Dental Implants

Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.

A Solution of Choice for Replacing Missing Teeth
Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.

Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.


Before (left) and after a dental implant
Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that you have "false teeth," and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.

After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.

Anatomy of a Dental Implant

A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.

Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.

Further, conventional dentures may contribute to the loss of bone in the area where teeth are missing. As illustration (a) indicates, the presence of natural teeth preserves the jawbone. When a tooth is missing, as in illustration (b), the bone may erode and weaken until it may be necessary for your oral and maxillofacial surgeon to graft bone to the area to strengthen it for placement of a dental implant. When a missing tooth is replaced by a dental implant, the fusion, or osseointegration, of the implant and bone provides stability, just as the natural tooth did.

If you are missing several teeth in the same area of your mouth, you may still enjoy the confidence and lifestyle benefits that come with dental implants. Your oral and maxillofacial surgeon will place two or more dental implants, depending on the number of teeth that are missing. Your replacement teeth will be attached to the implants to allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth and dentures to prevent slipping and bone loss.

With an overall success rate of about 95% and almost 50 years of clinical research to back them up, dental implants are frequently the best treatment option for replacing missing teeth.

Dental Implants vs. Conventional Dentures
Dental Implants vs. Conventional Dentures

Orthodontics: Creating a Well-Aligned Smile

Years ago, orthodontic treatments were used only for pre-teens and teens having problems with their bite (malocclusion). Today, orthodontic treatments like dental braces are not only for pre-teens and teens, but for adults as well.

Close to 30 percent of all orthodontic patients in the United States are adults. Despite this growing trend towards adult orthodontics, it pays to start orthodontic treatment early for maximum effectiveness. The American Dental Association recommends that children receive an orthodontic evaluation by age seven.

The Restorative and Esthetic Nature of Orthodontics
Since malocclusion may interfere with eating and speaking, it is usually considered a restorative issue. Although, because a malocclusion may prevent the development of a beautiful, well-aligned smile or facial jaw lines, it may also be classified as an esthetic issue and categorized as cosmetic dentistry.

No matter what your age, orthodontics can protect your bite (occlusion), maximize your teeth's effectiveness in performing their functions and create a well-aligned smile. Today's orthodontics involves repositioning of the teeth and underlying roots, providing better support for the crown of the tooth. Orthodontic treatment is now associated with the benefits of greater esthetic appeal, increased comfort and reduced treatment time.

Orthodontic treatment can also rejuvenate your facial appearance by reshaping the jaw, neck and lips, especially when combined with maxillofacial surgical procedures. In addition, well-aligned teeth make oral hygiene easier to maintain.

Orthodontists
Orthodontists are the dentists who focus on the practice of orthodontics. An orthodontist is typically required to complete an additional two to three years of post-dental school education before becoming a certified practitioner of orthodontics.

The Orthodontic Evaluation
If you are a candidate for orthodontics, you will likely be referred by your general dentist to an orthodontist for evaluation of your bite. During your first orthodontic visit, your orthodontist may use several methods to develop an individualized treatment plan, including:

Oral, facial and functional evaluation (examination).
Intraoral and facial photographs.
Panoramic and cephalometric X-rays.
Impressions for models of the teeth and bite.
An orthodontist reviews your dental records, performs a clinical assessment, takes X-rays of your mouth and head and makes models of the teeth by creating an accurate impression of them. The results of this evaluation are studied in order to formulate the best orthodontic treatment plan.

Typically during the second visit, your orthodontist reviews the treatment plan and estimates the number of months for the active phase of treatment. The standard treatment phase is two years. Following treatment, you may be required to wear a retainer for a period of time.


The duration of orthodontic treatment varies based on your age, the extensiveness of the procedure (some people require more work than others) and how closely you follow your treatment plan. For example, younger patients may respond more quickly to treatment than older patients because the bones supporting young teeth are more pliable than those supporting older teeth. However, adults tend to follow treatment instructions more consistently than pre-teens.

In some cases the treatment time is longer. For example, oral surgery and recovery may be needed before or during orthodontic treatment.

[Updated May 2009]
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Cosmetic Dentistry: Treatments, Trends and Cosmetic Dentists

While traditional dentistry focuses on oral hygiene and preventing, diagnosing and treating oral disease, cosmetic dentistry focuses on improving the appearance of a person's teeth, mouth and smile. In other words restorative, general and/or family dental practices address dental problems that require necessary treatment, whereas cosmetic dentistry provides elective – or desired – treatments or services.

Cosmetic dentistry may also provide restorative benefits. For example, dental fillings are a common procedure used to treat decayed teeth. Previously, most dental fillings were composed primarily of gold, amalgam and other materials that left visible dark spots on the teeth.

Today, dental fillings may fall into the category of cosmetic dentistry, because you can select fillings made of porcelain or composite materials that closely match the color of your teeth, thus maintaining the natural appearance of your teeth and smile. Many people may choose to have their older fillings replaced with newer, tooth-colored fillings to enhance their oral appearance.

Cosmetic Dentistry Trends
Technological advancements in natural-looking, tooth-colored dental materials make today's cosmetic dental treatments more durable and predictable than in years past. Additionally, dentists are now using more conservative cosmetic dentistry techniques to preserve as much of your natural tooth structure as possible, depending upon your specific clinical situation.

Cosmetic dentists may also use such technologies as lasers in order to perform some procedures necessary for cosmetic treatments in their own offices – without the need for referrals to specialists. This makes cosmetic dental procedures such as smile makeovers more comfortable and convenient for patients, as well as helps to reduce recovery time.

Cosmetic Dentistry Treatments
Cosmetic dentistry treatments currently in use include:

Inlays/Onlays: Also known as indirect fillings, inlays and onlays made from porcelain or composite materials are a long-lasting yet cosmetic way to provide a “filling” to teeth with tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are created in a dental laboratory before being fitted and adhesively bonded into place by your dentist.
Composite Bonding: Chipped, broken, discolored or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light. The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of your natural teeth to create a healthy, bright smile.
Teeth Whitening: Teeth whitening is perhaps the most commonly recommended cosmetic dentistry procedure. Teeth are often stained from smoking, food, drink (coffee, tea or red wine) or poor oral hygiene. Bleaching the teeth can enhance the appearance of your smile.
Dental Veneers: Composite or porcelain laminates that are adhesively bonded to the surface of a tooth to correct and repair chips and cracks will improve a worn appearance or severe tooth discoloration. Veneers may also be recommended if you have gaps in your teeth or if you have not had success with teeth whitening.
Dental Implants: Dental implants are artificial tooth root replacements that are used as a part of prosthetic (artificial replacement) dentistry in order to compensate for tooth loss. Often the result is not only an enhanced smile, but also a more youthful appearance, since missing teeth cause the face to collapse, making you look older.
Smile Makeover: Smile makeovers involve a comprehensive assessment of your smile esthetics in order to improve its overall appearance. Typically one or more cosmetic dentistry procedures, such as dental veneers, dental implants, gingival sculpting and teeth whitening, will be required for several teeth in both the upper and lower arches in order to achieve the look you want.
Full mouth reconstruction: While consulting with you about a smile makeover to primarily improve the esthetic appearance of your smile, your dentist may discover that there is a need to provide necessary treatment to correct functional problems with your bite, muscles, teeth and bone structure. If you need full mouth reconstruction, the materials available today make it possible for your dentist to provide you with durable, functional and clinically sound treatments that also look natural.
Cosmetic dentistry offers many options for people who are unhappy with their smile. If you are one of these people, we encourage you to read our comprehensive cosmetic procedure articles to learn about the various treatments available to beautify your smile.

Dental Health and Wisdom Teeth

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult
How Do I Know if I Have Wisdom Teeth?
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.

Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Happens During Wisdom Teeth Removal?
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic - the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.

What Does Recovery Involve After Wisdom Teeth Are Pulled?
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours

Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.
Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you're also taking narcotic pain medication.
Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses -- these can irritate the extraction site.
What Does Recovery Involve After Wisdom Teeth Are Pulled? continued...
After 24 hours

Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.


What Are Potential Complications of Wisdom Tooth Removal?
Two of the more important complications after having your wisdom teeth removed include:

Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia. Paresthesia is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.

How Much Does Wisdom Teeth Extraction Cost?
Simple extraction of a wisdom tooth can cost as little as $99 per tooth. The cost of wisdom teeth that are impacted can cost between $230 and $340 and even more. Because costs vary in different areas of the country, contact your dentist or oral surgeon for their charges. Also check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal.

The Teething Process

Teething can begin as early as 3 months and continue until a child's third birthday.

Between the ages of 4 and 7 months, you'll notice your baby's first tooth pushing through the gum line. The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.

Next to break through the gum line are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child experiences significant delay, speak to your doctor.)

In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.

As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may experience brief periods of irritability, and some may seem cranky for weeks, with crying jags and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very irritable, talk to your doctor.

Although tender and swollen gums could cause your baby's temperature to be a little higher than normal, teething doesn't usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, it's probably due to something else and you should contact your doctor.

Easing Teething
Here are some tips to keep in mind when your baby is teething:

Wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing.
Give your baby something to chew on. Make sure it's big enough so that it can't be swallowed and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid — just be sure to wash it after each use. Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, be sure to take it out of the freezer before it becomes rock hard — you don't want to bruise those already swollen gums!
Rub your baby's gums with a clean finger.
Never tie a teething ring around a baby's neck — it could get caught on something and strangle the baby.
If your baby seems irritable, acetaminophen may help — but always consult your doctor first. Never place an aspirin against the tooth, and don't rub alcohol on your baby's gums.
Baby Teeth Hygiene
The care and cleaning of your baby's teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay can hasten this process and leave gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.

Daily dental care should begin even before your baby's first tooth emerges. Wipe your baby's gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!). As soon as the first tooth appears, brush it with water.

Toothpaste is OK to use once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don't let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.

By the time all your baby's teeth are in, try to brush them at least twice a day and especially after meals. It's also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You can also get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.

Another important tip for preventing tooth decay: Don't let your baby fall asleep with a bottle. The milk or juice can pool in a baby's mouth and cause tooth decay and plaque.

The American Dental Association (ADA) recommends that kids see a dentist by age 1, when six to eight teeth are in place, to spot any potential problems and advise parents about preventive care.

Reviewed by: Lisa A. Goss, RDH, BS, and Charlie J. Inga, DDS
Date reviewed: October 2008

Tooth extractions aftercare: Common post extraction instructions / dry sockets

Tooth extractions aftercare: Common post extraction instructions / dry sockets
Aftercare during the time period beginning 24 hours following your tooth extraction.
Your dentist will provide you with a second set of aftercare instructions for the time period beginning 24 hours after your tooth extraction. Usually a dentist's instructions will include directions pertaining to the topics found on this page. Before following any of the aftercare directions that are found here you should print them out and show them to your dentist and ask them if these instructions apply to your specific situation. Your dentist may find reason to revise, add to, or delete from these generalized instructions, depending on your specific needs. In all cases, if you have a concern or feel you have developed a complication associated with your tooth extraction you should contact your dentist.


Addressing swelling that still exists 24 hours after the extraction.
Any swelling caused by the trauma of the tooth extraction process should reach its maximum after 24 to 48 hours. So to bring this swelling down more quickly, apply a warm moist towel to the swollen area for 20 minutes followed by 20 minutes of no application. Repeat this cycle, as you find necessary.


Keeping the extraction site clean.
In general, the cleaner you keep the extraction site (the hole in the bone where the tooth has been removed, also referred to as the tooth's socket) the quicker it will heal. Beginning 24 hours after your tooth extraction, you can gently rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and before bed. Do not use commercial mouth rinses. They may irritate the extraction site.

Stitches (resorbable and non-resorbable).
Your dentist may have found it necessary to place sutures ("stitches") in the extraction site after removing the tooth. Some types of stitches are resorbable (absorbable) and therefore will disintegrate and dissolve away on their own, others are not and will need to be removed by your dentist. If stitches were placed, make sure you know which type have been used. Usually a dentist will want to remove stitches that don't resorb in about a week or so after the extraction. The process of removing stitches is usually very easy and quite painless.

Dry sockets.
One of the more common complications people experience after a tooth extraction is that of developing a "dry socket." It is thought that dry sockets occur when either a blood clot has failed to form in the tooth socket (the hole left after extracting the tooth), or else the blood clot that did form has been dislodged. Since the formation of a blood clot is an important part of the healing process, the normal healing of the extraction site is interrupted.

Dry sockets are most frequently associated with difficult tooth extractions or extractions that have been traumatic in nature. An extraction that has involved the removal of bone from around a tooth in order for the dentist to access it, which is often the case when lower impacted wisdom teeth are removed, would be considered to be more traumatic in nature than an extraction where this step was not required.

People who follow their dentist's post-extraction recommendations will reduce their chances of developing a dry socket. Dry sockets are found to occur more often with women (even more so with those taking oral contraceptives), people over the age of 30, and smokers.

Typically dry sockets manifest themselves as a dull throbbing pain which doesn't appear until three or four days after the tooth extraction. The pain can be moderate to severe in intensity and often seems to radiate from the area of the extraction site to the ear. Dry sockets typically create a foul odor or bad taste. Visually, if you can see down into the socket, the extraction site appears "dry," in the sense that you just see exposed bone. There is no formation of pus.

How to Brush

What Is the Right Way to Brush?
Proper brushing takes at least two minutes — that's right, 120 seconds! Most adults do not come close to brushing that long. To get a feel for the time involved, try using a stopwatch. To properly brush your teeth, use short, gentle strokes, paying extra attention to the gumline, hard-to-reach back teeth and areas around fillings, crowns or other restoration. Concentrate on thoroughly cleaning each section as follows:


Clean the outer surfaces of your upper teeth, then your lower teeth
Clean the inner surfaces of your upper teeth, then your lower teeth
Clean the chewing surfaces
For fresher breath, be sure to brush your tongue, too
What Type of Toothbrush Should I Use?
Most dental professionals agree that a soft-bristled brush is best for removing plaque and debris from your teeth. Small-headed brushes are also preferable, since they can better reach all areas of the mouth, including hard-to-reach back teeth. For many, a powered toothbrush is a good alternative. It can do a better job of cleaning teeth, particularly for those who have difficulty brushing or who have limited manual dexterity. To find the right Colgate toothbrush for you, click here.


How Important is the Toothpaste I Use?
It is important that you use a toothpaste that's right for you. Today there is a wide variety of toothpaste designed for many conditions, including cavities, gingivitis, tartar, stained teeth and sensitivity. Ask your dentist or dental hygienist which toothpaste is right for you. To find the right Colgate toothpaste for you, click here.

How Often Should I Replace My Toothbrush?
You should replace your toothbrush when it begins to show wear, or every three months, whichever comes first. It is also very important to change toothbrushes after you've had a cold, since the bristles can collect germs that can lead to reinfection.

Dental Health and Tooth Discoloration

There are several causes of tooth discoloration, including:

Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for example, apples and potatoes) can stain your teeth.

Tobacco use. Smoking or chewing tobacco can stain teeth.
Poor dental hygiene. Inadequate brushing and flossing to remove plaque and stain-producing substances like coffee and tobacco can cause tooth discoloration.
Disease. Several diseases that affect enamel (the hard surface of the teeth) and dentin (the underlying material under enamel) can lead to tooth discoloration. Treatments for certain conditions can also affect tooth color. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting enamel development.
Medications. The antibiotics tetracycline and doxycycline are known to discolor teeth when given to children whose teeth are still developing (before the age of 8). Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and drugs for high blood pressure also cause teeth discoloration.
Dental materials. Some of the materials used in dentistry, such as amalgam restorations, especially silver sulfide-containing materials, can cast a gray-black color to teeth.
Advancing age. As you age, the outer layer of enamel on your teeth gets worn away revealing the natural yellow color of dentin.
Genetics. Some people have naturally brighter or thicker enamel than others.
Environment. Excessive fluoride either from environmental sources (naturally high fluoride levels in water) or from excessive use (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth) can cause teeth discoloration.
Trauma. For example, damage from a fall can disturb enamel formation in young children whose teeth are still developing. Trauma can also cause discoloration to adult teeth

Dental Hygiene: How to Care for Your Child's Teeth

How can I best care for my child's teeth?
Good dental hygiene habits should begin before your child's first tooth comes in. Wiping your baby's gums with a soft damp cloth after feedings helps to prevent the buildup of bacteria. When teeth appear, start using a soft children's toothbrush twice a day.

Once your child is preschool-age, start using fluoride toothpaste. Don't cover the brush with toothpaste; a pea-sized amount is just right (see picture above). Young children tend to swallow most of the toothpaste, and swallowing too much fluoride toothpaste can cause permanent stains on their teeth.

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What about using fluoride tablets?
Fluoride helps make teeth strong by hardening the tooth enamel. Many cities are required to add fluoride to tap water. If you live in an area where the tap water doesn't contain fluoride, your doctor may prescribe daily fluoride tablets when your child is about 6 months old. Fluoride is an important part of your child's dental health, but don't give him or her more than the directions call for. If you miss a dose, don't give your child extra fluoride to make up. Just as with swallowed toothpaste, too much oral fluoride can cause stains on your child's teeth.


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What are cavities?
Cavities are holes that are formed when bacteria (germs) in your mouth use the sugar in food to make acid. This acid eats away at the teeth. Cavities are common in children. Good tooth care can keep cavities from happening in your child
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Is my child at risk for cavities?
Your child might be at risk for cavities if he or she eats a lot of sugary foods (such as raisins, cookies and candy) and drinks a lot of sweet liquids (such as fruit juice and punch, soda and sweetened drinks). Your child also might be at risk if he or she has any of the following risk factors:


Was born early (prematurely) or weighed very little at birth (low birth weight)
Has ongoing special health care needs
Has white spots or brown areas on any teeth
Does not go to the dentist very often
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How can I help stop cavities?
Everyone in your family should take good care of their teeth. Family members with lots of cavities can pass the cavity-causing bacteria to babies and children.

Teeth should be brushed at least twice a day and adults should floss once a day. Everyone should see the dentist twice a year. Have your doctor or dentist show you the right way to brush your child's teeth.


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Does diet affect my child's teeth?
Yes. Avoiding sweets, sticky foods and between-meal snacks is good advice. To avoid cavities, limit sweet snacks and drinks between meals. Have meals and snacks at regular times. Teeth-friendly snacks include fresh fruits and vegetables, and cheese and crackers.

Baby bottles can create additional problems with your child's dental health. When liquid from a bottle--like milk and juice--stays in contact with the teeth for a long time, the sugars cause tooth decay. This can create a condition called bottle mouth. Your baby's teeth can develop cavities and become pitted or discolored. Never put a baby to bed with a bottle. Don't let your child walk around during the day with a bottle, and teach your child to use a drinking cup around his or her first birthday.


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Is thumb-sucking bad for my child?
It's normal for children to suck their thumbs, their fingers or a pacifier. Most children give up this habit on their own by age 4, with no harm done to their teeth. If your child still has a sucking habit after age 4, tell your dentist. Your dentist can watch carefully for any problems as the teeth develop. In most children there is no reason to worry about a sucking habit until around age 6, when the permanent front teeth come in.


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When should I start taking my child to the dentist?
The American Dental Association recommends that parents take their child to a dentist around his or her first birthday. This gives the dentist a chance to look for early problems with your child's teeth. Pediatric dentists specialize in treating children's dental health. You and your child's dentist should review important information about diet, bottles, tooth brushing and fluoride use. Visiting the dentist from a young age will help your child become comfortable with his or her dentist. It also establishes the good habit of regular dental check-ups.


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Getting Your Dentures

Conventional Dentures
Conventional dentures are made and inserted after your teeth have been taken out and the gums have healed.
A conventional denture typically is made and fitted within four or more appointments over one to two months. The process starts with an appointment with your dentist for an exam. You also will talk about what will work best for you. In later visits, your dentist will take impressions of your mouth and establish the bite (the way your teeth come together).

You and your dentist will select the teeth for your denture. The size of the teeth will be influenced by the size of your mouth and jaw, and how your upper and lower jaws come together when you bite down. If you liked the way your natural teeth looked, bring in a photograph of you smiling with your natural teeth. This will help your dentist and the dental laboratory that will make your dentures.

Your dentist will take impressions of your mouth and send them to the lab, along with a detailed prescription. A dental technician will make your dentures based on this information.

Once the denture is made, you'll have a trial fitting. Your dentist will set up your new denture and try it in your mouth. You'll be able to see how the denture looks and feels in your mouth. Your dentist can make sure that it fits, functions correctly and harmonizes with the rest of your face. This is your denture preview, or "try-in."

If the try-in goes well, you will receive the completed denture at the next visit. Your dentist will give you instructions on how to eat and speak with dentures. You'll also learn about how to take care of your dentures and your mouth and gums. Finally, you will need to see your dentist for a series of follow-up visits during the next few weeks and months. The dentist will check the fit and comfort of your denture.

Immediate Dentures
If you have teeth extracted, your mouth will need to heal for at least four weeks before a complete denture can be made. Your dentist may suggest that you use an interim or temporary denture called an immediate denture. This will be made and inserted at the time of extraction. The immediate denture will allow you to eat and speak without problems while the complete denture is made. As your mouth heals, the gums and bones will shrink. The immediate denture will need to be relined to adjust the fit.

Types of Dentures: Complete or Partial

Complete Dentures
See photos

Complete dentures cover your entire jaw, either upper or lower. Some people call them "plates." Complete dentures rest directly on the gum that covers the bone.
Complete dentures are custom made for you. The process involves multiple appointments, usually about five. The dentist first takes impressions of your mouth. At later visits, you and the dentist select the size, shape and color of the artificial teeth.

Learning to chew food with complete dentures takes patience and practice. You might have to cut your food into smaller pieces than you did in the past when you had your natural teeth.

On occasion, one or more natural teeth are kept when a denture is made. These teeth usually have root canal treatment and are shortened to fit under the denture. This type of denture is known as an overdenture.

Dentists like to maintain a few natural teeth and replace the missing teeth with an overdenture if possible. This has several advantages:

Your natural teeth help preserve bone.
Your natural teeth bear some of the chewing pressure. This reduces pressure on other areas of the jaw.
Your remaining teeth make the denture more stable and less likely to shift in your mouth.
You feel a better sense of where your jaw is in space and the pressure you are placing on the denture if you have not lost all of your teeth.
You may find it easier to accept wearing dentures if you have kept some teeth.


Lower dentures tend to be more difficult to keep in your mouth than
upper dentures. Therefore, an overdenture can be particularly helpful for the lower jaw. However, it is an option for almost anyone who has a few teeth remaining.

Teeth that will be preserved with an overdenture must meet certain standards of health. Canines and premolars are the most common teeth selected because of their root length and position in the jaw.

The teeth will have to be shaped to fit the denture. Shaping may expose the tooth's living pulp. For this reason, the teeth usually need root canal treatment. This removes the pulp (the nerve of the tooth) and replaces it with filling material.

The teeth that will remain are covered with thin metal castings called copings. They fit into openings in the denture. Attachments also can be put on the copings to help retain the denture in the mouth. On occasion, a natural tooth can be kept in the mouth without a metal coping. If this is done, the dentist will prescribe fluoride drops. These should be used in the overdenture to prevent decay of the tooth.

Overdentures also can fit over implants instead of natural teeth. In fact, implants originally were developed to give people "artificial roots" for bridges or dentures in the lower jaw. The denture can fit onto the implants directly, or onto a metal bar between implants.

Dentures Basics

Introduction



Dentures are false teeth, made mostly of plastic, that replace missing or lost teeth. Dentures are a solution of last resort. Many people assume that they will need dentures as they age, but losing teeth is not a normal part of the aging process. If you care for your teeth well and guard against periodontal (gum) disease, you should be able to keep your teeth for a lifetime.
Saving even a few natural teeth is often better than losing them all. Natural teeth or even parts of natural teeth can help you retain bone in your jaw. They also can act as stable supports for bridges, overdentures or removable partial dentures. Your dentist will try to save as many of your natural teeth as possible.

Dentures can be either complete or partial. Complete dentures are made for people who have lost all of their teeth. They can be given more support by placement of implants in the bone under the denture. Partial dentures are used to replace only a few teeth. They attach to nearby teeth.

The good news is that dentures aren't what they used to be. Newer materials and technology have allowed great improvements. Now dentists can fashion dentures that fit comfortably, appear natural and help you stay healthier.

Denture problems still can occur, of course. But problems such as clicking, slipping, frequent gum irritation and odor may be signs that your dentures don't fit well. They may need to be adjusted, relined or remade.

Although dentures may look like your natural teeth, they cannot work like them. Simple actions such as speaking and eating may feel different. You will have to learn how to use and adjust to your dentures. For some people, this can take up to several months.

Dental Amalgam Mercury Fillings

Dental Amalgam Mercury Fillings



Dental Amalgam Fillings, sometimes called “silver amalgams,” are actually half mercury. They are a time-release poison, a major source of mercury to those who have them. DAMS stands for Dental Amalgam Mercury Solutions and it is a non-profit organization based in Minnesota, in the United States, educating the public on mercury amalgams and other ways that dentistry may affect health.



This web page version is dated December 17, 2009. www.amalgam.org is a historic web site on the mercury amalgam issue, first set up in March 1997. More content and more links are being developed.

The DAMS information packet, the DAMS periodic newsletter, Dental Truth, and the books and DVDs that DAMS sells all provide information on dental amalgam filling (“silver fillings”), crowns, root canals, gum disease, fluoride and other important topics. On the subject of dental amalgam mercury fillings, we describe the symptoms of mercury toxicity, safe amalgam removal, choosing suitable replacement materials, and safe, natural detoxification including alternatives to the drug approaches. Many toxins can be found in crowns, bridges, dentures and in the mouths rinses and jell treatments that contain fluoride. Root canal treated teeth are dead teeth and are therefore prone to infection – infection which can be very toxic and hard to get rid of because there is no blood flow into a dead tooth. Such “root canals” have been linked to cancer and other chronic illnesses. The patient may want to consider extraction of such teeth, but extractions also merit some discussion; tooth extractions must be done properly and thoroughly in order to avoid leaving infection behind in the jawbone, a cause of jawbone disease. Jawbone disease is fairly common but is often overlooked and is rarely diagnosed. Jawbone disease (also jawbone “cavitations”) may cause facial pain, and may cause or contribute to a weakened immune system, and many of the same neurological and auto immune diseases that infected root canalled teeth and toxic metals may also be a factor in.



Is there a cover-up of these many dental – health hazards? It appears so. We understand that the dental industry and the American Dental Association (ADA) dismiss these many health concerns and many of us view their dismissal, their claims of amalgam safety as dishonest and a cover-up. We don’t know what the ADA’s inner thinking is, but behaps the ADA feels that, since it has defended and promoted the use of mercury amalgam fillings throughout its entire history, it could not survive if it were to admit that it has been wrong over the last century and a half, as mis-informed and harmed millions of people, including its own dentist members, some of them seriously, through its cover-up. Most of the media also participates in cover-up even though, based on the science and the clinical record, the cover-up should be over and amalgams should be banned in the USA. We note that amalgams have been banned in Norway and Sweden, so it is possible for the truth, and a responsible public policy, to triumph in a functioning democracy. Unfortunately, here in the USA the Food and Drug Administration (FDA) appears to be captured by the ADA, and remains in cover-up mode. No matter how much damning science is presented to the FDA Dental Division and how many case reports of patient injury are presented, FDA remains in a state of denial and cover-up of the hazards of dental amalgam fillings.



Non-profits to the rescue. DAMS is a tax-exempt educational non-profit organization helping educate people in the US, Canada and elsewhere on these very important dental-health issues. People who wish to get their dental amalgam fillings removed should find knowledgeable practitioners who can remove amalgams safely, with elaborate precautions to protect the patient. Such knowledgeable dentists are not merely “mercury-free” or “cosmetic” dentists; they should be “holistic” or “biological” dentists, meaning that they pay attention to the effects that their work has on the whole person and on his/her underlying health. We must emphasize that it is very hazardous to have mercury amalgam fillings replaced by a “regular” (i.e. conventional) dentist who does not have the training and equipment to replace the amalgams with elaborate precautions. DAMS maintains a list of holistic (biological) dentists in every state and province who are trained and equipped to replace amalgams safely. Hopefully they will also use better choice replacement materials, use natural, less toxic approaches to gum health and decay prevention (no fluoride) and be aware of the hazards of root canal treatments. To request a list of knowledgeable practitioners in your state of province, please call DAMS at 651-644-4572.

Please e-mail us at DAMS@usfamily.net Please leave your name and full address on the DAMS voice mail or with our person who answers the phone. . We normally mail out the list (or lists) with our information guide. Please accept our info guide, read it and study it. It has a wealth of information and helps make you a more informed dental patient. It discusses in detail the dental amalgam mercury issue and other ways that dentistry may affect health. To talk with a DAMS staff person, you may also call 651-644-4572. You may be surprised that a real person will answer. There may be additional information that can be supplied in your information packet that helps address your special questions.



To read more scientific details on mercury, amalgam and their health impacts, please go to our web site www.flcv.com/indexa.html. This is one of the largest, most detailed web sites on the hazards of dental amalgam fillings, with hundreds of scientific abstracts and references.



The information packet that you are being mailed and the information that you are being given on the phone are provided at no charge; but a contributions is requested. DAMS is a very caring, generous non-profit organization; no one is denied help on the basis of lack of money. But please look for a donation envelope in you packet, with a reply strip and donate what you can to keep the work of DAMS going, so it can continue to help you and others. You may also join DAMS as a member in order to receive the DAMS newsletter, Dental Truth, on an ongoing basis. (Ask for a sample newsletter in your packet, if you like). Memberships are normally $25 per year, and less for low income people. Contributions to DAMS are tax deductible.



Please remember, whether calling us at 651-644-4572 or e-mailing us at dams@usfamily.net, to provide name and full mailing address in order to receive the info guide and our list of holistic dentists in your state; and, if you need a call back, leave your phone number, including area code, and speak slowly in giving your phone number.

Fluoride Varnish

Remember when your dentist put that sour gel stuff in a giant foam tray put a straw suction tip in your outh and let you sit like that for 5 minutes? That flouride treatment was to help prevent tooth decay. Now there are some better options than that aweful gel. Fluoride Varnish is the most elegant version of office applied Fluoride.

Now there are a hundred different kinds of fluoride and many ways to apply fluoride. There is the fluoride in the drinking water, which you might drink every day which has been statistically proven to prevent tooth decay in large academic studies. That concentration is about one part per million of fluoride ion (ppm). The oral rinses you get in the grocery store are about 200 ppm. Toothpaste has about 1000 ppm. Once you get into those kinds of ranges you really don't want to swallow large amounts of fluoride. That's why we do not recommend regular toothpaste for very young children (under two) and we ask older children and adults to rinse and spit after brushing. The kinds of fluoride we apply in the office are much higher concentrations, usually of a version called APF or Acidualted Phosphate Fluoride (the sour stuff) or sodium fluoride. There has always been a concern for children that you don't want them to swallow too much fluoride during an in office delivery-those concentrations can be around 22,600 ppm! Foam systems were developed and we use that from time to time as you can get the fluoride on the teeth more easily without such a large total dosage.
Now there is an even better way-especially for children-Fluoride Varnish. It's sort of a thick liquid you paint on the teeth coating a concentrated dose of fluoride right up against the teeth, but in total dosage it is quite small. Better yet, long after the patient has left the office, it bathes the teeth in fluoride. It lasts for a few hours or until the patient brushes. It actually tastes pretty good, kind of like bananas I think. The first version thay had was called Duraphat. It was good, but was yellow colored and although very good, it always bothered patients to leave the dental office with goopy yellow looking teeth even if it was just for a few hours. Now they have improved the color. It's a sort of clear/white colored material. It is painted on and once it gets wet, it hardens up a little. Pretty cool, huh.

ADA on Fluoride Varnishes

The CDC on Fluoride
AAPD on Fluoride

More info and video:
Vanish brand varnish from 3M
CDC on fluoride products

Silver Fillings (Amalgam)

I don't want a silver filling! I hear this from time to time in the office. What are silver fillings (amalgam fillings)? They are sometimes called amalgam because they have a few different things in them amalgamated together to form something new.




Just so you know we do not do amalgam silver fillings anymore in our office and have not for many years. This mainly was a factor of the improvement in the strength and durability of white fillings and patient demand. We have found that the ability of the stonger newer composite white fillings that bond to the tooth (strengthening it) and the cosmetic benefits make it a very desirable restorative material.


Amalgam consists of a powder of ground up mainly silver and copper and some other metals mixed with a little drop of mercury. You shake it all together (amalgamate). After a few seconds of "trituration" the thing is kind of maleable and putty like. It is placed into the cavity preperation and initially hardens in a few minutes. It is very important to note that there is basically no murcury coming out of a silver filling once it is amalgamated. They are quite safe as determined by extensive scientific clinical studies-(See links below.)
Silver fillings were very common in the past and were the standard of care, and still are, because they hold up quite well to biting forces. If a dentist is still doing silver fillings, that is still an acceptable method of treatment. There are a few drawbacks to "silver" fillings: 1. They do not bond to the tooth, they basically just fill the cavity. 2. They are silver so there is a cosmetic concern. Now, how many people are looking at your back teeth trying to see in there? If you know them that well, it probably does not matter what your teeth look like. Still, we are all concerned with appearance and want the most cosmetic solution available. 3. thermal conductivity is better/lower with white fillings.

Teeth under a Microscope-Enamel

Dental Enamel is the outer part of a tooth; the part you see. It coveres the tooth like a thick eggshell. In baby teeth, it is quite thin. In permanent teeth, it is thicker, roughly 1-2mm. It is very hard. Under a microscope the enamel "rods" are arranged kind of like a stack of lumber with the surface being the ends of the stack. These rods have sort of a keyhole shape in crossection.

In order for a composite filling, sealant or other bonded material to adhere to the enamel, the surface is "etched". This is usually done by applying 37% phosphoric acid solution for about 15-20 seconds and then rinsed off. (No the acid does not hurt. In fact, you can touch it for a good while and nothing will happen. It's acid, but not that strong). The etchant removes inorganic material and parts of the enamel rods whose ends are exposed by demineralization. Yes, if you put an egg into vinegar it will eventually demineralize the eggshell. Same thing here, but a much shorter time, stronger acid and it's only the microscopic surface that is demineralized. This etching produces multiple areas for bonding material to mechanically adhere to the enamel surface. Visually the tooth has a frosted appearance. It's sort of like sandblasting or priming the surface. Bonding agent is then applied, flowing down into this rougher surface. Once curing occurs, this locks into the undercuts, and bonds the material to the tooth.


Dentin can also be etched, but the bond strength is less than with the enamel. It is much more organic with dental tubules evident on microscopic view. Newer bonding agents bond to enamel and dentin. You can see from these photos how the surface is primed for bonding.
Etched Dentin

Here is a good slide show on enamel: Enamel Histology
A good summary of the status of enamel and dentin bonding: JADA Article


Now, is the histology of enamel different with enamel flourosis? with hypoplasia? Basically, yes. That would be whole other post.

Letter to a Dental Student

A current dental was relating all the stress and frustration that is the dental school experience. I was remembering my time in dental school. That's a time most dentists want to forget. It is a stressful time with compressed time schedules, late night lab work, and endless examinations. We often had no dental assistant to help with patient treatment. There were what seemed like hours spent waiting for a "check" of a procedure from a faculty member. A doctor I know is an oral surgeon who has experienced both dental and medical school. He stated that dental school was actually much more difficult (although the medical residency was even more so). ---So, to any dental student:

For me the road seemed longest in my second year of dental school. One year completed and forever and a day to go. It is certainly a forbidding task to get all the "requirements" completed. Personally, I hated mundane lab work, carving wax patterns and setting plastic denture teeth in an articulator late into the night. I, therefore disliked prosthodontics (dentures). I knew I wanted to go into Pediatric Dentistry, so all this "other stuff" seemed designed exclusively to test my sanity. Still, in hind sight, all the difficulties you experience drift into the fog of the past and the skills and memories remaining that will stead you well. The juggling a dental student has to deal with is but a prelude to the business world's hustle. Enjoy, and do not fret too much. There is light at the end of the tunnel.

I remember the latter part of my senior year--all of a sudden the faculty accepted me as a peer, with more respect, as some kind of equal. They have been there before too, and respected the fact you made it through with your head held high.


Photo curtesy of http://manicmolar.blogspot.com/

Is Your Child's Dentist a Pediatric Specialist?

Many parents take their children to the Pediatrician for their expertise and training in the treatment of children and adolescents. This is also the idea behind the Pediatric Dentist. A Pediatric Dentist has completed additional education beyond dental school in an officially recognized specialty program. They are the Pediatricians of Dentistry.

If a dental practice says they treat children, are they "Pediatric Specialists"? Well, maybe --and maybe not. If you saw an add for these practices, wouldn't you think they are specialists in Pediatric Dentistry? Fact is, you cannot tell by the name or the advertisements:

Kids-R-Us
Little Smiles
Wee folks

I have run into an increasing phenomenon of practices "pretending" to be specialists in Pediatric Dentistry. They are usually general dentists who have set up a business model to emphasize the treatment of children. The most common manifestation is the clinic or practice treating mainly Medicaid insured patients. Now, a general dentist can legally treat children usually as part of a family practice. In fact, some general dentists do a good job, but do not have the additional specialty training and education of a Pediatric Dentist. In most states it is illegal to call onself a Pediatric specialist if one is not. These practices usually do not offer the full range of services as the specialist. Marketing can easily decieve the public. Don't assume that, if a practice looks like a kid's dentist, that they really are specialists.

Make sure your child's dentist is really a specialist in Pediatric Dentistry. If you are not sure, ask. Ask specifically if the dentist is a specialist in Pediatric Dentistry. Listen for the answer. If they say, "our dentists treat children" or "yes, we see children" or, "our practice is dedicated to treating children", they really did not answer your question. You need to be specific and get a specific answer. You can even research on where they did their specialty residency after dental school. Some states requre a specialty license. Now, sometimes there is a group practice that does actually have a Pediatric specialist on staff. However, is the dentist that is treating your child the specialist?--or, is that Pediatric Dentist retired, or only come in every other Friday? It could be that most of the dentists seeing your child are actually general dentists. Ask.

Broken tooth

When a child falls or generally is rough-housing, sometimes, they fracture a tooth.
Ugh, why does it have to the be the front teeth, the ones everyone sees? Almost every Monday, we receive a call from a parent with a child or teenager that fell over the weekend and chipped, broke, or otherwise fractured a tooth. Teeth can sustain a lot of force, but a sharp hard force concentrated in one spot can cause a fracture or "broken tooth". Now, baby teeth often have multiple small chips on the edges or facets from "normal" wear and tear. Of course, a fracture in a permanent tooth can be cause for concern.

Fractures are classified as to location and basic level of severity with the Ellis classification system:

Class 1--Chips or fractures in the outer enamel layer only
Class 2--Fractures into the dentin layer
Class 3--Fractures into the pulp of the tooth
Class 4--Fractures onto the root often vertical fractures

What to do?


Well, sometimes baby teeth are handled differently than permanent teeth. In general, the principles are the same:

Class 1--Well, they may look bad, but are usually not sensitive. If it is very small, we often just smooth off the edge. It is very difficult to do a very thin filling on the edge of a tooth. You can, but it will chip off again in a heartbeat. If the chip is larger, you often have to do a composite filling (bonding). It's the same material we use for white fillings. It is "bonded" onto the tooth -sort of like gluing something onto a flat wall.

Class 2--Larger fractures. Very common and sometimes sensitive to cold water/air, -at least for a while. A composite restoration is indicated to cover the sensitive dentin and for looks. A very large fracture may eventually need a crown or porcelain facing, but in growing children a more conservative approach is often indicated till growth and orthodontic treatment is completed. Although it often looks pretty good, a composite can be difficult to match existing tooth structure with all the minor enamel inclusions and shadings. So, if you are looking at the photographs below and think, "wow, that's not too bad", you are correct, but most results are not this good. With most repairs, if you look really close, you can see where the tooth ends and the filling begins. That's why porcelain work is often indicated later on.



Class 3--Always needs attention as bacteria are entering into the pulp. In adults this often means a root canal will be needed. This is not often the case in young permanent teeth. The more vigorous pulps with a better blood supply can often recover quite well. If most of the crown of the tooth is missing, a root canal may be indicated just to create something to hold a crown.

Class 4--Not common, but difficult to treat, and often need removal. Dental heroics may be needed to save such a tooth. Treatment may include orthodontic extrusion, a root canal, post and core, and a crown--if you are lucky.


Once teeth are restored, there still may be problems later on due to the initial trauma. The tooth may abscess or have other problems.

Treatment is sometimes different for a baby tooth. Often parents want whatever it takes to "save" a baby tooth that is not of any real consequence other than appearance. We are much more likely to just remove a severely damaged baby tooth rather than do a "baby tooth root canal". The main objective is protecting the developing permanent tooth. Small fillings in front baby teeth are more difficult to retain without doing a crown. Having said this, we still try and "fix" fractured baby teeth if we can. The age of the patient can dictate what you are able to do (or not). A chip in the tooth of a two year old may be handled differently than that of a 5 year old. Behavioral considerations, the need for sedation, and how much root is left on the baby tooth will influence the ultimate decision.

There is more on the blog on trauma (and I know you want more info on this one):

Fractured teeth, Knocked out teeth, and other pediatric dental accidents

The Autistic Dental Patient

Patients presenting with Autism can be a challenge for dental professionals. We as Pediatric Dentists see patients with all kinds of special needs, developmental conditions and disabilities. Autism is a relatively common condition affecting children throughout the country.


These children need dental care just like every other child. Children with Autism usually present with a spectrum of disorders and often have difficulty communicating or interacting with others. Loud sounds, lights, smells and sometimes touching can overwhelm a patient with Autism. This presents a special challenge for dental treatment because pretty much anything about dentistry involves these things. Other than these sensitivities and the patient's reaction to them, the dental problems are pretty much like every other patient. Special attention to oral hygiene is helpful along with a measured approach to dental examinations and cleanings.


When fillings or other treatment is needed, sedative medications can often help patients more easily cope with the stimulus and stress of their environment during treatment. In a few cases where extensive procedures are required, general anesthesia might be considered. Each child is different. Treatment modalitites for one may differ for the next. As patients with autism may present reactions and symptoms in varying degrees, many can be treated in a similar manner to other children.


I see Autistic patients almost every day and they do quite well for most things. Sometimes just doing an exam can cause a loud commotion, but the kids are sweet and none the worse for it. Most parents are well versed in their child's condition and special needs. Although, like most parents, I think they are more stressed out by any dental appointment than their child.

TADs, Temporary Anchorage Devices in Orthodontics

In orthodontics we move teeth with basic mechanics. When you push on something (a tooth), you have to pull on something else. You "brace" yourself against a stronger object. When you are moving teeth, the thing you brace against is called the anchor-you know, like an anchor on a boat. Most of the time, anchorage is achieved by placing one force against a small tooth that you are trying to move, against another large tooth (or several teeth tied together, the "anchor"). The small tooth moves a whole lot more than the anchor. There are several instances in orthodontics where this anchorage is an elusive thing to acheive. TAD means Temporary Anchorage Device. These are basically very small screws inserted into bone. The TAD does not move, the tooth then can be moved against this fixed point. TADs are removed when they are no longer needed.


Wait, a screw? in bone? Ouch! doesn't that hurt? Well, --no. We even tried this on each other before using it on patients. Topical anesthetic does great for placement. Here is one of our docs with a TAD in place:

National Museum of Dentistry Facebook Contest

The National Museum of Dentistry announces a two-month Facebook challenge to raise awareness of the museum and its mission to improve oral health nationwide. Help the National Museum of Dentistry reach 5,000 Facebook fans by June 1 —and you could win a tooth-rific dream tour…

Now through June 1, 2010, all National Museum of Dentistry fans on Facebook are automatically entered for a private tour package that features:

An exclusive curator-led tour of the museum for six people, including a rare chance to get up close and personal with George Washington’s choppers
A peek into the museum vault, where some of the most curious dental treasures are stored
A swag bag from the Museum Shop
And to cap it all off, smile kits for each of your guests, including toothbrushes, toothpaste and floss.
Help to share the power of a healthy smile. Make sure your friends “Become a Fan” of the National Museum of Dentistry. Go to www.smile-experience.org for details.

Brace yourself. One winner will be selected from a random drawing of fans on June 4, 2010. Tour package must be redeemed by December 31, 2010

Dentists Who Go Green Grow Green for Earth Day 2010

On April 22, that’s just a few days away, tree huggers and vegans will celebrate the 40th annual Earth Day. Even dentists have hopped on the clean green machine. From the Emerald Coast to Greenland, your colleagues are practicing eco-friendly dentistry. Some have designed office interiors with air filtration systems, natural lighting, bamboo flooring, and latex-free paint. Extreme green dentists hire architects to design offices that minimize electricity usage and recycle rainwater for landscape irrigation.

Don’t be envious or jaded, just get on board. For the average Dr. Joe, going green doesn’t have to involve redecorating or rebuilding. And contrary to a popular frog’s beliefs, it IS easy being green. Here are just a few ways to celebrate Earth Day this year:

Your Front Office

Online Registration Forms – instead of printed paperwork
Web Marketing – instead of phone book ads
Texted Recall Reminders – instead of postcards
Recycled Paper & Biodegradable Office Products
Recycling Program in the Office – call your city for details
Your Back Office

Digital X-rays – instead of conventional films
Composite Fillings – instead of amalgams
Safe Mercury Removal Procedures – see mercuryfreenow.com
The Facility

Recycled or Bio-Friendly Building Materials
Reusable Instruments & Supplies (when possible)
Lush Landscaping & Rainwater Irrigation System
Windows for Natural Light
Furniture with Eco-Resins
HVAC with Zone Controls
Energy Saving Appliances
Mercury-Free Lighting

Fact: The first LEED-certified dental office as Mint Dental Works in Portland. LEED® is the Leadership in Energy and Environmental Design program, which is part of the US Green Building Council.
Why Go Green?

Well, you are a human, aren’t you? Do you want your great-great grandchildren to have to wear a respirator 24/7? Other than that, green is good to get you more green. Let me explain. The hot trend in marketing today is giving – investing in people and community is what Generation G is all about. Consider that Miley Cyrus traded her mother’s Porsche in for a Prius, and you’ll see my point.

What better community could you support than the global community? Seriously, just like the Halloween Candy Buy Back can boost your marketing campaign in October, six months later, a Green Dentistry campaign centered around Earth Day has the potential to make a splash with local media.

Find out what your city is doing for Earth Day and get on board
Find out what local schools are doing for Earth Day and offer to help
Sponsor a community clean-up day in a high-visibility area and wear T-shirts with your practice’s name in big bold print on the back
Send out an e-newsletter advertising that any patient who wears green the week of Earth Day will get a special gift – and give away bedding plants or pet rocks
Create a “How to Save Your Smile and the Earth” article that reviews the green things your office does, and submit the article to local newspapers and blogs
Get creative this Earth Day and make a mint in the process.

An interesting read… The Wellness Factor.

Evora Plus™: The First Probiotic Mints for Complete Oral Care

Fresh breath. White teeth. Balanced oral health.

Evora Plus™ mints for adults and EvoraKids™ chews for children add good bacteria and a low level of hydrogen peroxide to the oral environment for fresher breath, a healthier mouth, and whiter teeth. Twenty-five years of research went into the making of this innovative product, developed by Jeffrey Hillman, DMD, PhD.

The company’s website states: “Within 30 days of using EvoraPlus twice daily, the natural healthy oral balance of good bacteria will be greatly restored and you will begin to notice a whiter, brighter smile and long-lasting fresh breath.”

How it Works

For some time, scientists have known that probiotics promote good digestive health. Yogurt, a food rich with probiotic power, is often recommended for patients with stomach aches and digestion issues. The same philosophy backs the effectiveness of Evora.

Good oral bacteria “crowd out” bad bacteria to promote a positive balance in the mouth. In addition, by reducing bad bacteria, Evora mints reduce potential for foul breath caused by bad bacteria. Good bacteria actually bond to teeth and gums, and even below the gum line for lasting results. This is unlike traditional mouthwashes that kill all bacteria in the mouth, not just the bad bacteria.

As for teeth whitening, Evora’s by product is a small amount of hydrogen peroxide, which is known to naturally brighten tooth enamel without causing sensitivity or irritation to oral tissues.

Each Evora mint has one calorie, and patients are instructed to use two mints each day for best results. Today, Evora is sold at these retail stores: Albertson’s, A&P, Kerr Drug, Walgreen’s, Sweetbay, Heartland, and Pathmark. Online, consumers can purchase Evora through ActiveForever.com, CVS.com, Drugstore.com, ProHealth.com, Quick2You.com, Swansonvitamins.com, Target.com, and Walgreens.com.

Visit Evora online at http://www.evoraplus.com/.

A guide to toothache and how to deal with it

What is toothache?
Toothache is a painful condition in your jaw and facial area. It usually occurs when a nerve in the tooth root is inflamed or irritated. It could also occur because of tooth decay, infection or even tooth loss.
Types of toothache
Everybody doesn’t experience the same kind of toothache, and very often a toothache can be a sign of a much deeper condition. The severity of the toothache may also vary, in terms of the sensitivity of the tooth and the pain intensity. No matter what type of toothache you suffer from, you should get it evaluated by a dentist.

Sharp tooth pain or sensitivity
When your teeth become extremely sensitive to cold, causing a sharp pain when you eat or drink very cold items, it could be due to loss of tooth enamel. This deterioration of tooth enamel occurs because of excessive brushing, as a natural part of the aging process, recession of the gums or the deterioration of a tooth cavity. If your teeth are overly sensitive to heat, this could be because of dental cavities, abscesses or a severely decayed tooth.

Chronic toothache
A consistently aching tooth can be the result of nerve damage. The nerves of the tooth may get damaged because of severe dental decay or because of excessive grinding of the teeth. It could also occur because of any kind of injury or trauma to the tooth.

Excruciating pain
Intense, agonizing pain, including a throbbing sensation, is most often because of an abscess or dental infection. Very often, when the pain is this intense, there is also a noticeable swelling in the face.

Pain while eating
If you experience pain while eating, it could be either due to a crack in the tooth or dental decay.

Pain the in back of the jaw
If the pain is mainly concentrated in the back of the jaw, it could be due to impacted back molars. People, who have a habit of grinding their teeth or TMD can also experience jaw pain.

Serious health issues
A little known fact is that a toothache can often be a symptom of serious underlying health problems. Studies have shown that a pain on the left side of the jaw can be the first sign of a heart attack. Your toothache can also be a sign of sinus infection. Inflammation of the jaw, and pain while eating can be one of the earliest symptoms of a maxillofacial condition called temporomandibular joint disorder (TMD).

Symptoms of toothache
The symptoms of toothache can manifest themselves suddenly, and can range from simple discomfort in your tooth to high intensity pain. At one end, you could have a mild irritation, while on the other, you may experience intense pain in your jaw, head and ear. The pain may worsen when you eat or drink, especially if what you are consuming is very hot or cold. Toothache can quickly spread to the entire jaw area, making it tender and sensitive. You may notice that the pain worsens when you lie down, because of the increased pressure on the tooth.

Generally, you will notice:

Sensitivity to hot or cold foods and drinks.
Bleeding in the gums or around the tooth.
Swelling of the tissue around the tooth.
Swelling of the jaw.
Pain while eating.
Causes of toothache
Dental caries.
Tooth cavities.
Tiny tooth fracture.
Exposed root of the tooth – this can happen when the gums recede, exposing the root.
Sensitivity – this can also be caused by gum recession, which leaves the sensitive areas of the teeth exposed.
Dental treatment – sometimes after a dental treatment, the tooth pulp may become irritated, leading to pain.
A periodontal abscess in the gum.
Acute ulcerative gingivitis, which causes ulcers on the gums.
Sinusitis, which can lead to pain in the upper jaw.
Inflamed gums around a tooth that a just beginning to emerge, like a wisdom tooth.
Temporomandibular joint injury – this is the joint that connects the jaw to the skull.
Teething – when babies and children begin to sprout new teeth, this can cause toothache.
Diagnosis of toothache...isn't it obvious?
Even if the toothache you are suffering from is mild, you must get it checked by a dentist immediately. Very often, pain in a tooth has got nothing to do with that tooth. The pain could easily be in another tooth, or in some cases, the other jaw. Your dentist will conduct an examination of your teeth, and look for signs of any damage to the tooth or inflammation. He may also look for sensitivity to heat. If your dentist suspects dental decay, jaw bone injuries, or minute fractures in your teeth, he will take an X-ray before he can confirm these conditions.

Treatment for toothache
Fortunately, these days a toothache cure doesn’t have to involve the extraction of the tooth. Depending on the cause of your toothache, your dentist will use different methods to treat it:

Tooth decay
Dental decay resulting from poor dental hygiene practices and a faulty diet can lead to toothache. Treatment will involve removing the decayed portion of the tooth, and replacing it with a composite or amalgam filling. When a number of tooth surfaces are decayed, fillings may not be sufficient to treat the problem, and your dentist may suggest dental crowns as a solution.

Loose filling
If an earlier filling breaks or becomes loose, your dentist will remove the filling, clean out any decay that has been formed, and replace it with a new filling.

Pulpitis
When your tooth pulp becomes infected, your dentist may suggest root canal treatment. This procedure can be performed by your dentist or an endodontist. He will remove the decayed pulp and fill the empty space with a paste. Then he will cover the tooth with a dental crown.

Gum recession
Receding of the gums away from the teeth can be reversed using a gum graft procedure. Your dentist will either graft tissue that has been removed from the palate, use synthetic gum tissue, or a sliding graft in which the root is covered by gum tissue from the neighboring areas.

Loss of enamel
Tooth enamel can be lost either due to an improper diet or aggressive brushing. Desensitizers can treat the sensitivity and sharp pain that results from the loss of tooth enamel.

Tooth sensitivity
Your dentist may apply desensitizers, which require frequent reapplication to treat sensitivity. He may also prescribe desensitizers to be used at home.

Abrasion
Your teeth can be exposed to all kinds of wear and tear in the form of minute chips and cracks, irregular teeth and loss of enamel. If there are uneven surfaces, your dentist may fill these with composite fillings. When there is extreme wear and tear, he may suggest dental crowns or veneers.

Infections
Infections can result in abscesses, and these are caused by dental decay or injury. Your dentist may prescribe a course of antibiotics and painkillers, and will suggest root canal treatment after the pain has subsided. The tooth that has become weak can be restored with a dental crown.

Teeth grinding
People who are in the habit of grinding teeth can experience tooth pain as a result of minute fractures, or even a shift in the position of the teeth. Your dentist may prescribe mouth guards to use while sleeping to protect your teeth.

Tooth fracture
Fractures in the tooth can result from abrasion, trauma or as a result of teeth grinding. A dentist will treat a fracture using a protective covering, like a dental veneer or crown.

Wisdom teeth
Impacted wisdom teeth (back molars that don’t surface) can result in crowding of the teeth, and can shift the other teeth. Your dentist may have to perform oral surgery, and remove the impacted wisdom teeth.

If these methods don’t help ease the pain, the tooth may have to be extracted. In cases where the tooth has become wedged between the jaw and another tooth, tooth extraction may be required.

First aid for toothache
To handle the pain while you wait to see the dentist, take paracetamol or ibuprofen. However, if you have a history of liver or kidney problems or peptic ulcers, or suffer from asthma, ibuprofen is not recommended for you. Also, avoid very hot and cold foods and drinks, because they worsen the problem.

Prevention is better than cure...
Toothache can easily be prevented by maintaining good dental hygiene practices.

Cut down the amount of sugar in your diet. Excessively sweet foods and drinks should be consumed only occasionally.
Follow a twice-a-day brushing routine, using a fluoride-containing toothpaste. Remember to brush your gums and tongue.
Use dental floss to clean between your teeth, and a mouthwash to rinse your mouth.
Avoid smoking
Get your teeth check regularly, and have them cleaned at least once a year by a dental hygienist.

How to Get Rid of a Toothache

I've had a mysterious hole in one of my molars for oh, about four years now. I've been without dental insurance for oh, about a million and a half years now, so I've yet to find out whether that hole is something I should be worried about. Luckily, said molar is not experiencing any pain or aches, so I've decided that the state of my dental health does not get a place on my "to worry about" list.

Toothaches are nasty things that can make it hard for you to eat, think, talk, sleep, and generally function. The cause of toothache can be varied (see the left sidebar), but the ultimate cure for a toothache is usually the same: go to a dentist. Lucky for tooth-achy you, though, there are lots of home remedies for toothache pain, and we offer those for your perusal here.


Toothache Remedies

Toothache RemediesSchedule an appointment with a dentist as soon as your toothache turns from twinge to pain. Most home toothache remedies are aimed at getting rid of toothache pain, not solving the problem at the root of the toothache. Chances are, if you have a painful toothache, you have a serious dental problem that only a dentist can get rid of with medical treatment. Therefore, it's in your best interest to spare yourself the painful experience, and possible extra medical expenses, and not wait until the toothache becomes unbearable to see a dentist.
Numb and soothe the pain of your toothache with gentle heat and cold. Hold a hot or cold pack, or ice cubes wrapped in a towel, to your jaw next to your aching tooth. Sip hot soup broth, hot tea, or eat some ice cream. Or, if your toothache is sensitive to extreme heat and cold, sip on lukewarm liquids, like tea, cocoa, or lemon water.
Don't eat or drink foods that will make your toothache pain worse. This can mean staying away from hot and/or cold foods (see above), or foods with a lot of sugar and spices, or even foods that need to be chewed thoroughly (like meat, fibrous fruits and vegetables, etc.). Stick to liquids and soft foods at a soothing temperature to alleviate some of your toothache pain.

Use aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) to get rid of toothache pain. Taking the recommended dose of aspiring, aleve, ibuprofen, or other NSAIDS may be enough to relieve the pain from you toothache until you can get to a dentist. If this isn't working, however, you can try crushing an aspirin or baby aspirin to a fine power, adding just enough water to make a thick paste, and applying this paste to the aching tooth and surrounding gum area for added pain relief.
Clove oil is a natural oil used in dentistry for its analgesic (pain relief) properties. You can purchase clove oil over the counter at pharmacies for topical toothache relief at home. Dab a small amount of clove oil on a cotton swab and hold the oil directly to the painful tooth or gum area until the oil has had time to absorb into the affected area. Clove oil has an unpleasant flavor, so it's probably wise to keep the oil from touching your tongue.
Dental Toothache Treatments
Once you see a dentist to get rid of your toothache, there are quite a few possibilities for treatment, depending on the cause of your toothache, of course. Fillings, drilling, extraction, root canals, and crowning are all procedures used to remove tooth decay and seal the tooth off from further infection and decay.

Your dentist may also give you an initial injection to relieve the pain of the toothache, and provide a prescription antibiotic to treat infection, swelling, and fever resulting from the toothache. Keep in mind that dental diagnoses can vary widely from dentist to dentist, so being as specific as possible about your toothache pain and symptoms, as well as your diet and hygiene habits, will help you get the most effective dental treatment possible.

Norway Bans Dental Amalgam

We mentioned in the last post that dental amalgam is one of the best direct restorative material as of today. However, we also posted here, and here, the possible dangers presented by one of the main ingredients of the amalgam: mercury. Now we’re going to update you on new information regarding this subject.

Norway has taken a stand against dental amalgam. They have totally banned its use across the country as they reasoned that safer alternatives are available. This not only includes dental fillings but also measuring instruments. They consider the mercury as “…among the most dangerous environmental toxins. Satisfactory alternatives to mercury in products are available, and it is therefore fitting to introduce a ban.”

Will the world soon follow suit or will this be disproved? Watch this blog for more details soon.

A Quick View on the Concept of Teeth Whitening System

When you think about whitening system for the teeth, you may want to consider all important factors like the time frame that you are willing to allot in the process, temperament and, of course, your budget. There are various options that people have in terms of teeth whitening system. These processes are becoming more and more popular worldwide that even in the field of cosmetic dentistry, one of the most favored procedures that people seek to have involves teeth whitening.

There are many kinds of teeth whitening system. The main thing that you have to remember is that the main ingredient that all these products and processes use is known as peroxide. This element acts like a bleaching agent that can help you get rid of the discoloration on the teeth. Different products and procedures contain different percentage of peroxide. The higher the amount of peroxide that is used to whiten your teeth, the faster the outcome would be seen, but this may also mean that the price, which you have to pay, is also higher.

Originally, whitening can help a person restore the original color of their teeth. In this case, you can opt to use any product, such as toothpaste, to help you whiten your teeth. These days, whitening can also refer to bleaching. The term is used because it sounds better and not as intimidating as bleaching. As per the FDA, bleaching is applicable in cases when a person asks to whiten their teeth beyond their natural color.

After you have gone through your preferred method of bleaching or teeth whitening system, you will likely see positive results after some days or weeks, depending on the amount of peroxide that was used in the process. This is not a permanent solution to the problem though, you have to back this up with maintenance and you should still keep in touch with the dentist for a touch-up.

In choosing which kind of teeth whitening system is right for you, you may want to consult a professional about this so that they can recommend you the best product according to the condition of your teeth