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.