of a bacterial infection or persistent soreness, the dentist may prescribe a dose of antibiotics to return the mucosa to its natural state. This will alleviate soreness and discomfort.
  • Diluted Hydrogen Peroxide – When poor oral hygiene is causing changes to the soft tissue, the dentist may prescribe a diluted hydrogen peroxide mouthwash. This will kill more bacteria than regular mouthwash and improve halitosis (bad breath).
  • Oral Surgery – If the patient has cysts or abnormal non-cancerous growths, the dentist may decide to completely remove them. This can improve comfort levels, alleviate breathing problems, and make speech substantially easier depending on the location of the cyst.

Oral Examinations

During the course of a regular check up, the dentist will thoroughly inspect the soft tissue of the mouth and take serious note of any changes. If there are cell changes present, the dentist will take a biopsy of the affected area and send it away to be analyzed by laboratory specialists. When definitive results are obtained, the dentist can decide on the best course of treatment.

Oral Cancer Screenings

An oral cancer screening is usually performed during a comprehensive or recall (check-up) exam. Screening is painless and only takes a few minutes. The dentist or hygienist will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.

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Orthodontics

Orthodontics is one of many dental specialties. The word “orthodontics” is derived from the Greek words orthos, meaning proper or straight and odons meaning teeth. Orthodontics is specifically concerned with diagnosing and treating tooth misalignment and irregularity in the jaw area. Initially, orthodontic treatments were geared toward the treatment of teens and pre-teens, but these days around 30 percent of orthodontic patients are adults.

There are many advantages to well-aligned teeth, including easier cleaning, better oral hygiene, clearer speech and a more pleasant smile. Though orthodontic treatment can be effective at any age, the American Dental Association suggests that an orthodontic assessment should be performed around the age of seven. The earlier orthodontic treatment begins, the more quickly the problem can be successfully resolved.

Conditions Requiring Orthodontic Treatment

Orthodontics is a technologically advanced field which offers many sophisticated solutions to malocclusions and other cosmetic problems. The orthodontist will generally perform a visual examination, panoramic x-rays and study models (bite impressions) in order to assess the exact nature of the discrepancy.

When a diagnosis has been made, there are a variety of orthodontic treatment options available.

Treatments

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Overbite

An overbite refers to the protrusion of the maxilla (upper jaw) relative to the mandible (lower jaw). An overbite gives the smile a “toothy” appearance and the chin looks like it has receded.

Related Topic

Orthodontics

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Overcrowding

An overcrowded mouth means there is insufficient space within the jaw for all of the adult teeth to fit naturally. Overcrowding may lead to displaced, rotated or completely misaligned teeth.

Related Topic

Orthodontics

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Pediatric Dentistry

Pediatric dentistry (formerly Pedodontics/Paedodontics) primarily focuses on children from birth through adolescence. The American Dental Association (ADA), recognizes pediatric dentistry as a specialty, and therefore requires dentists to undertake two or three years of additional training after completing a general dentistry degree. At the end of this training, the American Board of Pediatric Dentistry issues a unique diploma (Diplomate ABPD). Some pediatric dentists (pedodontists) opt to specialize in oral care for children with special needs; specifically children with autism, varying levels of mental retardation, or cerebral palsy.

One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.

Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.

Education - Pediatric dentists educate the child using models, computer technology, and child-friendly terminology; thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.

Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.

Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb- sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.

Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.

Baby Bottle Tooth Decay

Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months. For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well baby check up” with a pediatric dentist around the age of twelve months.

The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers. Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.

If baby bottle tooth decay becomes too severe, the pediatric dentist may be unable to save the affected tooth. In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.

Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can completely prevent baby bottle tooth decay.

Acid-producing bacteria in the oral cavity cause tooth decay. Initially, these bacteria may be transmitted from mother or father to baby through saliva. Every time parents share a spoon with the baby or attempt to cleanse a pacifier with their mouths, the parental bacteria invade the baby’s mouth.

The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweetened liquids. These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.

Especially when sweetened liquids are used as a naptime or nighttime drink, they remain in the mouth for an extended period of time. Oral bacteria feed on the sugar on and around the teeth and then emit harmful acids. These acids attack tooth enamel and wear it away. The result is painful cavities and pediatric tooth decay.

Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay. Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake. Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.

Care for Your Child’s Teeth

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home. Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth. Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups. In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

  • Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food – emitting harmful acids that erode tooth enamel, gum tissue, and bone if left unchecked. Space out snacks where possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.
  • Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.
  • General oral hygiene – Sometimes, parents cleanse pacifiers and teething toys by sucking them. Parents may also share eating utensils with the child. Harmful oral bacteria are transmitted from parent-to-child in these ways, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water and avoid spoon-sharing wherever possible.
  • Sippy cup use – Sippy cups are an excellent transitional aid for the baby bottle-to-adult drinking glass period. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning continuous acid attacks on tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months - or whenever the child has the motor capabilities to hold a drinking glass.
  • Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste. Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth. Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter). For babies, parents should rub the gum area with a clean cloth after each feeding.
  • Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process, and suggest tips for making flossing more fun!
  • Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

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Periodontal Scaling & Root Planing

The objective of scaling & root planning is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus). These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

  • Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infections and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
  • Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss. Periodontal disease is the number one cause of tooth loss in the developed world.
  • Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline. As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planning procedure.
  • Better breath – One of the most common signs of periodontal disease is halitosis (bad breath). Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth. The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly. During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.

Related Topic

Scaling | Root Planing | Periodontics

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Periodontics

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis. It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously. Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful. Eventually, this infection will; cause the jawbone to recede and the tooth to become loose.

There are several reasons why periodontal treatment may be necessary:

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues. Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection.

When to See a Periodontist

A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored. Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Referrals from General Dentists and Self Referral

There are several ways treatment from a periodontist may be sought. In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:

  • Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
  • Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
  • Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost all together.
  • Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
  • Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. The bacteria infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.

Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.

Moderate periodontal disease – If the gum pockets reach 4-6mm in length a more extensive scaling and root planning cleaning might be required. This cleaning is usually performed under local anesthetic.

Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planning will always be performed as the initial nonsurgical treatment. In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.

Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.

Antibiotic Treatment

Periodontal disease is a progressive condition which leads to severe inflammation and tooth loss if left untreated. Antibiotic treatments can be used in combination with scaling and root planning, curettage, surgery or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures.

Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease and juvenile periodontal disease, antibiotic treatments have been incredibly effective.

Antibiotics can be prescribed at a low dose for longer term use, or as a short term medication to deter bacteria from re-colonizing.

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Pocket Irrigation

Periodontal disease is a progressive condition which leads to gum inflammation, the recession of bone and gum tissue, and tooth loss if left untreated. There are a variety of effective treatments and procedures available, including pocket irrigation, which can assist in treating the progression of the disease.

Pocket irrigation aims to cleanse plaque from the interdental (between teeth) and subgingival (under the gumline) regions of the mouth in order to prevent the colonization of harmful oral bacteria. This procedure is also used to deliver antibacterials to the subgingival areas.

Reasons for pocket irrigation

What does pocket irrigation treatment involve?

Pocket irrigation is generally performed in combination with other dental treatments; for example, as part of a professional dental cleaning or in combination with pocket reduction surgery.

In the case of a pocket reduction surgery, the tartar and subgingival plaque will be removed with special scaling and root planing instruments. When the pockets are free of debris, an antimicrobial agent may be applied using an oral irrigator. This will help reduce harmful oral bacteria which still remain in the pockets.

During a deep cleaning procedure, a pocket irrigator may be used after scaling and root planing to cleanse the pockets. Again, an antimicrobial agent may be applied to help reduce subgingival oral bacteria.

Pocket irrigation can be performed at home as part of the daily oral routine using a water jet or water pick. Flushing the interdental area with water is less harmful to soft tissue than dental floss, but should not be used as a substitute for professional dental cleaning.

Related Topic

Periodontics

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Porcelain Veneers

Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory. They are bonded onto the front of teeth to create a beautiful and attractive smile.

Veneers can completely reshape your teeth and smile. They can often be alternatives to crowns and the ideal solution in treating many dental conditions.

As with most dental restorations, veneers are not permanent and may someday need replacement. They are very durable and will last many years, giving you a beautiful long lasting smile.

Reasons for porcelain veneers:

  • Cosmetically, to create a uniform, white, beautiful smile.
  • Crooked teeth.
  • Misshapen teeth.
  • Severely discolored or stained teeth.
  • Teeth that are too small or large.
  • Unwanted or uneven spaces.
  • Worn or chipped teeth.

What does getting porcelain veneers involve?

Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.

On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.

You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.

Related Topic

Prosthodontics

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Prophylaxis (Teeth Cleaning)

A dental prophylaxis is a cleaning procedure performed to thoroughly clean the teeth. Prophylaxis is an important dental treatment for halting the progression of periodontal disease and gingivitis.

Periodontal disease and gingivitis occur when bacteria from plaque colonize on the gingival (gum) tissue, either above or below the gum line. These bacteria colonies cause serious inflammation and irritation which in turn produce a chronic inflammatory response in the body. As a result, the body begins to systematically destroy gum and bone tissue, making the teeth shift, become unstable, or completely fall out. The pockets between the gums and teeth become deeper and house more bacteria which may travel via the bloodstream and infect other parts of the body.

Prophylaxis is an excellent procedure to help keep the oral cavity in good health and also halt the progression of gum disease. Here are some of the benefits of prophylaxis:

  • Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated. Even using the best brushing and flossing homecare techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets. The experienced eye of a dentist using specialized dental equipment is needed in order to spot and treat problems such as tartar and plaque buildup.
  • Aesthetics – It’s hard to feel confident about a smile marred by yellowing, stained teeth. Prophylaxis can rid the teeth of unsightly stains and return the smile to its former glory.
  • Fresher breath – Periodontal disease is often signified by persistent bad breath (halitosis). Bad breath is generally caused by a combination of rotting food particles below the gum line, possible gangrene stemming from gum infection, and periodontal problems. The removal of plaque, calculus and bacteria noticeably improves breath and alleviates irritation.
  • Identification of health issues – Many health problems first present themselves to the dentist. Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist is able to screen for oral cancer, evaluate the risk of periodontitis and often spot signs of medical problems like diabetes and kidney problems. Recommendations can also be provided for altering the home care regimen.

Prophylaxis can either be performed in the course of a regular dental visit or, if necessary, under general anesthetic. The latter is particularly common where severe periodontal disease is suspected or has been diagnosed by the dentist. An endotracheal tube is sometimes placed in the throat to protect the lungs from harmful bacteria which will be removed from the mouth.

Prophylaxis is generally performed in several stages:

  • Supragingival cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
  • Subgingival cleaning – This is the most important step for patients with periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
  • Root planing - This is the smoothing of the tooth root by the dentist to eliminate any remaining bacteria. These bacteria are extremely dangerous to periodontitis sufferers, so eliminating them is one of the top priorities of the dentist.
  • Medication - Following scaling and root planing, an antibiotic or antimicrobial cream is often placed in the gum pockets. These creams promote fast and healthy healing in the pockets and help ease discomfort.
  • X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease. X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.

Prophylaxis is recommended twice annually as a preventative measure, but should be performed every 3-4 months on periodontitis sufferers. Though gum disease cannot be completely reversed, prophylaxis is one of the tools the dentist can use to effectively halt its destructive progress.

Related Topic

Periodontics

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Prosthodontics

Prosthodontics is the specialized field of dentistry concerned with diagnosing, planning and executing restorative and cosmetic treatments. Dentists who choose to specialize in prosthodontics must complete three or four more years of dedicated training following dental school.

A prosthodontist is in essence an architect, who formulates a comprehensive treatment plan and informs the patient as to what is possible. Missing or defective teeth can be extremely detrimental to self-esteem and self-confidence. Using the latest technology, a prosthodontist is able to fill these gaps with functional, natural-looking teeth that boost confidence and enhance the smile.

There are many reasons why a prosthodontist may be consulted, including (but not limited to):

  • Creation of partial or full sets of dentures.
  • Desire to whiten the teeth or improve the aesthetics of the smile.
  • Filling gaps created by one or more missing teeth.
  • Interest in dental implants.

What treatments can the prosthodontist perform?

Prosthodontic treatments are designed to be functional, long lasting and pleasing to the eye. These procedures can only be completed on generally healthy teeth. Issues like gum disease need to be controlled before prosthodontic treatments can begin.

There are an ever-increasing number of hi-tech prosthodontic treatments available including:

In addition to performing the treatments described above, the prosthodontist is also adept at treating problems with the jaw (TMJ), alleviating severe snoring, managing sleep apnea, and reconstructing the teeth following oral cancer treatments. Generally, the prosthodontist works in combination with other dental health professionals to ensure the best possible restorative results are achieved.

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Pulp Therapy

The “pulp” of a tooth cannot be seen with the naked eye. Pulp is found at the center of each tooth, and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen. There are several ways in which pulp can be damaged. Most commonly in children, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.

Pediatric pulp therapy is known by several other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment. The primary goal of pulp therapy is to treat, restore, and save the affected tooth.

Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth. Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.

What are the signs of pulp injury and infection?

Inflamed or injured pulp is exceptionally painful. Even if the source of the pain isn’t visible, it will quickly become obvious that the child needs to see the pediatric dentist. Here are some of the other signs to look for:

  • Constant unexplained pain.
  • Nighttime pain.
  • Sensitivity to warm and cool food temperatures.
  • Swelling or redness around the affected tooth.
  • Unexpected looseness or mobility of the affected tooth.

When should a child undergo pulp therapy?

Every situation is unique. The pediatric dentist assesses the age of the child, the positioning of the tooth, and the general health of the child before making a recommendation to extract the tooth or to save it via pulp therapy.

Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:

  • Arch length may shorten.
  • In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.
  • Opposing teeth may grow in a protruding or undesirable way.
  • Premolars may become painfully impacted.
  • Remaining teeth may “move” to fill the gap.
  • The tongue may posture abnormally.

How is pulp therapy performed?

Initially, the pediatric dentist will perform visual examinations and evaluate X-rays of the affected areas. The amount and location of pulp damage dictates the nature of the treatment. Although there are several other treatments available, the pediatric pulpotomy and pulpectomy procedures are among the most common performed.

Pulpotomy - If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the pediatric dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay. The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment. The crown strengthens the tooth structure, minimizing the risk of future fractures.

Pulpotomy treatment is extremely versatile. It can be performed as a standalone treatment on baby teeth and growing permanent teeth, or as the initial step in a full root canal treatment.

Pulpectomy - In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be affected. In these circumstances, the pediatric dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material. This usually takes several office visits.

In general, reabsorbable material is used to fill primary teeth, and non-reabsorbable material is used to fill permanent teeth. Either way, the final treatment step is to place a crown on the tooth to add strength and provide structural support. The crown can be disguised with a natural-colored covering, if the child prefers.

Related Topic

Pediatric Dentistry

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Q-T

Removable Appliances

There are a wide range of removable appliances commonly used in orthodontics, including headgear that correct overbites, Hawley retainers that improve the position of the teeth even as the jawbone reforms, and facemasks which are used to correct an underbite.

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Orthodontics

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Retainers

When braces are finally removed, the “retention” phase begins for most individuals. The objective of this phase is to ensure the teeth do not regress back to their previous position. A retainer will be used to maintain the improved position of the teeth. A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth. Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.

Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient. Perseverance and commitment are required to make this final stage of treatment successful. If the retainer is not worn as directed by the orthodontist, treatment can fail or take much longer than anticipated.

Types of Retainers

  • Hawley retainer – The Hawley retainer consists of a metal wire on an acrylic arch. The metal wire may be periodically adjusted by the orthodontist to ensure the teeth stay in the desired position. The acrylic arch is designed to fit comfortably on the lingual walls or palate of the mouth.
  • Essix – The Essix retainer is the most commonly used vacuum formed retainer (VFR). A mold is initially made of the teeth in their new alignment, and then clear PVC trays are created to fit over the arch in its entirety. VFR’s are much cheaper than many other types of retainers and also do not affect the aesthetic appearance of the smile in the same way as the Hawley retainer. The disadvantage of VFR’s is that they break and scratch more easily than other types of retainers.
  • Fixed retainers – A fixed retainer is somewhat similar to a lingual brace in that it is affixed to the tongue side of a few teeth. Usually, a fixed retainer is used in cases where there has been either rapid or substantial movement of the teeth. It usually consists of a single wire. The inclination of the teeth to move rapidly means they are also more likely to regress back to their previous position if a fixed retainer is not placed.

What do I need to consider when using a retainer?

There are a few basic things to consider for proper use and maintenance of your retainer.

Don’t lose the appliance – Removable retainers are very easy to lose. It is advisable to place your retainer in the case it came in while eating, drinking and brushing. Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created. A brightly colored case serves as a great reminder.

Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device. However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.

Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device. Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath. When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet. This means that chewing is almost impossible.

Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria. It is essential to clean the inside and outside thoroughly as often as possible. Hawley retainers can be cleaned with a toothbrush. Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.

Wear the retainer as directed – This phase of treatment is critical. The hard work has been done, the braces are off and now it is tempting not to wear the retainer as often as the orthodontist recommends. Retainers are needed to give the muscles, tissues and bones time to stabilize the teeth in their new alignment. Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense and lost time.

Related Topic

Orthodontics

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Ridge Augmentation

This procedure, often called “recontouring” may be required to correct an uneven gum line. Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

Related Topic

Periodontics | Bone Grafting

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Root Canal Therapy

Root Canal Therapy

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed. Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.

Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

  • An abscess (or pimple) on the gums.
  • Sensitivity to hot and cold.
  • Severe toothache pain.
  • Sometimes no symptoms are present.
  • Swelling and/or tenderness.

Reasons for root canal therapy:

  • Decay has reached the tooth pulp (the living tissue inside the tooth).
  • Infection or abscess have developed inside the tooth or at the root tip.
  • Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist). While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed. You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

Retreatment

In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves the removal of the previous crown and packing material, the cleansing of the root canals, and the re-packing and re-crowning of the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment runs at around 75%. Root canal treatments and retreatments are a better alternative than extraction for most individuals. If a tooth has good bone support, a solid surface and healthy gums beneath it, it stands a good chance of being saved. Opting for root canal retreatment can be far less expensive than the alternatives. Dental implants, extensive bridgework and the creation of aesthetically pleasing prosthetic teeth cost far more than working with the natural tooth. They also require maintenance and feel less natural than a “real” tooth.

Related Topic

Endodontics

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Root Planing

This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Related Topics

Periodontics | Periodontal Scaling & Root Planing

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Scaling

This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown and root surfaces. In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Related Topics

Periodontics | Periodontal Scaling & Root Planing

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Sinus Lift

A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.

Related Topics

Periodontics | Bone Grafting

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Subgingival Cleaning

Pocket irrigators have a rounded tip which eliminates the risk of tissue damage while cleaning under the gumline. The side port opening facilitates extensive cleansing by flushing out bacteria, particles and toxins from below the gumline.

Related Topics

Periodontics | Pocket Irrigation

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SureSmile®

The SureSmile® system offers quicker and more efficient treatment times than traditional dental braces. In fact, SureSmile braces can reduce the overall treatment times by as much as 40%. Though the majority of people love the thought of straight, healthy teeth, most do not relish the prospect of spending several years wearing braces. Contrary to popular belief, SureSmile® does not move the teeth more quickly. The teeth move with added precision at the same speed.

The SureSmile® technologies allow the dentist to view the teeth in 3D from every angle, and then plan treatment accordingly. In addition, the braces themselves are created by a computer program, and activated by body heat.

SureSmile® has many advantages over traditional dental braces, including fewer visits to the orthodontist, less soreness and discomfort, more accurate, better results, and shorter treatment times.

How can SureSmile® help me?

There are many ways in which the SureSmile® system is helpful to patients. Better precision means better results and a much straighter smile. SureSmile® also reduces the amount of discomfort by maximizing the effectiveness of dental wires.

Generally, brace wearers dislike adjustment appointments because they cause pain and discomfort. Fortunately, SureSmile® is able to take most of these appointments out of the equation, and leave the teeth healthier and straighter. SureSmile® offers fantastic results to people of any age – the only prerequisite is generally healthy teeth and gums.

What does getting SureSmile® braces involve?

Initially, the orthodontist will want to check the mouth for signs of decay and disease. If any irregularities are noted, they will need to be controlled before SureSmile® braces are applied.

The first stage of orthodontic treatment involves planning. A three-dimensional model of the teeth will be created using a Cone Beam Computed Tomography (CBCT) device or an OraScanner. The images available to the dentist are remarkably sharp and show the exact position of every tooth, root, nerve and blood vessel.

The dentist is able to simulate how different treatments will change the orientation of the teeth with 3D software. Every angle is examined and different approaches are considered. The software is so advanced that the dentist can use it to “look into the future” and view the final position of the bite.

When the treatment has been fully planned, it is time for the SureSmile® robot to create the prescription braces. The SureSmile® robot engineers a Copper Ni Ti shape-memory archwire. The archwire will gently assert constant pressure on the teeth to move them into the desired position.

The main difference between the SureSmile® archwire and the traditional archwire is the technology involved. Instead of going back to the office every few weeks to have the brace adjusted, the SureSmile® archwire is activated by body heat and tightens automatically. As a result, adjustments should not cause discomfort, dental visits should be less frequent, and results should be achieved quicker.

Related Topics

Orthodontics | Braces

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Teeth Cleaning

See Prophylaxis


TMJ (Tempro-Mandibular Joint Dysfunction)

Tempro-Mandibular Joint Dysfunction Syndrome (TMJ) is a common condition affecting a wide variety of people. TMJ is characterized by severe headaches, jaw pain of varying degrees, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJ sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

The symptoms of TMJ are debilitating and can greatly interfere with every day life. The comfort and general well being of the patient is at the heart of the dental practice, so pain relief is the first consideration of the dentist. The dentist is able to test, diagnose, and devise an immediate plan to treat the underlying causes of the TMJ disorder.

Reasons for treating TMJ

TMJ sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress, and that intense outbreaks of the condition can lead to neck pain and dizziness.

The most common cause of TMJ is the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to realign or adjust the teeth without the need for painful or expensive surgeries. The realignment/adjustment will stop the pounding headaches, the jaw pain, and the dizziness.

The grinding teeth symptom is particularly common and usually occurs at night. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Untreated TMJ is one of the prime underlying factors in eroded jawbones and loose teeth.

It is important for anyone experiencing the symptoms of TMJ to visit the dentist for an exact diagnosis.

What does treating TMJ involve?

TMJ could be a result of several different problems. Bad bite is the most common, but an injury resulting from a blow to the meniscus cartilage is also a possibility. Initially, the dentist will thoroughly examine the jaw area, the patients bite, take x-rays, and review the patient’s history in order to make an accurate diagnosis and recommend necessary treatment.

Once a firm diagnosis is attained, there are several ways in which relief can be provided. A specially molded bite guard can be created to stop teeth grinding during the night. A bite relationship analysis may be recommended by the dentist. The dentist can also provide advice on relaxation techniques which will lessen the effects of stress. As a last alternative, the dentist is also able to prescribe muscle relaxants.

A better option is to change the shape of the teeth and get rid of the bad bite completely, often called “realignment.” This is especially useful because it alleviates TMJ symptoms and may improve the aesthetic appearance of the teeth as well. Realignment involves adjusting the relationship between how the upper teeth come together with the lower teeth. This may require new restorations and/or adjusting the natural teeth as well. It is not a painful procedure, and it is one the dentist has performed with great success numerous times. As with any procedure, the dentist will be happy to answer questions and discuss symptoms, options, and treatments.

Related Topics

Oral Maxillofacial Surgery

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Tobacco Use

Tobacco use is one of the leading causes of death in society. Fortunately, it is also among the most preventable. Aside from being a sociably undesirable habit, smoking can result in oral cancer, reduce smelling and tasting abilities, compromise recovery after oral surgery, stain the teeth, and increase the risk of contracting periodontal disease. The American Dental Association (ADA) and all pediatric dentists encourage children, adolescents, and adults to abstain from all forms of tobacco use.

Almost all adult smokers have tried smoking before the age of nineteen. In all likelihood, an individual who abstains from smoking throughout the teenage years will never pick up the habit. Therefore, it is essential that parents strongly discourage preadolescent and adolescent tobacco use.

Is smokeless tobacco less dangerous for teens?

Tobacco use in any form brings the oral region into direct contact with carcinogens (cancer causing agents). These carcinogens and other harmful chemicals cause irreparable damage to the child’s oral health.

Parents and teens often mistakenly evaluate smokeless tobacco as the “safer” option. In fact, smokeless tobacco has been proven to deliver a greater concentration of harmful agents into the body, and to be far more addictive. One snuff of tobacco has approximately the same nicotine content as sixty regular cigarettes. In addition, smokeless tobacco causes leukoplakias in the mouth, which are dangerous pre-cancerous lesions.

What are the signs of oral cancer?

Oral cancer can be difficult to detect without the aid of the dentist. In some cases, oral cancer is not noticeable or even painful until its later stages. Parents of tobacco users must be aware of the following symptoms:

  • Changes in the way the teeth fit together.
  • Difficulty moving the jaw.
  • Mouth sores that don’t heal.
  • Numbness or tenderness.
  • Red or white spots on the cheek, lip, or tongue.

Oral cancer is treatable if caught early. Disfiguring surgery can be avoided by having the child abstain from tobacco use and getting regular preventative dental checkups.

How can I stop my child from using tobacco?

There are several ways to discourage children and adolescents from using tobacco products. First, talking to the child personally about the dangers of tobacco use (or asking the dentist to talk to the child) has proven an effective preventative strategy. Second, parents should lead by example. According to research studies, children of non-smokers are less likely to pick up this dangerous habit. Third, monitor the child closely. If the child will not cooperate, screenings for tobacco can be requested at the dental office.

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U-Z

Underbite

An underbite, also known as a negative underjet, refers to the protrusion of the mandible (lower jaw) in relation to the maxilla (upper jaw). An underbite makes the chin look overly prominent. Developmental delays and genetic factors generally cause underbites and overbites.

Related Topic

Orthodontics

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X-Rays

Digital X-Rays

Digital radiography (digital x-ray) is the latest technology used to take dental x-rays. This technique uses an electronic sensor (instead of x-ray film) that captures and stores the digital image on a computer. This image can be instantly viewed and enlarged helping the dentist and dental hygienist detect problems easier. Digital x-rays reduce radiation 80-90% compared to the already low exposure of traditional dental x-rays.

Dental radiographs (x-rays) are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam. Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan. Without x-rays, problem areas may go undetected.

Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!

Dental x-rays may reveal:

  • Abscesses or cysts.
  • Bone loss.
  • Cancerous and non-cancerous tumors.
  • Decay between the teeth.
  • Developmental abnormalities.
  • Poor tooth and root positions.
  • Problems inside a tooth or below the gum line.

Are dental x-rays safe?

We are all exposed to natural radiation in our environment. The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources.

Dental x-rays produce a low level of radiation and are considered safe. Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays. These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each x-ray.

How often should dental x-rays be taken?

The need for dental x-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.

A full mouth series of dental x-rays is recommended for new patients. A full series is usually good for three to five years. Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

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Xylitol

Tooth decay is a common, yet preventable childhood problem. Left untreated, cavities in primary (baby) and permanent (adult) teeth become painful and negatively impact the esthetics and functionality of the teeth.

Some children are particularly susceptible to tooth decay, even after receiving regular dental examinations and oral care at home. The American Academy of Pediatric Dentistry (AAPD) has recently recognized the benefits of a substance called xylitol for reducing childhood tooth decay.

What is xylitol?

Xylitol is a natural substance that can be found in a variety of fruits and vegetables. Some of the most common xylitol- rich foods include: berries, mushrooms, corns, and lettuces. Study results indicate that 4-20 grams of xylitol each day, divided into three or more helpings, can reduce tooth decay and cavities by as much as 70%. As a point of reference, a single cup of berries contains a little less than one gram of xylitol.

It can be difficult to encourage children (especially toddlers) to consistently eat four or more cups of fruit or vegetables each day. For this reason, xylitol is also available as a sugar substitute, a gum, and as a concentrate in numerous health foods. No other sugar substitute has been shown to benefit young teeth in the same way.

It should be noted that excessive xylitol consumption does not provide “more” tooth protection. Sticking to the recommended daily amount is enough to enhance other cavity-reduction efforts, and the effects will last well into the future.

How does xylitol work?

The combination of many factors increases susceptibility to childhood tooth decay and cavities. These factors include: oral care habits, diet, carbohydrate consumption, sucrose consumption, salivary flow rate, and tooth resistance to plaque.

More specifically, harmful oral bacteria feed on sugars and carbohydrates, producing acids. When sugary foods are consumed, these acids attack and destroy vulnerable tooth enamel. Xylitol works to neutralize the acids, reducing enamel destruction, and minimizing the threat of cavities in the process. Xylitol also stimulates saliva production, meaning that food particles, plaque and bacteria are continually removed from the teeth. When used in combination with fluoride, xylitol works to remineralize teeth, protecting tooth enamel and minimizing new cavity formation.

When should my child start using xylitol?

Although xylitol gum is not suitable for very young children, infants actually benefit from maternal chewing! Mothers of children between three months and two years old who used xylitol gum several times each day, protected their child from tooth decay until the age of five years old. In this case, xylitol reduced the amount of microorganisms transmitted from mother to child.

Once the child reaches toddlerhood, xylitol can be consumed as a sugar substitute, or as a natural byproduct of eating fruit and vegetables. Older children can reduce the threat of new cavities by chewing xylitol gum.

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