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.

Hidden Dangers

Smokeless Tobacco

The myth of safety

Smokeless tobacco is not safe, because just like cigarettes, it contains nicotine and dangerous chemicals. In addition, smokeless tobacco is processed with nearly as much sugar as there is in candy.

Dental problems caused by smokeless tobacco

Smokeless tobacco can cause a number of problems with your oral health. Not only does that little pinch between your check and gums give you unsightly stains and bad breath, it is a hot spot for tooth decay, which can lead to fillings, crowns, and root canal therapy. Smokeless tobacco also causes receding gums and tooth abrasion, both of which can lead to sensitive teeth. It also contributes to periodontal disease that can lead to more infection and loss of teeth and bone.

Dangerous health risks of smokeless tobacco

Using chewing tobacco can also lead to mouth sores, and some of these sore can become cancerous. This is serious because oral cancer can kill. Smokeless tobacco leads to many other painful and debilitating diseases such as stomach ulcers, high blood pressure, diabetes, heart disease, clogged arteries and stroke. Our advice: to protect your oral and overall health, do not use smokeless tobacco. If you have already started, quit now.

Brushing Series

Importance of brushing

Whether you use a manual toothbrush or an electric toothbrush, brushing is important because it removes plaque and disrupts the bacteria that cause tooth decay and gum disease. Proper tooth brushing includes five key points:

• A soft toothbrush
• Toothpaste with fluoride
• Brushing long enough
• The correct brushing action
• Brushing at least twice a day

How to brush

Use a toothbrush with soft bristles. They are kinder to your teeth and gums. They also make it much easier to remove plaque from below the gumline, where gum disease starts. Use a pea-sized amount of toothpaste that contains fluoride. Fluoride strengthens the outer enamel layer of the teeth. It can stop a cavity in its tracks and give you more resistance to future cavities. Make sure your brushing routine lasts long enough to thoroughly remove plaque. We recommend that you brush for at least 2 minutes. Try using a timer or clock to confirm the time. Use the correct brushing action. To start, center your brush on the gumline and angle the bristles at a 45-degree angle. Apply gentle pressure so the bristles slide under the gumline. Gently vibrate the brush while you move in short, circular, wiggling motions. Brush one or two teeth at a time. Then move to the neighboring teeth, allowing some overlap. Use this method to brush the insides and outsides of all the teeth. To brush the backs of the front teeth, tilt the brush and make several up and down strokes. Then brush the chewing surfaces of teeth with a gentle, circular, scrubbing motion. End by brushing your tongue and the roof of your mouth. This removes germs and keeps your breath fresh.