FYI Friday: Decay

How Teeth Decay

Our goal is to help you prevent tooth decay and keep your natural teeth for a lifetime. That’s why we want you to understand the process of tooth decay, from start to finish. Armed with this knowledge, you can take steps to stop tooth decay in its tracks.

Bacteria and sugar are the culprits

Thousands of bacteria exist in everyone’s mouth. Most of these bacteria are beneficial. But there are two types of bacteria, mutans streptococcus and lactobacillus, that are the primary culprits in the tooth decay process. If you’re not brushing and flossing regularly, or if your oral environment is out of its natural balance, these bacteria reproduce quickly in your mouth, establishing huge colonies whenever they are given the opportunity to feast on foods that contain sugar.

Sugars, which are the building blocks of starchy foods like pasta, crackers, bread and sweets, can build up on your teeth if you don’t brush regularly. This sugar buildup is one component of plaque, a sticky film of saliva, food debris, and bacteria that’s constantly forming on your teeth. If it’s not removed, plaque mineralizes and can turn into rock-hard tartar in as little as 24 hours.

To survive and multiply in your mouth, the decay-causing bacteria feed off of the simple sugars that are produced from the starches you eat. This causes a chemical reaction in which the sugars ar broken down into simpler elements. One of these elements is an acid. As you probably know, acid breaks down many things, including your tooth enamel. Every time you eat a starchy food, your teeth are bathed in this acid for 20 minutes or more.

The process of decay

The acid slowly dissolves the hard, protective enamel layer on your teeth, forming a demineralized area that appears as a white or brown spot on your tooth. That spot is the first visible sign of tooth decay. If the area does not remineralize, it will progress until a hole, also known as a cavity, develops on the surface of your tooth. It’s vital that we treat your tooth decay early, before it can penetrate the surface of your tooth. Once a cavity has entered the softer dentin layer of your teeth, it can grow more quickly and may lead to a much more complicated and expensive set of problems.

How to avoid decay

You can cut down the frequency of acid production in your mouth by limiting the number of times you eat each day. Also, when you brush and floss properly and regularly, there’s very little plaque on your teeth. Consequently, the number of decay-causing bacteria on the surfaces of your teeth will be dramatically reduced, and in turn, they won’t be producing the enamel-destroying acid. You should also use toothpaste that contains fluoride, which will strengthen your tooth enamel so it’s more resistant to decay. And what about the times when you can’t brush? You’ll need to use other methods, like rinsing with water or a fluoride mouth rinse or chewing sugarless gum, to minimize the acid attacks and protect your teeth.

Hidden Dangers

Endodontic Abscess

An endodontic abscess forms at the root tip

An endodontic abscess is a pocket of pus that forms in the jawbone at the tip of a tooth root. An endodontic abscess is painful and can lead to much more serious conditions, but with prompt treatment, we can help you maintain a healthy mouth and body.

Symptoms of an endodontic abscess

You may realize that you have an endodontic abscess when:

• The tooth hurts when you tap or bite on it
• You have a bad taste in your mouth
• You experience pain and swelling

It is possible that you can have an endodontic abscess and experience no symptoms at all.

The causes of an endodontic abscess

An endodontic abscess is caused by an infection of the pulp layer of the tooth. It becomes infected when bacteria, which are always present in the mouth, invade the pulp through deep cavities, a fractured or broken tooth, or an injury to the tooth. In some cases, there is no apparent reason. The infection can then spread from the pulp chamber, down the root canals, through the tip of the root, and into the jawbone, where the pus builds up and creates a hole in the bone. This is the abscess. The abscess creates pressure inside the bone and on the ligaments surrounding the tooth, and this can cause excruciating pain. Sometimes, the abscess drains near the infected tooth, forming a gumboil.

Diagnosis and treatment

It is important to treat an endodontic abscess because, if left untreated, the abscess can damage the adjacent soft tissue, lead to bone loss, be a continuing source of infection that drags down your immune system, and even be life threatening. To find an endodontic abscess, we perform a thorough examination, including x-rays. On the x-ray above, you can see a dark area at the root tip, which indicates an endodontic abscess. We may also use an electric pulp tester to determine whether the pulp is inflamed or infected. An infected tooth will never heal on its own, so we remove the infection with root canal therapy, which allows the abscess to heal. Occasionally, however, the infection continues to grow after treatment. In that case, we may re-treat the tooth with root canal therapy or use a minor surgical procedure to stop the infection and restore the health of your tooth.

What If? Wednesday

Space Maintainers

If your child's bite becomes irregular from early tooth loss, an option is available to ensure proper tooth formation in the future. Space maintainers are a valuable investment in the success of your child's oral health for years to come.

Why are baby teeth important?

Normally, as a permanent tooth comes in under a baby tooth, the roots of the baby tooth dissolve away, and the permanent tooth replaces the baby tooth. In addition to being important for chewing, the baby tooth holds the adjacent teeth in place. When a baby tooth is lost early, due to decay or injury, the adjacent teeth may drift together, causing loss of space in the dental arch.

Placing a space maintainer

When a baby tooth is lost early, this shifting and loss of arch space can be prevented by placing a space maintainer. It generally takes two appointments to complete a space maintainer. During the first appointment, an orthodontic band is carefully placed and an impression is taken. A model of the child’s mouth is made from this impression so that the dental laboratory can form the space maintainer to the exact contours of the mouth. During the next appointment, the space maintainer is tried in, adjusted if necessary, and then cemented in place.

Caring for a space maintainer

Space maintainers are used until the permanent teeth begin to break through the gums. While wearing a space maintainer, it is important to avoid chewing gum, sticky candies, and hard foods like nuts or ice. Following up with periodic checks of the space maintainer here in our office will make sure it’s still functioning properly and keeping all the teeth in their proper position.

Hard Tissue Laser

At Riverside Dental, we are always seeking out the newest technology to make your visit more effective and comfortable. As part of our ongoing commitment to patient education, an explanation of hard tissue lasers follows. If you have any questions about your treatment, feel free to discuss them with any member of our staff on your next visit.

Healthy smiles go high tech with lasers

A laser uses a focused beam of energized light and water that is concentrated on the treatment area. A laser does not touch the teeth like a handpiece does, so there is no vibration to cause pain. Some people need a little anesthetic, but most do not need any at all. That means no shots, no numbness. Your procedure can be faster because you are not waiting for anesthesia to affect or wear off. A laser is quiet. The most you will hear is a low popping sound.

Usually the only preparation you need is to wear protective eyeglasses. When removing tooth decay, for example, the laser targets dead tissue. The bacteria absorb the light and infected cells explode. The laser also sterilizes the tissue, leaving it free from disease. Because the laser removes the decay – and only the decay, it leaves more of the healthy tooth structure than a handpiece would. Often, the repaired tooth is stronger because the laser is used.

A laser is a great breakthrough for working on hard tissue such as teeth and bone.

• It can work with little or no anesthesia
• It can sterilize infected tissue
• It eliminates the heat, noise, and vibration of a traditional handpiece
• If your do not need anesthesia, you spend less time waiting to get numb, and your recovery time can be faster.

Like any tool, a laser cannot do everything.

• It cannot remove silver fillings
• It cannot remove porcelain onlays or crowns
• It won’t completely eliminate the need for traditional handpieces

The FDA has approved the use of lasers on everyone of every age.

Dentistry is keeping up with scientific advances, and that makes it easier for you to have a healthy, beautiful smile.

TMI - The Monday Inquiry

Hygienists

When you come to our office for professional dental cleaning, you can be assured that we have some of the most highly qualified hygienists working for us. Always eager to increase the efficacy of our practice, we use top of the line instruments and technology to keep your mouth healthy.

Hygienists’ education and training

A registered dental hygienist is a highly trained, licensed oral health professional who specializes in providing you with clinical, therapeutic and educational services to enhance your oral and overall health. Hygienists receive intensive, specialized education and training that includes courses in chemistry, physiology, nutrition, microbiology, head and neck anatomy, oral pathology, pharmacology, and radiology. Additional courses also include advanced dental science and dental hygiene. Prior to graduation, a hygienist must pass rigorous tests and complete hundreds of clock hours of supervised instruction in clinical practice.

What hygienists do

A hygienist serves many functions in the dental office. The hygienist carefully examines your teeth, mouth, and gums and looks for any signs of decay, periodontal disease, oral cancer, or other problems. A hygienist also takes dental x-rays so the dentist can view them and quickly diagnose any problems that may exist. As part of the preventative function of the job, your hygienist uses specialized instruments and techniques to thoroughly clean all surfaces of your teeth. These procedures comfortably remove plaque, tartar, and stains from above and below your gumline. A hygienist is often involved with the specialized treatment of gum disease, such as scaling and root planing. A hygienist may also apply fluoride gels or other treatments. Your hygienist will teach you how to effectively care for your teeth at home to help you prevent decay, gingivitis and periodontal disease, show you how to select the proper toothbrush and dental floss, and demonstrate the most effective techniques for brushing and flossing. A hygienist can also explain the relationship between a healthy diet and dental health, offering suggestions about which foods select and which to avoid. Your hygienist is an excellent educational resource who can help you and your family keep your healthy smiles for a lifetime.

FYI Fridays: HIPAA

HIPAA regulations

HIPAA stands for the Health Insurance Portability and Accountability Act. It is a set of standards created by the US Congress to streamline the flow of information in the healthcare system and to protect your personal health information. HIPAA regulations apply to most health plans and to any healthcare provider who electronically transmits healthcare information.

Your rights under HIPAA

Your rights and the privacy of your healthcare information are important to us. Under HIPAA, you have the rights to:

• Confidentiality regarding your healthcare information
• Access your protected healthcare information
• Copy, amend and restrict access to your protected healthcare information
• File a complaint with the US Department of Health and Human Services about how your healthcare information has been used
• An accounting of how your healthcare information has been disclosed

The HIPAA Notice of Privacy Practices

As part of our compliance with HIPAA, we provide you with a Notice of Privacy Practices. We ask you to sign a form acknowledging your receipt of the Notice. Your rights and the privacy of your healthcare information are important to us. We are always glad to answer any of your questions about our privacy practices or your rights under the Health Insurance Portability and Accountability Act.

Dentures Series

Life with Dentures

Adjusting to new dentures

Now that you have your new dentures, here are some suggestions for living comfortably with them. Some temporary problems are a normal part of adjusting to new dentures. However, with time and practice, you will make the adjustment to dentures and be eating and talking with confidence.

Regular dental visits

Plan on regular visits to our office so we can monitor the health of your mouth and the fit of your denture. We will also let you know when it is time to adjust, reline, or replace your denture.

When to call us

Call us if your bite feels uneven, your dentures become loose, you have persistent discomfort, you have any gagging that persists beyond the initial adjustment period, or if you have any questions or concerns.

Chewing and eating

For the first few months, while you are learning to chew with your denture, start with soft foods, then gradually add more variety. Continue to eat a healthy diet, including plenty of fruits, vegetables and proteins. To make this easier, cut your food into small bites. Bite into foods with the side teeth, not the front teeth. If your denture tips when you chew, try keeping some food on both sides of your mouth to help balance the denture. Occasionally, small pieces of food will work their way under your denture while you eat. Simply remove your denture and rinse it with water. To protect your denture, avoid chewing ice or other hard objects.

Speaking and staying comfortable

You may have difficulty speaking for a short while. If this happens, practice by reading aloud in front of a mirror until you are comfortable. You can also try speaking more slowly and quietly. While your mouth gets used to the new denture, it may seem bulky, you may notice increased salivary flow, and your tongue will feel crowded. These sensations should pass with time. An upper denture causes some people to gag. Call us if this continues beyond the initial adjustment period.

Cleaning and using adhesives

Clean your mouth and denture daily. We will give you complete instructions. Denture adhesives are often not necessary with dentures that fit well. If you would like to try one, ask us about the best kind for your situation. If you do choose an adhesive, it is important to apply it to clean dentures and to thoroughly remove it every day.

Dentures Series

Caring for your Dentures

Now that you have received your denture, it is important to follow these recommendations to ensure its success.

Chewing and eating

To protect your denture, avoid chewing ice or other hard objects. If small pieces of food work their way under your denture while you eat, simply remove your denture and rinse it with water.

Brushing and flossing

Brush your tongue, gums, palate, and any remaining teeth at least twice a day to keep them free of plaque and bacteria. Brushing also massages the gums and keeps your breath fresh. In addition, we may recommend dental floss, mouth rinses, or other chewing aids.

Cleaning your denture

Clean your denture over a sink full of water to prevent your denture from breaking if it is accidentally dropped. Use a denture brush and a denture cleaning product at least once a day to thoroughly clean all of the surfaces of your denture. We may recommend special denture cleansers or brushes. Also, soak your denture periodically in a commercial soaking solution, or, if you denture has no metal parts, you can soak it in a solution of half white vinegar and half water. After soaking, rinse dentures thoroughly in cool water.

Sleeping and storing your denture

Unless we tell you otherwise, remove your denture for sleeping or for at least 6 to 8 hours a day. Store your denture in a soaking solution whenever it is out of your mouth, so it does not dry out.

When to call us

Call us right away if your denture breaks, cracks, or chips, or if a tooth becomes loose, so we can properly repair it. Also call us if your bite feels uneven, your dentures become loose, you have sore spots, irritation, swelling, or discomfort, or if you have any questions or concerns.

Overdentures

The dentures series continues with information about overdentures, an alternative to conventonial partial dentures, that may be easier for you and living with dentures.

Overdentures

There is a difference

When most of your teeth are missing or must be removed, an overdenture can be a good treatment for replacing them. From the top, an overdenture looks like a conventional denture, but unlike a conventional denture, some teeth are retained, and the overdenture fits over these teeth. With regular adjustments and careful attention to proper homecare, an overdenture can provide a functional bite and a natural-looking smile.

Placing an overdenture

The process of making an overdenture varies in each case, and it usually involves a series of steps and appointments. The first step is to prepare the supporting teeth by removing the portion above the gumline. Second, to prevent inflammation and infection, we perform root canal treatment of the teeth. We may also cover the teeth with small caps or attachments that help the denture stay in place. In the third step we take impressions of your mouth, including the prepared teeth. An accurate model is made from these impressions and the lab uses the model to create the overdenture base. Fourth, in many cases, a wax rim is mounted on the base for you to try in. This helps confirm that the upper and lower teeth are correctly aligned. Fifth, after the try in, the lab creates a wax-up, which is a replica of the final denture. You try in the wax-up, and we note any changes to the fit of the base and to the color, shape and placement of the teeth. We send the wax-up back to the lab, and they process it to create the final overdenture. Finally, when the overdenture is ready, you try it in, and we make any necessary adjustments here in the office.

The benefits of an overdenture

Overdentures have several advantages. Keeping some of your own teeth helps hold the denture in place and makes the denture feel more secure and natural. In addition, because we are able to retain some of your natural teeth, the overdenture slows the loss of jawbone that naturally occurs when teeth are missing. Dentures also provide support for cheeks and lips which give you a more attractive and youthful appearance.

Dentures

Dentures

Everything you ever wanted to know about dentures will be coming in the next few posts, part of our ongoing series postings. Today, an introduction to dentures and the most common - the partial denture. In the next post, overdentures will be discussed - followed by information about caring for your dentures and how they impact your oral care routine. As always, if you have any questions feel free to contact us at any time.

Conventional Partial Dentures

Removable appliances

When many teeth in your upper or lower arch are missing, a partial denture is a good treatment for replacing them. Conventional partial are removable appliances that are held in place by clasps that fir around some of the remaining teeth. With proper home care and regular adjustments and relines, your partial denture can provide a functional bite and a natural-looking smile.

Placing a partial denture

The process of making a partial denture varies in each case, and it usually involves a series of appointments. The first step is to shape the supporting teeth. Next, we take impressions of your mouth, including the prepared teeth. An accurate model of your mouth is made from these impressions, and the lab uses this model to create the denture framework. In some cases, a wax rim is mounted on the framework for you to try in. This helps confirm the correct relationship between the upper and lower teeth. After the try in, the lab creates a wax-up, which is a wax replica of the final denture. Depending on the circumstances, we may have you try in the wax up, and we note any changes to the fit and to the color shape and placement of the teeth. We send the wax-up back to the lab, and they process it to create the final partial denture. When the partial is ready, you try it in, and we make any necessary adjustments here in the office.

Diabetes and Your Health

Diabetes and periodontal disease

If you are diabetic, you are at a greater risk of suffering from oral infections and diseases, including periodontal disease. Periodontal disease is an infection of the teeth, gums, and bone that surrounds your teeth. It is caused by the bacteria that lives in plaque, the sticky film of food and bacteria that forms constantly on your teeth. The bacteria infect the tooth roots and cause pockets of infection to form in the gums. The bacteria also produces toxins, and these toxins, combined with your body’s reaction to them, destroy the bone around your teeth.

The connection to diabetes

Diabetes contributes to periodontal disease in three ways: it lowers your body’s ability to fight off infection, results in high blood sugar levels, and causes dry mouth. Diabetes lowers the body’s resistance to infection by causing blood vessels to thicken and become less elastic. This decreases the flow of white blood cells, oxygen, and nutrients to the body’s tissues and slows the removal of harmful wastes. This can weaken your mouth’s resistance to infections like periodontal disease. Having poorly controlled diabetes means that there are often excess levels of glucose in the blood and saliva. The harmful bacteria in your mouth that are responsible for periodontal disease thrive on this sugar. Diabetics who do not successfully control their blood sugar levels also frequently experiences a decrease in the flow of saliva which can lead to a condition called dry mouth, or xerostomia. Saliva is vital for helping wash away the bacteria that cause periodontal disease. A lack of saliva allows plaque to build up easily on teeth.

Preventing periodontal disease

If you are a diabetic, it is important for you to prevent or control periodontal disease. Infections, such as periodontal disease, can cause blood sugar levels to rise, making it much harder for you to control your diabetes. To help prevent bacterial infections in your mouth, you should brush and floss every day to remove the plaque and visit us regularly for dental cleanings. We may prescribe antibiotics, medicated mouth rinses, and more frequent dental exams. With good dental and medical care, your gums and teeth can remain health and free of periodontal disease.

Cardiovascular Health

What is periodontal disease?

Researchers have discovered that if you have periodontal disease, you may have an increased risk of coronary heart disease, stroke, and infective endocarditis. Periodontal disease is an infection of the teeth, gums and bone that live in plaque, the sticky film of food and bacteria that forms constantly on your teeth. The bacteria infect the tooth roots and cause pockets of infection to form in the gums. This results in red and swollen gums that bleed when you brush or floss.

The connection to cardiovascular health

Even with early periodontal disease, bleeding gums can create an open doorway that allows harmful bacteria to enter your bloodstream. More advanced periodontal disease can be even worse. It can be compared to a nine-square-inch open wound around your teeth, offering significant opportunity for harmful bacteria to enter your blood. Research indicates that the bacteria associated with periodontal disease may cause inflammation in the arteries. This inflammation could lead to the build-up of fatty deposits and the formation of blood clots that can block your arteries and even trigger a heart attack. These deposits may also build up in the carotid arteries in your neck. In serious cases, if these fat deposits break apart and are carried away in your bloodstream, they can lodge in your brain, block a blood vessel, and cause a stroke. Additionally, some studies have also shown that when plaque bacteria enter the bloodstream through infected gums, you may develop a heart condition called infective endocarditis. This is a potentially fatal bacterial infection that inflames the sac around the heart, the valves of the heart, and the heart muscle itself.

So, as you can see, it is vital to your overall health, as well as your oral health, to keep your gums healthy. If we determine that you have periodontal disease, we will see you for frequent professional cleanings and re-care appointments, and we will work with you to create a suitable oral hygiene.

Arestin

How is Arestin used?

As part of our therapy for periodontal disease, we have an effective treatment called Arestin that helps us control the infection in your mouth. Arestin is used together with scaling and root planing to significantly reduce the depth of the infected pockets and prevent the progression of the disease. Arestin in an antibiotic in powder form. After scaling and root planing, we apply the powder to your periodontal pockets, where it combines with moisture in your mouth and adheres immediately to the infected gum tissue. The individual powder particles release a controlled, steady flow of the active ingredient, minocycline, a potent antibiotic. The medication helps fight your periodontal infection for at least 21 days.

Arestin and your periodontal therapy

In certain conditions, Arestin may not be the right treatment for you. The active ingredient in Arestin is in the tetracycline family, so we won’t use it for patients who are allergic to tetracycline, pregnant or nursing, or under the age of eight. You should also know that Arestin is not a cure for periodontal disease. Once bone is lost, no medication will bring it back. For periodontal therapy to be successful, you still need to be very thorough with your daily oral hygiene and come see us regularly for exams. Arestin is an important part of the overall periodontal therapy program that we have designed for you to restore health to your gums.

What If? Wednesdays

If you think you have a soft spot in a tooth, or an area that is sensitive to hot/cold or sweet foods - you may have a cavity. Only your dentist can make this diagnosis, but follow the guide below to help you determine if your increased pain and sensitivity are the result of a cavity or something else.

What are cavities?

Plaque, a sticky film of food and bacteria that is constantly forming on your teeth, is the culprit when it comes to tooth decay. Bacteria that naturally exist in plaque break down the starches and sugars in the food you eat. A chemical reaction occurs, and as a result, an acid is produced. Like all acids , the acid produced in your mouth is corrosive, which means that it dissolves other materials. Your teeth are the victims of this corrosive action. The acid dissolves their protective outer enamel layer, eventually creating holes in your teeth, also known as cavities.

Regular checkups are a must

Cavities first form in the hard, protective enamel layer of your teeth. Beneath the enamel is a softer layer called dentin. If a cavity wears through the enamel and reached the dentin, it can grow much more quickly and threaten the inner layer of the tooth, containing its nerves and blood vessels. This part of your tooth is called the pulp chamber.

If the decay is allowed to penetrate the enamel and dentin gets into the pulp chamber, it’s likely that we’ll need to perform root canal treatment. That’s why regular checkups and professional cleanings are so important. They allow us to restore your tooth while the cavity is still small and confined to the outer enamel layer.

Diagnosing cavities

Sometimes, we can detect cavities just by looking at your teeth, but to find cavities in their early stages when they are very small, we use a dental explorer and x-rays. A dental explorer finds cavities on the surfaces of your teeth, and the explorer catches or sticks in the tiny pits created by cavities. X-rays locate cavities between teeth where the explorer can’t reach.

Repairing and preventing cavities

To repair a tooth with a cavity, we usually remove the decayed portion of the tooth and replace it with a filling, provided the damage is not extensive and there is still plenty of healthy tooth structure remaining. However, preventing tooth decay in the first place is the preferred solution. We’ll be happy to work with you, so you’ll learn to keep your teeth free of plaque and decay.

How Teeth Decay

As part of our ongoing commitment to you and your oral health, we want to keep you as informed as possible about your mouth. One of the biggest keys to successful oral health is building a knowledge and understanding of how your mouth works. While we can tell you to brush and floss daily, avoid sugary drinks, etc., until you as a patient understand the why our efforts will not be as beneficial as they could be.

The following information is meant to help you prevent tooth decay and keep your natural teeth for a lifetime. That’s why we want you to understand the process of tooth decay, from start to finish. Armed with this knowledge, you can take steps to stop tooth decay in its tracks.

Bacteria and sugar are the culprits

Thousands of bacteria exist in everyone’s mouth. Most of these bacteria are beneficial. But there are two types of bacteria, mutans streptococcus and lactobacillus, that are the primary culprits in the tooth decay process. If you’re not brushing and flossing regularly, or if your oral environment is out of its natural balance, these bacteria reproduce quickly in your mouth, establishing huge colonies whenever they are given the opportunity to feast on foods that contain sugar.

Sugars, which are the building blocks of starchy foods like pasta, crackers, bread and sweets, can build up on your teeth if you don’t brush regularly. This sugar buildup is one component of plaque, a sticky film of saliva, food debris, and bacteria that’s constantly forming on your teeth. If it’s not removed, plaque mineralizes and can turn into rock-hard tartar in as little as 24 hours.

To survive and multiply in your mouth, the decay-causing bacteria feed off of the simple sugars that are produced from the starches you eat. This causes a chemical reaction in which the sugars ar broken down into simpler elements. One of these elements is an acid. As you probably know, acid breaks down many things, including your tooth enamel. Every time you eat a starchy food, your teeth are bathed in this acid for 20 minutes or more.

The process of decay

The acid slowly dissolves the hard, protective enamel layer on your teeth, forming a demineralized area that appears as a white or brown spot on your tooth. That spot is the first visible sign of tooth decay. If the area does not remineralize, it will progress until a hole, also known as a cavity, develops on the surface of your tooth. It’s vital that we treat your tooth decay early, before it can penetrate the surface of your tooth. Once a cavity has entered the softer dentin layer of your teeth, it can grow more quickly and may lead to a much more complicated and expensive set of problems.

How to avoid decay

You can cut down the frequency of acid production in your mouth by limiting the number of times you eat each day. Also, when you brush and floss properly and regularyly, there’s verylittle plaque on your teeth. Consequently, the number of decay-causing bacteria on the surfaces of your teeth will be dramatically reduced, and in turn, they won’t be producing the enamel-destroying acid. You should also use toothpaste that contains fluoride, which will strengthen your tooth enamel so it’s more resistant to decay. And what about the times when you can’t brush? You’ll need to use other methods, like rinsing with water or a fluoride mouth rinse or chewing sugarless gum, to minimize the acid attacks and protect your teeth.

TMI - The Monday Inquiry

PerioChip

Special periodontal disease treatment

As part of our therapy for periodontal disease, we have an effective treatment that helps us control the infection in your mouth. It is called PerioChip.

How is PerioChip used?

PerioChip is a small biodegradable gelatin chip that contains the antimicrobial agent chlorhexidine.

To administer PerioChip, we first remove plaque and bacterial toxins form the infected area with a scaling and root planing procedure. Then we place PerioChip on the affected bum tissues. It slowly disintegrates, releasing the medication, first in a larger concentration, then at a controlled rate for the duration of the treatment.

This medication greatly reduces the bacteria in the infected pocket and speeds the healing process.

PerioChip and your periodontal therapy

Depending on your needs, we may place up to eight PerioChips during a single office visit. We can repeat PerioChip treatment about every three to six months for as long as periodontal pockets are five millimeters deep or more.

However, PerioChip is not an option if you are sensitive to chlorhexidine.

It is also important to know that PerioChip is not a cure for periodontal disease and cannot replace supportive bone lost due to periodontal disease. And even with medication, you still need to be very thorough with your daily oral hygiene and come to see us regularly for exams and professional cleanings.

PerioChip has been shown to be a safe and effective tool we can use as part of your periodontal therapy to prevent the further destruction of bone and connective tissue caused by periodontal disease.

FYI Fridays: Digital X-ray Technology

Digital radiography

The computer era has brought us an exciting new technology called digital radiography.

With this technology, we use a computerized equipment and software to capture x-ray images of your mouth and teeth. We do this by exposing a small sensor or plate that feeds the image into a computer.

The advantages of digital radiography

Digital radiography has many advantages over traditional x-rays:

• It’s faster
• It’s safer, with no chemical development and less radiation
• We can view images instantly
• We can enhance images to improve viewing
• Images can be stored electronically and emailed to specialists and insurance companies.

Taking x-rays is faster because the sensor is merely moved from tooth to tooth, and your x-ray can be seen on a computer monitor just moments after exposure. There’s no waiting for chemical development, as with film packets. It’s also faster because the x-rays are available within moments on the computer monitor, with no development step in between.

The lack of chemicals also makes digital x-rays safer for the environment. Digital radiography is safe for you, too. Because the unit is so sensitive, the amount of x-ray radiation is up to 80% less than with conventional x-rays.

Digital x-ray technology enables more efficient diagnosis and treatment because it provides a large, easy-to-see image and it allows us to make adjustments and see details in the x-ray images. The digital x-rays can then become part of your dental record and be easily emailed to specialists and insurance companies.

With digital radiography, we can offer you faster and safer diagnosis and dental treatment.

Hidden Dangers: Oral Cancer

Oral Cancer Detection

At Riverside Dental, we believe prevention is the key to excellent oral health. As part of our ongoing dedication to your overall oral health, we have taken a keen interest in staying on top of the best oral cancer detection techniques available. With regular checkups and professional cleaning, you can be assured that we will do everything possible to protect your oral health and beautiful smile.

The signs of oral cancer

We perform a thorough oral cancer exam during your checkups because early detection can save your life.

Oral cancer is the uncontrolled growth of abnormal cells in the mouth and throat. Some of the warning signs are:

• A red, white, or discolored patch or lump in or around your mouth
• A sore that bleeds easily or that doesn’t heal within 2 weeks
• An area that has thickened, raised, or become hardened
• A rough patch of tissue
• Difficulty chewing or swallowing
• A chronic sore throat or hoarseness

The exam for oral cancer

Because early detection is vital to surviving oral cancer, we will perform a thorough oral cancer screening each time we see you in our office for an exam. In addition, if you notice any warning signs, tell us right away. Do not ignore one or more of the signs just because it does not hurt. Most pre-cancerous lesions are completely painless.

As part of our oral cancer exam, we can offer comfortable, non-invasive technologies for detecting cancer in its earliest stages. There can be two steps in oral cancer detection: screening and biopsy.

Screening for oral cancer

First we use a cancer screening technology to help us find and identify suspicious tissues, especially the ones that cannot be seen with the naked eye.

The technology combines a specifically formulated mouthrinse with a special light.

We use a concentrated light that identifies abnormal areas. Under the light, abnormal or suspicious tissues appear white in contrast with the surrounding healthy tissue. If we find any suspicious sores or lesions, we may then use an in-office biopsy system to determine if the area is pre-cancerous or cancerous.

Performing a biopsy for oral cancer

We press a small brush firmly against the area and rotate it gently to collect a sample of cells.

The sample is spread onto a glass slide and sent to the laboratory for examination. At the lab, a computer analyses the cell sample. A pathologist then evaluates the sample and provides a diagnosis.

What If? Wednesdays: Failing Resin Fillings

What if my filling fails?

Fillings eventually fail. A common misconception is that a filling will last forever. Composite resin fillings are durable, but they eventually will fail and need to be replaced. We consider a filling to be failing when it no longer seals out bacteria and allows them to infect the inner layers of the tooth.

Replacing a failing resin filling with a new restoration can prevent more decay form developing and keep your mouth healthy.

What causes a resin filling to fail?

Resin fillings have to endure an incredible amount of biting force. Over time, they become worn, and their edges can wear away.

In a few cases, the resin material may shrink after it’s placed. This can open a space where the filling meets the tooth, allowing bacteria into the tooth. The shrinkage can also force the filling to pull on tooth structure as the resin shrinks, stressing the tooth.

Replacing the filling

When we discover a failing resin filling, it’s important to replace it with another restoration as soon as possible to protect your tooth. There are several types of restorations, including fillings, inlays, onlays and crowns, and these can be fabricated from a variety of different materials. After doing a thorough exam, we’ll recommend the best restoration for your situation.

Esthetics Series: Power Whitening

Power Whitening

Power whitening makes it possible to achieve a whiter, brighter smile – right here in our office.

How power whitening works

A pecial light is shined onto the teeth after they have been coated with a whitening gel. The light works with the gel to release oxygen. The oxygen penetrates the outer enamel layer and tehn the dentin layer of the teeth, bleaching away stains and discolored areas.

Power whitening quickly brightens your smile

Once we have determined that power whitening is right for you, we may being by thoroughly removing any plaque and tartar from your teeth. Then we’ll start the whitening process with protective glasses, a lig retractor, and a cream or lotion to shield your eyes, lips and face.

We’ll then isolate the teeth and protect your gums by applying a special protective material to the gum tissue by placing a rubber dam.

Next, we paint the whitening gel onto your teeth, and while you relax in the chair, we shine a light or laser onto the teeth. We may repeat this cycle several times.

Since every case is different, we carefully evaluate your individual results. Your new smile will lighten, on average, about 6 to 10 shades. We may sometimes recommend a fluoride treatment, additional bleaching at home, or another session here in our office. We’ll also give you instructions for taking care of your new smile and for handling any post-whitening sensitivity.

Power whitening is a safe and effective technology that can help give you a beautiful new smile, all in one appointment.

TMI - The Monday Inquiry

Crown Lengthening

A crown covers and protects.

A crown is an excellent way to cover and protect a tooth that has fractured or been damaged by decay or injury. Sometimes, however, the damage is so extensive that there simply is not enough tooth structure to support a crown. In these cases, we can often use a minor surgical procedure called crown lengthening.

This procedure increases the amount of available tooth structure so that the tooth can support a crown, which is the best choice for covering and protecting the tooth.

The procedure

The first step in crown lengthening is to thoroughly numb the entire area.

Incisions are made in the gums around the tooth, and then the gums are gently pulled back. Next, the bone and gum tissue are reshaped to reveal just enough of the natural tooth to create a secure anchor for a crown. The gums are replaced, and a couple of stitches are placed to speed healing. In some cases, we may also build up the tooth using a post and buildup material.

After a few weeks of healing, a crown in placed to cover and protect the damaged tooth. The crown restores your damaged tooth to normal health, appearance, and chewing function. Crown lengthening is a predictable and effective way to save a tooth that might otherwise be lost.

FYI Fridays: Alternatives to Periodontal Treatment

What are your choices for treating periodontal disease?

If you have periodontal disease, your choices are limited. You could:

• Delay treatment
• Choose treatment
• Delaying treatment

We do not recommend delaying treatment because periodontal disease does not go away on its own. Periodontal disease is an ongoing, degenerative infection of the teeth, gums, and bone that surrounds the teeth caused by bacteria. The bacteria produce toxins, and these toxins, combined with the body’s reaction to them, destroy the bone around your teeth.

Bone lost never grows back on its own. If too much bone is lost, teeth become loose and have to be removed.

Choosing treatment

The sooner you choose treatment, the better chance we have of controlling the disease and saving your teeth.

Treatment involves a combination of scaling and root planing, new homecare techniques, and frequent dental cleanings and recare appointments. In more severe cases, treatment could also include medication and surgery.

Treatment removes the infection and keeps the disease under control.

Soft Tissue Laser

The laser comes of age

The first dental laser was approved for use in 1976. Since then, laser technology has greatly improved many dental procedures.

Treating the soft areas in your mouth is a lot easier and more comfortable thanks to lasers.

How a laser works

A laser uses energized light to precisely remove soft tissue. The light beam simultaneously sculpts and cauterizes the area. That means there is little to no bleeding, making your healing time faster. The laser beam sterilizes the tissue, reducing the chance of infection.

The laser targets just the area to be treated, leaving surrounding areas untouched. Because lasers work on a cellular level, the procedure is usually painless.

Most people do not need anesthesia. This means no shots or numbness. A laser is quiet. You will probably only hear a light hum or beep.

Lasers are versatile

Lasers can be used for a number of procedures including:

• Crown lengthening to improve your smile
• Sterilizing areas infected with bacteria
• Removing gum tissue without cutting
• Removing cold sores and lesions

The FDA says lasers are safe to use on everyone.

Lasers can be a welcome tool to help you get a bright, healthy smile.

What If? Wednesdays

Whatif my child's front tooth breaks?

Repairing a Broken Front Tooth

It can be traumatic when your child breaks a front tooth, but today a broken tooth can be restored to nearly new condition, function and appearance, thanks to new bonding techniques and materials.

Bonding is the artistic placement of a tooth-colored plastic material to restore a misshapen, discolored, or broken tooth. Bonding is a flexible and adaptable means for repairing teeth, as it can restore the appearance and function of one tooth or a number of teeth. And the effects are not merely cosmetic. Bonding protects your child’s teeth from additional wear and damage.

The procedure

Bonding is usually a single-appointment procedure. The first step is the careful selection of the color and type of tooth-colored bonding material, called composite resin, to match the color of your child’s teeth. Next, we lightly reduce the tooth with a dental handpiece, and a conditioning solution is applied to roughen the tooth surface and ensure that the resin will bond to it. Then, we apply the bonding material, sculpt and contour it to the proper shape, and then harden it with a harmless, high-intensity light. Lastly, we smooth and polish the new restoration to a high luster.

What are the alternatives?

Broken front teeth are a common problem among children. They can be unsightly, and may have a negative impact on your child’s self-esteem. The problems don’t end there; a broken tooth may be more susceptible to fractures and decay. Alternative treatments include crowns and veneers, but bonding conserves a maximum amount of tooth structure while providing a terrific-looking result.

Esthetic Series: Whitening

At-Home Whitening

Over time, your teeth darken as minerals penetrate their outer enamel layer. This darkening can be caused by foods and beverages that stain, such as coffee, colas, teas, red wine, and berries. Tobacco products like cigarettes, cigars, and chewing tobacco, can cause teeth to take on a yellowish brown hue. The natural aging process can also cause your teeth to darken. We can prescribe a home whitening system that will safely lighten these stains, giving you a whiter, brighter smile. A specially formulated whitening gel, designed to be highly effective, yet safe, gently forces oxygen through the enamel of your teeth. The process virtually erases stains and brightens your teeth, without damaging your tooth enamel or your gums.

Designing your whitening system

First, we thoroughly examine your teeth and your mouth to make sure at-home whitening is an appropriate option for you. We then take impressions of your teeth, and use the impressions to make models of your teeth. Using these models, we make a personalized whitening tray that fits tightly over your teeth, allowing us to achieve optimum results. At home, you’ll fill the tray with the whitening gel and place the tray over your teeth, keeping it in place for several hours each day. You can wear the whitening trays while you sleep, or if you prefer, you can wear them as you go about your day. Typically, you’ll begin to see results in two to three weeks. We’ll monitor your progress on a regular basis, ensuring that your gums aren’t becoming irritated and your teeth are whitening as desired. When the process is complete, your smile will be noticeably whiter and brighter.

Maintaining your new whiter smile

Let us know if you experience some sensitivity during or following the whitening process. This is normal, and should subside shortly. We can suggest toothpaste that will alleviate the sensitivity. Avoid foods and beverages that stain, like coffee, cola, tea, berries and red wine, or brush or rinse with water after consuming them. See us periodically for touch-ups to remove new stains.

Overhangs

What Are Overhangs?

One of the keys to the long-term success of your restoration and the health of your gums is the accuracy of the fit. This is especially true where the restoration meets the tooth.

When everything is ideal, there is a seamless transition where the tooth and the filling or crown meet. When a restoration is too bulky where it meets your tooth, we call it an overhang. Overhangs can cause a lot of damage in a short period of time because they:

• Trap food and bacteria
• Make it difficult or impossible to floss
• Can contribute to periodontal disease and cavities
• Can lead to long-term bone loss

What causes overhangs?

Over time, silver amalgam fillings can absorb moisture and change their original shape. Challenges and technique problems at the time of placement may also be the cause of overhangs. Whatever their origin, overhangs must be corrected. In most cases, this requires removal of the old filling or crown and replacement with a new one that fits properly. Overhangs are a serious problem and a threat to the health of your teeth and gums. Let us know if you ever have difficulty flossing, or if your floss catches or tears. We can avoid many serious problems by finding and replacing any restorations that have overhangs.

All About TMD

What is TMD?

Temporomandibular disorder, known as TMD, is a cycle of pain, muscle spasms, and joint imbalance where the jaw meets the skull. The lower jaw meets the skull at the temporomandibular join, known as the TMJ. This joint connects the temporal bone of the skull with the mandible bone of the jaw. Cushioning these two bones is a thin disc of cartilage. Five muscles support the joint.

Symptoms of TMD

When the balance of these bones, cartilage, and muscle is lost, it can cause:

• Headaches
• Earaches
• Difficulty opening and closing your mouth
• A clicking or popping in the joint
• A dull aching pain around the ear that spreads into the face
• Sore or painful jaw muscles

This cycle of pain, spasms, and joint imbalance can be started by clinching or grinding the teeth, a bad bite caused by missing teeth or poorly aligned teeth, a blow to the joint, arthritis or emotional stress.

Breaking the cycle

Clenching and grinding will often go away once a person’s stress is reduced. In the meantime, there are other ways to break this cycle. You can reduce muscle spasm and pain with:

• Moist heat
• Inflammation-reducing drugs and muscle relaxants
• Muscle massage
• A soft diet

To restore balance to the joint, we can crown teeth, fill spaces, adjust the bite using a procedure called equilibration, or even move teeth. A splint, which is a plastic mouthpiece, can reduce clenching and grinding, which will also help restore harmony to the joint. In extremely severe cases, surgery may be necessary to repair the damaged part of the joint.

Millions of people suffer from TMD. Treatment and lifestyle changes can break the TMD cycle and restore harmony to the joint.

FYI Fridays: Frenectomy

Frenectomy

What is the frenum?

Your lips, cheeks and tongue are connected to your jawbone with a fold of tissue called the frenum. If the frenum is too long or too short, it can cause problems and should be removed. This procedure is called a frenectomy.

The frenum at all stages of life

The frenum can be fixed in all stages of life. If an infant’s frenum is too long, it can make it difficult for the baby to breast feed. Toddlers just learning to speak may get “tongue tied” because the frenum is close to the tip of the tongue. Even teens and adults have this problem, and a frenectomy can help them, too. An abnormally attached frenum can prevent baby teeth from properly erupting. As a child ages, a frenum that is attached too closely to the teeth can cause a gap to form between the teeth. The gap cannot be closed unless the abnormal frenum attachment is surgically removed. A short or tight frenum will constantly constantly tug on the gum tissue and can cause the tissue to pull away from the tooth, leading to serious gum recession, tooth decay, and periodontal disease. For adults who wear a denture, the frenum can pull the denture and loosen it, which makes wearing the denture extremely uncomfortable.

The procedure

A fenectomy is performed in the dental office usually with just a local anesthetic, and takes only about 10 or 15 minutes. The frenum can be removed with a scalpel or a laser. If a laser is used, it is very important that you remain completely still, so you may be offered sedation if you think it might help you relax. If your dentist must suture the area, healing may take a few weeks.

Hidden Dangers: Plaque

Disclosing Tablets

Plaque detective

Using disclosing tablets is a good way to find the plaque that is left on your teeth after brushing and flossing. Disclosing tablets are made with a harmless vegetable dye that stains plaque red.

Why use disclosing tablets

Disclosing tablets can work to prevent cavities and periodontal disease by helping you see the plaque on your teeth. Plaque is a sticky film of food and bacteria that constantly forms on your teeth. Because plaque is colorless, it can be hard to see. You can see how it shows up after the disclosing tablet stained it with red vegetable dye. If plaque is not removed every day, it builds up and hardens to become tartar, which becomes stained blue. It takes professional help to remove tartar. There is no way for you to effectively remove tartar at home. A toothbrush or floss will not remove the hardened tartar. It is important to keep your teeth and gums free of plaque and tartar because they are the main cause of tooth decay, gingivitis and periodontal disease. That is why it is important that you find and remove all the plaque at home every day.

How to use disclosing tablets

To use disclosing tablets, first brush and floss. Then simply chew a tablet, swish it around your mouth, and rinse with water. Use a small dental mirror to check your teeth for any signs of red, especially near the gumline. Brush and floss these missed areas again until the red is gone. Using disclosing tablets, you can improve your homecare technique and keep your smile healthy.

What If? Wednesdays

What if your (or your child's) wisdom teeth are causing problems with your bite and overall comfort? If you haven't spoken with your dentist about your wisdom teeth, follow the guide below and take the necessary precautions to prevent further problems from arising.

Extracting wisdom teeth

For many people, the best treatment for wisdom teeth is to remove them. This treatment helps prevent future dental problems and maintain a healthy mouth and smile.

Wisdom teeth can cause problems

Your last molars, called the third molars or wisdom teeth, typically begin to come in (erupt) during the late teens or early twenties. When they don’t have enough room to grow in properly, they are considered impacted. This can cause serious problems, including;

• A very painful infection, called pericoronitis, can affect a partially erupted wisdom tooth and the surrounding gums. This infection can spread into the face and jaw.
• When a wisdom tooth tries to erupt at an angle, it can cause decay in the neighboring tooth. This happens because the wisdom teeth are nearly impossible to keep free of plaque, and the area between the teeth becomes a trap for the bacteria in plaque that cause tooth decay.
• Additional bacteria in plaque case periodontal (gum) disease, which may start near the wisdom teeth and spread throughout the mouth.
• A fluid-filled sac called a cyst may develop around an impacted tooth. A cyst can destroy a great deal of bone in the jaw before it’s noticed.

Diagnosis and treatment

To determine if extracting wisdom teeth is right for your situation, we will do a thorough examination, which typically includes x-rays. It’s often better to remove wisdom teeth early, while their roots are still small, even before the teeth have come in through the gums. This allows for easier removal, fewer complications, and faster healing.

Esthetic Series: Veneers

Veneers cover and protect

When teeth are stained, dark, chipped, or misaligned, laminate veneers may be a good choice to brighten your smile. A veneer is an ultra-thin sheet of porcelain that covers the front of a tooth. Veneers also can be used to close spaces between teeth, lengthen small teeth or to cover misshapen teeth. When teeth are chipped or beginning to wear, veneers can protect them from damage and restore their original appearance.

The procedure

Getting veneers usually takes only two office visits. First, we examine your teeth and may take x-rays. Next, we lightly prepare the surface of the teeth so that the thin veneers won’t look too thick or bulky. Because such a small amount of tooth is removed, most people don’t need an anesthetic. After preparation, we take an impression of your teeth. The mold is sent to a lab where the accrual thin veneers are made. On your second office visit, we place the veneers onto your teeth to make sure they are a good fit. We prepare the teeth for final bonding. Then, we shine a special light onto the placed veneers that hardens the cement to secure the veneers to the teeth. We check your bite and make any minor adjustments. Thin veneers are very strong and with proper home care, can last 10 to 15 years, sometimes even longer.

Your bright future

Current research indicates that you could live into the century mark. Taking good care of your teeth now may be money in the bank for the future. The lighter and brighter color of the veneers is permanent, and you can go home with the smile of your dreams.

TMI - The Monday Inquiry

Cavities

What Causes Cavities?

In science classes, you learned to be very careful with acid. Did you know that you can have acid in your mouth, and that this acid can cause a hole to develop in your tooth?

Plaque – enemy number one

Our enemy in the fight against cavities is plaque. Plaque is a sticky film of food and bacteria that forms constantly on your teeth. The bacteria in plaque thrive on the sugar in the food, and produce acid as a by-product when they break down the sugar. Like all acids, the acid produced by the bacteria is corrosive, which means that it dissolves other materials. Your teeth are the victims of the corrosive action; the acid wears away at them, eventually creating holes in the outer layer of your teeth, called cavities.

Regular checkups are a must

The hard outer layer of your teeth is called the enamel. Cavities first form in the enamel layer of your teeth. Beneath the enamel is a softer layer called the dentin. If a cavity develops through the enamel and reaches the dentin, it can grow much more quickly. That’s why regular checkups and cleanings are so important. If we find a cavity, we can restore your tooth while the cavity is still small and isolated in the outer enamel layer.

Repairing and preventing cavities

To repair a tooth with a cavity, we usually remove the decayed portion of the tooth and replace it with a filling, provided the damage is not extensive and there is still plenty of healthy tooth structure remaining. However, preventing decay is the preferred solution. We’ll be happy to work with you so you’ll learn to keep your teeth free of plaque and decay.

FYI Fridays: Fillings

White Fillings

Until recently, silver amalgam was the material most often used to restore decayed portions of your teeth, especially back teeth. Unfortunately, silver fillings can really darken a smile, and amalgam, by its very nature, can cause damage to your tooth in the long run. Amalgam fillings absorb moisture and expand and contract with heat and cold. So, as the filling ages, it can fracture your tooth; we will then need to place a crown on your tooth to save it. Also, silver fillings often undergo metal fatigue, corroding and leaking over time. This destroys the protective seal of the filling and allows new decay to develop underneath it. This leakage can give a gray appearance to the entire tooth.

New tooth-colored options

Dental research has resulted in the development of new tooth-colored materials that are not only durable and long lasting, but attractive as well. These materials, porcelain and composite resin, provide an attractive, natural look while at the same time restoring strength and durability to your tooth. Both porcelain and composite resin are bonded directly to the tooth, restoring it to near its original strength and function. Both can be custom-colored to precisely match your teeth, so when porcelain or resin fillings are placed, they’re extremely natural looking. This can really make a difference in your appearance, especially if the restoration is visible when you smile.

More advantages of white restorations

When we place an amalgam filling, we have to remove extra healthy tooth structure, just so the filling will stay in place. When we restore your tooth with composite resin, we need to remove only the decayed portion because the bond anchors the material tightly in place. This means you retain more of your healthy tooth structure. Also, because white fillings are bonded to your tooth, they add strength to the tooth. So if you’re looking for an attractive and effective option for restoring one or more decayed teeth, be sure to ask us about the latest choices in white restorative materials.

Pericoronitis

A painful problem

Pericoronitis is an inflammation of the gum tissues that cover the chewing surface of molars that have not fully erupted through the gum tissue. It most often occurs with the wisdom teeth, also called third molars. Pericoronitis is painful and can lead to more serious problems. It is important to treat it as soon as possible to restore the health of your mouth.

Symptoms of pericoronitis

You may realize you have pericoronitis when:

• Your back gums are swollen, red, and painful
• You have a bad taste, pus or odor in your mouth
• You have difficulty opening your mouth wide

The causes of pericoronitis
The most common cause of pericoronitis is food, bacteria, or plaque trapped beneath a flap of gum tissue. The flap is formed when a molar begins moving toward the surface of the gum tissue. Before the tooth erupts through the gum, gum tissue covers the area completely, but as the molar emerges, only part of the tooth remains covered by gum tissue. This creates a flap where food and bacteria can become easily trapped but that is difficult to clean. Inflammation and infection can very quickly develop. In addition, if the upper molar comes through fully before the lower one, the upper tooth may bite down on the lower gum flap, worsening the condition.

Diagnosis and treatment

It is important to treat pericoronitis because, if it is left untreated, a much more serious infection can spread to the neck and cheeks. To determine whether you have pericoronitis, we perform a thorough examination. The exam may include probing the gum around the affected tooth and taking x-rays. To treat pericoronitis, we remove plaque and bacteria from the affected tooth and rinse around and under the gum flap. To prevent pericoronitis from recurring, we may, depending on the circumstances, surgically remove or reshape the gum around tooth, or extract the tooth. Homecare may include rinsing your mouth with warm salt water or an antimicrobial mouthwash. We may suggest that you use an oral irrigator to help keep the area bacteria-free.

What If? Wednesdays

What if my teeth are sensitive?

Tooth sensitivity is a common problem among many different types of people. Fortunately, this is a treatable and manageable condition with proper attention and thorough homecare.

Sensitive Teeth

The reasons to treat sensitive teeth

One of the most common problems in dentistry is sensitive teeth. If you have sensitive teeth, you may feel discomfort when they are exposed to cold air, hot or cold food and beverages, or sweets. Left untreated, tooth sensitivity can have far-reaching effects. Sometimes it stops people from properly brushing and flossing. This can lead to more sensitivity, decay, infection, and even loss of teeth and jawbone. With proper treatment and care, your sensitive teeth can once again be healthy and comfortable.

The causes of sensitive teeth

There are many possible causes, including improper stresses on teeth, loss of the tooth’s protective enamel layer, and occasionally some dental procedures. One of the major sources of improper stresses is the unconscious habit of grinding and clenching the teeth. Another source of stress occurs when teeth do not come together properly. Some teeth always hit sooner than the rest, and they become sensitive. Teeth also become sensitive when they lose their protective outer layer which exposes the dentin. The dentin is the middle layer of the tooth, and it is normally protected by enamel (above the gumline) and cementum (below the gumline). Dentin contains millions of tiny tubes that extend from the nerves at the center of the tooth to the outer layer. When the dentin is exposed, these tubes are left open. Any stimulation at the surface of the dentin is transmitted through the tubes to the nerves, causing pain. The dentin can become exposed through various processes, such as abfraction, erosion, and abrasion. Abfraction occurs when one tooth hits sooner than the rest, causing the tooth to flex. Over time, this continual flexing causes the enamel to separate from the dentin. Erosion occurs when acids dissolve the enamel. This is often caused by frequent sipping of acidic soft and sports drinks or exposing the teeth to stomach acids through acid reflux disease. Abrasion takes place when the protective layer is worn away. This can happen when you brush too hard, use a medium- or hard-bristled tooth brush, or use an abrasive “tartar control” or “whitening” toothpaste. Lastly, some dental procedures, such as bleaching and placing restorations, may sometimes lead to short-term sensitivity.

Diagnosis and treatment

To determine the cause of your tooth pain, we do a thorough examination. Then we perform the most appropriate treatment for the situation. Short-term sensitivity can often be handled by using a desensitizing toothpaste or mouthwash. If the problem is improper stress on the teeth, we may adjust you bite or recommend that you wear a mouthguard. If the problem is exposed dentin, we may present a plan for improved brushing techniques, counsel you about your diet, treat the area with fluoride, or apply a protective coating, bonding agent, or restoration.

Snoring & Apnea

Snoring & apnea differences

During sleep, many people suffer from a problem breathing ranging from mild snoring to a dangerous condition called obstructive sleep apnea. Snoring is the sound the soft tissues in the mouth and throat make when they vibrate. When you sleep, the tongue, soft palate, and lower jaw relax and narrow your airway. This increases the speed of the air flowing through the airway and causes the soft tissues to vibrate, much like air whooshing out of a balloon. Obstructive sleep apnea causes sufferers to stop breathing periodically during sleep. The soft tissues collapse against the back of the throat, cutting off the airway for 10 seconds or more. Lack of oxygen forces you to partially awaken, often with a loud gasp in order to open the airway. The cycle repeats many times every night, sometimes up to 40 instances an hour.

The symptoms of obstructive sleep apnea

Some of the most common symptoms of obstructive sleep apnea include:

• Loud snoring, gasping or jerking during sleep
• Headache and sore throat
• Confusion upon waking, difficulty concentrating, irritability, or depression
• Excessive sleepiness during the day
• Cardiovascular problems, such as high blood pressure, stroke, heart attack, and congestive heart failure

Diagnosis and treatment

Several simple actions may help you stop snoring, including losing weight, avoiding alcohol, sleeping on your side, and using a humidifier. If we suspect that you suffer from sleep apnea, we recommend that you see your physician as soon as possible for a complete diagnosis. Then we can work closely with your medical team to treat the condition. One of the most common treatments for snoring and sleep apnea is a customized oral appliance. An appliance pulls the lower jaw forward and keeps the airway clear. To make a custom oral appliance, we take impressions and bite registrations from your teeth. From these records, precise working models of your teeth are made, and the models are used to create an appliance specific to your needs. Some oral appliances are made in our office, while others are made in a dental laboratory. When the appliance is ready, we check the fit and make any necessary adjustments. For the first few nights, you place the appliance into your mouth about 15 minutes before sleep to help your mouth get used to it. Some initial soreness is normal, but let us know if the appliance is otherwise uncomfortable, so we can adjust the fit.

Importance of Nutrition

Nutrition

The importance of a balanced diet

Eating right needs to be a daily habit, just like brushing and flossing. Eating a balanced diet will help boost your body’s immune system so you will be less vulnerable to oral disease. It will also provide you with the nutrients your body needs to maintain strong teeth and healthy gums. So what is a balanced diet? It includes plenty of fruits and vegetables, moderate portions of protein, complex carbohydrates like whole grains and beans, low-fat dairy products and unsaturated fats.

Frequency and timing

Good nutrition plays a large role in your dental health, and that includes what you eat and how often you eat. Every time you eat a sweet or starchy food, the bacteria in your mouth feast on it and produce acids that attack your teeth. An acid attack can last 20 minutes or longer, until your saliva is able to help neutralize the acids and repair the enamel on your teeth. So, the more often you eat, the more your teeth are exposed to these acids, and the less time there is for saliva to do its job. Eventually, the acids dissolve the tooth enamel and cause decay.

Food suggestions

You should limit the amount of sodas you drink and other beverages that contain sugar. One of the main causes of tooth decay is soda consumption. A 12-ounce can of soda contains about 12 teaspoons of sugar. Soda also contains phosphoric and citric acids that dissolve the protective layer of enamel on your teeth. Combining starches and sweets in a meal with proteins and fats helps stimulate saliva production. So, if you eat dessert, eat it with your meal, not sometime afterward. It has also been found that certain foods like nuts, cheese, onions, and many teas actually slow the decay process. To maximize your nutrition and your dental health, eat a well-balanced diet. Limit sugary, starchy and sticky foods and drinks, and avoid between-meal snacking.

TMI - The Monday Inquiry

What are canker sores and how do I prevent and treat them?

Canker Sores

Canker sores, also called recurrent aphthous ulcers, are small round sores that form inside the mouth. They most often appear on the loose tissues of the mouth, like the inside of the lips or cheeks, the underside of the tongue, the floor of the mouth, and sometimes near tonsils. They usually begin as a tingling sensation, followed by a white or yellow sore surrounded by a bright red area. Pain usually decreases in about a week, and the sores heal in 7 to 14 days. Fortunately, most canker sores are not serious and will soon go away on their own.

The causes of canker sores

No one knows what causes canker sores, but some experts say that the tendency to get canker sores is inherited. Another theory is that they may be a result of actions by the body’s immune system. Certain triggers seem to set off outbreaks, including injury in the mouth, like a bite or cut, toothpastes that contain sodium lauryl sulfate, emotional stress, hormonal changes, food allergies, and dietary difficiencies, especially of vitamin B, zinc, folic acid, iron and selenium. If you have had a canker sore, you are likely to get one again. Fortunately, canker sores are not contagious.

Diagnosis and treatment

There is no cure for canker sores, but you can ease the pain and perhaps reduce how often you get them. Common remedies include:

• Using toothpastes and mouthwashes that do not contain lauryl sulfate
• Applying over-the-counter remedies that contain numbing agents, like benzocaine or phenol
• Rinsing with salt water or an antimicrobial mouthwash
• Avoiding spicy or acidic foods during an outbreak
• Working with healthcare provider to treat any food allergies
• Taking a daily multivitamin

If this is the first time you have had a canker sore, let us know, so we can distinguish it from other kinds of mouth sores. Tell us now if you get canker sores more than three times a year, since this may be a sign of a more serious illness. If the sores are large, painful or persistent, we may recommend medication.

FYI Fridays

Cold Sores

Cold sores, also called fever blisters or oral herpes, are small sores that form most commonly on or near the lips. Cold sores usually follow a predictable pattern of four stages that lasts about 10 to 14 days. The first symptom is a painful, itchy tingling. A day or so later, small red blisters appear. Then, in a few days, the blisters form into oozing sores with yellowish crusts. Finally, in a week to 10 days, the sores scab over and heal. Outbreaks can be accompanied by low fever, headaches, body aches, and fatigue. Cold sores are painful and annoying, but be patient. They do go away on their own, and you will soon be pain-free again.

The cause of cold sores

Cold sores are caused by the herpes simplex virus. Symptoms appear from 1 to 3 weeks after initial exposure. Once you are infected with the virus, it lives in your nervous system forever. Certain triggers seem to set off outbreaks. Some of these triggers include exposure to ultraviolet light, physical and emotional stress, fatigue, hormone fluctuations, the menstrual cycle, and illnesses like fever, cold, or flu.

Diagnosis and treatment

There is no cure for cold sores, but you can ease the pain by applying over-the-counter remedies that contain numbing agents, like benzocaine or phenol, washing the infected area gently with water and an antiseptic soap, applying either a warm compress or ice, and avoiding spicy or acidic foods during an outbreak. If this is the first time you have a cold sore, or if fever, swollen glands, or bleeding gums accompany your cold sore, let us know right away, so we can determine the correct diagnosis. In some cases, we may prescribe an anti-viral medication.

Preventing the spread of cold sores

The cold sore virus is extremely contagious. It spreads by direct contact with an infected person or through contact with personal items such as infected towels, toothbrushes, or razors. You can help to prevent cold sores from spreading by:

• Not touching the area
• Washing thoroughly with water and an antiseptic soap if you have touched the sore
• Not touching anyone if you have just touched the sore
• Not kissing anyone while symptoms persist
• Being extremely careful to prevent the spread of the infection to the eye, as blindness can result

Defending Your Mouth

Bad Breath

The embarrassment of bad breath
A lot of people are embarrassed by their bad breath, but it is a problem that can be solves. Certain foods and beverages can cause bad breath. When strong foods, like onions and garlic, are the cause, bad breath is temporary.

The causes of bad breath

Most bad breath, also known as halitosis, is caused by poor oral hygiene. When you eat, minute particles of food get trapped between your teeth and in the tiny grooves and bumps on your tongue. The particles grow bacteria which release a sulfur compound that causes bad breath. Another common cause of bad breath is dry mouth. Dry mouth happens naturally when you sleep, causing morning breath, and it is worse if you sleep with your mouth open. Some medications also cause dry mouth, and it is more common as you age. Additionally, almost all people who use tobacco products have bad breath.

Diagnosis and treatment

Proper brushing and flossing are the first line of defense against halitosis. Many people use mouthwash to combat bad breath, but most over-the-counter mouthwashes are just a temporary mask and do not solve the problem. We may recommend a medicated mouthwash.

Here are some ways you can improve your breath:

• Brush after every meal. You might want to carry a toothbrush with you.
• Floss at least once a day
• Brush your tongue to help dislodge any remaining particles. You can use your toothbrush or a special tongue cleaner. Bacteria can build up, so use a new toothbrush. You should change your toothbrush every three to four months.
• To avoid dry mouth, stay hydrated by drinking lots of water. Other liquids like soda and coffee do not count because they can cause bad breath.
• If you wear dentures or braces, clean them well
• See your dentist at least twice a year for a professional cleaning

Sometimes, bad breath is a sign of a more serious health problem. If your breath has a particular odor, perhaps fishy, fruity, or smells like ammonia, you might need to see your physician. With good care on your part, you can combat bad breath and enjoy life with confidence.

Hidden Dangers

Oral Cancer Exam

Life saving measures

We perform a thorough oral cancer exam during your checkups because early detection of oral cancer can save your life.

The signs of oral cancer

Oral cancer is the uncontrolled growth of abnormal cells in the mouth and throat. Some of the warning signs are:

• A red, white, or discolored patch or lump in or around your mouth
• A sore that bleeds easily or that does not heal within 2 weeks
• An area that has thickened, raised, or hardened
• A rough patch of tissue
• Difficulty chewing or swallowing
• A chronic sore throat or hoarseness

Oral cancer exam

During the exam, we feel for lumps or abnormal tissue changes on your neck and inside your mouth. We thoroughly examine the soft tissues in your mouth, especially the most frequent oral cancer sites:

• Your tongue
• The floor of your mouth
• Your soft palate
• Your lips
• Your gums

We may also do additional testing or use specialized equipment to identify any suspicious areas, particularly if you’re at higher risk for developing oral cancer, including adults over 40, tobacco users, people who consume alcohol excessively, and those with oral contact of the human papilloma virus.

Lifestyle changes

Some lifestyle changes can minimize your chances of developing oral cancer changes, including;

• Do not smoke or use smokeless tobacco
• Avoid excessive use of alcohol
• Eat plenty of fruits and vegetables each day

With regular exams and a healthy lifestyle, you can better maintain your oral and overall health.

What If? Wednesdays

What if I have a lot of plaque and tartar buildup on my teeth?

If you notice your teeth have a lot of build-up on the surface, we can help you remove a lot of the excess tartar from your mouth. Plaque and tartar can be incubators of bacteria, causing serious problems like periodontal disease and gingivitis. It is important for your oral health to remove this build-up and continue a preventative homecare regimen.

Full Mouth Debridement

When heavy plaque and tartar deposits have built up on your teeth, we often recommend a procedure called full mouth debridement to remove that build up.

The benefits of debridement

Plaque is a sticky, colorless film of food and bacteria that constantly forms on your teeth. If it is not removed every day, plaque hardens and turns into tartar. Over time, this plaque and tartar builds up on your teeth. A heavy build up blocks our ability to clearly see and examine your teeth and gums. It is also important to remove the accumulation of plaque and tartar because they are the main cause of tooth decay and gum disease. Many factors can contribute to heavy build up, including:

• Dry mouth, also called xerostomia
• Tobacco use
• Certain health conditions
• Wearing braces
• Poor oral homecare
• Not getting regular professional dental cleanings

The debridement procedure

Depending on the situation, we may begin the procedure by recommending a numbing gel or offering nitrous oxide to make you more comfortable. Next, we use a variety of instruments to carefully remove the plaque and tartar above and around the gumline. We may also apply an antimicrobial rinse. Then, we finish the procedure by carefully reviewing your homecare routine. A full mouth debridement is an important initial step in the ongoing evaluation and treatment of your oral health.

Homecare Series

Oral Irrigator

Practicality of using an oral irrigator

Cleaning your teeth and gums with an oral irrigator can be a great idea for several reasons. Many people use the powered stream of water to help remove bacteria that cause tooth decay and gum disease. Others use an oral irrigator because it makes it easier to clean around braces, bridgework and implants. Some use an oral irrigator to help control periodontal disease. No matter why you choose an oral irrigator, you will get the best results when you correctly use it.

How to use an oral irrigator

Begin by filling the reservoir with lukewarm tap water according to the manufacturer’s directions. Depending on your situation, we may recommend that you use saline (water mixed with salt), an antiseptic mouthwash, or a medicated solution instead of water. Choose the best tip for your oral condition. If you are using a regular tip, place it at a 90-degree angle to the gumline, almost touching the tooth. If you are using a tip that is designed for rinsing below the gumline, place it against the tooth at a 45-degree angle, and gently move the tip into the tiny groove between the tooth and gum. Set the pressure to the lowest setting and turn on the irrigator. Close your tips slightly, allowing the liquid to flow out of your mouth. Move the tip along the gumline, pausing for a few seconds at the spaces between your teeth. If you are rinsing below the gumline, make sure to reach into each gum groove as you go. Irrigate around all the teeth, especially the back teeth.

How we can help

Ask us if you have any questions about choosing or using an oral irrigator. We are happy to offer tips for keeping your teeth and gums clean and healthy.

TMI - The Monday Inquiry

Oral Piercing

Piercing the tongue

Many people want their tongue or lips pierced. This is not the same as getting your ears pierced. Unlike your ear lobe, your tongue is a muscle that has many blood vessels and nerves.

What to expect

First, a cork is placed underneath your tongue. Then, a long needle is punched through the sensitive tissue. A barbell is inserted into the hole in your tongue. All of this is done without anesthesia. Soon after the barbell is inserted, your tongue will swell. The swelling is significant and usually lasts three to five days. Because your tongue is covered with bacteria, they can invade the open wound and enter your bloodstream. This can result in painful infections that ooze pus into your mouth and throat. If this happens, you need to get immediate medical attention. The needle used to pierce the tongue is quite thick. If it hits one of the many veins in your tongue, you can expect to have heavy bleeding. The needle can also sever a nerve in the tongue, which can result in permanent numbness.

Problems with jewelry

The jewelry itself can present problems. The hard metal ball is constantly hitting the fragile tooth surface, much like a wrecking ball. People with tongue studs tend to habitually bite them, which increases the chance of chipping or scratching a tooth. Lip rings can also wear away the gums. This can lead to gingivitis and expose the tooth roots, which can make your teeth sensitive to hot, cold and sweet foods.

Take precautions

We do not advocate it, but if you must get an oral piercing, take some precautions:

• Make sure the shop is clean
• The piercer should be properly trained, follow OSHA guidelines for blood-borne pathogens, and use only sterilized needles and equipment
• The piercer should thoroughly explain the procedure and your follow-up care
• Use a new toothbrush when you return home

Oral piercings are a trend that can cause severe damage. Because our goal is to keep your teeth and gums healthy, we do not recommend oral piercings.

Brushing Series

Electric Toothbrush

Popularity increases

Electric toothbrushes have become more popular for a variety of reason. They do a good job of reducing stains, removing plaque, and disrupting the bacteria that cause tooth decay and gum disease. Electric toothbrushes can be easier to manage than a manual toothbrush, and they are fun to use.

How to brush with an electric toothbrush

No matter why you have chosen an electric toothbrush, it is important to use it correctly. Make sure the brush head has soft bristles because these are kinder to your teeth and gums.

• Apply a pea-sized amount of fluoride toothpaste
• Place the toothbrush in your mouth, and close your lips slightly to prevent splattering. Hold your jaw in a relaxed, open position so you can reach all tooth surfaces
• Center your brush on the gumline, and angle the bristles according to the manufacturer’s directions. Turn on the toothbrush, holding it gently against the tooth and gumline for a few seconds. Do not press hard; let the toothbrush do the work. Then, move to the next tooth.
• Make sure you brush the insides and outsides of each tooth, including the backs of the front teeth, and all the chewing surfaces
• Your brushing routine should last at least 2 minutes. To help you, electric toothbrushes often have built-in timers.

When to brush

Your brushing schedule is important, too. Brushing after breakfast cleans away the morning’s food debris. Brushing your teeth before bedtime protects your teeth all night. Ask us if you have any questions about your electric toothbrush. We are happy to offer tips for better brushing and having a clean, fresh, healthy mouth.

FYI Friday

Fluoride

Oral healthcare breakthrough

One of the greatest breakthroughs in preventative dentistry is the use of fluoride. Almost all water naturally contains some fluoride, but not in sufficient quantity to protect teeth. Many American cities add some fluoride to the water supply to bring it up to levels that help prevent tooth decay.

The benefits of fluoride

Fluoride has many benefits for people of all ages. When children are young and their teeth are forming, fluoride joins with the structure of the tooth, making the enamel surface harder and more resistant to decay. The benefits for adults are also important. Fluoride can help repair a cavity in its earliest stage before it has become invisible in the mouth. Fluoride rebuilds the enamel layer of the tooth.

Fluoride treatments

Fluoride treatments are sometimes prescribed to help eliminate the bacteria that cause gum disease. Fluoride treatments for older adults help to treat decay on tooth roots and to minimize root sensitivity. For these reasons, we recommend fluoride toothpaste for all of our patients. We may also recommend additional sources of fluoride for you to use at home. Depending on your situation, these could include fluoride drops, tablets, rinses, gels, or high-concentration fluoride toothpaste. We may also apply fluoride foam, varnish, or gels in our office. Fluoride is an important part of every prevention program. When combined with the good dental habits of brushing and flossing, fluoride can dramatically reduce cavities and keep your mouth healthy.