 Frequently Asked Questions
- What is gum disease?
- What is a root canal?
- What is a crown?
- What is a bridge?
- When should a tooth be extracted?
- Won't it be cheaper to just take out the tooth?
- How do you do a filling?
- What is tooth decay?
- Do you use white or silver fillings?
- Should I have all of the silver amalgam fillings in my
mouth replaced?
- Is amalgam dangerous?
- Why do I need to come in for cleanings/recare/maintenance?
- What are crown buildups/post and cores/cast cores?
- Why should I save my teeth?
- Why can't you just take them all out and give me
dentures?
- If I have dentures, I'll never need to come back.
Right?
- Why don't you accept managed care plans?
- What is periodontal surgery?
- What is endodontic surgery?
- Do you extract wisdom teeth?
- Do you sedate patients?
- What is nitrous oxide?
- My tooth that recently had a filling placed is
sensitive. What should I do?
- I don't like my smile. What can I do?
- My teeth are yellow or look old. Can you fix that?
- My teeth hurt when I chew. Why?
- My tooth is sensitive to hot temperatures. What can I
do?
- I broke a piece off of my tooth. Can it be saved?
- My crown/bridge came off. Should I be worried?
- What is an implant?
- What are sealants?
- Are the home tooth whitening kits you see at the store
any good?
- When should I bring my child to the dentist for the
first time?
- Can smoking affect my dental health?
- What type of oral hygiene products should I use?
- How should I care for my baby's
teeth?
Periodontal disease is a progressive,
chronic, often painless disease of the mouth, which is caused by a bacterial
infection of the gum tissue. It is not a "normal part of getting
old..."
Periodontal disease is the number one cause of adult tooth loss in the United
States.
The symptoms or warning signs of periodontal disease include:
- Swollen gums
- Redness
- Tender gums
- Gums that bleed easily
- Bleeding when brushing
- Pus that comes from between the teeth and gums
- Gums that have pulled away from your teeth
- Halitosis [bad breath]
- Persistent bad taste in your mouth
- Loosening or loss of teeth
- Teeth that are drifting or separating
- Changes in the fit of partial dentures
- Changes in the way that your teeth fit together when
biting
It is possible to have periodontal disease without any
warning signs, therefore it is important to visit your dentist regularly to
prevent periodontal disease from becoming severe.
For more information on periodontal disease and its treatment, click
here.
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| A root canal is a procedure, technically
called Endodontic
Treatment, that allows a severely damaged
tooth to be saved.
The procedure basically follows these steps:
- The tooth and surrounding area are anesthetized.
- An opening is made in the top or back of the tooth
into the pulp chamber of the tooth.
- The pulp chamber is carefully cleaned and shaped.
- The pulp chamber is sealed and filled to help prevent
future symptoms.
- The opening is sealed with a temporary filling until a
final restoration can be placed on the tooth.
For more information and a more detailed description,
see the Endodontic
Treatment page.
|
| Crowns
are a restorative option that allows our dentists, working with our dental
laboratory, to replace and replicate tooth structure while simultaneously
protecting the remaining tooth structure. Crowns, also known as
"caps," are a type of restoration that covers all or almost all of the
tooth. This allows a tooth to be restored to proper contours and shape, while
simultaneously protecting the tooth from fracture. More complete information may
be found in the Restorative
Dentistry
section of our site. |
| A fixed partial denture, or bridge,
is a treatment option which allows the replacement of one or more missing teeth.
A bridge is a non-removable restoration, which means that the bridge is cemented
into the mouth. A bridge is a complex precision restoration, and its uses are
occasionally limited by the condition of the patient’s oral health. In
relatively simple terms, a bridge is one or more false teeth attached to crowns
on either side of the empty space[s]. The Restorative
Dentistry page has more information on
bridges. |
| Extraction of severely damaged teeth may
be necessary in certain situations. If insufficient tooth structure is remaining
for the placement of a restoration or an unfavorable restorative relationship
exists in your mouth, extraction may be recommended as a treatment option.
Obviously, extraction of a tooth is a terminal, non-reversible treatment option
and is recommended only when absolutely necessary. Replacement of the extracted
tooth is highly desirable and may be required in many circumstances to prevent
unfavorable shifting of the remaining teeth. The alternative treatment to
extraction is non-treatment, which can lead to acute pain, infection in the
gums, bone or jaw that may spread to other portions of the mouth, face or body,
severe bone loss, and the potential loss of the affected tooth as well as
adjacent teeth.
Circumstances that may require extraction of a tooth
include, but are not limited to: severe bone loss due to periodontal disease;
tooth decay that extends between the roots of a tooth, weakening the tooth;
vertical or horizontal root fracture; traumatic injury to the tooth; and
internal or external resorption of a root.
|
| This question often gets asked when a
patient is informed that in order to "save" one of their teeth,
extensive treatment will be required. This often includes endodontic
[root canal] treatment, a crown buildup,
and a crown. The reasons that a tooth may require this type of extensive
treatment vary, but many times a tooth has had multiple restorations placed over
the years, and the pulp [nerve] tissue has become traumatized and died.
There are basically two answers to this question:
- YES, it is cheaper to take out the tooth in the short
term, avoiding the treatment costs associated with the retention of the tooth
for the time being.
- NO, it is more expensive to take out the tooth in the
long term. By removing the tooth the delicate balances present in your mouth are
upset, leading to teeth that tip forward and erupt into the empty space. This
complicates further treatment, possibly requiring more expensive treatment to
replace the missing tooth. In general, the placement of a bridge to
replace the missing tooth/teeth is more expensive than the root canal/crown
option, and the placement of a removable partial denture may approach or surpass
the expense of retaining the tooth.
The decision to remove a tooth in the presence of
restorative options is a highly personal one, and should not be made lightly, as
it is an irreversible treatment option. If
you have a question that you would like answered, please send them to us in our Question
& Answer form.
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| The first step in placing a filling is the
use of local anesthetic to numb the tooth, allowing comfortable restoration of
the tooth. After adequate anesthesia is achieved, the damaged portion of the
tooth is removed with a high-speed handpiece ["the drill"] along with
any defective restoration that may be associated with the damaged tooth
structure. Teeth may be damaged in several ways. The most common source of tooth
structure destruction is dental caries, or tooth decay. After the
all damaged areas have been removed, the tooth is restored to proper form and
function with composite resin using an acid-etch bonding technique. |
What is tooth decay?
| Tooth decay (the technical term is "dental
caries") is a result of bacteria found in
your mouth. What happens is that the bacteria eat the sugars that are released
from the foods that you consume, and the waste products of the bacteria consist
of acidic compounds. These acids destroy the tooth structure, weakening it, and
allowing the bacteria to spread to deeper and deeper parts of the tooth.
If the decayed portions are not removed and restored,
the decay will grow, eventually reaching the "nerve" of the tooth.
When this occurs, you are very likely to get an abscess, which is a bacterial
infection in and around your tooth and bone. If you get an abscess, a root
canal will be required to remove the
infection and retain the tooth.
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| We use "white" (composite
resin) fillings where appropriate. If a
restoration is too large for a composite restoration, it is too large for an
amalgam ["silver"] restoration as well. We choose to use composite
restorations for several reasons. One, they look a whole lot better than amalgam
fillings, and our patients really appreciate that. Two, the technology of
composite resin has advanced to the point that a skilled and knowledgeable
dentist can place a resin restoration with the full confidence that it will be
as durable as an amalgam filling. Three, the edge, or margin, of the filling is
bonded to the tooth structure, eliminating leakage around the filling. Amalgam
fillings do not bond to tooth structure. This bonding helps to prevent a
recurrence of decay. |
| It is the opinion of most dentist that amalgam fillings should only be replaced if they are no longer
functional for the patient. This means that if an amalgam is intact, able to be
kept free of plaque, and allows proper chewing, there is no reason to replace
the amalgam filling at this time. |
| ABSOLUTELY NOT. There is NO evidence that
has been confirmed by scientific studies that suggests, let alone proves, that
there is a health risk associated with amalgam restorations. If a dentist is
recommending that you have all of your amalgams removed for health reasons, such
as "curing" Chronic Fatigue Syndrome, or Multiple Sclerosis, seek a
second and third opinion. There are some dentists that have suggested that they
can "cure" all manner of incurable disorders through the removal of
amalgam restorations. In general, these are dentists who are preying on the
desperation of these patients. |
| A key factor in the long-term success of
your dental treatment is the maintenance of your dental health. The most
successful methods of maintaining your oral health are through the use of
effective daily oral hygiene [including brushing and flossing] as well as
regularly scheduled professional cleanings and examinations.
The specific interval of re-care is determined on a
patient-by-patient basis, and may change over time, depending on your specific
treatment needs. Every patient [even denture patients] needs to be seen at least
once a year, and the vast majority of patients should make re-care appointments
with their dentist two, three or four times a year. Believe it or not, there is
no scientific basis for twice-a-year cleanings. This convention was popularized
by a toothpaste advertisement early this century that stated "Use [brand
name] toothpaste twice a day, and see your dentist twice a year."
Scientific studies have shown that calculus [tartar] begins to accumulate on
tooth surfaces between 90 and 120 after professional cleaning. This is true even
in the case of patients that maintain regular oral hygiene. Some patients
accumulate calculus even faster than 90 days! It stands to reason that many
patients would benefit from professional cleanings that are more frequent than
every six months [especially those that don’t floss daily!].
Just as regular preventive maintenance will enhance the
longevity and value of an automobile, your oral health will be enhanced and the
maximum value for your investment of time and effort will be realized with
proper care.
Unfortunately, even the best planned and executed
dental treatment will ultimately fail without this maintenance care. The
potential adverse consequences of failing to maintain your oral health with
adequate home care and regular maintenance appointments include tooth decay
[including cervical decay on the margins of crowns and fillings], progression of
periodontal disease,
bone loss, tooth loss, pain and/or infection.
If I have dentures, I'll never need to go
to FAQ
|
| Obviously, the decision to keep one’s
teeth is a highly personal one, and we respect this. We look upon the education
of our patients on the benefits of retaining their natural teeth as one of the
most important tasks that we perform.
It is important to retain your teeth for several
reasons, not the least of which is the ability to eat properly and comfortably.
A nutritional consultant would be the first to tell you that the teeth and mouth
are the first part of the digestive tract, and are just as important to proper
nutrition as any other part. You see, without the ability to chew, it is
difficult to digest certain important foods, especially those high in fiber. In
fact, many people that are missing several [or many] teeth or who wear dentures
tend to avoid high fiber and other difficult to eat foods, leading to
nutritional deficiencies.
There are many other reasons to keep your teeth, of
course. When you lose a tooth, you also lose a portion the bone that was
surrounding it. This bone loss can lead to future problems with the ability to
wear a denture or having an implant placed to replace a missing tooth or teeth.
The loss of a tooth without having that tooth replaced in a timely manner will
result in the shifting of the remaining teeth [both those above and behind the
missing tooth] to attempt to fill the empty space. This tooth movement can lead
to periodontal [gum] problems as well as possible difficulties in the future
restoration of the empty space.
Some people may say to themselves "Well, I’m
going to lose all of my teeth anyway. Why should I care what happens to the
bone?" A big problem with the early loss of teeth and placement of dentures
is that the bone supporting the denture will gradually disappear without the
presence of teeth. This leads to a "loosening" of the denture, and the
need for surgery to augment the remaining bone to allow the patient to continue
wearing a denture. Therefore, it is imperative that patients, even those
determined to be denture patients, retain their teeth as long as possible to
preserve the bone levels of their jaws.
|
| This is a simple question. We can, of
course, take out every tooth in your mouth, healthy or otherwise, and make a
denture for you. But that might be a very stupid thing to do. There are some
patients that simply have no option other than the extraction of their remaining
teeth, but thankfully, they are few and far between in this day and age. The
extraction of large numbers of otherwise healthy or restorable teeth presents an
ethical issue to the dentist, and must be considered very carefully before
proceeding.
You will need to examine your motivations for wanting
all of your teeth extracted. If you are trying to save money, you will find that
dentures are not inexpensive, and all of the extractions will add up in a hurry.
Add to that the expense of denture maintenance, and you are talking about a
great deal of money. If you are afraid of the dentist, and you just don’t want
to come back, you need to know that dentures require adjustments, regular
examination, and laboratory procedures to maintain proper fit and function. If
you feel that you are just going to lose all of your teeth in the future [with
this attitude you are probably right…] you need to read the section on Why
should I save my teeth? to learn about bone
loss and the preservation of bone.
|
| Wrong. It is very important that denture
patients be examined on a regular basis, at least once a year, to evaluate their
oral health. Without routine examination, it is impossible to diagnose and treat
any number of oral conditions, both common and rare, that a denture patient may
present. The most common problem is a persistent, chronic fungal infection under
a denture. Many times the patient is unaware of the infection due to the slow
growing nature of the organism. Much more rare, but far more serious, is the
occurrence of cancer in the oral cavity. According to the American Cancer
Society, between 3 and 3.4% of all cancers diagnosed in the United States in any
given year will be cancer of the oropharyngeal area. Unfortunately, oral cancer
has a relatively low survival rate over five years of 31 to 54%. Even more
distressing is that approximately 18% of oral cancer patients will develop
secondary oral cancer lesions within one year of treatment [this rate was nearly
doubled for patients that did not quit smoking after diagnosis]. Nearly 20
percent of the patients with oral cancer will develop another cancerous lesion
in the upper respiratory tract, upper gastrointestinal tract, or breast. One
reason that oral cancer is so lethal is that it is often not detected in an
early stage due to the patient not receiving routine dental care.
The bone that remains in the jaws after teeth are
extracted is the foundation upon which the denture is supported. Over time, this
bone gradually goes away without the stimulation that teeth provide. As this
bone changes [or "remodels"] the dentures do not fit as well as they
once did, and subsequently, they begin to move around in the mouth. This creates
irritations on the gum tissue that is underneath the denture. These irritations
can cause outgrowths of tissue, as the gums attempt to protect themselves, and
these growths can become traumatized and raw. In rare cases, these raw and
irritated areas may become cancerous.
|
There are several procedures that have
been gathered under the title of "periodontal surgery." These include:
- Crown Lengthening surgery:
This is a procedure performed to increase the amount of tooth structure
available above the gum line for restorative procedures. Generally, a small
incision is made to expose the bone supporting the tooth and a small amount of
this bone is removed. A definitive restoration may now be placed on the tooth.
- Gingivectomy:
Excess gum tissue is surgically removed to reduce the depth of the periodontal
pocket. This surgery is only an option when the gum disease does not involve
destruction of the bone around the tooth.
- "Flap Surgery":
This is the procedure most commonly associated with gum surgery. It is used in
instances when there has been significant bone destruction, or persistent
pocketing that is resistant to treatment. The gum tissue is "flapped"
away from the teeth and gums, allowing the dentist to surgically recontour the
bone, reducing pocket depth. The end result of the surgery is a more easily
cleaned area, but there is more root showing, leading some patients to state
that they dislike their "long teeth."
|
| Endodontic surgery is a group of
procedures that are occasionally required, in conjunction with root
canal treatment, to attempt to save a damaged
tooth. The most common type of endodontic surgical procedure is the apicoectomy.
This is a procedure that is performed to remove a chronic, or persistent,
infection or inflammation from the end of the root of a tooth. The procedure
involves the making of a small incision in the gums above the tooth, and the
removal of the infected tissue from the tip of the root. Generally, a small
filling is placed in the tip of the root to prevent re-infection by sealing the
canal. Local anesthetics are used for the procedure, just like when a filling is
placed, and the patient is usually able to return to normal activities within
one or two days. |
| Sometimes. If we feel that the patient’s
comfort will be enhanced by treatment by an oral surgeon, we will refer that
patient to them. However, there are plenty of occasions that we extract wisdom
teeth in our office. |
| Nitrous oxide,
also known as laughing gas, is a great way for us to help anxious patients
relax. It is also very helpful for fearful children. There are very few adverse
reactions associated with laughing gas, and patients don’t have any lasting
effects after treatment. |
| Call your dentist. It is very likely that
your filling is just a little too high in your bite and has become slightly
traumatized. Do not delay in having your tooth evaluated, as a small problem
such as a tooth that needs a bite adjustment can become a large problem if not
fixed quickly. It is possible to traumatize the pulp [or nerve] of a tooth
sufficiently that it dies inside the tooth, leading to possible infection and
pain.
If you had a filling placed that was fairly deep, the
pulp may have already been sufficiently traumatized by the decay that attacked
the tooth to kill the pulp. If your tooth has been subjected to repeated cycles
of decay, filling, decay, filling, etc. the stress may have been too much for
the pulp, and it may be dying. On occasion, a pulp will become symptomatic and
require a root canal for no discernable reason.
Before you get too worried, however, the vast majority
of sensitive teeth that have recently received a filling require only a bite
adjustment, and occasionally a short course of anti-inflammatory medication.
|
| Give us a call! We’d love to do a
"Smile Evaluation" and let you know what your options are for making
your smile more appealing! Using advanced techniques in cosmetic
dentistry, we can improve your smile in as few
as one or two appointments. You can even get "instant orthodontics"
with porcelain veneers. |
| Absolutely! Some of the things that we may
be able to do include tooth whitening if you don’t like the color, or we can
even place porcelain veneers to change the size, shape and color of your teeth
at once. If you are happy with your teeth, but just want a whiter, more youthful
appearance, our new one-visit
in-office tooth whitening is just the thing for
you. If you are interested in improving your smile, make an appointment for a
smile consultation today! |
| There are many reasons that your teeth may
hurt during chewing.
If you have had a filling placed recently, you should
be seen by your dentist to have your bite evaluated. If your bite is not
correct, you can traumatize the tissues inside your teeth and in the surrounding
bone.
Other common reasons for pain on chewing include a
fractured tooth, an abscess,
advanced periodontal disease,
occlusal [bite] trauma and pulpal
trauma. On occasion, a sinus infection can
mimic a toothache in the back upper teeth.
If you are experiencing pain on chewing, you should
contact your dentist at once to be evaluated. It is important that you receive
treatment as soon as possible to prevent further pain, infection or possible
tooth loss.
|
| See you dentist immediately!!! Sensitivity
to heat is a symptom of pulpal necrosis, which is when the nerve of the tooth is
dying. You may require a root canal to treat the tooth. Without treatment, it is
possible that you will get an abscess in the bone above the tooth, which can be
very painful. Prompt diagnosis by a dentist is essential for the relief of your
pain. |
| In most cases, a fractured tooth may be
successfully restored. There are a variety of ways to repair a damaged tooth,
the proper selection of which depends on the location of the tooth and the
severity of the damage. The options include composite
resin fillings, porcelain
veneers, inlays,
onlays,
and crowns. |
| Absolutely. If the crown or bridge is not
replaced quickly enough, the surrounding teeth may shift, resulting in the
inability to replace the restoration. Now that statement was made under a very
large assumption, that being that the restoration is, in fact, structurally
sound and able to be replaced. It is fairly common that a crown or bridge that
dislodges can be re-cemented with few complications, however this is not always
the case. Sometimes a restoration pops out because of a significant problem with
the tooth or teeth, such as decay, periodontal [gum] disease, or fracture of a
tooth. In these cases, you may require a new restoration to be fabricated.
Additionally, even if the tooth or teeth are in good shape, if the crown or
bridge is damaged in any way, it is very unlikely that it can be re-cemented. |
| An implant is a piece of metal that is
surgically placed in the area of a missing tooth. It is made of titanium, which
allows it to attach to the bone of your jaw. The implant can then be used as an
artificial root to place a new crown
or bridge on. Implants can also be used to
anchor a denture in place, providing a more stable chewing experience. |
| Sealants are a protective plastic coating
placed on the chewing surface of a back tooth to help prevent tooth decay. They
work by sealing off the deepest parts of the grooves of the teeth, preventing
decay-causing bacteria from being able to destroy the tooth. |
| That depends on the result that you are
trying to get. If a predictable, uniform result with a minimum of symptoms is
your goal, then a store-bought whitening kit will not be adequate. Although the
chemicals used in the kits are similar to some of the dentist-prescribed
systems, they lack the key component of those kits, a custom fabricated tray.
Without the custom fit tray, the whitening gel will wash out of the trays in a
non-uniform manner, creating a "blotchy" result and gum irritation.
One of the advantages of the dentist-prescribed systems
includes the ability for the dentist to choose a system that is best for your
teeth. There are now systems that may be worn overnight, ones that may be worn
for only one hour a day, and even systems that can whiten your teeth at the
office in as little as one hour!
You can find more information about tooth whitening
options in the Cosmetic
Dentistry section of the site.
|
| It is a good idea to bring your child to
the dentist as soon as all twenty of his/her primary teeth. This allows the
dentist to check for any problems, helping to prevent large problems from
occurring. In general, the earlier a child visits the dentist, the less likely
he or she is to develop a fear of the dental office. |
Absolutely! There have been various
studies that have confirmed the adverse effects smoking may have on the oral
cavity, including:
- There has been a 100% correlation reported between
smoking and gum disease
[ranging from gingivitis to advanced periodontitis]. Smoking has been shown to
decrease the success rate of periodontal treatment in our Soft
Tissue Management program by approximately 10
to 20 percent.
- Stained, yellow teeth due to the
"tar" present in cigarette, pipe and cigar smoke.
- Halitosis, or bad breath, is a common side
effect of smoking.
- Increased risk of oropharyngeal [mouth and
throat] cancers. According to the American Cancer Society, between 3 and
3.4% of all cancers diagnosed in the United States in any given year will be
cancer of the oropharyngeal area. Unfortunately, oral cancer has a relatively
low survival rate over five years of 31 to 54%. Even more distressing is that
approximately 18% of oral cancer patients will develop secondary oral cancer
lesions within one year of treatment [this rate was nearly doubled for patients
that did not quit smoking after diagnosis]. Nearly 20 percent of the patients
with oral cancer will develop another cancerous lesion in the upper respiratory
tract, upper gastrointestinal tract, or breast.
- Decreased healing within the oral cavity. This
can result in complications following treatment for gum disease or extractions.
- Dry mouth, or xerostomia, is another common
complaint from smokers. In addition to being uncomfortable, xerostomia can
increase the risk for tooth decay along the gumline, resulting in unsightly
brown areas and a need for fillings to be placed.
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