• Teeth Whitening
  
• Cosmetic Dentistry
  
• Implants
  
• Preventative Dentistry
  
• Teeth Grinding
  
• Wisdom Teeth

• Sports Mouthguards
  
• Children's Dentistry
  
• Root Canal Treatment
  
• Dental Emergencies
  
• Gum Disease

Your wedding is coming up and you want your smile to be its brightest. Or maybe you have an important speaking engagement. Whatever the reason, tooth bleaching isn't just for the movie stars, and it isn't just for one day. Many people have had their teeth bleached, and probably millions more are thinking about it. The desire for a brighter smile with whiter teeth is very strong, and tooth bleaching safely lightens the color of the teeth, lasting for up to five years. The most effective and safest method of tooth bleaching is dentist-supervised.

Is bleaching for you?
Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by fluorosis, smoking or tetracycline are lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

What's involved?
First, the dentist will determine whether you are a candidate for tooth bleaching and what type of bleaching system would provide the best results.

If you're in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. Your dentist will use either an in-office bleaching system or laser bleaching while you sit in the dental chair. However, most patients choose dentist-supervised at-home bleaching, which is more economical and provides the same results.

At the next appointment if you don't choose laser bleaching, the dentist or hygienist will make impressions of your teeth to fabricate a mouthguard appliance for you. The mouthguard is custom made for your mouth and is lightweight so that it can be worn comfortably while you are awake or sleeping. The mouthguard is so thin that you should even be able to talk and work while wearing your mouthguard. Along with the mouthguard, you'll receive the bleaching materials. You'll be given instructions on how to wear the mouthguard.

Some bleaching systems recommend bleaching your teeth from two to four hours a day. Generally this type of system requires three to six weeks to complete, and works best on patients with sensitive teeth. Other systems recommend bleaching at night while you sleep. This type of system usually requires only 10-14 days to complete.

How long does it last?
Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea. At this point you may choose to get a touch up. This procedure may not be as costly because you can probably still use the same mouthguard. The retreatment time also is much shorter than the original treatment time.

How does it work?
The active ingredient in most of the whitening agents is 10 percent carbamide peroxide (CH4N2O2), also known as urea peroxide; when water contacts this white crystal, the release of hydrogen peroxide lightens the teeth.

Is it safe? Any side effects?
Several studies, during the past five years, have proven bleaching to be safe and effective. The American Dental Association has granted its seal of approval to some tooth bleaching products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

What are realistic expectations?
No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement as seen on a dentist's shade guide. The success rate depends upon the type of stain involved and your compliance. Bleaching can only provide a shift in color from gray to a lighter shade of gray, for example. Bleaching does not lighten artificial materials such as resins, silicants, or porcelains.

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Can my dentist improve my smile?
From subtle changes to major repairs, your dentist can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discolored, chipped, misshapen or missing. Your dentist can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include bleaching, bonding, caps, crowns, veneers, and reshaping and contouring.

These improvements are not always cosmetic. Many of these treatments can improve oral problems, such as your bite.

Bleaching
Bleaching is a common and popular chemical process used to whiten teeth. Some people get their teeth bleached to make stains disappear, while other just want a whiter shade.

Discoloration occurs in the enamel and can be caused by medication, coffee, tea and cigarettes. Discoloration also can be caused by your genetic make-up or simply getting older.

Bleaching can be performed by your dentist in the office or, under dental supervision, at home. Many patients enjoy bleaching at home because it is more convenient. Treatment begins when your dentist creates a custom mouthpiece to ensure the correct amount of whitening solution-10 percent to 20 percent carbamide peroxide-is used and that your teeth are properly exposed. Typically, whitening at home takes two or three weeks, depending on the desired shade you wish to achieve. Whitening in the office may call for two to six 45-minute visits to your dentist's office.

Bonding
Bonding is tooth-colored material used to fill in gaps or change the color of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities and broken or chipped surfaces. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape.

Crowns, also known as caps, are used in cases where other procedures will not be effective. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time consuming.

Veneers
Veneers are placed over the front teeth to change color or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth. Little or no anesthesia is needed. Veneers are used to treat some of the same problems as bonding.

This treatment is an alternative to crowns, which are more expensive. The procedure requires your dentist to take an impression of your tooth. Before the custom-made veneer is glued directly onto the tooth, your dentist will lightly buff the tooth to compensate for the added thickness of the veneer. Once the cement is between the veneer and your tooth, a light beam is used to harden it. Porcelain veneers require more than one visit because they are fabricated in a laboratory. Veneers have a longer life expectancy and color stability than bonding.

Contouring and reshaping
Tooth reshaping and contouring, is a procedure to correct crooked teeth, chipped teeth, cracked teeth or even overlapping teeth in a single session. Tooth reshaping and dental contouring, is commonly used to alter the length, shape or position of your teeth. Contouring teeth may also help correct small problems with bite. It is common for bonding to be combined with tooth reshaping.

This procedure is ideal for candidates with normal healthy teeth, but who want subtle changes to their smile. Your dentist will take X-rays to evaluate the size and location of the pulp of each tooth to ensure that there's enough bone between the teeth to support them.

Which procedure is right for me?
Your dentist can answer many of the questions you may have about techniques used to improve your smile. The condition of your teeth and desired result you want often dictates the best procedure. If you are considering a treatment, there are a few questions you can ask your dentist before deciding if a particular procedure is right for you.

• What will the changes look like?

• What should I expect through the course of treatment?

• What type of maintenance will be required?

Your dentist will answer questions you may have about the procedure, maintenance and price to help you choose the treatment that best suits you.

A composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide). Introduced in the 1960s, dental composites were confined to the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth. Since then, composites have been significantly improved and can be successfully placed in the back teeth as well. Composites are not only used to restore decayed areas, but are also used for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

How is a composite placed?
Following preparation, the dentist places the composite in layers, using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.

How long does it take to place a composite?
It takes the dentist about 10-20 minutes longer to place a composite than a silver filling. Placement time depends on the size and location of the cavity-the larger the size, the longer it will take.

What is the cost?
Prices vary, but composites average about one-and-a-half to two times the price of a silver filling. Most dental insurance plans cover the cost of the composite up to the price of a silver filling, with the patient paying the difference. As composites continue to improve, insurance companies are more likely to increase their coverage of composites.

What are the advantages of composites?
Esthetics are the main advantage, since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

What are the disadvantages?
After receiving a composite, a patient may experience post-operative sensitivity. Also, the shade of the composite can change slightly if the patient drinks tea, coffee or other staining foods. The dentist can put a clear plastic coating over the composite to prevent the color from changing if a patient is particularly con-cerned about tooth color. Composites tend to wear out sooner than silver fillings in larger cavities, although they hold up as well in small cavities.

How long will a composite last?
Studies have shown that composites last 7-10 years, which is comparable to silver fillings except in very large restorations, where silver fillings last longer than composites.

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

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

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

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

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

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

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

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

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

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

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

Why crowns and not veneers?
Crowns require more tooth structure removal, hence, they cover more of the tooth than veneers. Crowns are stationary and are customarily indicated for teeth that have sustained significant loss of structure, or to replace missing teeth. Crowns may be placed on natural teeth or dental implants.

What is the difference between a cap and a crown?
There is no difference between a cap and a crown.

How long do crowns last?
Crowns should last approximately 5-8 years. However, with good oral hygiene and supervision most crowns will last for a much longer period of time. Some damaging habits like grinding your teeth, chewing ice, or fingernail biting may cause this period of time to decrease significantly.

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

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

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

How do they work?
Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

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

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

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

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

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

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

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

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

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

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

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

What can I do to help protect my teeth?
The best way to combat cavities is to follow three simple steps:

1. Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk.





2. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits-the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.





3. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

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

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

Why should I floss?
Flossing is the one most important step in oral care that people forget to do or claim they don't have time for. By flossing your teeth daily, you increase the chances of keeping your teeth a lifetime and decrease your chance of having periodontal or gum disease. Flossing cleans away the plaque from between your teeth, decreases the chance of interproximal decay and increases blood circulation in the gums.

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

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

How often should I floss?
At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

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

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

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

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

Which toothbrush is best?
In general, a toothbrush head should be small (1" by 1/2") for easy access to all areas of the mouth, teeth and gums. It should have a long, wide handle for a firm grasp. It should have soft nylon bristles with rounded ends so you won't hurt your gums.

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

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

How long should I brush my teeth?
You should brush your teeth at least 2-3 minutes twice a day. Brush your teeth for the length of a song on the radio, the right amount of time to get the best results from brushing. Unfortunately, most Americans only brush for 45-70 seconds twice a day.

Electric vs. manual toothbrushes
Electric toothbrushes don't work that much better than manual toothbrushes, but they do motivate some reluctant brushers to clean their teeth more often. The whizzing sounds of an electric toothbrush and the tingle of the rotary tufts swirling across teeth and gums often captivates people who own electric toothbrushes. They are advantageous because they can cover more area faster. Electric toothbrushes are recommended for people who have limited manual dexterity, such as a disabled or elderly person and those who wear braces. Sometimes, it takes more time and effort to use an electric toothbrush because batteries must be recharged, and it must be cleaned after every use. Most electric toothbrushes have rechargeable batteries that take 10 to 45 minutes to recharge. The gearing in an electric toothbrush occasionally must be lubricated with water. Prices range from $30 to $99.

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

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

Don't forget . . .
Visit your dentist regularly because toothbrushing and flossing is most effective with periodic checkups and cleanings.

A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972.

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

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

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

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

Are sealants covered by insurance?
Although insurance benefits for sealant procedures have increased considerably, coverage is still minimal. The trend is toward expanded coverage of this benefit, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and in most foods. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible.
"Systemic" fluoride is ingested when added to public and private water supplies, soft drinks and teas, and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

What's a "topical" fluoride, and when should I use it?
"Topical" fluoride is found in products containing strong concentrations of fluoride to fight tooth decay. These products, including toothpastes and mouthrinses, are applied directly to the teeth and are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.
Professionally-administered topical fluorides such as gels or varnishes are applied by the dentist and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of dental caries, the dentist may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Why is most of the water we drink fluoridated?
Fluoridated water protects against cavities and root caries-a progressive erosion of adult root surfaces caused by gum recession-and helps remineralize early carious lesions. Thanks to these preventive benefits, public water fluoridation is considered the most efficient and cost-effective dental caries prevention measure available. More than 144 million United States residents in more than 10,000 communities drink fluoridated water, most from public water supplies with sodium fluoride added artificially. A small percentage get water from private wells with naturally fluoridated water.

The Environmental Protection Agency has determined that the accepted "optimal" range of fluoride in water lies between 0.7 and 1.2 parts per million (ppm) or mg per liter. The limit allowed by the EPA in public water is 4 ppm. Backed by results from more than 140 documented studies undertaken in 20 different countries over the past several decades, fluoridated water adhering to these standards has been scientifically established as safe for drinking. Water fluoridation is endorsed by nearly every major health and safety-related organization. Fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay and to improve oral health for a lifetime.

Can I get too much fluoride?
In general, the use of fluoride is considered safe unless it's misused or overconcentrated. Drinking excessively fluoridated water can cause dental fluorosis, a harmless cosmetic discoloring or mottling of the enamel, visible by chalky white specks and lines or pitted and brown stained enamel on developing teeth.

Avoid swallowing toothpaste, mouthrinses or other topical supplements, check with your dentist on proper dosage, and be careful not to accidentally take too much. If you are concerned about the fluoride levels in your drinking water, call the local public water department. If the source is a private well, request a fluoride content analysis taken via a water sample through your local or county health department.

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

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

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

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

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

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

The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that's worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient's destructive behavior.

Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.

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What Are Wisdom Teeth?
Wisdom teeth are third molars. Normally people have three permanent molars that develop in each quadrant of the mouth; upper, lower, right and left. The first molars usually grow into the mouth at around six years of age. The second molars grow in at around age 12. The third molars usually will try to grow in at around age 18 to 20 years. Since that is considered to be the age when people become wiser, third molars gained the nickname, "wisdom teeth." Actually, they are no different than any other tooth except that they are the last teeth to erupt, or grow into the mouth. They are just as useful as any other tooth if they grow in properly, have a proper bite relationship, and have healthy gum tissue around them. Unfortunately, this does not always happen.

What is an impaction?
When wisdom teeth are prevented from erupting into the mouth properly, they are referred to as impacted. Teeth that have not erupted are not necessarily impacted. It may be that it is still too early in someone's dental development, and if time passes they might grow in properly. A dentist must examine a patient's mouth and his or her x-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems. Impacted teeth can result in infection, decay of adjacent teeth, gum disease or formation of a cyst or tumor from the follicle, which is the tissue which formed the crown of the tooth. Many dentists recommend removal of impacted wisdom teeth to prevent potential problems.

Erupted wisdom teeth
Erupted wisdom teeth may also need to be removed. The dentist may recommend this if the tooth is non-functional, interfering with the bite, badly decayed, involved with or at risk for periodontal disease, or interfering with restoration of an adjacent tooth. Once again, every case is different and only your dentist can determine if there is a reason for you to have a tooth removed.

When should wisdom teeth be removed?
The following symptoms may indicate that the wisdom teeth have erupted and surfaced, and should be removed before they become impacted-meaning, the teeth have surfaced and have no room in the mouth to grow. However, each individual may experience symptoms differently. Symptoms may include:

• pain

• infection in the mouth

• facial swelling

• swelling of the gumline in the back of the mouth

Many oral health specialists will recommend removal of the wisdom teeth, (when the roots are approximately formed, or three-fourths developed, usually in the adolescent years),as early removal will help to eliminate problems, such as an impacted tooth that destroys the second molar. Third molar impaction is the most prevalent medical developmental disorder.

What problems are often associated with impacted third molars?

• bacteria and plaque build-up

• cysts development (a fluid- filled sac)

• tumor development

• infection

• jaw and gum disease

What is involved in the extraction procedure?
Wisdom tooth extraction involves accessing the tooth through the soft and hard tissue, gently detaching the connective tissue between the tooth and the bone and removing the tooth.

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A mouthguard is a flexible appliance made out of plastic that is worn in athletic and recreational activities to protect teeth from trauma.

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

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

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

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

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

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

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

How should I care for a mouthguard?

• Clean your mouthguard by washing it with soap and warm (not hot) water.

• Before storing, soak your mouthguard in mouthwash.

• Keep your mouthguard in a well-ventilated plastic storage box when not in use. Make sure the box has several holes so the mouth-guard will dry.

• Heat is bad for mouthguards, so don't leave it in direct sunlight or in a closed automobile.

• Don't bend your mouthguard when storing.

• Don't handle or wear someone else's mouthguard.

• Call your dentist who made the mouthguard if there are any problems.

This information was compiled for you by the Academy of General Dentistry. Your dentist cares about long-term dental health for you and your family and demonstrates that concern by belonging to the Academy of General Dentistry. As one of the 37,000 general dentists in the United States and Canada who are members of the Academy, your dentist participates in an ongoing program of professional development and continuing education to remain current with advances in the profession and to provide quality patient treatment. Visit the AGD's website at www.agd.org. To find a dentist, please call 877/2X-A-YEAR (877/292-9327). You have permission to photocopy this page and distribute it to your patients.

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

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

What will happen on the first visit?
Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem.
Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 24-36 months, the parent may need to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.
 

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

• A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas;

• If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar build-up and stains;

• X-rays;

• A demonstration on proper home cleaning; and,

• Assessment of the need for fluoride.

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

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

How do I find a good dentist for my child?
Many general dentists treat children. If yours does not, ask for a referral to a good dentist in your area. A word-of-mouth recommendation from a friend or family member can also yield the name of a quality dentist.

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

• Clean your infant's gums with a clean, damp cloth. Ask your dentist if you may rub a tiny dab of toothpaste on the gums.

• As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste. Remember, most children are also getting fluoride from the community water supply.

• To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the breast and bottle by one year of age, and monitor excessive sucking of pacifiers, fingers and thumbs. Never give your child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime.

• Help a young child brush at night-the most important time to brush, due to lower salivary flow and higher susceptibility to cavities and plaque. Perhaps let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. Usually by age 5 or so, the child can learn to brush his or her own teeth with proper parental instruction.

• The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

Many different types of food can cause tooth decay, not just candy. Foods that are high in carbohydrates, as well as some fruits, liquids, peanut butter, crackers and potato chips are culprits. Factors that cause tooth decay include the frequency in which the foods are eaten and the time they remain as particles in the mouth.

Can decay affect infants?
Yes. Tooth decay in infants and young children most often occurs in the upper front teeth, but also may affect other teeth. Sometimes parents do not realize that a baby's teeth can decay soon after they first appear. The decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. This problem is frequently referred to as baby bottle tooth decay. This kind of decay is caused by long-term exposure of a childÕs teeth to liquids containing sugars. When a child consumes a sugary liquid, acid attacks the teeth and gums and causes decay.

Are children safe from soda and other beverages?
 

Dentists believe that kids who consume too much soda and not enough nutritional beverages are prone to tooth decay in addition to serious ailments later in life, such as diabetes and osteoporosis. Drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel. Soft drinks contain sticky sugars that bacteria in our mouths use as an energy source. They break down into acids and adhere to tooth surfaces.

How does bacteria hurt teeth?
 

Decay is caused by bacteria that feed on any food that contains sugars and carbohydrates. Decay occurs when solid or liquid food particles are left unswallowed and cling to the teeth or gums for long periods. Bacteria in the mouth use sugars to produce acid that attacks the enamel of the teeth, softening and then eroding them. Enamel breakdown leads to cavities. If erosion spreads beneath the enamel, pain and sensitivity may eventually result. This can cause nerve infection, which can result in the need for a root canal.

My children rarely drink soda. Are they still at risk for tooth decay?
 

Yes, any prolonged exposure to soda can cause damage. Sipping a soft drink all afternoon is more harmful to your teeth than drinking a large soda with a meal and then not drinking any soda for the rest of the day. While many dentists advocate drinking nutritional beverages, such as milk, many agree soda should be consumed from a can rather than a bottle with a replaceable cap to discourage prolonged exposure to soda.

How can children prevent damage to their teeth?
 

Children at school should rinse their mouth with water after meals, leaving their teeth free of sugar and acid. Children also should seek sources of fluoridation. If you purchase bottled water, be sure that it is fluoridated. Encourage children to drink tap or fountain water. Use a straw when drinking soda to keep sugar away from teeth. Remember, bottled juices are not a good alternative due to the high sugar content. Regular dental check-ups, combined with brushing with fluoride toothpaste also will help protect children's teeth.

How can you help your child prevent tooth decay?
 

Parents should take their infant to the dentist just after the first tooth appears. Brushing teeth after meals, regular flossing and fluoride treatments are the best ways to prevent tooth decay. Children should also be supervised as they brush. A good rule of thumb is that when children can dress themselves and tie their own shoes, then they are ready to brush unsupervised. Children should be supervised in proper flossing techniques until the age of 10. If you have any concerns about your child's dental health or want some tips on preventing tooth decay, ask your dentist.

Children's Oral Health

At what age are my children supposed to see a dentist?
The general rule is six months after eruption of the first tooth. Some children require a bit more time to be comfortable. If an area of concern is noticed, then the child should see a dentist as soon as possible.

Why is it important to fix baby teeth that have decay? Aren't they going to come out soon anyway?
It is very important to maintain the baby teeth because these teeth hold space for the future eruption of the permanent teeth. If a baby tooth decays or is removed too early, the space necessary for the permanent teeth is lost and can only be regained through orthodontic treatment. Infected baby teeth can cause the permanent teeth to develop improperly resulting in stains, pits and weaker teeth.

When will my child lose his/her baby teeth?
Children will begin losing their teeth at approximately age 4. They will usually lose their front teeth first. Children will continue to lose baby teeth until the age of 12 or 13 when all of the permanent teeth finally erupt.

When does thumb-sucking become damaging to the teeth?
Generally, if the child has stopped sucking his/her thumb by age 5 there is no permanent damage. If the child is a vigorous and constant thumbsucker, however, there can be moderate to severe movement of teeth and prevention of normal bone growth.

Should my child wear a mouthguard while playing sports?
It is strongly recommended that children wear a mouthguard while playing any contact sport. It is always better to prevent an injury than to repair one. The earlier a child begins to wear the mouthguard, the easier it is to become comfortable and continue to wear it as they get older.

What should I do if my child gets a tooth knocked out?
If the tooth is a permanent tooth, time is extremely crucial. Immediately stick the tooth back in the socket. Don't worry about getting it in straight or having it turned backwards, just get it in the socket and immediately call your dentist. If you are uncomfortable placing the tooth in the socket, put it in a glass of milk and get your child to the dentist as quickly as possible. If the tooth is a baby tooth, do not put it in the socket because damage to the permanent tooth can occur. When in doubt, put the tooth in milk and see your dentist immediately.

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

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

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

What is a root canal procedure?
A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with gutta percha, a rubberlike material, to prevent recontamination of the tooth. The tooth is then permanently sealed with possibly a post and/or a gold or porcelain crown. This enables patients to keep the original tooth.

What is involved in root canal therapy?
Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an endo-dontist (a pulp specialist). Treatment usually involves one to three appointments.

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

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

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

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

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What Is A Dental Emergency?
Injuries to the mouth may include teeth that are knocked out (avulsed), forced out of position and loosened (extruded) or fractured. In addition, lips, gums or cheeks are often cut. Oral injuries are often painful and should be treated by a dentist as soon as possible.

How soon should I see a dentist?
Immediately. Getting to a dentist with 30 minutes can make the difference between saving or losing a tooth.

When a tooth is knocked out:

• Immediately call your dentist for an emergency appointment.

• Handle the tooth by the crown, not the root. Touching the root (the part of the tooth below the gum) can damage cells necessary for bone re-attachment.

• Gently rinse the tooth in water to remove dirt. Do not scrub.

• Place the clean tooth in your mouth between the cheek and gum to keep it moist. It is important not to let the tooth dry out.

• If it is not possible to store the tooth in the mouth of the injured person, wrap the tooth in a clean cloth or gauze and immerse in milk.

When a tooth is pushed out of position:
 

• Attempt to reposition the tooth to its normal alignment using very light finger pressure, but do not force the tooth.

• Bite down to keep the tooth from moving.

• The dentist may splint the tooth in place to the two healthy teeth next to the loose tooth.

When a tooth is fractured:
 

• Rinse mouth with warm water.

• Use an ice pack or cold compress to reduce swelling.

• Use ibuprofen, not aspirin, for pain.

• Immediately get to your dentist, who will determine treatment based on how badly the tooth is broken. Only a dentist can tell how bad the break is.

• Minor fracture: Minor fractures can be smoothed by your dentist with a sandpaper disc or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days.

• Moderate fracture: Moderate fractures include damage to the enamel, dentin and/or pulp. If the pulp is not permanently damaged, the tooth may be restored with a full permanent crown. If pupal damage does occur, further dental treatment will be required.

• Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery.

When tissue is injured:
Injuries to the inside of the mouth include tears, puncture wounds and lacerations to the cheek, lips or tongue. The wound should be cleaned right away with warm water, and the injured person taken to a hospital emergency room for the necessary care. Bleeding from a tongue laceration can be reduced by pulling the tongue forward and using gauze to place pressure on the wound.

What can I do to be prepared?
Pack an emergency dental care kit, including:

• Dentist's phone numbers (home and office)

• Saline solution

• Handkerchief

• Gauze

• Small container with lid

• Ibuprofen (Not aspirin. Aspirin is an anti-coagulant, which may cause excessive bleeding in a dental emergency.)

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

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

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

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

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

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

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

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

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