Quick reference

Deciphering Dental Credentials

When you see abbreviations like AACD or FAGD after a dentist’s name, what does that mean to you as a patient? Should you choose a dentist with a DMD, or a DDS? Are dentists with MAGD after their names superior to those without this designation? And what…

And what about dental specialists? What is the difference between a periodontist and a prosthodontist? Or an orthodontist and an endodontist? Here’s what it all means:

  • DDS—Doctor of Dental Surgery or Doctor of Dental Science. This is a four-year dental degree that is required before a dentist can be licensed to practice in the United States. Dentists with training in other countries must complete approximately two years of additional coursework in the United States before they are eligible for licensing here.
  • DMD—Doctor of Medical Dentistry. There is no difference between a DMD and a DDS degree. The American Dental Association states that the credentials are identical; dental students at the University of Pittsburgh, the University of Florida, Tufts, the University of Oregon Health Sciences Center and the University of Louisville earn DMDs. All other schools confer DDS’s.
  • FAGD—Fellow of the Academy of General Dentistry. General dentists do not specialize in any one facet of dentistry. According to the AGD, an FAGD “has been recognized by other dentists as a leader who is committed to quality patient care through continuing dental education.” An FAGD dentist must earn a minimum of 500 approved continuing dental education credits and pass a comprehensive 400-question examination. She must also be an Academy of General Dentistry member for five continuous years.
  • MAGD—Master of the Academy of General Dentistry. To achieve this status, AGD members must first be fellows in the Academy of General Dentistry. They then must earn an additional 600 approved continuing education credits—of which 400 hours are hands-on courses. A Master of the Academy of General Dentistry has taken a total of 1,100 hours of continuing education, with courses in 16 disciplines in dentistry, such as periodontics, orthodontics and implants.

Additionally, to remain a member of the AGD, a dentist must complete at least 75 hours of continuing education every three years.

Dental specialists

To be a legitimate “specialist” within a particular discipline in dentistry, a dentist is required by the American Dental Association to undergo at least two years of advanced training, accredited by the ADA Council on Dental Education.

Endodontists

specialize in the diagnosis and treatment of the root pulp and related structures of the teeth, such as the root canal.

Oral and maxillofacial surgeons

perform tooth extractions and diagnose and surgically treat diseases, injuries, and defects of the mouth, jaw, and face.

Oral pathologists

diagnose tumors and other diseases and injuries of the head and neck.

Orthodontists

diagnose and correct tooth alignment and facial deformities.

Pediatric dentists

provide dental care for infants, children, adolescents, and sometimes special-needs patients.

Periodontists

diagnose and treat diseases of the gums and related structures in the mouth.

Prosthodontists

perform diagnosis and treatment involving the replacement of missing teeth.

Public health dentists

prevent and control dental disease and perform public education services related to the promotion of oral health and hygiene.

If you would like a specialist to treat you, be sure to ask if she has advanced training in that dental discipline. Some dentists claim to be specialists, when they merely limit their practice or wish to focus on a certain aspect of their practice. They may provide excellent dental care but not have the advanced training necessary to earn the “specialist” designation.

Dental Emergencies

My son was hit in the mouth with a bat and his front permanent tooth was knocked out. My daughter fell and bumped her front baby tooth and now it’s dark…

My son was hit in the mouth with a bat and his front permanent tooth was knocked out. What should I do?
Your child must see a dentist within one hour of the incident. If you wait any longer, the chances of the tooth being successfully re-implanted are poor. If you can, rinse it in cool water; don’t wipe it or scrub it. Place it in a glass of water or milk, or gently wrap it in a clean, damp cloth until you get to your dentist’s office.

Teeth that have been knocked out will almost always require a root canal, but they can often survive for years if treated within one hour after the injury.

To protect your child in the future, have your dentist fit your child for a mouthguard and consider purchasing one or more tooth-saver boxes for your home and your car. These boxes are designed to hold and protect a knocked-out tooth until you can see a dentist.

My daughter fell and bumped her front baby tooth and now it’s dark. Is it dead? Probably. The discoloration may mean that the impact has broken a blood vessel at the tip of the tooths root. Here is one note of encouragement: Baby teeth often survive blows that would kill a permanent tooth. Take your daughter to a dentist right away and have the tooth examined.

My son chipped his front tooth. How difficult will it be to fix it, and how long will it take?
If you find the fragment, bring it with you to the dental office. A fragment can occasionally be bonded back onto the tooth. Even without the broken piece, a dentist can often restore the tooth to its natural appearance in less than one hour.

What should I do if my child has a toothache?
Call your dentist immediately. Some dentists recommend that, until your child can be treated, you should rinse her mouth with lukewarm water and apply cloth-wrapped ice to her face. Dentists do not recommend that you apply heat, and you should never put an aspirin on the tooth or gums. Aspirin is acidic; placed on a tooth or against the gums, it can produce burns. If you’re going to use aspirin, make sure it’s swallowed.

Finally, children who complain of a toothache often have food lodged between their teeth. Gently flossing the area of discomfort may provide immediate relief.

How can I prevent injuries to my child’s teeth?
If you have toddlers, make sure your house is childproof. This means sharp corners or protruding knobs and handles on furniture have been padded; if this isn’t possible, lock the doors to the rooms with this furniture. When your child is in a stroller or car, make sure she is strapped in firmly. Never let your child stand on a seat or sit in your lap while you are in a car.

Mouthguards can prevent injuries in older children. Most dental injuries occur in your neighborhood, not on the gym floor or playing field, so a mouthguard should ideally be worn during all rough play, even if it’s just in your own backyard.

Dental Fears

My daughter is terrified of all doctors. How will she do if she needs a filling? When given appropriate and truthful information, most children do well with their dentist. Since kids can easily sense fear or concern in their parents, let your dentist work…

My daughter is terrified of all doctors. How will she do if she needs a filling?
When given appropriate and truthful information, most children do well with their dentist. Since kids can easily sense fear or concern in their parents, let your dentist work alone with your child. Once the dentist has developed a bond with your child, her behavior during treatment may far exceed your expectations.

I want my son to have a positive dental experience. I don’t want any sedation, restraint, or firm voices used with him. Is this possible?
Yes, but much depends on the age of your child. If he is two or three years old and needs a great deal of treatment, it isn’t likely that he can sit through several long visits that involve complicated procedures without some form of sedation. However, if your child is older, or needs minimum treatment, his experience at the dentist will probably be quite positive. Before treatment, it’s best to let your dentist meet your child, then determine how best to provide the kind of care you want.

Dental Fees

Why are dental fees so high? When compared to other medical fees, dental fees are actually low. In fact, unlike most medical costs, dental fees have not kept pace with inflation. As with all other businesses, dental offices are faced with increasing cost…

Why are dental fees so high?
When compared to other medical fees, dental fees are actually low. In fact, unlike most medical costs, dental fees have not kept pace with inflation. As with all other businesses, dental offices are faced with increasing costs of utilities, rent, maintenance, insurance, taxes and, of course, payroll.

But unlike many other business owners, dentists must also pay the high costs of owning and maintaining an elaborate array of dental equipment. A physician’s examining room may contain a table, stool, scale and basic instruments for examining the ears and throat. By contrast, each dental operatory (and a practice may have several of these) may be filled with an electronically controlled chair, computer, examining lights, air abrasion unit, digital x-ray system, curing systems, instruments, supplies, sterilization systems, patient education systems and more. And dentists and their staff continuously educate themselves on advances in dental techniques and materials.

Dental Insurance Lingo

Want to get the most from your dental benefit plan? You’ll need to learn the lingo…

Understanding your dental insurance is the key to maximizing the benefits that it offers. But like anything, you must have a basic understanding of some of the key terms associated with dental insurance; this will help you sort through the complexities of your plan and net as many of those dollars as you possibly can.

Here’s a crash course on “dental insurance-ese” that will give you the advantage in choosing—and using—your dental insurance benefits!

Who administrates your plan?

Third parties: These are the plan providers who provide the financial benefits for your dental insurance plan. There are three third-party types:

  • Insurance companies: For-profit organizations that take on the financial risk of your benefit plan. They are the ones who will process your claim. Insurance carriers enter into a contract with either groups or individuals, and offer a variety of benefit packages.
  • Dental service corporations: Not-for-profit organizations that negotiate and coordinate contracts for dental treatment, either for individuals or patient groups.
  • Self-funded insurers: Employers that reimburse their employees for the dental care they receive. There are typically limitations on dollar amounts spent and treatments covered under a self-funded insurance plan.

Can you continue to see the same dentist?

If you currently have a dentist with whom you’re comfortable, you’ll want to be very careful about which insurance plan you choose.

Open panel plans allow you the freedom to choose your own dentist. They also allow any dentist to participate in their plan. These plans may also be called “freedom of choice” plans.

Closed panel plans allow you to see only dentists who are contracted to participate in the plan. There are two types of closed panel plans:

Preferred provider organization (PPO): Under this plan, you can select from a group of dentists in your area who have agreed to provide treatment for less than their usual fee. If you choose a dentist who is not a “preferred provider,” you will have to pay a greater portion of your dental bill.
Exclusive provider organization (EPO): This is the more restrictive of the two closed-panel plans. Under this plan, you will be required to select your dentist from a limited number of dentists who have agreed to accept substantially reduced fees for their work. Participating dentists may even be salaried employees of the EPO. For this reason, many dentists do not participate in EPO plans, which greatly limits your choices. EPOs will often restrict your access to specialists and limit the amount of care you can receive each year.

How much dental care will you receive?

Each plan uses a different method to calculate your benefits and payments. Below are the most common payment schedules:

Usual, customary and reasonable (UCR): This is the payment schedule used for most traditional, fee-for-service benefit plans. The payments are usually made directly to the dentist, and are based on a fee schedule that was set decades ago (the “usual, customary and reasonable” fees). As a result, the fee schedules are quite low compared to the actual fees charged by dentists, and you wind up paying a good deal more out of pocket for the dental treatment you receive. However, with UCR plans, you are free to see any dentist you’d like.

Table or schedule of allowances: This benefit calculation method is similar to UCRs, but more restrictive. You may not be able to choose your own dentist, the level and quality of the care you receive may be lower than you’d like, and your access to specialists will be extremely limited. Under this payment schedule, a maximum dollar value is assigned to each procedure, regardless of what the actual fees for that service are in your area. If you are considering a benefit plan that uses this as their payment schedule, it’s important that you ask how often the fees are adjusted to account for inflation, because you’ll be expected to pay the difference.

Capitation (also called per capita): This fee schedule is usually associated with plans that predetermine a certain level of dental benefits that will be offered to you. If the plan administrator decides that a certain treatment is not covered, you will be responsible for paying for it. Quality of care is also compromised when this payment schedules is used, because frequently the amount paid to the dentist is actually less than the cost of providing that care. When this is the case, dentists have an incentive to under-treat; the more services they provide to you, or the more patients they see, the less money they make.

Other terms you should know

  • Predetermination of costs (also called preauthorizaton: This is a treatment proposal that your dentist submits to the administrator of the benefit plan prior to the beginning of treatment. The administrator evaluates the proposal, then makes a determination of the benefits they will allow, based upon your eligibility, covered services, and the plan’s limitations. A predetermination of costs may be required by some plans when the proposed treatment exceeds a certain dollar amount. A predetermination of costs is helpful to both you and your dentist. It can help you to prioritize, plan and budget your dental treatment plan, making the best use of the benefits allotted for each year.
  • Coordination of benefits: If you have dual insurance coverage (for example, you and your spouse both have family dental coverage), coordinating benefits is essential, as it will maximize the coverage you receive from each benefits plan. You should notify the administrator of your primary plan (the one provided by your employer) if you have double coverage.
  • Non-duplication of benefits: Unfortunately, some plans have a clause that disallows overlap in benefits if you are covered by two dental plans.
  • Annual benefits limitations: Many plans have annual caps on the dollar amount and/or the number of treatments or procedures that you may receive annually. Find out what your plan’s annual maximum is, and work with your dentist to maximize these benefits each year AND minimize your out-of-pocket expense.
  • Least expensive alternative treatment (LEAT): Most dental benefit plans require that dentists follow treatment plans that are based upon providing the option that is least expensive, even if a more expensive option would better suit your individual needs. If you choose a more expensive option, you will be responsible for the difference in the cost. Unfortunately, the least expensive treatment is frequently not the one that will provide you with the best long-term results.
  • Premium adjustments and re-evaluations: Both you and your employer should lobby the third party to regularly re-evaluate premium levels to be sure that the UCR or Table of Allowances payments are in line with actual fees charged by dentists in your area.
  • Peer review for dispute resolution: This is a system that is in place to resolve disputes between patients, third parties, and dentists. If a case goes to peer review, individual records, treatments and results are thoroughly evaluated before a resolution is recommended. This usually resolves any disputes to the satisfaction of all parties.

How do third parties categorize the services your dentist provides?

  • Diagnostic: Exams, x-rays and other services that are used to evaluate your oral health and detect malfunction or disease.
  • Preventive: Services that are designed to prevent decay and disease, such as dental cleanings, fluoride treatments and the application of sealants.
  • Restorative: Fillings, crowns, inlays and onlays used to restore strength and functionality to decayed or damaged teeth.
  • Discretionary (or elective/cosmetic): These are treatments that the third party administrator determines to be optional
Do I have Periodontal Disease?

Periodontal disease is an infection of the teeth, gums, and the bone that surrounds the teeth…

Most people who have periodontal disease aren’t even aware of it. It’s rarely painful, especially in the early stages.

The main cause of periodontal disease is the accumulation of plaque. Plaque is the sticky film of food and bacteria that forms constantly on your teeth. It’s hard to see plaque, but look at how it shows up after it’s been stained with red dye.

You must completely remove plaque each day, or it builds up and mineralizes to become tartar, also called calculus. It takes a professional to remove tartar; there’s no way for you to remove it at home. A toothbrush or floss won’t budge it. If tartar isn’t removed, it migrates to the root surfaces.

Tartar shows up on this x-ray as small white lumps on the sides of the teeth. Bacteria that cause periodontal disease thrive here. Bacteria produce toxins, and it’s these toxins, combined with your body’s reaction to them, that destroy bone around your teeth.

Some of the warning signs of periodontal disease are:

  • persistent bad breath
  • bleeding gums when brushing or flossing
  • soft, swollen or tender gums
  • gums pulling away from the teeth
  • loose teeth
  • changes in the spaces between your teeth, which reflect changes in the underlying boneKeep in mind, however, that you can have periodontal disease and experience none of these symptoms!

The roots of the teeth extend into the bone of the jaw. When everything is healthy, the bone comes up around the necks of the teeth and is even throughout the mouth. The crevice between the tooth and gums, called the sulcus, is two to three millimeters deep when it’s healthy. When plaque and tartar invade a sulcus and it becomes deeper than three millimeters, it’s called a pocket. Pockets are excellent hiding places for plaque and bacteria, so the problem usually worsens, and bone tissue is lost.

Once bone has been lost, it never grows back. When too much bone is lost, there’s so little support for the teeth that they get loose and have to be removed.

Since you may have periodontal disease, yet have none of the symptoms, your dentist will perform a thorough examination using x-rays and a periodontal probe to measure bone levels around the teeth. When the bone level falls, the gums pull away from the tooth, forming a pocket.

Your dentist measures the depth of this pocket with a periodontal probe. The measurement is from the bottom of the pocket, where the gum is attached to the tooth, to the top of the gums.

These are healthy gums. They’re tight against the teeth and there aren’t any pockets. Below, notice the difference with early periodontal disease. In general, the deeper the pockets, the greater the spread of periodontal disease.

Bleeding is a sign of infection. Healthy gums don’t bleed! Your dentist also examines the color and shape of the gums. Notice the pink color and the lightly stippled appearance of the healthy gums, like the surface of an orange. Look especially close at the difference of the gums between the teeth. This is where periodontal disease usually starts. X-rays tell us a lot about periodontal disease.

So now you know how your dentist finds periodontal disease:

  • probe readings greater than three millimeters
  • bleeding upon probing of the gums
  • swollen and red gums, especially between the teeth
  • bone loss or tartar on your x-rays
Do I Need a Crown after Root Canal Treatment?

After root canal treatment, the tooth is weak and brittle…

t is weak because the center of the tooth was removed to get at the infected nerve; only the sides of the tooth are left for support. And it is more brittle because the nerve and blood supply are gone.

This tooth was not crowned after root canal treatment. There is a tremendous amount of force on the edges of the teeth when they bite together, so it’s likely that this tooth will break. After a tooth breaks, it is much more difficult to repair. A crown covers and protects a root canaled tooth and helps to prevent it from breaking.

Do I Need a Crown when My Filling Wears Out?

When a filling reaches the end of its life, it’s time to consider an alternative…

sually it’s best to switch to a crown. Unlike a filling, a crown covers and protects a damaged tooth and can keep it from breaking.

The edges of these small fillings have broken, and they have lost their seal. Since most of the tooth is still intact, it’s safe to replace them with new fillings.

It’s a different story for large fillings. From a top view, a filling like this doesn’t look too bad. However, from a side view, it’s clear that hardly any tooth structure remains to keep the tooth from breaking. After a tooth breaks, it is much more difficult to repair. Switching to a crown when a large filling has worn out protects and strengthens the tooth.

Do I Need a Lower Jaw Implant?

If you have a lower denture, you probably know how hard it can be to eat comfortably…

When lower teeth are lost, the bone in the jaw continually recedes. Even worse, there are nerves passing through these holes in the jaw that can end up on the surface of the bone. If this happens, there is a great deal of pain when you bite down.

Fortunately, it’s usually possible to place implants into the lower jaw. Dental implants are small titanium cylinders that are surgically inserted into the bone of the jaw to replace the roots of missing teeth. One way to use implants on the lower jaw is to connect the implants with a bar and then put clips into a new lower denture. These clips snap onto the bar and keep the denture from rocking and shifting. A denture, like this one, can still be removed for easy access and at-home cleaning of the implants and bar. Another option is a lower bridge. It may be cemented in, or held in place by screws.

Using dental implants to support either a lower denture or a bridge will keep the pressure off the bone and nerves. The implants also help stop the bone loss in the jaw that continues once teeth have been removed. Securing your teeth with dental implants can make a world of difference. You can eat, talk, laugh and smile with confidence.

Do I Need an Upper Jaw Implant?

Occasionally, a patient just isn’t able to comfortably wear an upper denture. He may complain of constant pain or a persistent “gaggy” feeling. Or he might say his upper dentures just don’t stay in place…

Simply put, for these people, the transition from their own teeth to an upper denture just never worked out. In such cases, implants may be the answer. Dental implants are small titanium cylinders that are surgically inserted into the bone of the jaw to replace the roots of missing teeth. Bone in the upper jaw is continually lost once teeth have been removed. Implants help to stabilize the bone.

There are several ways to use implants on the upper jaw to replace a denture. One way is with a modified denture that’s open on the palate. It clips to a bar that connects the implants. You can remove this device for cleaning by yourself at home. Another option is a bridge. It may be cemented in or held in place by screws.

Securing your teeth with dental implants can make a world of difference. You can eat, talk, laugh and smile with confidence.

Do I Need an Upper Partial Denture?

An upper partial denture can be a good way to replace missing teeth. When remaining teeth are saved and a partial denture is installed, you will chew more comfortably and have a healthier mouth…

This is a typical upper denture. Notice how the metal clasps fit around the anchor teeth and hold the partial denture in place.

A partial denture stops several problems. By filling in spaces, it stops neighboring teeth from shifting. When missing teeth aren’t replaced, it can set off a chain reaction that might result in cavities and periodontal disease. Partial dentures also help to balance your bite. This means better chewing and a healthier jaw joint. And, partials add support to the cheeks and lips. This support is necessary for clear speaking and proper facial appearance. There are some disadvantages to a partial denture. The clasps sometimes show when you smile. The bar across the palate can make tasting more difficult. It may feel bulky and may cause you to gag at first.

Even when an upper partial denture fits correctly, food will collect under it when you eat. It should be rinsed after every meal. Over the years, as the partial is repeatedly taken in and out, it can wear on the anchor teeth and even loosen them. And bone will continue to recede in areas where the teeth are missing. This may mean that a partial will have to be relined every few years for an optimal fit.

Some temporary problems are normal during the initial adjustment to an upper partial denture. At first, it may tip when chewing, and there may be increased salivation. It may feel bulky and cause gagging. The tongue will feel crowded, and you may have difficulty speaking. As you get used to the partial, however, these problems will diminish. With time and practice, the adjustment can be made, and you can eat and speak with confidence.

Do I Need a Single Tooth Implant?

An implant is an excellent way to replace a missing tooth and keep a good-looking smile…

A dental implant is a small titanium cylinder that’s surgically inserted into the bone of the jaw to replace the root of a missing tooth. An artificial tooth is attached to the implant.

Placing a dental implant after a tooth’s been lost can prevent a chain reaction of problems that could affect the entire mouth. Teeth need each other for support. When a tooth is lost, it changes the biting forces on the teeth next to the space, causing them to shift. When a tooth no longer has anything to chew against, it begins to extrude out of the socket. You can eventually end up losing that tooth, as well.

As your bite changes, it becomes increasingly difficult to chew your food, possibly damaging your jaw joint, the TMJ.

It’s much harder to clean teeth that have shifted. Harmful plaque and tartar collect in these new hard-to-reach places, causing cavities and the permanent bone loss that comes with gum disease. A bridge is another way to solve the missing-tooth problem. But two advantages of an implant over a bridge are that the teeth next to the space aren’t affected with an implant as they are in the preparation for a bridge. Also, the implant helps stop the ongoing bone loss that occurs once a tooth has been lost.

A missing tooth really changes a person’s smile, but a dental implant can replace the missing tooth and greatly improve your smile!

Do I Need Braces?

Malocclusion is the dental term for teeth that don’t fit together properly…

Orthodontics is the branch of dentistry that corrects malocclusions.

The size of teeth and how they fit into a person’s jaw are inherited traits. Some people are lucky and naturally have straight teeth. Others aren’t so lucky. Also, habits like thumb-sucking can also put pressure on teeth and cause a malocclusion. Missing teeth can cause a bad bite to develop, as well; the teeth around a space will shift, throwing off the entire bite.

A malocclusion that isn’t corrected can really affect a person’s profile and appearance. It may also contribute to tooth decay, bone destruction, jaw-joint problems, and headaches.

Correcting your bite through orthodontic treatment can improve your dental health.

Do I Need Overdentures?

An overdenture fits over your teeth after they have been specially prepared…

From the outside, an overdenture looks the same as a regular denture. But under the denture, there is a difference. Some of your natural teeth are retained, and the overdenture fits over those teeth.

The bone in the jaw begins to recede when teeth are extracted. If some of the roots of the teeth are left in place, bone loss is slowed significantly. This can result in a more stable denture.

To prepare the teeth that support an overdenture, first your dentist will remove the portion of teeth above the gum line. Next, root canal treatment is performed on these teeth, and they may then be covered with small metal caps. To begin the process of creating the overdenture, impressions of the mouth are taken. From these impressions, precise working models of the mouth are made, upon which the dentures are constructed. You will then select the best color and shape for your new teeth. When the denture is ready, teeth that won’t be kept are extracted and the denture is placed.

Some temporary problems are a normal part of new denture adjustment. At first, the denture may tip when chewing. There may be an increase in salivation, and the overdenture may seem bulky and cause gagging. The tongue may feel crowded, and you might have some difficulty speaking. But as you adjust to the new denture, these problems will go away.

Do You Need a Bridge?

Placing a bridge after a tooth has been lost can prevent a chain reaction of problems that would affect your entire mouth…

Like other things, teeth need each other for support. When one tooth is lost, the biting force changes on the teeth next to the space, and they begin to shift. When a tooth no longer has anything to chew against, it begins to extrude out of the socket. You can eventually end up losing the tooth. As your bite changes, it gets harder and harder to chew your food. This can cause damage to your jaw joint, the TMJ.

It’s much harder to clean teeth that have shifted. Harmful plaque and tartar accumulate in these new hard-to-reach places, which can result in cavities, gum disease, and permanent bone loss.

Like other bridges, a dental bridge uses abutments for support to hold it in place. Bridges are custom-crafted in a dental laboratory to precisely fit your teeth. A missing tooth really changes a person’s smile, but a bridge is a good way to get your smile back!

Early Detection of Oral Cancer Increases Survial Rates by 400%

Take this quick and easy self-test now! As with other forms of cancer, the chances of surviving oral cancer are greatly increased when you catch it in its early stages…

In fact, survival rates are as high as 81 percent when oral cancer is detected early, compared to a survival rate of 17 percent or less with late intervention. And while nothing can take the place of a thorough oral cancer screening by a dentist or physician, regular self-exams at home can increase the likelihood that an oral cancer lesion will be detected early.

The American Association of Oral and Maxillofacial Surgeons recommends the following procedure for oral cancer self-exams:

As you examine your mouth, you are looking for the following:

  • reddish patches
  • white patches
  • raised, lumpy, or thinkened areas
  • a sore that fails to heal within about two weeks, or that bleeds easily

Now you know what to look for. Time to start checking.

  • Use a flashlight or other bright light to see inside your mouth.
  • Remove any dental appliances (retainers, dentures).
  • Facing a mirror, look and feel inside your lips and at your front gums.
  • Pull your cheek out to see the inside, as well as the back gums.
  • Tilt your head back and check the roof of your mouth.
  • Put out your tongue and check all surfaces, particularly the sides and underneath.
  • Feel for lumps or enlarged lymph nodes in both sides of the neck and under the lower jaw.

Other signs of oral cancer include a chronic sore throat, hoarseness, and difficulty chewing or swallowing. If your self-exam reveals anything suspicious, see your healthcare provider immediately.

Getting Dentures? Some Tips to Ease the Adjustment

Losing your teeth, no matter what the reason, can be a traumatic experience…

And dentures, particularly a full set, can give you some problems in the beginning. Here are some tips to make the adjustment period more comfortable for you:

  • When you first get your dentures, leave them in for the first 24 hours. The “full-mouth” feeling is common; it will eventually go away.
  • If you feel “gaggy,” sucking on a hard candy will help.
  • The muscles of your mouth may be a bit sore; you are now using different muscles than you may have used before.
  • Some sore spots might develop from the dentures rubbing against the sensitive soft tissue in your mouth. These spots will toughen and the soreness will disappear.
  • Feel like you are drooling? This too will diminish with time.
  • Talking might feel a little awkward at first. You can practice by talking to yourself or reading aloud.
  • Avoid eating foods that are too hard or sticky.
  • Try not to bite with your front teeth; this can pull dentures out.

Be patient with yourself. It takes time to get used to new dentures, but soon they will feel more natural in your mouth. If you have a persistent problem, though, be sure to contact your dentist as soon possible.

How Cavities Get Started

In science classes we learned that acid is a dangerous substance. The acids in our mouth are no different; they ‘re a primary cause of tooth decay, also called cavities…

The enemy in the fight to prevent cavities is plaque. Plaque is the sticky film of food and bacteria that forms constantly on your teeth.

It isn’t easy to see plaque, but look at how it shows up after we’ve stained it with red dye.

If you don’t remove the plaque every day, the germs in your mouth produce acid that can eventually create a hole in your tooth. That’s what a cavity is: a small hole in the outer layer of your tooth. That hard outer layer of your tooth is called the enamel. Inside the enamel is a softer layer called the dentin. Once a cavity gets through the hard outer enamel and reaches the softer dentin, it can grow very quickly. That’s why it’s so important to have regular checkups and cleanings. Your dentist can find the cavity and fix your tooth while the cavity is still small and only in the outer enamel layer.

How does your dentist fix your tooth? He simply removes the decay and replaces it with a filling. Fillings are a great solution when you have a cavity, but it’s much better not to get the cavity in the first place. So floss and brush daily to to keep plaque off your teeth.

How Does Fluoride Protect Your Teeth Against Decay?

Teeth are primarily made up of hard minerals like calcium…
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If you were to look at the outer enamel layer of your tooth under a powerful microscope, you would see that it is made up of long, narrow crystals that look like spikes. The main component of these crystals is a substance called hydroxyapatite (pronounced hi-drock-see-ap-uh-tite).

This crystal structure that makes up your tooth enamel is comprised primarily of calcium. It’s the calcium portion of your tooth enamel that’s destroyed by the acids that are produced as the harmful bacteria in your mouth feed on the sugars in plaque. When we apply fluoride to the crystal structures, they actually harden and become more resistant to decay. This hardening process is called “remineralization.”

In addition to remineralizing your teeth, fluoride also slows down the bacteria’s feast on the starchy food debris in plaque, lessening the formation of acids. And frequent, regular brushing and flossing gets rid of much of the plaque, so there’s less for the bacteria to feast upon.

That’s why it’s important that we regularly apply fluoride to your child’s teeth. It’s a comfortable, inexpensive treatment that can make teeth stronger and more resistant to decay.

How Do I Get a Precision Partial Denture?

A precision partial denture replaces missing teeth and restores your bite with a better fit and appearance than traditional partial dentures…
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Traditional dentures use clasps to hold them in place. Though these clasps do a fair job of holding a partial denture in place, they are visible and detract from your smile. Now, with special new crowns and matching attachments built into the framework, the clasps can be eliminated, creating a much tighter-fitting partial denture. The photos on the left show the dramatic difference in appearance.

Precision partial dentures help create a new, natural look.

How Do I Know if I Need a Filling?

You’re probably familiar with the damage acid can do…

The acid caused by plaque in your mouth can be a big problem too. Plaque is the sticky film of food and bacteria that forms constantly on your teeth.

It’s hard to see plaque. But look how it shows up after we’ve stained it with red dye. If you don’t remove the plaque every day, these bacteria produce acid that will eat through your enamel and give you cavities.

Finding cavities is sometimes easy, but sometimes it is more difficult. For hard-to-find cavities, a dental explorer and x-rays are used. The tops and sides of your teeth are checked with a dental explorer. X-rays are used to look for cavities between teeth. Metal fillings and crowns show up as bright white on the x-ray, and cavities show up as dark spots.

It’s far better to catch and restore decayed areas while they’re still small and in the enamel layer of the tooth. Once they’re in the softer dentin layer, they really grow quickly. If they make it to the pulp chamber, we have a whole new set of problems and a different treatment to discuss—root canal therapy.

The dental profession has assigned each tooth a number and every surface of a tooth a letter. If cavities are discovered in your teeth, you’ll hear your dentist name the numbers and letters for each cavity. This keeps an accurate record of the condition of your teeth, and helps your dentist restore their healthy condition.

How Do I Know if I Need a Root Canal?

When the nerve of a tooth becomes infected, root canal treatment can save the tooth…

How do you know if you have an infected tooth? Some of the signs are heat and cold sensitivity, swelling and pain, or a bad taste in your mouth. Or, you may experience no symptoms at all and not realize that you have a dental problem.

The white outside portion of a tooth is called the enamel. Inside the enamel is another hard layer, the dentin. There’s a small chamber at the center of the dentin called the pulp chamber. Inside the pulp chamber is the tooth pulp, a soft tissue made up of nerves, arteries, and veins. The pulp extends from the pulp chamber all the way to the tip of the root through a narrow channel called the root canal.

In general, teeth in the front of the mouth have only one root canal, while teeth in the back have two, three or four root canals.

How do teeth become infected?
Deep cavities allow germs to get into the pulp chamber. These germs cause infection, and the pulp dies. The pus from the infection eventually builds up at the root tip and makes a hole in the bone. This is called an abscess. A blow to a tooth may also cause the pulp to die and then become infected. An infected tooth will never heal on its own, and as it gets worse, it will continue to be a source of infection that weakens your immune system. This can affect your entire body. This damage to the bone and the swelling inside the bone can also be excruciatingly painful, and even life-threatening. Years ago, an infected tooth would have to be extracted, but today, we can save your tooth with root canal treatment.

How Do I Know if My Crown is Failing?

While it’s true that a crown protects and strengthens a tooth, sometimes a crowned tooth will get a cavity below the crown…

Cavities never come through the crown, but they can get started at the edge where the crown and tooth meet.

Unfortunately, this is one of the toughest spots to keep free of plaque, and that is what caused this cavity. In the early stages, cavities are easy to catch and fix with a filling, unless they’re between the teeth where they can’t be reached. However, once established, cavities grow quickly because they have already gotten past the first line of defense. At this point, the crown must be replaced.

By replacing the crown now, before the cavity has reached the pulp chamber of the tooth, you can avoid a root canal.

How Do Teeth Decay?

The better your understanding of the decay process, the better equipped you’ll be to maintain good dental health. Here’s a basic rundown of the tooth decay process, start to finish…

Colonies of bacteria
First of all, thousands of bacteria exist in your mouth. This is completely normal. In fact, most of these bacteria are beneficial. But there are a few bacteria that play a role in the decay process. One bacteria in particular, streptococcus mutans, is a primary culprit, reproducing quickly and setting up large colonies wherever they’re given the opportunity to feast on starchy foods. These starches, also known as carbohydrates and consisting of foods such as pasta, bread, crackers, and sweets, can build up on teeth if they aren’t brushed away regularly; this buildup is called plaque. Plaque is a sticky film that’s a mixture of saliva, food debris and bacteria, and it’s constantly forming on your teeth.

Streptococcus mutans will eat any carbohydrate, but the starch it will eat most quickly is sugar. And the more refined the sugar is, the quicker the bacteria will eat through it. What this means is that the natural sugars that exist in fruit, called fructose, won’t be consumed by the bacteria as quickly as would granulated white sugar.

When the bacteria eat the sugars in plaque, a chemical reaction occurs. The sugars are broken down into simpler elements, and one of these elements is an acid (called lactic acid). And as you learned in high school science, acid breaks down many things, including tooth enamel.

Consequently, the bacteria in your mouth feast on the sugar that resides in the plaque on your teeth. Then, acids are produced that go to work breaking down your tooth’s enamel. Eventually, there will be a hole on the surface of the tooth, where the acids dissolved the enamel. You now have a cavity (also called caries), the visible evidence of tooth decay. Once this occurs, the only way to stop the decay process in its tracks is for us to remove the decayed portion of your tooth and put in a filling material.

There is a bright side to this story! When you brush and floss properly, there’s very little plaque on your teeth, so bacteria don’t have an all-you-can-eat carbohydrate buffet. This means they can’t colonize on your teeth, and they won’t be producing the acids that lead to tooth decay.

I have a large cavity. Do I need a crown?

Small cavities can be fixed with fillings because there is still plenty of healthy tooth structure…

However, large cavities need to be fixed with crowns, because they weaken the tooth. Without a crown to strengthen it, the tooth can break. A crown strengthens a damaged tooth by covering and protecting it.

Inlays and Onlays—What's the Difference?

Dentists frequently recommend inlays or onlays to restore damage to the chewing surfaces of back teeth…

oth inlays and onlays are pre-formed from a mold so they’ll fit your tooth precisely. But what’s the difference between the two?

Inlays fit within the grooves between the cusps of your tooth. Onlays fit within the grooves and wrap up and over the cusp tips, so they cover more of the tooth’s surface. Your dentist will decide which is most appropriate for you, based on the amount of tooth structure lost to wear or decay.

The procedure

Restoring a tooth with inlays or onlays takes two or more appointments to accomplish, since they are fabricated in a lab for a custom fit to your teeth.

During the first appointment, your dentist will carefully remove the part of your tooth that is damaged and then shape the remaining portion of the tooth so that it can hold the inlay or onlay.

At this point, an impression will be made of the damaged tooth and the teeth that surround it, as well as your bite, using a soft, clay-like substance. Dental lab technicians then build a model on the impression; this model is an exact duplicate of that particular part of your mouth. The inlay or onlay is then created on that model.

At the next visit, the inlay or onlay is placed on your tooth and is adjusted for a precise fit. Once that’s achieved, the restoration will be cemented permanently onto your tooth. It then will be polished, and your bite will be checked to ensure a perfect fit.

What material is used?

The teeth in the back of your mouth are used primarily for chewing, so it’s vital that the material used for inlays and onlays be strong enough to withstand frequent pressure. Your dentist will likely use alloy, a mixture of metals such as gold, palladium, nickel or chromium, if the tooth remains unseen when you smile. If the restoration is closer to the front of your mouth, so it shows when you smile, she will probably recommend that a tooth-colored ceramic be used. Ultimately, that choice will be yours.

Working with your dentist, you can restore decayed, damaged or worn teeth to near-perfect condition with inlays or onlays.

Make Sure Your Dental Insurance Covers These Services

Most dental benefit plans allow you to receive a specified amount of oral health care each year…

efore you decide on one plan over another, be sure you know how much treatment is allowed in a given year at no cost to you and how much you will be expected to pay for yourself.

At minimum, most plans allow the following:

  • initial oral exam (when you are seeing a new dentist)—once per dentist
  • regular (recall) examinations—every six months
  • complete x-rays—once every three years
  • bitewing x-rays—once each year
  • tooth cleaning (also called prophylaxis or hygiene appointment)—every six months
  • topical fluoride treatment—twice each year
  • sealant application—as needed for children under 18 years of age

These services are all either diagnostic or preventive, in that they are designed to evaluate your oral health, detect problems and prevent decay and gum disease. It’s important that you understand that dental care in itself is not expensive; it’s dental neglect that winds up hitting you hard in your wallet.

Widespread diagnostic and preventive care has greatly reduced the incidence of dental decay. Today, more than half of the nation’s school children have never had a cavity. Dental insurance, despite its flaws, complexities and exclusions, has played a big role in improving our oral health. It’s up to you to use that insurance effectively.

My silver fillings are wearing out. What should I do?

Everything wears out eventually, and silver fillings are no exception…

They have to endure an incredible amount of biting force, and as they age, they wear down and sometimes break. The edges of this filling have broken away and a space has opened up between the filling and the tooth. When this happens, the filling loses its seal and no longer protects the tooth from decay. When your dentist recommends a restoration to replace a worn-out filling, both the size of the filling and the amount of remaining tooth structure are considered.

When a worn-out filling is fairly small, you could safely replace it with another silver filling. However, it too will eventually wear out and have to be replaced again. When a worn filling is larger, and less tooth structure remains, tooth fractures become a problem. In this case the entire front half of the tooth broke away. By switching to a gold or porcelain onlay or crown, we can strengthen the tooth and prevent the occurance of problems such as this.

Selecting the Dentist Who's Best for YOU

It’s crucial that you feel comfortable with your dentist. After all, you can feel pretty vulnerable lying prostrate in an exam chair, bright lights glaring into your gaping mouth…
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You’ll feel much better about the whole experience if you trust the person behind the mask, gloves and dental instruments.

It’s well worth an investment in time to be thorough in your search for a dentist who suits your needs and your personality, because ideally, the relationship you develop with your dentist will be a long-term one. Also, when you actively seek out the dentist who best suits your needs, you are taking an active, as opposed to passive, role in your dental healthcare.

We’ve come up with some step-by-step guidelines that will help you make the best choice.

Communication – Comfort – Trust

Healthy, open communication and feelings of comfort and trust are vital to all relationships, but are particularly important when it comes to the people you entrust with your healthcare. Communication should flow freely in both directions; you shouldn’t hesitate to ask your dentist to explain something you don’t understand, and your dentist shouldn’t resent having to explain, or re-explain, any proposed treatment or procedure in language that is clear to you. Any anxiety or fear that you feel about dental treatment should also be discussed openly, as should your dentist’s methods for ensuring your comfort while you are undergoing treatment. And you should feel good about your dentist’s judgement, level of skill and expertise.

So how do you find a dentist who suits these requirements and any others you might have?

  • First, start by asking for referrals from relatives, friends and co-workers. A dental visit can be an intensely personal experience, so chances are a dentist will only earn a referral from someone if he is skillful and personable.
  • If you are moving to a different city, ask your current dentist if he can recommend a dentist for you in your new location.
  • Call the local dental society or the state dental board, and ask for names of three or four dentists in your area.
  • Ask for recommendations from your family physician or your local pharmacist.

Once you’ve got a few names to work with, it’s time to do some leg work. Get on the phone and call their offices. Is the staff courteous and helpful? Do they answer questions to your satisfaction? If they pass these tests, ask the following questions:

  • Is the dentist accepting new patients?
  • How long do I have to wait to get in for my first exam?
  • Does the dentist participate in my dental insurance plan?
  • Does the dentist have specific training and/or experience related to my condition?
  • How and when is payment expected?
  • Can the dentist accommodate my health and accessibility requirements?
  • Is the dentist an active participant in continuing education programs?
  • How are emergency appointments handled?
  • Is the dentist available in the early mornings, after 5 p.m., or on Saturdays?
  • What type of preventive care and instruction will I receive?
  • How does the dentist handle sterilization and infection control?
  • Is the dentist progressive, using new techniques and equipment that give you the best dental care available?
  • Is the dentist an advocate for patient education, having an Internet site and patient education materials?

Once you’ve gotten this information, you should have a pretty good idea whether or not you and the dentist can establish a trusting, communicative relationship.

Your next question should be, “Can I come in for an introductory appointment?” This is your opportunity to meet the staff, check out the office and exam room, and interact with the dentist one-on-one. X-rays and an exam might also be part of this appointment, but even if you don’t select that particular office to be your dental healthcare provider, the x-rays and initial exam records are transferable.

There should be no commitment required from you during this introductory visit, other than the fee for the x-rays and exam. Dental care teams that offer this service tend to have the mindset that they will be partners with you in your dental health. Establishing this type of relationship is an essential first step towards becoming an active participant in your own healthcare.

Should a Baby (Primary) Tooth Be Extracted?

Normally, baby teeth come out on their own without any special attention…

These permanent teeth are right below the gums, growing directly beneath the baby teeth. As the permanent teeth grow in, the roots of the baby teeth dissolve, and the tooth loosens and falls out. However, sometimes permanent teeth don’t come in directly under the baby teeth, so the roots of the baby teeth stay strong, instead of dissolving away as they should. When this happens, permanent and baby teeth exist side by side in a child’s mouth. In this situation, the baby teeth need to be removed. Sometimes, when the permanent teeth are a little out of alignment, we see something like this.

In other situations, children can’t bring themselves to wiggle the loose baby tooth; they just need a little help from their dentist!

If a baby tooth is decayed, and the permanent tooth isn’t due to come in for a while, it’s usually best to restore the damaged tooth. But if an x-ray shows that a permanent tooth is ready to come in, then the better option would be to extract the decayed baby tooth.

Sometimes a baby tooth is so damaged that it has to be removed, even though the permanent tooth isn’t ready to come in. Space maintainers are then used to hold the other teeth in place until the permanent tooth comes in and fills the space.

Should a Tooth Be Extracted Because of Decay?

Dentistry has come a long way, but there are still some situations where teeth have been so damaged by decay that they must be removed…

Here’s an explanation of a situation where a tooth can be saved, followed by a scenario where it cannot.

A crown is often used to cover and protect a damaged tooth. It fits over the part of the tooth that’s above the bone, but it can’t go below the bone. So the more healthy tooth structure your dentist has to work with above the bone, the better.

This is an example of crowning a tooth in a normal situation. The tooth has been damaged, but there’s still an adequate amount of healthy tooth structure for the dentist to work with. In the second case, nearly half of the tooth has broken away. The dentist just barely has enough remaining tooth to place a crown.

It’s impossible for a dentist to save a tooth if there isn’t enough healthy tooth structure left above the bone. In such a situation, the tooth simply has to be removed.

Should a Tooth Be Extracted Because of Gum Disease?

Periodontal (gum) disease is an infection of the teeth, gums, and the bone that surround the teeth. It’s this infection, combined with your body’s reaction to it, that causes bone loss…

The roots of teeth extend into the bone of the jaw. This is a healthy mouth. The bone comes up high around the necks of the teeth.This is advanced periodontal disease. The bone level is much lower. Notice how uneven the bone levels are, compared to the healthy mouth. Once bone has been lost, it never grows back. When too much bone is lost, there’s so little support for the teeth that they get loose and have to be removed.

Should My Wisdom Teeth Be Extracted?

Wisdom teeth, also called third molars, are the last teeth to develop…

If there’s room for them, they usually start to appear in the late teens or early twenties, and that’s when problems can begin.

An impacted wisdom tooth may push on other teeth. It can be excruciatingly painful when a wisdom tooth that’s partially erupted becomes infected. This is a common dental emergency and can cause pain for days, even after antibiotics are started. A misaligned tooth can also cause cavities.

This x-ray shows a wisdom tooth coming in sideways and causing a cavity in the second molar. Wisdom teeth are nearly impossible to keep free of plaque. Plaque causes decay, as well as periodontal disease, a serious condition which can start near the wisdom teeth and spread throughout the mouth.

Sometimes cysts form around impacted wisdom teeth; they can destroy a tremendous amount of bone before they’re even noticed. This dark area is a cyst that required surgery to repair. With time, the roots of wisdom teeth may grow around a nerve in the jaw, which can be damaged during the extraction. This could leave your lip and chin permanently numb.

Because of these many serious potential problems, it’s usually better to remove wisdom teeth early, even before they break through the gums.

There are many advantages to removing wisdom teeth in the mid-teen years:

  • The roots of the teeth are still short.
  • There’s still a space around them, making them easier to remove.
  • There’s less risk of nerve damage.
  • Bone will fill in better behind the second molar.

All of this adds up to less pain and faster, easier healing.

Should Toothbrushes Carry Warning Labels?

A suburban Chicago man, Mark Trimarco, thinks they should, and he has filed a class-action lawsuit against eight toothbrush manufacturers and the American Dental Association in an attempt to force the issue…

The suit, filed in April of 1999, is seeking damages on behalf of anyone who suffers from a condition known as “toothbrush abrasion,” which is characterized by gum irritation, gum recession, and tooth sensitivity. It is caused in part by brushing too aggressively, incorrectly, or with medium- or hard-bristled toothbrushes.

However, the litigants maintain that even soft toothbrushes are capable of inflicting damage on your gums if used improperly.

The lawsuit claims that, because of their potential to cause toothbrush abrasion, toothbrushes are “unsafe and unreasonably dangerous” and should carry package warnings and instructions for safe use.

Michael Applebaum, Trimarco’s attorney, said dentists have been aware of toothbrush abrasion for nearly half a century. The ADA countered that toothbrush abrasion is associated with several behaviors in addition to improper brushing, such as eating acidic foods and consumption of citrus drinks and carbonated beverages.

The suit names the ADA because its “Seal of Acceptance” can be found on medium- and firm-bristled toothbrushes, which most dentists say are too rough on your gums.

“If a toothbrush is used properly, toothbrush abrasion is not an issue,” said ADA President S. Timothy Rose in an April 12 ADA press release. “To allege that the seal in some way causes harm to consumers is nonsensical.”

“There are no allegations that the ADA seal itself causes harm to anyone,” countered the litigants in their response to the ADA’s press release. “People use toothbrushes the best they can,” they say, but, “if, in fact, a substantial number of people injure themselves trying to do the right thing, then it is arguably legitimate to call into question the safety of this particular device.”

“The ADA’s Seal of Acceptance Program has been in existence for nearly 70 years . . . the seal helps prevent inferior products from falling into consumers’ hands because they are tested thoroughly to make sure they meet the seal’s rigorous standards,” Rose said.

Lawsuit proponents maintain that medium- and firm-bristled toothbrushes are in fact “inferior products” that most dentists discourage their patients from using, yet most carry the ADA’s seal.

The ADA recommends gentle brushing using only toothbrushes with soft, polished bristles. Look on the package for the word “soft” or “extra soft,” and avoid toothbrushes that are described as “medium” or “firm.”

Tooth Pain - What's Causing It?

If you have tooth pain, you can use the chart below to give you some idea as to what the source of the pain might be. Bear in mind, though, that the intention of this chart is not to diagnose your pain; only your dentist can do that…

When you contact your dentist regarding your tooth pain, it’s important that you be as thorough as you can in your explanation of the pain; i.e., how severe it is, when you feel it, where it’s located, and whether any conditions make it better or worse. That way, your dentist will have a sense as to the urgency of your problem.

What are immediate dentures?

When many of your teeth are loose or painful, they may be beyond saving…

This condition is usually caused by advanced periodontal disease. Periodontal disease causes bone to be lost; if it’s not caught in time, there’s so little support for the teeth that they have to be removed.

Removing your teeth and replacing them with a denture may be the best way to eliminate the infection and restore the health of your mouth. When the entire procedure is completed in one day, it’s called an immediate denture.

To begin the process, your dentist first takes impressions of your mouth. From these impressions, precise working models of your mouth are made. It’s from these models that the dentures are made. We’ll work with you to select the best color and shape for your new teeth. When your denture is ready, we’ll extract your remaining teeth. You’ll be thoroughly numbed before any teeth are removed, and should feel no pain.

As soon as your teeth are out, your denture will immediately be placed in your mouth. For the first 24 hours, your new denture will feel tight because your gums are swollen. As your bone heals over the next six to nine months, your gums will shrink and your denture will feel loose. When this happens, we’ll use a temporary lining material to tighten the fit. After this period of healing, when the shape of your mouth has stabilized, we’ll send your denture back to the lab and have it relined for its final fit.

Some temporary problems are a normal part of adjusting to your new denture. At first your denture may tip when you chew. You may notice increased salivation. The denture may seem bulky, and you might gag a little. Your tongue will feel crowded and you might have difficulty speaking. Like learning any new skill, at first it will feel awkward to eat with your new denture. But with time and practice, you’ll make the adjustment.

Nobody likes to lose their teeth, but when they’re infected, removing them and getting an immediate denture can improve your health, smile and confidence.

What are some of the problems I might have with dentures?

Some people believe that their problems will be over if they have their teeth removed and get dentures…

ut instead, as most denture wearers will tell you, this marks the beginning of many new and different problems.

It’s tough to chew with a denture. It could take five times longer to chew your food. And when you add up all the costs, removing your teeth, making the dentures, periodic relines and re-creation (as often as every 3 years), dentures end up being very expensive.

Farther down the road, as chewing becomes more difficult, you may be forced to consider implants and, as you may already know, they’re one of the most expensive tooth-replacement options. When you wear a denture, over time the bone in your jaw will recede. This is what causes a denture to get loose and floppy. When this happens, your denture will have to be remade to regain a proper fit. It’s not uncommon for this to occur every few years, particularly in your lower jaw. That’s because the base for the denture is smaller and the bone is much less stable. When you have your teeth removed, eventually the ridge of the bone in your lower jaw becomes very flat, and there’s practically nothing to hold the denture in place. Even worse, there are nerves passing through these holes that can end up on the surface of the bone, so when you bite down, it hurts! Some long-term denture-wearers suffer greatly from this. Their jaw hurts and goes numb every time they try to chew.

Unfortunately, these difficulties occur in a person’s later years, when healthy eating is critical to continued good health and quality of life.

When the bone under dentures recedes, two things happen: your nose gets closer to your chin, and your lips collapse. This causes you to look older, with more wrinkles and less support in your mouth.

An upper denture also covers most of the taste buds on the roof of your mouth. This makes it much harder to taste and enjoy your food. Additionally, the tissues and bone in the mouth were never made to have plastic continually rubbing against them, so sore spots will develop in your mouth. And if you have an active gag reflex, an upper denture might even be impossible to wear.

If you have the choice, keeping your natural teeth is the preferred option. You’ll look better, feel better, enjoy your food more and have more confidence.

What can I do when there's a crack in my tooth?

Some cracks in teeth can be a problem, while others are not…

This tooth has been cracked for years, and it’s not a problem. Other cracks, especially those near fillings, are a problem.

The crack on this tooth runs from the edge of the filling up to the gumline.

This tooth broke along a crack and the front half snapped off.

Before a cracked tooth breaks, it might hurt when you chew, or it might be sensitive to hot or cold. Or it may feel just fine.

To prevent the tooth from breaking, the solution is a crown. It covers the crack and protects and strengthens the tooth.

What is Air Abrasion?

Until recently, there was only one way to remove small, worn-out fillings or decay in teeth…

he traditional dental drill. Today there is a new option that in many cases allows your dentist to work without physically touching the tooth. This new technology is called air abrasion.

Air abrasion involves the use of a special handpiece that creates a beam of abrasive particles propelled by a stream of clean, dry air. Air abrasion is most effectively used for:

  • Small, early cavities
  • Repair of small chips
  • Removal of small discolorations and stains
  • Repair or replacement of fillings

The advantages of air abrasion over traditional techniques are:

  • There is no vibration and little or no heat generation, so anesthetic can often be avoided.
  • It eliminates any “microfractures” that sometimes occur with a traditional handpiece.
  • It accurately removes the very minimum amount of tooth structure.

After preparation, teeth are generally restored with one of the new white filling materials that can be bonded to the teeth. Air abrasion is a terrific new technology that helps avoid the use of needles and that uncomfortable numb feeling. It removes the smallest possible amount of tooth structure, and enables your dentist, in only a few minutes, to place strong, natural-looking restorations.

What is a lower partial denture?

A lower partial denture is often a good method for replacing missing teeth…

When remaining teeth are saved and a partial denture installed, a person will chew better and have a healthier mouth.

This is a typical lower denture. Notice how the metal clasps fit around the anchor teeth and hold the partial denture in place.

A partial denture stops several problems. By filling in spaces, it stops neighboring teeth from shifting. When missing teeth aren’t replaced, this can set off a chain reaction that can result in cavities and periodontal disease.

A partial denture also helps to balance a person’s bite. This means better chewing and a healthier jaw joint. Partials also add support to the cheeks and lips. This support is necessary for clear speaking and good facial structure. There are some disadvantages to a partial denture. The clasps sometimes show when you smile. The bar connecting the two sides might feel bulky, and may bother your tongue at first. Even when a lower partial denture fits correctly, food will collect under it when you eat. It should be rinsed after every meal.

Over the years, as the partial is repeatedly taken in and out, it can wear on the anchor teeth, and even loosen them. The bone will continue to recede in areas where the teeth are missing. This may mean that every few years, a partial will have to be relined for an optimal fit.

Some temporary problems are normal during the initial adjustment to a lower partial denture. At first, it may tip when chewing, and there may be increased salivation. It might seem bulky and cause gagging. The tongue will feel crowded, and you might have difficulty speaking. But as you get used to the partial, however, these problems will go away. With time and practice, the adjustment can be made, and you can eat and speak with confidence.

What is a Maryland Bridge?

Like other bridges, a Maryland bridge uses adjacent teeth for support…

This is a Maryland bridge
But unlike the others, a Maryland bridge doesn’t require extensive reduction of the supporting teeth.

Instead, only the backs of the teeth are reduced slightly. Then the small “wings” of the bridge, which may be made of metal or of resin, are bonded to the backs of the adjacent teeth. The advantages of a Maryland bridge are:

  • Less tooth reduction
  • Stronger teeth and less likelihood of tooth sensitivity
  • Retained natural color and shape of the supporting teeth
  • Healthier gums with less risk of future disease

The Maryland bridge is a highly-aesthetic option that conserves as much tooth structure as possible.

What is an Apicoectomy?

An apicoectomy is a minor surgical procedure that’s necessary when root canal treatment hasn’t completely healed an infected tooth…

After root canal treatment, an abscess, which is a hole in the bone at the tip of the root, sometimes continues to grow.

To stop the infection, we make a small incision in the gums. Your dentist remove the infection and then seals the tip of the root. Once this has been done, the infection will heal, new bone will grow in, and the tooth will be healthy again.

What is a Pulpectomy?

When the nerve of a baby tooth becomes infected, a pulpectomy can save the tooth…

As in a root canal in an adult tooth, a pulpectomy involves removal of the infected nerve and the placement of a filling material.

Though treatment is individualized in each case, there are four common steps to a pulpectomy:

  • An opening is made into the tooth to get at the infection
  • The infected nerve tissue is removed
  • A filling material is placed in the root canals

Your dentist places a rubber dam around the tooth to isolate it from the rest of the mouth. It protects like a safety net, nothing can fall to the back of the throat.

To get at the infection, your dentist makes an opening through the top of the tooth down into the pulp chamber and carefully cleans out the infected tissue.

Next, the dentist will place a filling material.

The last step in the procedure is a crown..

What is a Rubber Dam?

When it’s wet and rainy outside it’s always a good idea to wear a raincoat…

When your dentist works on your teeth, he will sometimes use a special kind of a “tooth raincoat” called a rubber dam.

A rubber dam is made out of a stretchy, rubbery material.

To put a rubber dam on your tooth, your dentist first puts holes in it that match the teeth being worked on. Then your dentist places a special metal holder on your tooth. The rubber dam just slips on over the metal holder (it is called a dental clamp). A special frame is attached to hold the rubber dam tight and out of the way.

Once the rubber dam is in place, it keeps your tooth dry and prevents any debris from the procedure from falling to the back of your throat. It keeps you more comfortable, and lets your dentist do a better job. When the procedure is complete, it comes right off.

Just like your raincoat at home, the rubber dam protects you and keeps things dry.

What is a Space Maintainer?

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 shift together, causing loss of space in the dental arch.

Fortunately, by placing a space maintainer, this loss of arch space can be prevented.

Depending on the situation, space maintainers are usually cemented in place, but they can be removable in some cases. It generally takes two appointments to complete a space maintainer. On the first appointment, orthodontic bands are carefully placed and an impression is taken. A duplicate model of the child’s mouth is made from this impression so the dental laboratory can custom make the space maintainer to the exact contours of the mouth.

On the next appointment, your child will try out the space maintainer. Then the dentist adjusts it if necessary, and it’s cemented in place. 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 Corn Nuts or ice.

What is a two-implant bridge?

Using implants to support a bridge is an excellent way to replace missing teeth…

Like other bridges, a dental bridge uses abutments for support and to hold it in place. Dental implants are small titanium cylinders that are surgically inserted into the bone of the jaw to replace the roots of missing teeth. Artificial teeth are attached to the implants and can be used as part of a bridge. Placing a bridge after teeth have been lost can prevent a chain reaction of problems that could affect your entire mouth.

Teeth need each other for support. When a tooth is lost, the biting forces change on the teeth next to the space, causing them to shift. When a tooth no longer has anything to chew against, it begins to extrude out of the socket. You can eventually end up losing this tooth, as well. Also, as your bite changes, it becomes increasingly difficult to chew your food, possibly damaging your jaw-joint, the TMJ.

-What is a two-implant bridge?
Using implants to support a bridge is an excellent way to replace missing teeth. Like other bridges, a dental bridge uses abutments for support and to hold it in place. Dental implants are small titanium cylinders that are surgically inserted into the bone of the jaw to replace the roots of missing teeth. Artificial teeth are attached to the implants and can be used as part of a bridge.

Placing a bridge after teeth have been lost can prevent a chain reaction of problems that could affect your entire mouth. Teeth need each other for support. When a tooth is lost, the biting forces change on the teeth next to the space, causing them to shift. When a tooth no longer has anything to chew against, it begins to extrude out of the socket. You can eventually end up losing this tooth, as well. Also, as your bite changes, it becomes increasingly difficult to chew your food, possibly damaging your jaw-joint, the TMJ.

It’s also much harder to clean teeth that have shifted. Harmful plaque and tartar collect in these new hard-to-reach places, causing cavities and the permanent bone loss that comes with gum disease.

A partial denture is another way to solve the missing-tooth problem. Butimplant-supported bridges offer several advantages over partial dentures. For one, you can avoid the clasps and metal work that come with a partial denture. Also, an implant can help stop the continuing bone loss that begins when teeth are removed. All things considered, using dental implants to support a bridge is an excellent way to replace missing teeth.

What is Plaque?

Plaque is made up of a colony of bacteria that forms on teeth when food particles are not removed on a regular basis…

These colonies require a full 24 hours to assemble and gain a foothold on the surface of the tooth, so that with proper oral hygiene, brushing and flossing, their formation is constantly being disrupted.

When formed, colonies of bacteria (plaque) can convert all carbohydrate food sources (in particular refined sugars) into acids that literally eat through the enamel coating of teeth. This is traditionally referred to as a “cavity.” By disrupting this destructive process with daily brushing and flossing, the chances of forming a cavity is radically reduced, especially if a fluoride toothpaste is used.

Children are unlikely to fully assimilate this scientific explanation, so parents should formulate a version appropriate to their children’s ages. For example, for young children, you can describe plaque as being the gummy, sticky stuff that collects on your teeth when they aren’t brushed well, and that this sticky stuff can make cavity in their teeth because of the sugar bugs that live in them.

Depending on your child’s age, you may want to modify that basic “kid’s plaque” explanation to a higher or lower level. Be sure to use words that your child will comprehend, while being mindful of your own comfort level with using words that may seem a bit silly to you. Typically, children readily understand this approach and conceptually have a firm basis of understanding and an incentive to brush and floss!

What Is that Stuff in my Toothpaste?

Looking at the label on most toothpastes, it would seem that you need an advanced degree in biochemistry to decipher the ingredient names…

Propylene glycol, sodium bicarbonate, sodium pyrophosphate, anhydrous dicalcium phosphate and dioctyl sodium sulfosuccinate, are you sure you want to put this stuff in your mouth?

Fear not. Here’s an explanation of which ingredients do what in various types of toothpaste:

  • Hydrogen peroxide is one of the few ingredients actually proven to whiten teeth. It is in essence a bleach; H.P. is found in the kits dentists can prescribe to bleach your teeth, as well as in over-the-counter bleaching kits. The American Dental Association advises that you should bleach your teeth only under the recommendation and supervision of your dentist.
  • Sodium bicarbonate sounds high-tech, but it’s actually nothing more than old-fashioned baking soda. Its function in toothpaste is questioned by the ADA, although some dentists say it can help to remove coffee and food stains from your teeth. It’s a mild abrasive, so it scours your teeth, helping to eliminate plaque. And it does make your teeth feel clean and smooth. So if it gets you to brush your teeth regularly, it’s a good thing.
  • Other abrasives you’ll often find in toothpastes are dicalcium phosphate, kaolin, bentonite, silica and calcium carbonate (chalk).
  • Sodium pyrophosphate is the active ingredient normally found in tartar-control toothpaste. It has been shown to prevent the formation of plaque when used regularly. However, once tartar hardens to your teeth, it can’t be removed at home. Only a professional cleaning will get rid of it.
  • Propylene glycol is a humectant, an ingredient that keeps the toothpaste moist, and prevents the solid and liquid ingredients from separating. Other common humectants in toothpaste are sorbitol, pentatol and glycerol.
  • Dioctyl sodium sulfosuccinate is a surfactant, a detergent-type ingredient that causes toothpaste to foam in your mouth. You may also see ingredients such as sodium stearyl fumarate and sodium lauryl sulfate; some believe SLS induces canker sores in people sensitive to this ingredient. As with any product, if its use causes discomfort, stop using it and consult your dentist or doctor.
  • Sodium saccharin is the least-expensive sweetener, so it’s the one you are most likely to see in most toothpastes. It is 600 times sweeter than table sugar, so only a small amount is used to sweeten your toothpaste. Other common toothpaste sweeteners are aspartame and ammoniated diglyzzherizins.
  • Desensitizing ingredients are used in toothpastes specially formulated for sensitive teeth. Strontium chloride and potassium nitrate are the two ingredients recognized by the ADA to reduce discomfort if your teeth are sensitive to hot or cold foods. How do they work? They block the transmission of pain to the nerves in your teeth. They don’t work immediately, though; it takes 4-6 weeks for these ingredients to desensitize your teeth.
  • Triclosan is an antibacterial agent that was recently approved for use in toothpaste by the FDA. It’s been used for years as the active ingredient in antibacterial soaps, lotions, sponges and cutting boards. In toothpaste, triclosan has been clinically proven to fight gingivitis, gum disease, in adults by inhibiting the growth of plaque-causing bacteria. Colgate Total, manufactured and distributed by Colgate-Palmolive Co., is the only toothpaste that currently contains the disinfectant triclosan. Other toothpaste manufacturers are expected to follow suit, but since triclosan is considered a drug, all toothpastes that contain it will have to obtain FDA approval before going on the market.

Mayo Clinic dentist Philip J. Sheridan said, “When it comes to choosing a toothpaste, antibacterial, tartar control, desensitizing, baking soda, my advice is, unless you have special needs, just go with one you like but make sure it contains fluoride. The ‘extras’ are nice but not really a necessity for most people.”

“No toothpaste can replace good oral hygiene and regular visits to a dentist,” Dr. Sheridan said.

Wisdom Teeth

My dentist says my 18-year-old daughter has to have her wisdom teeth removed. Do I really need to have this done?…
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Assuming your dentist has examined your daughter, we suspect that her wisdom teeth (often called third molars) don’t have enough room to fully grow into her mouth. When this happens, food may get trapped under the gums that partially cover the tops of the wisdom teeth. Unless your daughter practices a rigorous, daily program of dental hygiene that focuses on the wisdom teeth, the trapped food will produce decay and gum infection.

In addition to avoiding decay and infection, extraction is a good idea for other reasons. Because of her age, the roots of her wisdom teeth may still be small and far from the large nerve that runs along the jawbone. After the extractions, bone will more easily fill in the spaces left by her wisdom teeth. All of this means that the extraction process should be easier and the healing more rapid and complete.

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