Dental topics

What's baby bottle tooth decay?

Baby bottle tooth decay is caused by the frequent and long-term exposure of a child's teeth to liquids containing sugars. Among these liquids are milk, formula, fruit juice, sodas, and other sweetened drinks. The sugars in these liquids pool around the infant's teeth and gums, feeding the bacteria that cause plaque. Every time a child consumes a sugary liquid, acid attacks the teeth and gums. After numerous attacks, tooth decay can begin.

The condition also is associated with breast-fed infants who have prolonged feeding habits or with children whose pacifiers are frequently dipped in honey, sugar or syrup. The sweet fluids left in the mouth increases the chances of cavities while the infant is sleeping.

How can I prevent baby bottle tooth decay?

Never allow children to fall asleep with a bottle containing milk, formula, juice or other sweetened liquids. Clean and massage the baby's gums to help establish healthy teeth and to aid in teething. Wrap a moistened gauze square or washcloth around the finger and gently massage the gums and gingival tissues. This should be done once a day.

Plaque removal activities should begin upon eruption of the first baby tooth. When brushing a child's teeth, use a soft toothbrush and a pea- shaped amount of fluoride toothpaste. Parents should first bring their child to the dentist when the child is between six and 12 months old.

Will changes in my child's diet help prevent baby bottle tooth decay?

Preventing baby bottle tooth decay involves changes in a child's diet. A series of small changes over a period of time is usually easier, and eventually leads to better oral health.

To incorporate these changes:

Gradually dilute the bottle contents with water over a period of 2-3 weeks.
Once that period is over, if you give a child a bottle, fill it with water or give the child a clean pacifier recommended by a dentist. The only safe liquid to put in a bottle to prevent baby bottle tooth decay is water.

Decrease consumption of sugar, especially between meals. Children should be weaned from the bottle as soon as they can drink from a cup, but the bottle should not be taken away too soon, since the sucking motion aids in the development of facial muscles, as well as the tongue.

Why should I be worried about baby bottle tooth decay?

Giving an infant a sugary drink at nap or nighttime is harmful because during sleep, the flow of saliva decreases, allowing the sugary liquids to linger on the child's teeth for an extended period of time. If left untreated, pain and infection can result. Severely decayed teeth may need to be extracted. If teeth are infected or lost too early due to baby bottle tooth decay, your child may develop poor eating habits, speech problems, crooked teeth, and damaged adult teeth. Healthy baby teeth will usually result in healthy permanent teeth.

Gradually dilute the bottle contents with water over a period of 2-3 weeks.
Once that period is over, if you give a child a bottle, fill it with water or give the child a clean pacifier recommended by a dentist. The only safe liquid to put in a bottle to prevent baby bottle tooth decay is water.

Decrease consumption of sugar, especially between meals. Children should be weaned from the bottle as soon as they can drink from a cup, but the bottle should not be taken away too soon, since the sucking motion aids in the development of facial muscles, as well as the tongue.

Why do I need X-rays?

Radiographic or X-ray examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

Do all patients have X-rays taken every six months?

No. Your radiographic schedule is based on the dentist's assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

What kind of X-rays does my dentist usually take?

Typically, most dental patients have "periapical" or "bitewing" radiographs taken. These require patients to hold or bite down on a piece of plastic with X-ray film in the center. Bitewing X-rays typically determine the presence of decay in between teeth, while periapical X- rays show root structure, bone levels, cysts and abscesses.

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My dentist has prescribed a "panoramic radiograph." What is that?

Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

Why do I need both types of X-rays?

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray can not show. On the other hand, periapical or bitewing X- rays show a highly-detailed image of a smaller area, making it easier for your dentist to see decay or cavities between your teeth. X-rays are not prescribed indiscriminately. Your dentist has a need for the different information that each radiograph can provide to formulate a diagnosis.

Should I be concerned about exposure to radiation?

All health care providers are sensitive to patients' concerns about exposure to radiation. Your dentist has been trained to prescribe radiographs when they are appropriate and to tailor radiographic schedules to each patient's individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, your dentist knows which techniques, procedures and X-ray films can minimize your exposure to radiation.

Do women need to be more careful with their oral health?

Women's oral health depends on their different stages of life. For many women, these changes are directly related to surges in sex hormone levels, such as in puberty, menstruation, pregnancy, lactation and menopause. Women are also more likely to be diagnosed with TMJ, Myofascial pain, eating disorders, and Sjogren's Syndrome (dry mouth).

What types of conditions will my dentist watch for?

As a woman, you need to adhere to good oral hygiene. Make sure to brush with fluoride toothpaste at least twice a day and after each meal when possible, and floss thoroughly each day. To help avoid problems, your dentist may request to see you more frequently during hormonal surges.

Puberty-The surge in hormones that occurs during puberty may cause swollen gums, especially during menstruation. Herpes-type lesions and ulcers also can develop. Girls may experience sensitive gums that react more to irritants.

Oral Contraceptives-Oral contraceptives mimic pregnancy because they contain progesterone or estrogen. Therefore gingivitis may occur with long-term use. Use of certain antibiotics while taking oral contraceptives can decrease its effectiveness. Women who use birth control pills are twice as likely to develop dry sockets and should consult their dentist before scheduling major dental procedures.

Pregnancy-Pregnant women have a risk for increased inflammation of the gums because of the surge in estrogen and progesterone. If the

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plaque isn't removed, it can cause gingivitis-red, swollen, tender gums that are more likely to bleed. And, women with periodontal disease may be at risk for pre-term, low-birth weight babies. They are also at risk for developing pregnancy tumors- inflammatory, benign growths that develop when swollen gums become irritated. Usually these tumors shrink soon after the pregnancy is over. If a women experiences morning sickness, it is important to neutralize the acid caused by vomiting which causes tooth erosion. Patients can use a paste made of baking soda and water, rubbing it on the teeth. After 30 seconds, rinse off the paste, then brush and floss. If this is not possible, rinse with water.

Menopause-During menopause, some women can experience dry mouth, burning sensation, and changes in taste. Gums can even become sore and sensitive. Hormonal replacement therapy may cause gums to bleed, swell and become red.

Other factors-Diet pills and certain medications (over-the-counter and prescriptions) can decrease salivary flow, which puts patients at risk for cavities, gum disease and discomfort. Patients with eating disorders, such as bulimia (self-induced vomiting) can't hide their symptoms from their dentists because the episodes of binging and purging cause erosion on the backside of the upper front teeth. (An additional sign is sores that appear at the corners of the mouth.) Smoking also creates a higher risk for periodontal disease.

How will my dentist know if I have a problem?

Keep your dentist informed if you experience changes in your oral health or if you are approaching a different life stage. Also, visiting your dentist regularly will help him or her see any physical changes in your mouth. Your dentist should complete a thorough medical history to determine if you are at a higher risk for problems.

Wisdom teeth, or third molars, do not always erupt properly when they decide to make an appearance. It's wise to get an early opinion from your dentist on getting wisdom teeth pulled before they become impacted, causing pain, swelling, infection, cavities or gum disease.

Why don't wisdom teeth grow in right?

Although we have seen a reduction in the size of the human jaw during the course of human evolution, we still retain the same number of teeth. The change in jaw size of modern humans is related to the discovery and use of fire to prepare food, and the development of crude tools, such as blades, to process food. These advances not only enhanced the culinary skills and diet of early humans, they significantly lightened the workload of the jaw. The result? As the need for a powerful jaw vanished, the jaw became smaller, and the teeth became crowded, the space required for the proper growth of wisdom teeth, no longer available. (The modern, human mouth is too small to accommodate wisdom teeth, which make their appearance in young adults between the ages of 15-25.)

What does "impacted" mean?

When wisdom teeth don't have room to grow or they haven't reached their final position by age 25, they are considered impacted-no place to go and no plans to grow. Third molar impaction is the most prevalent medical developmental disorder. A full set of healthy teeth sometimes doesn't leave much room for wisdom teeth to erupt.

What kind of problems can impacted third molars cause?

Partially erupted wisdom teeth are breeding grounds for bacteria and germs and may lead to infection. In addition to jaw pain and gum disease, which may also develop, impacted third molars are ripe sites for the growth of tumors and cysts. Not all wisdom teeth cause problems, however.

Can't I just use an antibiotic?

Antibiotics only soothe infected wisdom teeth for a short time. Since people frequently use a wide variety of antibiotics, the infection may be resistant to such medication and doesn't solve the real problem: The tooth can't fit in your mouth.

When is removal necessary?

It isn't wise to wait until wisdom teeth bother you. Early removal, as advised by your dentist, is generally recommended to avoid problems, such as an impacted tooth that destroys the second molar. People younger than 16 heal easier too. At an early age, people should be evaluated by their dentist who can track third molar development with the help of X-rays. Second molars should be visible to lessen the chance of damaging them during surgery. This occurs at age 11 or 12, so wisdom teeth should be removed when the decision has been made that they cannot erupt into an acceptable position.

What if I don't have any symptoms?

People with symptoms of impaction, such as pain, swelling and infection should have their wisdom teeth removed immediately. However, those with no symptoms can avoid the chance of ever suffering from the pain of impacted wisdom teeth or achieve better orthodontic treatment results by having them removed. A symptomatic impacted wisdom teeth also should be removed to reduce the chance of unexplained pain, accommodate prosthetic appliances, or avoid cavities, periodontal disease, bone shrinkage and tumor development.

How is the tooth removed?

Surgery for impacted wisdom teeth consists of removing of the gum tissue over the tooth, gently stripping connective tissue away from the tooth and bone, removing the tooth and sewing the gum back up.

What is tooth decay, and what causes it?

Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime.

Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

How are cavities prevented?

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body's natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.

If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Who is at risk for cavities?

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities.

What can I do to help protect my teeth?

The best way to combat cavities is to follow three simple steps: 

• Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk. 
• Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits-the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally,because caries is a transmittable disease, toothbrushes should never be shared, especially with your children. 
• See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dentalexamination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

What is the Temporomandibular Joint?

The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side and base of the skull) and the mandible (lower jaw). Mastication (chewing) muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways, and open and close.
The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. Temporomandibular Disorder (TMD) may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

What is Temporomandibular Disorder?

TMD describes a variety of conditions that affect jaw muscles, temporomandibular joints, and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men and is the most common non-dental related chronic orofacial pain.

What causes TMD?

Normal function for this muscle group includes chewing, swallowing, speech and communication. Most experts suggest that certain tasks, either mental or physical, cause or aggravate TMD, such as strenuous physical tasks or stressful situations. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth (bruxism).
These excessive habits tire the jaw muscles and lead to discomfort, such as headaches or neck pain. Additionally, abnormal function can lead to worn or sensitive teeth, traumatized soft tissues, muscle soreness, jaw discomfort when eating, and temporal (side) headaches.

What TMD symptoms can I experience?

• An earache without an infection 
• Jaw pain or soreness that is more prevalent in the morning orlate afternoon 
• Jaw pain when you chew, bite or yawn 
• Clicking when opening and closing your mouth 
• Difficulty opening and closing your mouth 
• Locked or stiff jaw when you talk, yawn or eat 
• Sensitive teeth when no dental problems can be found

What can I do to treat TMD?

The majority of cases can be treated by unloading (resting) the joint, taking a non-aspirin pain reliever and practicing stress management and relaxation techniques. It's important to break bad habits to ease the symptoms. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. If you still experience pain, you may be grinding or clenching your teeth at night. So see your dentist for a nighttime mouthguard.
Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint). Eating soft foods and avoiding chewing gum also help relax the muscles.

Is TMD permanent?

The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment, by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis.

Why are my teeth sensitive?

Tooth sensitivity is caused by the stimulation of cells within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp). When the hard enamel is worn down or gums have receded-causing the tiny tube surfaces to be exposed-pain can be caused by eating or drinking food and beverages that are hot or cold; touching your teeth; or exposing them to cold air.

Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth.

Is tooth sensitivity a common condition?

Sensitive teeth is one of the most common complaints among dental patients. At least 45 million adults in the United States and 5 million Canadians, suffer at some time from sensitive teeth.

How can I avoid sensitivity?

Some toothpastes contain abrasive ingredients that may be too harsh for people who have sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes may increase tooth sensitivity.

To prevent sensitivity from occurring, use a soft-bristled toothbrush. Avoid using hard bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth's root surface and expose sensitive spots. The way to find out if you're brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you're brushing too hard.

How do I know when it's time to see a dentist?

If a tooth is highly sensitive for more than three or four days, and reacts to hot and cold temperatures, it's best to get a diagnostic evaluation from your dentist to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that's not yet visible.

How do I describe my symptoms to my dentist?

Sensitivity may be defined as a short sharp pain, which is usually initiated by hot or cold foods or exposure to cold air. Aching often follows. Because sensitivity may mean different things to a patient and dental professional, be sure to clarify exactly what you feel when you discuss the condition with your dentist. Be sure to tell the dentist when the pain started and if there is anything, such as the application of a warm compress, that helps eliminate the pain.

Do some products work to help decrease sensitivity?

Toothpastes for sensitive teeth usually contain a desensitizing agent that protects the exposed dentin by blocking the tubes in the teeth that are connected to nerves. In most cases, these products must be used on a regular basis for at least a month before any therapeutic benefits may be noticed.

What can the dentist do for my sensitive teeth?

Dentists have a variety of regimens to manage tooth hypersensitivity, including both in-office treatments and patient-applied products for home use. If you are diagnosed with dentin hypersensitivity, your dentist may apply a desensitizing agent or a protective coating. You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride. These ingredients help block transmission of sensation from the tooth to the nerve. It also might help to massage the special paste onto your gums with your finger after brushing.

What should I do after the dentist has applied a desensitizing agent?

Listen closely to your dentist's instructions. He or she may advise you not to eat or drink for a short period of time, to eliminate all sources of irritation, such as acidic foods or medication, highly concentrated foods or flavored toothpastes. You may also be instructed to change oral hygiene habits that are likely to cause abrasion or use a daily fluoride application (a rinse or brush-on gel.)

What is a root canal?

Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.

Why do I feel pain?

When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

Why do I need root canal therapy?

Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall-out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it's always best to keep your original teeth.

What is involved in root canal therapy?

Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an Endodontist (a pulp specialist). Treatment usually involves one to three appointments.

First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, a gap is drilled from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp and reshaped. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or the dentist may go right ahead and fill the canals.

If you're given a temporary filling, usually on the next visit it's removed and the pulp chamber and canal(s) are filled with rubber like gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.

What are the risks and complications?

More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal filing instrument used-both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

What happens after treatment?

Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods on the treated tooth, and see your dentist regularly.

How does pregnancy affect my oral health?

It's a myth that calcium is lost from the mother's teeth and "one tooth is lost with every pregnancy." But you may experience some changes in your oral health during pregnancy. The primary change is a surge in hormones-particularly an increase in estrogen and progesterone-which is linked to an increase in the amount of plaque on your teeth.

How does a build-up of plaque affect me?

If the plaque isn't removed, it can cause gingivitis-red, swollen, tender gums that are more likely to bleed. So-called "pregnancy gingivitis" affects most pregnant women to some degree, and generally begins to surface in the second trimester. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontal disease, a more serious form of gum disease. 

Pregnant women are also at risk for developing pregnancy tumors, inflammatory, benign growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own. But if a tumor is uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.

How can I prevent these problems?

You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If tooth brushing causes morning sickness, rinse your mouth with water or with anti-plaque and fluoride mouthwashes. Good nutrition-particularly plenty of vitamin C and B12-help keep the oral cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.

When should I see my dentist?

If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a check-up in your first trimester for a cleaning. Your dentist will assess your oral condition and map out a dental plan for the rest of your pregnancy. A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to gauge the effectiveness of your oral hygiene. Depending on the patient, another appointment may be scheduled early in the third trimester, but these appointments should be kept as brief as possible.

Are there any procedures I should avoid?

Non-emergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

Will pregnancy affect my oral health?

Expectant mothers (and women who take some oral contraceptives) experience elevated levels of the hormones estrogen and progesterone. This causes the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as "pregnancy gingivitis." Symptoms include swollen, red gums and bleeding of the gums when you brush. Remember that the bacteria in plaque (not hormones) is what causes gingivitis. Brush twice a day and floss before you go to bed to help avoid plaque buildup. 

What are "pregnancy tumors"?

Pregnancy tumors (pyogenic granuloma) are rare, usually painless lesions that may develop on your gums in response to plaque. Although they are not cancerous, they should be treated. Pregnancy tumors usually subside shortly after childbirth.

Could gingivitis affect my baby's health?

New research suggests a link between pre-term, low birth weight babies and gingivitis. Excessive bacteria, which causes gingivitis, can enter the bloodstream through your mouth (gums). If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called "prostaglandins," which are suspected to induce premature labor.

Should I receive dental treatment while I'm pregnant?

Good oral health care is vital during your pregnancy. Continue with your regular dental cleaning and check-ups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease. Dentists recommend that major dental treatments that aren't urgent be postponed until after your child is born. The first trimester, the stage of pregnancy in which most of the baby's organs are formed, is the most crucial to your baby's development, so it is best to have procedures performed during the second trimester to minimize any potential risk.

Dental work is not recommended during the third trimester because the dental chair tends to be too uncomfortable for the mother. If you lie back, the chair may cut off circulation by placing pressure on the vein that returns blood to the heart from the lower part of your body.

If I do need treatment, what drugs are safe?

Be extremely cautious of all drugs during pregnancy. If you have gingivitis or periodontal disease, your dentist may want to treat you more often to achieve healthy gums and a healthy baby. Although dental anesthetics such as novocaine or lidocaine can enter the placenta, which filters out most drugs, the doses used in most dental procedures are considered safe. If you need to have dental work done during your pregnancy, research has shown that some acceptable antibiotics include penicillin, amoxicillin, and clindamycin, but avoid tetracycline, which can cause discoloration of your child's temporary and permanent teeth. Products containing acetaminophen, such as Tylenol, are approved, but you should be wary of other over-the-counter medications such as aspirin or ibuprofen. Avoid using narcotics for dental pain until your child is carried to term.

Who can I talk to?

If you have any concerns about treatment or medications, make sure to ask your dentist or physician before receiving treatment. Most dental procedures are safe during pregnancy. Remember, the healthier your mouth is, the healthier and happier your pregnancy and baby will be.

What are porcelain veneers?

Porcelain veneers are ultra-thin shells of ceramic material, which are bonded to the front of the teeth. This procedure requires little or no anesthesia, and can be the ideal choice for improving the appearance of the front teeth. Porcelain veneers are placed to mask discolorations, to brighten teeth, and to improve a smile. Highly resistant to permanent staining from coffee, tea, or even cigarette smoking, the wafer-thin porcelain veneers can achieve a tenacious bond to the tooth, resulting in an esthetically pleasing naturalness that is unsurpassed by other restorative options.

Why a porcelain veneer?

Porcelain veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth's color, size, or shape. Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.

What happens during the procedure?

Patients need three appointments for the entire procedure: diagnosis and treatment planning, preparation, and bonding.

Diagnosis and treatment planning: It's critical that you take an active role in the smile design. Spend time in the decision-making and planning of the smile. Understand the corrective limitations of the procedure. Have more than one consultation, if necessary, to feel comfortable that your dentist understands your objectives.

Preparation of teeth: This appointment will take from one to two hours. To prepare the teeth for the porcelain veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which may require a local anesthetic. At this appointment, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This can take about one to two weeks. If the teeth are too unsightly a temporary veneer can be placed, at an additional cost.

Bonding of veneers: This appointment will take about one or two hours. First, the dentist places the veneers with water or glycerin on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, view the esthetic results, and pay particular attention to the color. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. The color cannot be altered after veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a visible light beam initiates the release of a catalyst to harden the cement.

How about maintenance?

For about a week or two, you will go through a period of adjustment as you get used to your "new teeth" that have been changed in size and shape. Brush and floss daily. After one or two weeks, you'll return for a follow-up appointment.

Have realistic expectations

Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It's not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth. Nevertheless, this procedure can greatly enhance your smile, and can heighten inner satisfaction and self-esteem.

How can I take care of my teeth?

Proper oral care can keep you smiling well into retirement. Brushing at least twice a day with a fluoride toothpaste and a soft-bristle brush are as important as ever. Flossing can help you save your teeth by removing plaque between teeth and below the gum line that your toothbrush cannot reach.

What are some problems I should watch for?

Gingivitis. Most people don't realize how important it is to take care of their gums. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and possible bleeding when you brush. If you have any of these symptoms, see a dentist at once. Gingivitis can lead to gum disease if problems persist. Three out of four adults over age 35 are affected by some sort of gum (periodontal) disease. In gum disease, the infection becomes severe. Your gums begin to recede, pulling back from the teeth. In the worst cases, bacteria form pockets between the teeth and gums, weakening the bone. All this can lead to tooth loss if untreated, especially in patients with osteoporosis. If regular oral care is too difficult, your dentist can provide alternatives to aid in flossing and prescribe medication to keep the infection from getting worse.

What if it's too difficult to brush?

If you have arthritis, you may find it difficult to brush and floss for good oral health care and prevention of disease. Ask your dentist for ways to overcome this problem. Certain dental products are designed to make dental care less painful for arthritis sufferers. You may want to try strapping the toothbrush to a larger object, such as a ball, to make the brush more comfortable to handle, or electric toothbrushes can help by doing some of the work for you.

What are the signs of oral cancer?

Oral cancer most often occurs in people over 40 years of age. See a dentist immediately if you notice any red or white patches on your gums or tongue, and watch for sores that fail to heal within two weeks. Unfortunately, oral cancer is often difficult to detect in its early stages, when it can be cured easily. Your dentist can perform a head and neck exam to screen for signs of cancer. Since oral cancer is often painless in its early stages, many patients will not notice the signs until it is too late. In addition, many older people, especially those who wear dentures, do not visit their dentists enough and problems go unseen.

Should I be concerned about dry mouth?

Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications or cancer treatment. This can make it hard to eat, swallow, taste and speak. In certain cases, such as radiation therapy, dry mouth can lead to severe complications, which is why it is important you see a dentist immediately before beginning any form of cancer treatment. Drinking lots of water and avoiding sweets, tobacco, alcohol and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to fight severe dry mouth.

Maintaining your overall health

Studies have shown that maintaining a healthy mouth may keep your body healthier and help you avoid diabetes, heart disease and stroke. The best way to achieve good oral health is to visit your dentist for a cleaning at least twice a year.

How does what I eat affect my oral health?

You may be able to prevent two of the most common diseases of modern civilization, tooth decay (caries) and periodontal disease, simply by improving your diet. Decay results when the hard tissues are destroyed by acid products from oral bacteria. Certain foods and food combinations are linked to higher levels of cavity-causing bacteria. Although poor nutrition does not directly cause periodontal disease, many researchers believe that the disease progresses faster and is more severe in patients whose diet does not supply the necessary nutrients. Periodontal disease affects the supporting tissues of the teeth and is the leading cause of tooth loss in adults.

Poor nutrition affects the entire immune system, thereby increasing susceptibility to many disorders. People with lowered immune systems have been shown to be at higher risk for periodontal disease. Additionally, today's research shows a link between oral health and systemic conditions, such as diabetes and cardiovascular disease. So eating a variety of foods as part of a well-balanced diet may not only improve your dental health, but increasing fiber and vitamin intake may reduce the risk of other diseases.

How can I plan my meals and snacks to promote better oral health?

Eat a well-balanced diet characterized by moderation and variety. Develop eating habits that follow the recommendations from reputable health organizations such as The American Dietetic Association and The National Institutes of Health. Choose foods from the four basic food groups: fruits and vegetables, breads and cereals, milk and dairy products, meat, chicken, fish or beans. Avoid fad diets that limit or eliminate entire food groups which usually result in vitamin or mineral deficiencies.

Always keep your mouth moist by drinking lots of water. Saliva protects both hard and soft oral tissues. If you have a dry mouth, supplement your diet with sugarless candy or gum to stimulate saliva.

Foods that cling to your teeth promote tooth decay. So when you snack, avoid soft, sweet, sticky foods, such as cakes, candy and dried fruits. Instead, choose dentally healthy foods such as nuts, raw vegetables, plain yogurt, cheese and sugarless gum or candy.

When you eat fermentable carbohydrates, such as crackers, cookies and chips, eat them as part of your meal, instead of by themselves. Combinations of foods neutralize acids in the mouth and inhibit tooth decay. For example, enjoy cheese with your crackers. Your snack will be just as satisfying and better for your dental health. One caution: malnutrition (bad nutrition) can result from too much nourishment as easily as too little. Each time you eat, you create an environment for oral bacteria to develop. Additionally, studies are showing that dental disease is just as related to overeating as heart disease, obesity, diabetes and hypertension. So making a habit of eating too much of just about anything, too frequently, should be avoided.

When should I consult my dentist or dietitian about my nutritional status?

Always ask your dentist if you're not sure how your nutrition (diet) may affect your oral health. Conditions such as tooth loss, pain, or joint dysfunction can impair chewing and are often found in elderly people, those on restrictive diets and those who are undergoing medical treatment. People experiencing these problems may be too isolated or weakened to eat nutritionally balanced meals at a time when it is particularly critical. Talk to your dental health professional about what you can do for yourself or someone you know in these circumstances.

What is halitosis?

More than 90 million people suffer from chronic halitosis or bad breath. In most cases it originates from the gums and tongue. The odor is caused by bacteria from the decay of food particles, other debris in your mouth, and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

Does bad breath come from other sources than the mouth?

Bad breath also may occur in people who have a medical infection, gum disease, diabetes, kidney failure, or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate post-nasal drip. This is where the mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor. Bad breath originating in the stomach, however, is considered to be extremely rare.

Why is saliva so important in the fight against bad breath?

Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware because the odor may reappear even if you've brushed your teeth.

Do certain foods cause bad breath?

Very spicy foods, such as onions and garlic, and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.

How do I control bad breath?

It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. To alleviate the odor, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control the odor. If you have dentures or a removable appliance, such as a retainer or mouthguard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouth rinses, deodorizing sprays or tablets, talk with your dentist because these products only mask the odor temporarily, and some products work better than others.

What is my dentist's role?

Visit your dentist regularly because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, your dentist can help determine its source. He or she may ask you to schedule a separate appointment to find the source of the odor. Or, if your dentist believes that the problem is caused from a systemic source (internal), such as an infection, he or she may refer you to your family physician or a specialist to help remedy the cause of the problem.

Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

What causes gum disease?

Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control.

What are the warning signs of gum disease?

This photo shows healthy gums in light pink color and teeth are free of tartar. Also,the gums and bone are at a healthy level.

Tartar has begun to develop on the teeth.The bacteria in the tartar release toxins causing irritation of gums .Gums become swollen, tender and blessed easily. This condition is called as gingivitis where the gums are inflamed but the bone is at a healthy level.

As the tartart builds up gradually, the toxins & enzymes from the bacteria then start to destroy the bone around the tooth. As a result, the bone level reduces and depending on the extent to which the bone is affected. This condition is called as mild or moderate periodontitis.

With heavy tartar buildup,bone loss increases.This reduces the support for the teeth. They become loose and may tend to shift in the position. This advanced periodontitis leads to loss of the teeth unless intervened by extensive treatment.

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs. If a dentist doesn't do a periodontal exam during a regular visit, the patient should request it. Children also should be examined.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

Is maintenance important?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy. Patients should visit the dentist every 3-4 months (or more, depending on the patient) for spot scaling and root planning and an overall exam. In between visits, they should brush at least twice a day, floss daily, and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don't reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) are the best way to clean in between the recesses in the teeth, and should be used once a day. Wooden tooth picks and rubber tips should only be used if recommended by your dentist

What is a dental implant?

A dental implant is an artificial tooth root (synthetic material) that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support, they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth.

Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

Can anyone receive dental implants?

Talk with your dentist about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

What can I expect during this procedure?

The dentist must perform surgery to anchor the "artificial root" into or on your jaw bone. The procedure is done in the dental office with local anesthesia. Medications may be prescribed for soreness.

How long does the process take?

The process can take up to nine months to complete. Technology, however, is trying to decrease the healing time involved. Each patient heals differently, so times will vary. After the screws and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months.

What is the success rate of implants?

The success rate for implants depends on the tooth's purpose and location in the mouth. The success rate is about 95 percent for those placed in the front of the lower jaw and 85 percent for those placed in the sides and rear of the upper jaw.

How do I care for implants?

Your overall health may affect the success rate of dental implants. Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day, without metal objects. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

What is the cost of implants?

Since implants involve surgery and are more involved, they cost more than traditional bridge work. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. Your dentist can help you with this process.

Is my dentist trained in implant therapy?

Dentists who have received training through an extensive program can complete this procedure. Your dentist may perform the procedure or consult with a team of dental health specialists to produce the result discussed with you. Ask your dentist questions about his or her training in implant therapy.

Why do I need anesthesia at the dental office?

To make your dental visit as comfortable as possible, your dentist may suggest anesthesia to reduce or eliminate any pain or anxiety that may be related to your dental treatment. The type of anesthesia required for any dental procedure depends on the needs or preferences of the patient.

How do I know if I'm a candidate for dental anesthesia?

You and your dentist will decide what level of anesthesia is right for you. Some patients prefer a higher level of anesthesia than others. Children, people with special needs, such as mental retardation, and those with a condition, such as a dental phobia may require a higher level of anesthesia. The type of anesthesia administered by your dentist is more dependent on individual patient preferences than specific dental procedures.
What are the levels of dental anesthesia?

Local anesthesia is produced by the application or injection of a drug to eliminate pain in a specific area in the mouth. Topical anesthetics are frequently used by your dentist to numb an area in preparation for administering an injectable local anesthetic. Injectable local anesthetics, such as Lidocaine, numb mouth tissues in a specific area of your mouth for a short period of time. Your dentist will probably inject a local anesthetic before filling cavities, preparing your teeth for crowns, or for any surgical procedure. Local anesthesia is the most commonly used form of anesthesia in the dental office.

Conscious sedation can be used to help you relax during a dental procedure. Your dentist may administer an anti-anxiety agent, such as nitrous oxide, or a sedative, in combination with a local anesthetic for pain. During conscious sedation, you will remain calm during treatment, yet rational and responsive to speech and touch. Anti-anxiety agents and sedatives can be administered by mouth, inhalation or injection.

Deep sedation and general anesthesia is used for complex procedures and for patients who have trouble controlling their movements or need a deeper level of anesthesia during treatment. During deep sedation you will be unable to respond appropriately to verbal commands. During general anesthesia you will be unconscious.
What should I tell my dentist before receiving anesthesia? 

Your dentist needs to know about all the medications that you are taking, any allergic reactions you've had to medicines in the past, and your past and present health conditions. It's important that you answer your dentist's questions completely and ask about your concerns. This way your dentist will be sure to tell you everything you need to know before receiving treatment. For example, in some cases, your anesthesia treatment may require that you suspend certain medications or abstain from eating or drinking for a period of time before the treatment.

Is anesthesia in the dental office safe?

Although taking any medication involves a certain amount of risk, the drugs that produce anesthesia are entirely safe when administered by a trained anesthesia provider. The best thing to do is ask questions about any procedure that you are not familiar with. Ask about alternatives, training, the doctor's commitment to continuing education and the credentials of other personnel in the dental office who might be assisting with your treatment. Good communication between the dentist and the patient is the best way of insuring safety.

Flosses and waterpicks

Plaque is a sticky layer of material containing germs that accumulates on teeth, including places where toothbrushes can't reach. This can lead to gum disease. The best way to get rid of plaque is to brush and floss your teeth carefully every day. The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. Some people use waterpiks, but floss is the best choice.

Should I floss?

Yes. Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces, and controls bad breath. Floss is the single most important weapon against plaque, perhaps more important than the toothbrush. Many people just don't spend enough time flossing or brushing and many have never been taught to floss or brush properly. When you visit your dentist or hygienist, ask to be shown.

Which type of floss should I use?

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridgework. Tapes are usually recommended when the spaces between teeth are wide. They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss makes a squeaking sound to let you know your teeth are clean. Bonded unwaxed floss does not fray as easily as regular unwaxed floss, but does tear more than waxed floss.

How should I floss?

There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity. Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger. (Don't cut off your finger's circulation!) Wind the rest of the floss similarly around the same finger of the opposite hand. This finger takes up the floss as it becomes soiled or frayed. Maneuver the floss between teeth with your index fingers and thumbs. Don't pull it down hard against your gums or you will hurt them. Don't rub it side to side as if you're shining shoes. Bring the floss up and down several times forming a "C" shape around the tooth being sure to go below the gum line. The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis. Take an 18-inch piece of floss and make it into a circle. Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop. Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gumline forming a "C" on the side of the tooth.

How often should I floss?

At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

What are floss holders?

You may prefer a prethreaded flosser or floss holder, which often looks like a little hacksaw. Flossers are handy for people with limited dexterity, for those who are just beginning to floss, or for caretakers who are flossing someone else's teeth.

Is it safe to use toothpicks?

In a pinch, toothpicks are effective at removing food between teeth, but for daily cleaning of plaque between teeth, floss is recommended. Toothpicks come round and flat, narrow and thick. When you use a toothpick, don't press too hard as you can break off the end and lodge it in your gums.

Do I need a waterpick (irrigating device)?

Don't use waterpicks as a substitute for toothbrushing and flossing. But they are effective around orthodontic braces that retain food in areas a toothbrush cannot reach. However, they do not remove plaque. Waterpicks are frequently recommended for persons with gum disease when recommended by your dentist. Solutions containing antibacterial agents like chlorhexidine or tetracycline, available through a dentist's prescription, can be added to the reservoir.

What is the best technique for brushing

There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since, tooth position and gum condition vary.

One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth.

Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

Soft or hard bristles?

In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?

It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing.
To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day, instead of brushing quickly five or more times through the day.

Should I brush at work?

Definitely, but most Canadians don't brush during the workday. Yet a recent survey by Oral-B Laboratories and the Academy of General Dentistry shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent. Dentists recommend keeping a toothbrush at work.
Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

The following tips may improve your work-time brushing habits:

• Post a sticky note on your desk or computer at work as a reminder to brush teeth after lunch. 
• Brush teeth right after lunch, before you become absorbed in work. 
• Store your toothbrush and toothpaste at work in a convenient and handy place. 
• Make brushing your teeth part of your freshening up routine at work.

Angled heads, raised bristles, oscillating tufts and handles that change colors with use: you name it, toothbrushes come in all shapes, colors and sizes, promising to perform better than the rest. But no body of scientific evidence exists yet to show that any one type of toothbrush design is better at removing plaque than another. The only thing that matters is that you brush your teeth. Many just don't brush long enough. Most people brush less than a minute, but to effectively reach all areas and scrub off cavity-causing bacteria, it is recommended to brush for two to three minutes.

Which toothbrush is best?

In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp. It should have soft nylon bristles with rounded ends so you won't hurt your gums.

When should I change my toothbrush?

Be sure to change your toothbrush, or toothbrush head (if you're using an electric toothbrush) before the bristles become splayed and frayed. Not only are old toothbrushes ineffective, but also they may harbor harmful bacteria that can cause infection such as gingivitis and periodontitis. Toothbrushes should be changed every three to four months. Sick people should change their toothbrush at the beginning of an illness and after they feel better.

How do I brush?

Place the toothbrush beside your teeth at a 45-degree angle and rub back-and-forth gently. Brush outside the teeth, inside the tooth, your tongue, and especially brush on chewing surfaces and between teeth. Be sure to brush at least twice a day, especially after meals.

Electric vs. manual toothbrushes

Electric toothbrushes don't work that much better than manual toothbrushes, but they do motivate some reluctant brushers to clean their teeth more often. The whizzing sounds of an electric toothbrush and the tingle of the rotary tufts swirling across teeth and gums often captivates people who own electric toothbrushes. They are advantageous because they can cover more area faster. Electric toothbrushes are recommended for people who have limited manual dexterity, such as a disabled or elderly person and those who wear braces. Sometimes, it takes more time and effort to use an electric toothbrush because batteries must be recharged, and it must be cleaned after every use. Most electric toothbrushes have rechargeable batteries that take 10 to 45 minutes to recharge. The gearing in an electric toothbrush occasionally must be lubricated with water.

How do electrics work?

Electric toothbrushes generally work by using tufts of nylon bristles to stimulate gums and clean teeth in an oscillating or rotary motion. Some tufts are arranged in a circular pattern, while others have the traditional shape of several bristles lined up on a row. When first using an electric toothbrush, expect some bleeding from your gums. The bleeding will stop when you learn to control the brush and your gums become healthier. Children under 10 should be supervised when using an electric toothbrush. Avoid mashing the tufts against your teeth in an effort to clean them. Use light force and slow movements, and allow the electric bristle action to do its job.

How long have toothbrushes been used?

The first toothbrush was invented in China in 1000 A.D. It was an ivory-handled toothbrush with bristles made from a horse's mane. Toothbrushes became popular in the 19th century among the Victorian affluent. Mass marketing and the advent of nylon bristles in the 20th century made toothbrushes inexpensive and available to everyone.

Don't forget . . .

Visit your dentist regularly because tooth brushing and flossing is most effective with periodic checkups and cleanings.Fluoride & Your Health

Toothpaste: Putting the Squeeze On Dentifrice

Why is brushing with toothpaste important?

Brushing with toothpaste (also called a "dentifrice") is important for several reasons. First and foremost, a toothpaste and a correct brushing action work to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes caries, gum disease, and eventual tooth loss if not controlled. Second, the toothpaste contains fluoride, which makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage can even be seen. Third, special ingredients in the dentifrice help to clean and polish the teeth and remove stains over time. Fourth, toothpastes help freshen breath and leave your mouth with a clean feeling.

What type of toothpaste should I use?

As long as your toothpaste contains fluoride, the brand you buy really does not matter, whether or not it is in paste, gel, or even powder form, or containing a certain flavor. All fluoride dentifrices work effectively to fight plaque and cavities and clean and polish tooth enamel. 

If your teeth are hypersensitive to hot or cold, consider trying a toothpaste designed for sensitive teeth. Dentifrices containing baking soda and/or hydrogen peroxide (which are both good cleansing agents) give the teeth and mouth a clean, fresh, pleasant feeling that can offer an incentive to brush more, but fluoride is the true active ingredient at work protecting your teeth. Some prefer a tartar control toothpaste containing pyrophosphates to prevent the buildup of soft calculus deposits on their teeth. New pastes offer advanced whitening formulas aimed at safely removing stains to make teeth brighter and shinier, although they can't nearly match the effectiveness of a professional bleaching formula administered or prescribed by a dentist.

How much should I use?

Contrary to what toothpaste commercials show, the amount of paste or gel needed on your brush for effective cleaning does not have to be a heaping amount. Simply squeeze on a pea-sized dab of paste on the top half of your brush. If you brush correctly, holding the toothbrush at a 45-degree angle and brush inside, outside and between your teeth, the paste should foam enough to cover all of your teeth. Children under six, however, should be given a very small, baby pea-sized dab of dentifrice on their brush.

Is brushing with toothpaste enough to fight cavities and gum disease?

No. Although brushing thoroughly after each meal helps, flossing your teeth every day to remove plaque and food particles between teeth and at the gumline is just as important. Studies show that plaque will regrow on teeth that are completely clean within 3 to 4 hours of brushing.What is fluoride, and why is it good for my teeth?

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and in most foods. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible.

Systemic" fluoride is ingested when added to public and private water supplies, soft drinks and teas, and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

What's a "topical" fluoride, and when should I use it?

"Topical" fluoride is found in products containing strong concentrations of fluoride to fight tooth decay. These products, including toothpastes and mouthrinses, are applied directly to the teeth and are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.

Professionally-administered topical fluorides such as gels or varnishes are applied by the dentist and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of dental caries, the dentist may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Why is most of the water we drink fluoridated?

Fluoridated water protects against cavities and root caries-a progressive erosion of adult root surfaces caused by gum recession-and helps remineralize early carious lesions. Thanks to these preventive benefits, public water fluoridation is considered the most efficient and cost-effective dental caries prevention measure available. "Optimal" range of fluoride in water lies between 0.7 and 1.2 parts per million (ppm) or mg per liter. Fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay and to improve oral health for a lifetime.

Can I get too much fluoride?

In general, the use of fluoride is considered safe unless it's misused or over concentrated. Drinking excessively fluoridated water can cause dental fluorosis, a harmless cosmetic discoloring or mottling of the enamel, visible by chalky white specks and lines or pitted and brown stained enamel on developing teeth. Avoid swallowing toothpaste, mouthrinses or other topical supplements, check with your dentist on proper dosage, and be careful not to accidentally take too much. If you are concerned about the fluoride levels in your drinking water, call the local public water department. If the source is a private well, request a fluoride content analysis taken via a water sample through your local or county health department.

Are children more sensitive to fluoride?

Children are more vulnerable to dental fluorosis because their developing teeth are sensitive to higher fluoride levels. They are at greater risk if they swallow or use too much toothpaste and fluoride supplements, or regularly drink water containing excessive fluoride levels. Monitor your child's intake and use of fluoride, and consult with your family dentist on the matter.

What are the differences in Mouth Rinses?

Rinses are generally classified as either cosmetic or therapeutic, or a combination of the two. Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste. Therapeutic rinses have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases. Therapeutic rinses also can be categorized into types according to use: antiplaque/ antigingivitis rinses and anticavity fluoride rinses.

Should I use a rinse?

That depends upon your needs. Most rinses are, at the very least, effective oral antiseptics that freshen the mouth and curb bad breath for up to three hours. Their success in preventing tooth decay, gingivitis (inflammation of the gingival gum tissue) and periodontal disease is limited, however. Rinses are not considered substitutes for regular dental examinations and proper home care. Dentists consider a regimen of brushing with a fluoride toothpaste followed by flossing, along with routine trips to the dentist, sufficient in fighting tooth decay and periodontal disease.

Which type should I use?

Again, that depends upon your needs. While further testing is needed, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics aren't much more effective against plaque and periodontal disease than rinsing with plain water. Most dentists are skeptical about the value of these antiplaque products, and studies point to only a 20 to 25 percent effectiveness, at best, in reducing the plaque that causes gingivitis.

Anticavity rinses with fluoride, however, have been clinically proven to fight up to 50 percent more of the bacteria that cause cavities. Nevertheless, many dentists consider the use of fluoride toothpaste alone to be more than adequate protection against cavities. Dentists will prescribe certain rinses for patients with more severe oral problems such as caries, periodontal disease, gum inflammation and xerostomia (dry mouth). Patients who've recently undergone periodontal surgery are often prescribed these types of rinses. Likewise, many therapeutic rinses are strongly recommended for those who can't brush due to physical impairments or medical reasons.

When and how often should I rinse?

If it's an anticavity rinse, dentists suggest the following steps, practiced after every meal: brush, floss, and then rinse. Teeth should be as clean as possible before applying an anticavity rinse to reap the full preventive benefits of the liquid fluoride. The same steps can be followed for antiplaque rinses, although Plax brand recommends rinsing before brushing to loosen more plaque and debris, a measure which has not been clinically proven to be effective. If ever in doubt, consult your dentist or follow the instructions on the bottle or container. Be sure to heed all precautions listed.

What is the proper way to rinse?

First, take the proper amount of liquid as specified on the container or as instructed by your dentist into your mouth. Next, with the lips closed and the teeth kept slightly apart, swish the liquid around with as much force as possible using the tongue, lips, and sucking action of the cheeks. Be sure to swish the front and sides of the mouth equally. Many rinses suggest swishing for 30 seconds. Finally, rinse the liquid from your mouth thoroughly.

Are there any side effects to rinsing?

Yes, and they vary depending on the type of rinse. Habitual use of antiseptic mouthwashes containing high levels of alcohol (ranging from 18 to 26 percent) may produce a burning sensation in the cheeks, teeth and gums. Many prescribed rinses with more concentrated formulas can lead to ulcers, sodium retention, root sensitivity, stains, soreness, numbness, changes in taste sensation and painful mucosal erosions. Most anticavity rinses contain sodium fluoride, which if taken excessively or swallowed, can lead over time to fluoride toxicity. Because children tend to accidentally swallow mouthwash, they should only use rinses under adult supervision. If you experience any irritating or adverse reactions to a mouth rinse, discontinue its use immediately and consult your dentist.

What is Bruxism?

Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren't diagnosed with bruxism until it is too late because so many people don't realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.

Can bruxism cause harm?

People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

What are the signs?

When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth, which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ)-the jaw-which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching.

Stress and certain personality types are at the root of bruxism. For as long as humankind has existed, bruxism has affected people with nervous tension. Anger, pain and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.

What can be done about it?

During regular dental visits, the dentist automatically checks for physical signs of bruxism. If the dentist or patient notices signs of bruxism, the condition may be observed over several visits to be sure of the problem before recommending and starting therapy.

The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that's worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient's destructive behavior. Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.

What is a mouthguard?
Why should I wear a mouthguard?

To protect your mouth from injuries. The dental profession unanimously supports the use of mouthguards in a variety of sports activities. More than 200,000 injuries to the mouth and jaw occur each year.

Do mouthguards prevent injuries?

A mouthguard can prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by helping to avoid situations where the lower jaw gets jammed into the upper jaw. Mouthguards are effective in moving soft issue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks, especially for those who wear orthodontic appliances.

In what sports should I wear a mouthguard?

Anytime there is a strong chance for contact with other participants or hard surfaces, it is advisable to wear a mouthguard. Players who participate in basketball, soft ball, football, wrestling, soccer, lacrosse, rugby, in-line skating, martial arts as well as recreational sports such as skateboarding, and bicycling should wear mouthguards while competing.

Why don't kids wear mouthguards?

Parents are sometimes uninformed about the level of contact and potential for serious dental injuries involved with sports in which the child participates. Some, though not all schools, reinforce the health advantage of mouthguards for their contact sports. Cost may be another consideration, although mouthguards come in a variety of price ranges.

What are the different types of mouthguards?

Stock mouthguard: The lowest cost option is a stock item, which offers the least protection because the fit adjustment is limited. It may interfere with speech and breathing because this mouthguard requires that the jaw be closed to hold it in place. A stock mouthguard is not considered acceptable as an facial protective device.

Mouth-formed protectors: These mouthguards come as a shell-liner and "boil-and-bite" product. The shell is lined with acrylic or rubber. When placed in an athlete's mouth, the protector's lining material molds to the teeth and is allowed to set. 

Custom-made mouth protectors: The best choice is a mouthguard custom-made by your dentist. It offers the best protection, fit and comfort level because it is made from a cast to fit your teeth.

How should I care for a mouthguard?

• Clean your mouthguard by washing it with soap and warm (not hot) water. 
• Before storing, soak your mouthguard in mouthwash. 
• Keep your mouthguard in a well-ventilated plastic storage box when not in use. Make sure the box has several holes so the mouth-guard will dry. 
• Heat is bad for mouth-guards, so don't leave it in direct sunlight or in a closed automobile. 
• Don't bend your mouth-guard when storing. 
• Don't handle or wear some-one else's mouthguard. 
• Call your dentist who made the mouthguard if there are any problems.

What is a bridge?

A bridge is a dental appliance that replaces one or more natural missing teeth, thereby "bridging" the space between two teeth. Fixed bridges are cemented into place next to the "abutment" teeth- -the surrounding teeth on either side of the space, or "span." Unlike removable partial dentures, fixed bridges cannot be taken out of the mouth by the patient.

A fixed bridge is a device that typically consists of three units-a pontic (a false tooth) fused between two crowns that are cemented onto the abutment teeth.

Who should get a bridge?

If you are missing any teeth and are committed to maintaining good oral hygiene practices, you may be a good candidate for a bridge. A bridge is the most natural choice to fill the space in your mouth left by missing teeth. If left unfilled, this space can cause the surrounding teeth to drift out of position and can cause teeth and gums to become more susceptible to tooth decay and gum disease that can cause further tooth loss. Fixed bridges not only correct an altered bite, improve your chewing ability and speech, but they also safeguard your appearance by preventing the collapse of your facial features that can cause premature wrinkles and age lines.

What type of bridges are there?

Besides traditional bridges, another popular design is the resin bonded or "Maryland" bridge, primarily used for the front teeth. This is usually the most economical choice when the abutment teeth are healthy and don't contain large fillings. The pontic is fused to metal bands that can be bonded to the abutment teeth with a resin cement and hidden from view, reducing the amount of preparation on the adjacent teeth.

A cantilever bridge may be used if there are teeth on only one side of the span. This involves anchoring the pontic to one side over one or more natural, adjacent teeth. If there are no adjacent teeth to act as anchors, your dentist may recommend an implant-a metal post that is surgically imbedded into the bone and capped with a crown as an abutment.

In some cases where the span is large, your dentist may recommend a removable partial denture or even an implant-supported prosthesis.

What procedures are involved?

For a traditional fixed bridge, the first appointment consists of the dentist reducing the adjacent abutment teeth that will act as anchors. Impressions are made, from which a metal framework, including the pontic, is created. By the second appointment, the final bridge is fitted over the teeth.

The total treatment time is usually between two or four weeks, depending on the type of bridge. However, because it is often difficult to match the natural shade of your teeth, the treatment time may be longer.

How do I care for a bridge?

With a bridge, it is more important than ever to brush, floss and see your dentist regularly. If you do not control the buildup of food debris and plaque-the sticky film of bacteria formed from food acids-your teeth and gums can become infected, requiring further treatment and resulting in possible loss of the bridge. Your dentist may also recommend using floss threaders that help remove bacteria from hard to reach spaces between the bridge and adjacent teeth and gums. If you maintain optimal oral hygiene care, you can expect your fixed bridge to last as many as 8-10 years, or even longer.

What is a denture?

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either "conventional" or "immediate." A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. The drawback behind an immediate denture is that it may require more adjustments after the healing has taken place.

Who needs a denture?

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

What happens when you get a denture? 

A dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed, following any minor adjustments.

New denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days to a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers often notice a slight change in facial appearance, increased salivary flow, or minor speech difficulty.

How do you care for a denture?

A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpastes. Never use harsh, abrasive cleansers, including abrasives toothpastes, because they may scratch the surface of the denture. Don't sterilize your denture with boiling water because it will cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth.
When not in use, soak it in a cleanser solution or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.

Should a denture be worn at night?

While you may be advised to wear your denture almost constantly during the first two weeks- even while you sleep-under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of the gums.

Continue seeing your dentist regularly

It is important to continue having regular dental checkups so that a dentist can examine oral tissues for signs of disease or cancer. As of aging, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. When in doubt, consult your dentist.

What is periodontal disease? 

Periodontal (gum) disease may result from gingivitis, an inflammation of the gums usually caused by the presence of bacteria in plaque. Plaque is the sticky film that accumulates on teeth both above and below the gum line. Without regular dental checkups, periodontal disease may result if gingivitis is left untreated. It also can cause inflammation and destruction of tissues surrounding and supporting teeth, gums (gingiva), bone and fibers which hold the gums to the teeth. A number of factors increase the probability of developing periodontal disease, including diabetes, smoking, poor oral hygiene, diet, and genetic makeup; and it is the primary cause of tooth loss in adults. 

How are periodontal disease and diabetes related?

It is estimated that 12 to 14 million people, or one-third of the population in the United States, have diabetes, but only one-half of these individuals are diagnosed.

Studies have shown that diabetics are more susceptible to the development of oral infections and periodontal disease than those who do not have diabetes. Oral infections tend to be more severe in diabetic patients than non-diabetic patients. And, diabetics who do not have good control over their blood sugar levels tend to have more oral health problems. These infections occur more often after puberty and in aging patients.

What types of problems could I experience?

Diabetics may experience diminished salivary flow and burning mouth or tongue. Dry mouth (xerostomia) also may develop, causing an increased incidence of decay. Gum recession has been found to occur more frequently and more extensively in moderate- and poorly-controlled diabetic patients because plaque responds differently, creating more harmful proteins in -9the gums. To prevent problems with bacterial infections in the mouth, your dentist may prescribe antibiotics, medicated mouth rinses, and more frequent cleanings.

How can I stay healthy?

Make sure to take extra good care of your mouth and have dental infections treated immediately. Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease.
Diet and exercise may be the most important changes that diabetics can make to improve their quality of life and their oral health. Diabetic patients should be sure both their medical and dental care providers are aware of their medical history and periodontal status. To keep teeth and gums strong, diabetic patients should be aware of their blood sugar levels in addition to having their triglycerides and cholesterol levels checked on a regular basis. These may have a direct correlation on your chances of obtaining periodontal disease.

What is the best time to receive dental care?

If your blood sugar is not under control, talk with both your dentist and physician about receiving elective dental care. Dental procedures should be as short and as stress free as possible. Also make morning appointments because blood glucose levels tend to be under better control at this time of day.
If you have a scheduled appointment, eat and take your medications as directed. See your dentist on a regular basis, keep him or her informed of your health status, and keep your mouth in good health.

What are crowns?

A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Crowns are necessary when a tooth is generally broken down and fillings won't solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn't get worse. Crowns are also used to support a large filling when there isn't enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth, or cover badly shaped or discolored teeth.

How is a crown placed?

To prepare the tooth for a crown, it is reduced so the crown can fit over it. An impression of teeth and gums is made and sent to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown is made. On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.

Will it look natural?

Yes. The dentist's main goal is to create crowns that look like natural teeth. That is why dentists take an impression. To achieve a certain look, a number of factors are considered, such as the color, bite, shape, and length of your natural teeth. Any one of these factors alone can affect your appearance.
If you have a certain cosmetic look in mind for your crown, discuss it with your dentist at your initial visit. When the procedure is complete, your teeth will not only be stronger, but they may be more attractive.

Why crowns and not veneers?

Crowns require more tooth structure removal, hence, they cover more of the tooth than veneers. Crowns are stationary and are customarily indicated for teeth that have sustained significant loss of structure, or to replace missing teeth. Crowns may be placed on natural teeth or dental implants.

How should I take care of my crowns?

To prevent damaging or fracturing the crowns, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting your dentist and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.

When should my child first see a dentist, and why?

The ideal time is six months after your child's first (primary) teeth erupt. This time frame is a perfect opportunity for the dentist to carefully examine the development of your child's mouth. Because dental problems often start early, the sooner the visit the better. To safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.

How do I prepare my child and myself for the visit?

Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit-cooperative or non- cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child's complete medical history.

What will happen on the first visit? 

Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem. 

Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 24-36 months, the parent may need to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.

If the child is compliant, the first session often lasts between 15-30 minutes and may include the following, depending on age:

• A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas; 
• If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar build-up and stains; 
• X-rays; 
• A demonstration on proper home cleaning; and, 
• Assessment of the need for fluoride. 

The dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. The entire dental team and the office should provide a relaxed, non- threatening environment for your child.

When should the next visit be?

Children, like adults, should see the dentist every six months. Some dentists may schedule interim visits for every 3 months when the child is very young to build up a comfort and confidence level, or to treat a developing problem.

Five ways to protect your child's oral health at home

Parents typically provide oral hygiene care until the child is old enough to take personal responsibility for the daily dental health routine of brushing and flossing. A proper regimen of preventive home care is important from the day your child is born. 

• Clean your infant's gums with a clean, damp cloth. Ask your dentist if you may rub a tiny dab of toothpaste on the gums. 
• As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste. Remember, most children are also getting fluoride from the community water supply. 
• To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the breast and bottle by one year of age, and monitor excessive sucking of pacifiers, fingers and thumbs. Never give your child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime. 
• Help a young child brush at night-the most important time to brush, due to lower salivary flow and higher susceptibility to cavities and plaque. Perhaps let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. Usually by age 5 or so, the child can learn to brush his or her own teeth with proper parental instruction. 
• The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

What is "orthodontics," and why do people get braces?

Orthodontics is a special discipline of dentistry concerned with aligning the teeth and jaws to improve one's smile and oral health. "Ortho" means correct or straight, and "Odont" means tooth.

A dentist usually recommends braces to improve the patient's physical "orofacial" appearance. Through orthodontic treatment, problems like crooked or crowded teeth, overbites or underbites, incorrect jaw position and disorders of the jaw joints are corrected.

When is the right time for braces?

Patients with orthodontic problems can benefit from treatment at nearly any age. An ideal time for placement of braces is between 10 and 14 years of age, while the head and mouth are still growing and teeth are more accessible to straightening. However, because any adjustments in facial appearance can be traumatic to a child during these sensitive years, parents should discuss the matter with their children before braces are applied.

Good news! Braces aren't just for kids. More and more adults are also wearing braces to correct minor problems and to improve their smiles.

What kind of braces will I have to wear?

Your dentist will know what appliance is best for your particular problem, but the patient often has a choice. Braces generally come in three varieties: The most popular type are brackets, metal or plastic, that are bonded to teeth and are far less noticeable. The "lingual" type of braces are brackets that attach to the back of teeth, hidden from view. Bands are the old-fashioned type that cover most of your teeth with metal bands that wrap around the teeth. All use wires to move the teeth to the desired position.

How long will I have to wear braces?

That depends upon your treatment plan. The more complicated your spacing or bite problem is, and the older you are, the longer the period of treatment, usually. Most patients can count on wearing full braces between 18 and 30 months, followed by the wearing of a retainer for at least a few months to set and align tissues surrounding straightened teeth.

Will treatment be uncomfortable?

The interconnecting wires are tightened at each visit, bearing mild pressure on the brackets or bands to shift teeth or jaws gradually into a desired position. Your teeth and jaws may feel slightly sore after each visit, but the discomfort is brief. Keep in mind also that some teeth may need to be extracted to make room for teeth being shifted with braces and for proper jaw alignment.
Do I have to avoid any foods or personal habits?

Yes. Cut down on sweets, chips and pop. Sugary and starchy foods generate acids and plaque that can cause tooth decay and promote gum disease.
Cut healthy, hard foods like carrots or apples into smaller pieces. Sticky, chewy sweets like caramel can cause wire damage and loosen brackets. Avoid hard and crunchy snacks that can break braces, including popcorn, nuts and hard candy. More dont's: ice cube chewing, thumb sucking, excessive mouth breathing, lip biting and pushing your tongue against your teeth.

What about home care of my teeth with braces?

With braces, oral hygiene is more important than ever. Braces have tiny spaces where food particles and plaque get trapped. Brush carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush. Rinse thoroughly and check your teeth in the mirror to make sure they're clean. Take time to floss between braces and under wires with the help of a floss threader. Have your teeth cleaned every six months to keep your gums and teeth healthy. Insufficient cleaning while wearing braces can cause enamel staining around brackets or bands.

Who will provide my orthodontic treatment?

Your family general dentist is responsible for coordinating your dental treatment, and this could encompass any orthodontic treatment plan, including diagnosis, examinations and some orthodontic procedures. Your dentist may, however, refer you to an "orthodontist"-a specialist trained in the development, prevention and correction of irregularities of the teeth, bite and jaws and related facial abnormalities.

What is a sealant? 

A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research in the 1950s and first became available commercially in the early 1970s. 

How effective are sealants? 

Scientific studies have proven that properly applied sealants are 100 percent effective in protecting the tooth surfaces from caries. Because sealants act as a physical barrier to decay, protection is determined by the sealants' ability to adhere to the tooth. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

How are sealants applied? 

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light. Other sealants are applied and allowed to harden much the same way nail polish is applied to fingernails. Sealant treatment is painless and could take anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

How long will a sealant last? 

Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental check-ups are necessary to monitor the sealants' bond to the tooth.

Who should receive sealant treatment? 

Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities and the least benefited by fluoride. Surveys show that approximately two-thirds of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.