Patient Education

Plaque is an insidious substance—a colorless, sticky film—that blankets your teeth and creates an environment in which bacteria erode tooth enamel, cause gum irritation, infection in inner structures such as pulp and the roots, and in extreme cases, tooth loss.

Some of the biggest culprits causing plaque are foods rich in sugar and carbohydrates, including soda beverages, some juices, candy and many kinds of pasta, breads and cereals.

Plaque also can attack fillings and other restorations in your mouth, which can lead to more costly treatment down the road.

Plaque is the main cause of tooth decay.  It can also cause your gums to become irritated, inflamed, and bleed. Over time, the plaque underneath your gums may cause periodontal disease, which can lead to bone loss and eventual tooth loss.

Inside your teeth, decay can gradually destroy the inner layer, or dentin.  It can also destroy the pulp, which contains blood vessels, nerves and other tissues, as well as the root. 

Periodontal disease is advanced gum disease. This serious condition occurs when the structures that support your teeth—the gums and bone—break down from the infection.  Pain, hypersensitivity and bleeding are some of the signs of periodontal disease.

Simple Preventative Measures

The two best defenses against tooth decay and gum disease are a healthy, well-balanced diet and good oral hygiene, including daily brushing with fluoride toothpaste, flossing and rinsing. Most public drinking water contains fluoride, but if you are unsure of your water supply, then use a good quality mouth rinse containing fluoride.

A good way to help your oral health between brushing is chewing sugarless gum; this stimulates your body's production of saliva, a powerful chemical that actually neutralizes plaque formation and rinses decay-causing food particles and debris from your mouth.

In some cases, our office can prescribe anti-cavity rinses or apply special anti-cavity varnishes or sealants to help fight decay.

Brushing is the most effective method for removing harmful plaque from your teeth and gums. Getting the debris off your teeth and gums in a timely manner prevents bacteria in the food you eat from turning into harmful, cavity causing acids.

Most dentists agree that brushing three times a day is the minimum; if you use a fluoride toothpaste in the morning and before bed at night, you can get away without using toothpaste during the middle of the day. A simple brushing with plain water or rinsing your mouth with water for 30 seconds after lunch will generally do the job.

Brushing techniques

Since everyone's teeth are different, see me first before choosing a brushing technique. Here are some popular techniques that work:

• Use a circular motion to brush only two or three teeth at a time, gradually covering the entire mouth.
• Place your toothbrush next to your teeth at a 45-degree angle and gently brush in a circular motion, not up and down. This kind of motion wears down your tooth structure and can lead to receding gums, or expose the root of your tooth. You should brush all surfaces of your teeth - front, back, top, and between other teeth, rocking the brush back and forth gently to remove any plaque growing under the gum.
• Don't forget the other surfaces of your mouth that are covered in bacteria - including the gums, the roof and floor of your mouth, and most importantly, your tongue. Brushing your tongue not only removes trapped bacteria and other disease-causing germs, but it also freshens your breath.
• Remember to replace your brush when the bristles begin to spread because a worn toothbrush will not properly clean your teeth.
• Effective brushing usually takes about three minutes. Believe it or not, studies have shown that most people rush during tooth brushing.

What is flossing?

Flossing is a method for removing bacteria and other debris that cannot be reached by a toothbrush. It generally entails a very thin piece of synthetic cord you insert and move up and down between the sides of two adjoining teeth.

Why is flossing important?

Many dentists believe that flossing is the single most important weapon against plaque. In any event, daily flossing is an excellent and proven method for complementing your brushing routine and helping to prevent cavities, periodontal disease, and other dental problems later in life. It also increases blood circulation in your gums. Floss removes plaque and debris that stick to your teeth and gums.

How often to floss

Floss at least once every day. Like brushing, flossing should take about three minutes and can easily be done while doing another activity, such as watching television. Do not attempt to floss your teeth while operating a motor vehicle or other machinery.

Flossing techniques

There are two common methods for flossing, the "spool method" and the "loop method".

The spool method is the most popular for those who do not have problems with stiff joints or fingers. The spool method works like this: Break off about 18 inches of floss and wind most of it around your middle finger. Wind the rest of the floss similarly around the middle finger of your other hand. This finger takes up the floss as it becomes soiled or frayed. Move the floss between your teeth with your index fingers and thumbs. Maneuver the floss up and down several times forming a "C" shape around the tooth. While doing this, make sure you go below the gum line, where bacteria are known to collect heavily.

The loop method is often effective for children or adults with dexterity problems like arthritis. The loop method works like this: Break off about 18 inches of floss and form it into a circle. Tie it securely with two or three knots. Place all of your fingers, except the thumb, within the loop. Use your index fingers to guide the floss through your lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gum line and forming a "C" on the side of the tooth.

With either method of flossing, never "snap" the floss because this can cut your gums. Make sure that you gently scrape the side of each tooth with the floss.

Your gums may be tender or even bleed for the first few days after flossing - a condition that generally heals within a few days.

For decades, fluoride has been held in high regard by the dental community as an important mineral that is absorbed into and strengthens tooth enamel, thereby helping to prevent decay of tooth structures.

In nearly every U.S. community, public drinking supplies are supplemented with sodium fluoride because the practice is acknowledged as safe and effective in fighting cavities.

Some private wells may contain naturally fluoridated water.

What Is Fluoride?

Fluoride is a compound of the element fluorine, which can found throughout nature in water, soil, air and food.  By adding fluoride into our drinking water, it can be absorbed easily into tooth enamel, especially in children’s growing teeth, which helps to reduce tooth decay.

Why Is Fluoride Important To Teeth?

Fluoride is absorbed into structures, such as bones and teeth, making them stronger and more resistant to fractures and decay. A process in your body called "remineralization" uses fluoride to repair damage caused by decay.

How Do I Get Fluoride?

Just drinking public water will provide a certain measure of fluoride protection. But for years, health professionals have endorsed the practice of supplementing our intake with certain dietary products, and topical fluorides in many toothpastes and some kinds of rinses. Certain beverages such as tea and soda may also contain fluoride. Certain kinds of dental varnishes and gels may also be applied directly to teeth to boost fluoride intake.

Fluoride Safety

It is generally NOT safe to swallow toothpastes, rinses, or other products containing topical fluoride. In rare cases, some people may be overexposed to high concentrations of fluoride, resulting in a relatively harmless condition called fluorosis, which leaves dark enamel stains on teeth.

The Food and Drug Administration classifies mouth rinses into two categories - therapeutic and cosmetic.

In general, therapeutic rinses with fluoride have been shown to actually fight cavities, plaque and gingivitis.

On the other hand, cosmetic rinses merely treat breath odor, reduce bacteria and/or remove food particles in the mouth. They do nothing to treat or prevent gingivitis.

People who have difficulty brushing (because of physical difficulties such as arthritis) can benefit from a good therapeutic mouth rinse.

Caution: Even rinses that are indicated to treat plaque or cavities are only moderately effective. In fact, regular rinsing with water and use of good quality fluoride toothpaste are just as or more effective.

Sealants are liquid coatings that harden on the chewing surfaces of teeth and are showing a great deal of effectiveness in preventing cavities—even on teeth where decay has begun.

The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses these intricate structures on the chewing surfaces of your teeth.

The sealants are applied to the chewing surfaces and are designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of teeth.

Sealants actually were developed about 50 years ago, but didn't become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants (especially on molars) because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.

Application

Sealants are applied by first cleaning the tooth surface. The procedure is followed by "etching" the tooth with a chemical substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.

When X-rays pass through your mouth during a dental exam, more X-rays are absorbed by the denser parts (such as teeth and bone) than by soft tissues (such as cheeks and gums) before striking the film. This creates an image on the radiograph. Teeth appear lighter because fewer X-rays penetrate to reach the film. Cavities and gum disease appear darker because of more X-ray penetration. The interpretation of these X-rays allows the dentist to safely and accurately detect hidden abnormalities.

How often dental X-rays (radiographs) should be taken depends on the patient`s individual health needs. It is important to recognize that just as each patient is different from the next, so should the scheduling of X-ray exams be individualized for each patient. Your medical and dental history will be reviewed and your mouth examined before a decision is made to take X-rays of your teeth.

The schedule for needing radiographs at recall visits varies according to your age, risk for disease and signs and symptoms. Recent films may be needed to detect new cavities, or to determine the status of gum disease or for evaluation of growth and development. Children may need X-rays more often than adults. This is because their teeth and jaws are still developing and because their teeth are more likely to be affected by tooth decay than those of adults.

Dentures today are made from very advanced materials designed to give you a natural appearance.

However, keep in mind that just like your teeth, dentures should be cared for with the same diligence. This means daily brushing and regular visits to your dentist.

Regular visits to your dentist are critical. Your dentist also can make minor adjustments that ensure that your dentures continue fitting naturally and comfortably.

Just like natural teeth, dentures need to be cleansed of plaque, food particles and other debris. Keeping your dentures in top shape will also help keep the soft tissues of your mouth healthy; an unclean or malformed denture can cause infections and irritation.

Cleaning Techniques

Remember to rinse and brush your dentures after every meal, and soak them in denture solution overnight. This also allows your gums to breathe while you sleep.

Here are some simple techniques for keeping your dentures clean:

• People can brush their dentures in a variety of ways. Some people use soap and water or a slightly abrasive toothpaste. Popular denture pastes and creams also can be used.
• Avoid using highly abrasive chemicals or pastes, or vigorously brushing with hard bristled toothbrushes. These can scratch or even crack dentures.
• Hold your dentures gently to avoid loosening a tooth.
• Clean your dentures with cool or tepid water over a water-filled sink. Hot water may warp a denture. A small washcloth placed in the bottom of the bowl will ensure that your denture isn't damaged if it falls.
• Soak your dentures overnight in any commercially available product like Efferdent or Polident, and remember to rinse your dentures before placing them back in your mouth.
• Remember to use a separate toothbrush to clean your own natural teeth, as well as all of your gum tissues. In lieu of a toothbrush, a soft washcloth may be used to wipe your gums.

Over time, even daily care of your dentures may require them to be cleaned by the dentist. A powerful ultrasonic cleaner may be used to remove hard accumulations of tartar and other substances.

A knocked out tooth or bitten tongue can cause panic in any parent, but quick thinking and staying calm are the best ways to approach such common dental emergencies and prevent additional unnecessary damage and costly dental restoration. This includes taking measures such as application of cold compresses to reduce swelling, and of course, contacting our office as soon as possible.

Infants

Infants should be seen by our office after the first six months of age, and at least by the child's first birthday. By this time, the baby's first teeth, or primary teeth, are beginning to erupt and it is a critical time to spot any problems before they become big concerns.

Conditions like gum irritation and thumb-sucking could create problems later on. Babies who suck their thumbs may be setting the stage for malformed teeth and bite relationships.

Another problem that can be spotted early is a condition called "baby bottle tooth decay," which is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby's mouth.

If left untreated, this can lead to premature decay of your baby's future primary teeth, which can later hamper the proper formation of permanent teeth.

One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Avoid dipping pacifiers in sweet substances such as honey, because this only encourages early decay in the baby's mouth. Encouraging your young child to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.

Teething, Pacifiers and Thumb-Sucking

Teething is a sign that your child's gums are sore. This is perfectly normal. You can help relieve this by allowing the baby to suck on a teething ring, or gently rubbing your baby's gums with the back of a small spoon, a piece of wet gauze, or even your finger.

For babies under the age of 4, teething rings and pacifiers can be safely used to facilitate the child's oral needs for relieving gum pain and for suckling. After the age of 4, pacifiers are generally discouraged because they may interfere with the development of your child's teeth.

Moreover, thumb-sucking should be strongly discouraged because it can lead to malformed teeth that become crooked and crowded.

Primary and Permanent Teeth

Every child grows 20 primary teeth, usually by the age of 3. These teeth are gradually replaced by the age of 12 or so with a full set of 28 permanent teeth, and later on, four molars called "wisdom teeth."

It is essential that a child's primary teeth are healthy, because their development sets the stage for permanent teeth. If primary teeth become diseased or do not grow in properly, chances are greater that their permanent replacements will suffer the same fate. For example, poorly formed primary teeth that don't erupt properly could crowd out spaces reserved for other teeth. Space maintainers can sometimes be used to correct this condition, if it is spotted early enough.

Brushing

Babies' gums and teeth can be gently cleaned with special infant toothbrushes that fit over your finger. Water is suitable in lieu of toothpaste (because the baby may swallow the toothpaste). Parents are advised to avoid fluoride toothpastes on children under the age of 2.

Primary teeth can be cleansed with child-sized, soft-bristled toothbrushes. Remember to use small portions of toothpaste (a pea-sized portion is suitable), and teach your child to spit out, not swallow, the toothpaste when finished.

Fluoride

Fluoride is generally present in most public drinking water systems. If you are unsure about your community's water and its fluoride content, or learn that it has an unacceptable level of fluoride in it, there are fluoride supplements your dentist can prescribe. Your child may not be getting enough fluoride just by using fluoride toothpaste.

Toothaches

Toothaches can be common in young children. Sometimes, toothaches are caused by erupting teeth, but they also could indicate a serious problem.

You can safely relieve a small child's toothache without the aid of medication by rinsing the mouth with a solution of warm water and table salt. If the pain doesn't subside, acetaminophen may be used. If such medications don't help, contact your dentist immediately.

Injuries

You can help your child prevent oral injuries by closely supervising him during play and not allowing the child to put foreign objects in the mouth.

For younger children involved in physical activities and sports, mouth guards are strongly encouraged, and can prevent a whole host of injuries to the teeth, gums, lips and other oral structures.

Mouth guards are generally small plastic appliances that safely fit around your child's teeth. Many mouth guards are soft and pliable when opened, and mold to the child's teeth when first inserted.

If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see our office.  Remember to hold the dislocated tooth by the crown—not the root. If you cannot relocate the tooth, place it in a container of cold milk, saline or the victim's own saliva. Place the tooth in the solution.

First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.

For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.

If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.

If a child's primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.

Irritation caused by retainers or braces can sometimes be relieved by placing a tiny piece of cotton or gauze on the tip of the wire or other protruding object. If an injury occurs from a piece of the retainer or braces lodging into a soft tissue, contact our office immediately and avoid dislodging it yourself.

Sealants

Sealants fill in the little ridges on the chewing part of your teeth to protect and seal the tooth from food and plaque. The application is easy to apply and typically last for several years.

Women have special needs when it comes to their oral health. That’s because the physical changes they undergo through life—menstruation, pregnancy and childbirth, breast-feeding and menopause—cause many changes in the body, some harmful to teeth and gums.

Lesions and ulcers, dry sockets, as well as swollen gums, can sometimes occur during surges in a woman's hormone levels. These periods would be a prime time to visit the dentist. Birth control pills have been shown to increase the risk of gingivitis, and hormone replacement therapy has been shown to cause bleeding and swollen gums. Gum disease can also present a higher risk for premature births.

Some research has shown that women may be more likely to develop dry mouth, eating disorders, jaw problems such as temporomandibular joint disorders, and facial pain—all of which can be difficult from a physical and emotional standpoint.

Taking care of your mouth with proper oral health care is essential, and can go a long way to helping you face the physical changes in your body over the years.

More and more people are avoiding the need for dentures as they grow older, going against the notion that false teeth are a normal part of growing older.

In fact, there's usually no reason for you NOT to keep your teeth your entire life, providing you maintain a healthy balanced diet and practice good oral hygiene.

Another desirable side effect of good oral hygiene: avoiding more serious problems such as hypertension, cardiovascular disease, diabetes, and even stroke. Indeed, medical research is beginning to show that a healthy mouth equates to a healthy body and a longer life.

Dexterity and Arthritis

People who suffer from arthritis or other problems of dexterity may find it difficult and painful to practice good oral hygiene.

Thankfully, industry has responded with ergonomically designed devices such as toothbrushes and floss holders that make it easier to grasp and control.

You can also use items around the house to help you. Inserting the handle of your toothbrush into a small rubber ball, or extending the handle by attaching a small piece of plastic or Popsicle stick may also do the trick.

Floss can also be tied into a tiny loop on either side, making it easier to grasp and control the floss with your fingers.

It has long been known that good nutrition and a well-balanced diet is one of the best defenses for your oral health. Providing your body with the right amounts of vitamins and minerals helps your teeth and gums—as well as your immune system—stay strong and ward off infection, decay and disease.

Harmful acids and bacteria in your mouth are left behind from eating foods high in sugar and carbohydrates. These include carbonated beverages, some kinds of fruit juices, and many kinds of starch foods like pasta, bread and cereal.

Children's Nutrition and Teeth

Good eating habits that begin in early childhood can go a long way to ensuring a lifetime of good oral health.

Children should eat foods rich in calcium and other kinds of minerals, as well as a healthy balance of the essential food groups like vegetables, fruits, dairy products, poultry and meat. Fluoride supplements may be helpful if you live in a community without fluoridated water, but consult with our office first. (Be aware that sugars are even found in some kinds of condiments, as well as fruits and even milk.)

Allowing your children to eat excessive amounts of junk food (starches and sugars)—including potato chips, cookies, crackers, soda, artificial fruit rollups and granola bars—only places them at risk for serious health problems, including obesity, osteoporosis and diabetes. The carbonation found in soda, for example, can actually erode tooth enamel. Encourage your child to use a straw when drinking soda; this will help keep at least some of the carbonated beverage away from the teeth.

Adult Nutrition and Teeth

There's no discounting the importance of continuing a healthy balanced diet throughout your adult life.

An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.

Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.

What causes bad breath?

Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

• Diabetes - acetone, fruity
• Liver failure - sweetish, musty
• Acute rheumatic fever - acid, sweet
• Lung abscess - foul, putrefactive
• Blood dyscrasias - resembling decomposed blood
• Liver cirrhosis - resembling decayed blood
• Uremia - ammonia or urine
• Hand-Schuller-Christian disease - fetid breath and unpleasant taste
• Scurvy - foul breath from stomach inflammation
• Wegner`s granulomatosis - Necrotic, putrefactive
• Kidney failure - ammonia or urine
• Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor
• Syphilis - fetid

Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Caring for bad breath

Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.

Controlling periodontal disease and maintaining good oral health helps to reduce bad breath.  If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.

If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.

Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.

People with eating disorders can suffer from oral health problems as well. This is because many of the behaviors associated with anorexia nervosa and bulimia nervosa—such as binge eating, self-induced vomiting, and use of diuretics or laxatives—cause changes in the mouth. 

For example, repeated episodes of vomiting, which is common in people with bulimia, release harmful stomach acids that pass through the mouth and can erode tooth enamel, causing cavities, discoloration and tooth loss.  Other problems, such as poorly fitting fillings and braces, are another byproduct of such eating disorders.

Brushing after episodic vomiting is actually more harmful than one would think. The best practice is to rinse thoroughly with a neutral solution such as baking soda and water.

People sometimes confuse canker sores and cold sores, but they are completely unrelated. Both can be painful, but knowing the differences can help you keep them in check.

A canker sore is typically one that occurs on the delicate tissues inside your mouth. It is usually light-colored at its base and can have a red exterior border.

A cold sore or fever blister, on the other hand, usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.

In most cases, patience is the best medicine for treating canker sores. A healthy diet and good oral hygiene are usually the best remedy, but some special rinses and anesthetics can help. Cold sores can be treated effectively with some over-the-counter topical creams; sometimes, an antiviral medication will be prescribed by your doctor.

What Is Tooth Decay?

Tooth decay is caused by a variety of things; in medical terms, cavities are called caries, which are caused by long-term destructive forces acting on tooth structures such as enamel and the tooth's inner dentin material.

These destructive forces include frequent exposure to foods rich in sugar and carbohydrates. Soda, candy, ice cream—even milk—are common culprits.  Left inside your mouth from non-brushing and flossing, these materials break down quickly, allowing bacteria to do their dirty work in the form of a harmful, colorless sticky substance called plaque.

The plaque works in concert with leftover food particles in your mouth to form harmful acids that destroy enamel and other tooth structures.

If cavities aren't treated early enough, they can lead to more serious problems requiring treatments such as root canal therapy.

Preventing Cavities

The best defense against cavities is good oral hygiene, including brushing with a fluoride toothpaste, flossing and rinsing. Your body's own saliva is also an excellent cavity fighter, because it contains special chemicals that rinse away many harmful materials. Chewing a good sugarless gum will stimulate saliva production between brushing.

Special sealants and varnishes can also be applied to stave off cavities from forming.

If you have any of the following symptoms, you may have a cavity:

• Unusual sensitivity to hot and cold water or foods.
• A localized pain in your tooth or near the gum line.
• Teeth that change color.

Baby Bottle Tooth Decay

Baby bottle tooth decay is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby's mouth.

If left untreated, this can lead to premature decay of your baby's future primary teeth, which can later hamper the proper formation of permanent teeth.

One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Encouraging your toddler to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.

Simple toothaches can often be relieved by rinsing the mouth to clear it of debris and other matter. Sometimes, a toothache can be caused or aggravated by a piece of debris lodged between the tooth and another tooth. Avoid placing an aspirin between your tooth and gum to relieve pain, because the dissolving aspirin can actually harm your gum tissue.

Broken, Fractured, or Displaced Tooth

A broken, fractured or displaced tooth is usually not a cause for alarm, as long as decisive, quick action is taken.

If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see your dentist.

First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.

If you cannot locate the tooth back in its socket, hold the dislocated tooth by the crown - not the root. Next, place it in a container of warm milk, saline or the victim's own saliva and keep it in the solution until you arrive at the emergency room or dentist's office.

For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.

If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.

If a child's primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.

People living with diabetes are vulnerable to a host of systemic problems in their entire body. Unfortunately, the mouth and teeth are not immune from such problems, and many diabetics with oral problems go undiagnosed until conditions become advanced.

Infections and other problems such as receding gums and gum disease, or periodontal disease, are common afflictions among diabetics for many reasons; for instance, diabetics often are plagued by diminished saliva production, which can hamper the proper cleansing of cavity-causing debris and bacteria from the mouth. In addition, blood sugar levels that are out of balance could lead to problems that promote cavities and gum disease.

As with any condition, good oral hygiene, including regular brushing, flossing and rinsing, as well as the proper diabetic diet, will go a long way in preventing needless problems.

Saliva is one of your body's natural defenses against plaque because it acts to rinse your mouth of cavity-causing bacteria and other harmful materials. Dry mouth (also called Xerostomia) is a fairly common condition that is caused by diminished saliva production. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Eating foods such as garlic, tobacco use, and some kinds of medications, including treatments such as cancer therapy can diminish the body's production of saliva, leading to dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems.

Some of the less alarming results of dry mouth include bad breath. But dry mouth can lead to more serious problems, including burning tongue syndrome, a painful condition caused by lack of moisture on the tongue.

If dry mouth isn't readily apparent, you may experience other conditions that dry mouth can cause, including an overly-sensitive tongue, chronic thirst or even difficulty in speaking.

If you don't have a medical condition that causes it, dry mouth can be minimized by sipping water regularly, chewing sugarless gum and avoiding smoking. Of course, there is no substitute for regular checkups and good oral hygiene.

Fluorosis is a condition in which your body has been exposed to too much fluoride. In normal doses (typically found in a safe drinking water system and an ADA-approved toothpaste), fluoride is a healthy compound that promotes strong teeth, which has the ability to fight cavities and other problems.

But sometimes, fluorosis occurs when fluoride-containing toothpastes or rinses are swallowed, instead of expelled.

Fluorosis causes a number of aesthetic problems, including abnormally darkened or stained teeth. While such problems are generally harmless to your health, they can create concerns with your appearance.

Gingivitis is the medical term for early gum disease, or periodontal disease. In general, gum disease can be caused by long-term exposure to plaque, the sticky but colorless film on teeth that forms after eating or sleeping.

Gum disease originates in the gums, where infections form from harmful bacteria and other materials left behind from eating. Early warning signs include chronic bad breath, tender or painful swollen gums and minor bleeding after brushing or flossing. In many cases, however, gingivitis can go unnoticed. The infections can eventually cause the gums to separate from the teeth, creating even greater opportunities for infection and decay.

Although gum disease is the major cause of tooth loss in adults, in many cases it is avoidable.

If gingivitis goes untreated, more serious problems such as abscesses, bone loss or periodontitis can occur.

Periodontitis is treated in a number of ways. One method, called root planing, involved cleaning and scraping below the gum line to smooth the roots. If effective, this procedure helps the gums reattach themselves to the tooth structure.  However, not all instances of scaling and root planing successfully reattach the tooth to the gums.  Additional measures may be needed if the periodontal pockets persist after scaling and root planing

Pregnancy has also been known to cause a form of gingivitis. This has been linked to hormonal changes in the woman's body that promote plaque production.

Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.

If wisdom teeth are causing a problem, this could mean that they are impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: pain, inflammation, and some kinds of infections.

Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one's ability to properly bite down, speak or eat.

Any kind of cut to your face and the delicate soft tissues inside your mouth should be addressed immediately in order to prevent further tissue damage and infection.

If a traumatic injury involves a broken facial bone such as the jaw, nose, chin or cheek, maxillofacial surgery may be required.

With jaw surgery, rubber bands, tiny wires, metal braces, screws or plates are often used to keep a fractured jaw in place following surgery. This allows the bone to heal and stay in proper alignment. Dental splints or dentures may also be required to supplement the healing process following jaw surgery.

Oral cancer is one of the most common cancers today and has one of the lowest survival rates, with thousands of new cases being reported each year. Fewer than half of all people diagnosed with oral cancer are ever cured.

Moreover, people with many forms of cancer can develop complications—some of them chronic and painful—from their cancer treatment.  These include dry mouth and overly sensitive teeth, as well as accelerated tooth decay.

If oral cancer is not treated in time, it could spread to other facial and neck tissues, leading to disfigurement and pain.

Older adults over the age of 40 (especially men) are most susceptible to developing oral cancer, but people of all ages are at risk.

Oral cancer can occur anywhere in the mouth, but the tongue appears to be the most common location. Other oral structures could include the lips, gums and other soft palate tissues in the mouth.

Warning Signs

In general, early signs of oral cancer usually occur in the form of lumps, patchy areas and lesions, or breaks, in the tissues of the mouth. In many cases, these abnormalities are not painful in the early stages, making even self-diagnosis difficult.

Here are some additional warning signs:

• Hoarseness or difficulty swallowing.
• Unusual bleeding or persistent sores in the mouth that won't heal.
• Lumps or growths in other nearby areas, such as the throat or neck.

If a tumor is found, surgery will generally be required to remove it. Some facial disfigurement could also result.

Prevention

Prevention is the key to staving off oral cancer. One of the biggest culprits is tobacco and alcohol use. Certain kinds of foods and even overexposure to the sun have also been linked to oral cancer. Some experts believe certain oral cancer risk factors are also hereditary.

A diet rich in fruits and vegetables is one of the best defenses against oral cancer. Maintaining good oral hygiene, and regular dental checkups, are highly recommended.

Plaque is a film of bacteria that forms on your teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods such as bread, crackers, and cereal.

Tooth decay, commonly known as cavities, occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to ‘eat away’ at the surfaces of your teeth and gums.  Ironically, the areas surrounding restored portions of teeth (where fillings, or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.

Plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque. This gradual degeneration can often cause gums to pull away from teeth. This condition is called receding gums.

Long-term plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.

If you wince with pain after sipping a hot cup of coffee or chewing a piece of ice, chances are that you suffer from "dentin hypersensitivity," or more commonly, sensitive teeth.

Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits.

At least 45 million adults in the United States suffer at some time from sensitive teeth.

Sensitive teeth result when the underlying layer of your teeth (the dentin) becomes exposed. This can happen on the chewing surface of the tooth as well as at the gum line. In some cases, sensitive teeth are the result of gum disease, years of unconsciously clenching or grinding your teeth, or improper or too vigorous brushing (if the bristles of your toothbrush are pointing in multiple directions, you're brushing too hard).

Abrasive toothpastes are sometimes the culprit of sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes, may increase tooth sensitivity.

In some cases, desensitizing toothpaste, sealants, desensitizing ionization and filling materials including fluoride, and decreasing the intake of acid-containing foods can alleviate some of the pain associated with sensitive teeth.

Sometimes, a sensitive tooth may be confused by a patient for a cavity or abscess that is not yet visible.

In any case, contact your dentist if you notice any change in your teeth's sensitivity to temperature.

Teeth grinding, also called bruxism, is often viewed as a harmless, though annoying, habit. Some people develop bruxism from an inability to deal with stress or anxiety.

However, teeth grinding can literally transform your bite relationship and worse, severely damage your teeth and jaws over long periods of time.

Teeth grinding can cause abrasion to the chewing surfaces of your teeth. This abnormal wear and tear will prematurely age and loosen your teeth, and open them to problems such as hypersensitivity (from the small cracks that form, exposing your dentin). Bruxism can also lead to chronic jaw and facial pain, as well as headaches.

If no one has told you that you grind your teeth, here are a few clues that you may suffer from bruxism:

• Your jaw is often sore, or you hear popping sounds when you open and close your mouth.
• Your teeth look abnormally short or worn down.
• You notice small dents in your tongue.

Bruxism is somewhat treatable. A common therapy involves use of a special appliance worn while sleeping. Less intrusive, though just as effective methods could involve biofeedback, and behavior modification, such as tongue exercises and learning how to properly align your tongue, teeth and lips.

People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth. One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.

People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.

Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.

Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint.

The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses some of these intricate structures on the chewing surfaces of your teeth.

Enter sealants, which are thin coatings applied to the chewing surfaces designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of your teeth.

Sealants actually were developed about 50 years ago, but didn't become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.

Sealants are applied by first cleaning the tooth surface. The procedure is followed by etching the tooth with an abrasive substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.

Fixed bridges and implants are often used to replace missing teeth and to correct some kinds of bite problems.

Crowns and bridges are the most effective procedure for replacing missing teeth or bite problems.

Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.

There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges.  Some bridges are removable and can be cleaned by the wearer; others need to be removed by a dentist.

Porcelain, gold alloys or combinations of materials are usually used to make bridge appliances.

Appliances called implant bridges are attached to an area below the gum tissue, or the bone.

Crowns are synthetic caps, usually made of a material like porcelain, placed on the top of a tooth.

Crowns are typically used to restore a tooth's function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth must usually be reduced in size to accommodate a crown. A cast is made of the existing tooth and an impression is made. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.

Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.

Caring For Your Crowns

With proper care, a good quality crown could last up to eight years or longer. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.

Certain behaviors such as jaw clenching or bruxism (teeth grinding) significantly shorten the life of a crown. Moreover, eating brittle foods, ice or hard candy can compromise the adhesion of the crown, or even damage the crown.

Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root.

All teeth have between one and four root canals.

Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.

A diseased inner tooth brings a host of problems including pain and sensitivity as the first indications of a problem.  However, inside a spreading infection can cause small pockets of pus to develop, which can lead to an abscess. 

Root canal therapy is a remarkable treatment with a very high rate of success, and involves removing the diseased tissue, halting the spread of infection and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.

Procedure

Root canal therapy usually entails one to three visits. During the first visit, a small hole is drilled through the top of the tooth and into the inner chamber. Diseased tissue is removed, the inner chamber cleansed and disinfected, and the tiny canals reshaped. The cleansed chamber and canals are filled with an elastic material and medication designed to prevent infection. If necessary, the drilled hole is temporarily filled until a permanent seal is made with a crown.

Most patients who have root canal experience little or no discomfort or pain, and enjoy a restored tooth that can last almost as long as its healthy original.

General Procedure

When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, it may need to be pulled, or extracted.

Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has tooth pulled experiences little or no discomfort, and only minor bleeding.

Before a tooth is extracted, the area surrounding the tooth is numbed with a topical/and or injectable anesthetic such as Novocaine.

Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn't occur.

Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.

Wisdom Teeth

Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.

If wisdom teeth are causing a problem, this could mean that they are impacted.  Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: severe discomfort, inflammation, and some kinds of infections.

Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one's ability to properly bite down, speak or eat.

If you experience any of the following symptoms, you may have an impacted wisdom tooth:

• Facial swelling
• Infection
• Pain
• Gum swelling

Some cases of acute periodontal (gum) disease that do not respond to more conventional treatment and self-care such as flossing may require a special kind of cleaning called scaling and root planing.

The procedure begins with administration of a local anesthetic to reduce any discomfort. Then, a small instrument called a "scaler," or an ultrasonic cleaner, is used to clean beneath your gum line to remove plaque and tartar.

The root surfaces on the tooth are then planed and smoothed. If effective, scaling and root planing helps the gums reattach themselves to the tooth structure.  Additional measures may be needed if the periodontal pockets persist after scaling and root planing.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to thrive and wreak havoc.

As bacteria accumulate and advance under the gum tissue in these deep pockets, additional bone and tissue loss follows. Eventually, if too much bone is lost, the teeth will need to be extracted.

Flap surgery is sometimes performed to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for you or your dental professional to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.

A pocket reduction procedure is recommended if daily at-home oral hygiene and a professional care routine cannot effectively reach these deep pockets.

In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.

Types of dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient`s jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Partials with precision attachments generally cost more than those with metal clasps.

How are dentures made?

The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient`s final denture is placed, following any minor adjustments.

First, an impression of your jaw is made using special materials. In addition, measurements are made to show how your jaws relate to one another and how much space is between them (bite relationship). The color or shade of your natural teeth will also be determined. The impression, bite and shade are given to the dental laboratory so a denture can be custom-made for your mouth.

The dental laboratory makes a mold or model of your jaw, places the teeth in a wax base, and carves the wax to the exact form wanted in the finished denture. Usually a "wax try-in" of the denture will be done at the dentist`s office so any adjustments can be done before the denture is completed.

The denture is completed at the dental laboratory using the "lost wax" technique. A mold of the wax-up denture is made, the wax is removed and the remaining space is filled with pink plastic in dough form. The mold is then heated to harden the plastic. The denture is then polished and ready for wear.
 

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Your denture should easily fit into place. Never force the partial denture into position by biting down. This could bend or break the clasps.

At first, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your denture can be adjusted to fit more comfortably. After making adjustments, you may need to take the denture out of your mouth before going to bed and replace it in the morning.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum.
 

Care of your denture

It's best to stand over a folded towel or a sink of water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance. Pay special attention to cleaning teeth that fit under the denture`s metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay.

Hand soap or mild dishwashing liquid to clean dentures is also acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution.

Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.
 

Adjustments

Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over the counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear.
 

Common concerns

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing.

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you`re talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.
 

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.

People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth.

One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.

People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.

Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.

Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint. Traumatic injuries also can cause jaw dislocation.

In these cases, jaw surgery may be required to correct the condition. Some jaw surgery can be performed arthroscopically.

When facial reconstruction, including procedures involving the oral cavity, is called for, a specialist is needed. Surgical procedures of the neck and head area are performed by a maxillofacial surgeon.

Common maxillofacial procedures include denture-related procedures and jaw surgery.

Jaw Correction

Protruding chins, crooked or buck teeth or misaligned teeth are good candidates for maxillofacial surgery.

In some people, jaws do not grow at the same rate; one may come in larger than the other, or simply not be aligned properly with other bony structures in the skull. This can cause problems other than appearance issues; an improperly aligned jaw can cause problems with the tongue and lips, and speech and chewing problems as well. Jaw surgery can move jaws into their proper place.

Other kinds of maxillofacial surgery can correct problems with upper facial features such as the nose and cheek.

In addition to correcting jaw problems surgically, orthodontic appliances such as braces may be needed to restore bite relationship and ensure continued proper alignment of the jaw. In some cases, tiny wires or small rubber bands may be needed to keep the jaws in place and promote faster healing. In other cases, small "fixation" screws or plates may need to be inserted in the jaws to facilitate easy movement of the jaws following surgery.

Denture Fatigue

People who have worn dentures for a long time can sometimes experience loss of gum tissue and even bone, mostly from the wear and tear of the appliance on the soft tissues of their mouth.

In extreme cases, maxillofacial surgery, including bone grafts, manipulation of soft tissues or even jaw realignment, may be performed to correct such problems.

Overview

People choose esthetic dental procedures/surgery for various reasons—to repair a defect such as a malformed bite or crooked teeth, treat an injury, or just improve their overall appearance.  Whatever the reason, the ultimate goal is to restore a beautiful smile.

For these and many other reasons, esthetic dentistry has become a vital and important part of the dental profession.

Common esthetic dental procedures can be performed to correct misshaped, discolored, chipped or missing teeth. They also can be used to change the overall shape of teeth—from teeth that are too long or short, have gaps, or simply need to be reshaped.

Some of the more common procedures involve:

• Bonding - A procedure in which tooth-colored material is used to close gaps or change tooth color.
• Contouring and reshaping - A procedure that straightens crooked, chipped, cracked or overlapping teeth.
• Veneers - A procedure in which ultra-thin coatings are placed over the front teeth. Veneers can change the color or shape of your teeth. For example, veneers have been used to correct unevenly spaced, crooked, chipped, oddly shaped or discolored teeth.
• Whitening and bleaching - As the term implies, whitening and bleaching, a rapidly increasing procedure, are used to make teeth whiter.

Which techniques should be used to improve your smile? A dental exam will take many factors into consideration, including your overall oral health.

Dentistry has advanced to the point in which pain is almost a thing of the past.
Powerful pain-killing medications known as anesthetics not only help a patient avoid discomfort during a procedure, but post-operatively as well.
Some patients, especially children, may require higher doses of anesthetic than others.
Types of pain-killing medications include:

• Analgesics - These are also called pain relievers and include common non-narcotic medications such as ibuprofen and aspirin. Analgesics are usually used for mild cases of discomfort, and are typically prescribed following such procedures as a root canal or tooth extraction.
• Anesthetics - Anesthetics can either be topically applied, injected or swallowed. Dentists often apply topical anesthetics with a cotton swab to an area of the mouth where a procedure such as a restoration will be performed. This numbs the affected area. Topical anesthetics are used in many dental procedures such as tooth restoration. Topical anesthetics also are used to prepare an area for injection of an anesthetic. Novocaine and Lidocaine are the most common kind of injectable anesthetics. Such medications block the nerves from transmitting signals and are used for more major types of procedures, such as fillings and root canals.
• Sedatives - Sedatives are medications designed to help a patient relax. This can be a powerful tool in avoiding pain. Sedatives are sometimes used in combination with other types of pain relievers and pain-killers. Nitrous oxide, or laughing gas, is a form of sedative. Conscious sedation involves administering a sedative while the patient is alert and awake. Deep sedation or general anesthesia involves administering a medication that places a patient in a state of monitored and controlled unconsciousness.

Types of sedatives include:

• Intravenous (IV) sedation - Usually in the form of a tranquilizing agent; patients given IV sedation are often awake, but very relaxed.
• Inhalation sedation - a form of sedation in which nitrous oxide is administered through a special mask.

Many people associate the high-pitched whirring of a dental drill with pain. Just the sound alone can make many people wince.
A relatively new technique called air abrasion uses powerful particles of aluminum oxide to remove debris and decay. The most exciting thing for patients is that air abrasion is painless and, in some cases, doesn't require an anesthetic.
Air abrasion leaves behind a gritty feeling in your mouth, which is simply rinsed away almost instantaneously using a small suction device.
Tiny cracks and imperfections on a tooth can be fixed using air abrasion. Although air abrasion is not suitable for work on crowns and bridges, it is often used for bonding procedures, and on tooth restorations involving composite, or tooth-colored fillings.

Some dental procedures, such as tooth extractions and oral surgery, may call for our office to prescribe medications before or after a procedure. These medications are used to prevent or fight an infection, or to relieve any post-operative discomfort and pain.
For these reasons, it is extremely important that you share your entire medical history - including any medications you are currently taking - with our office. Some medications used in dentistry, and other medical practices, could interact with those medications in a detrimental way.  In addition, if you have any allergic reactions to certain medications, it is important for our office to know beforehand.
Finally, if you are prescribed any medication by our office, follow the dosage instructions very carefully, and if instructed, finish your entire prescription even if you are no longer feeling pain.

A knocked out tooth or bitten tongue can cause panic in any parent, but quick thinking and staying calm are the best ways to approach such common dental emergencies and prevent additional unnecessary damage and costly dental restoration. This includes taking measures such as application of cold compresses to reduce swelling, and of course, contacting our office as soon as possible.

Patient Rights

• You have a right to choose your own dentist and schedule an appointment in a timely manner.
• You have a right to know the education and training of your dentist and the dental care team.
• You have a right to arrange to see the dentist every time you receive dental treatment, subject to any state law exceptions.
• You have a right to adequate time to ask questions and receive answers regarding your dental condition and treatment plan for your care.
• You have a right to know what the dental team feels is the optimal treatment plan as well as the right to ask for alternative treatment options.
• You have a right to an explanation of the purpose, probably (short and long term) results, alternatives and risks involved before consenting to a proposed treatment plan.
• You have a right to be informed of continuing health care needs.
• You have a right to know in advance the expected cost of treatment.
• You have a right to accept, defer or decline any part of your treatment recommendations.
• You have a right to reasonable arrangements for dental care and emergency treatment.
• You have a right to receive considerate, respectful and confidential treatment by your dentist and dental team.
• You have a right to expect the dental team members to use appropriate infection and sterilization controls.
• You have a right to inquire about the availability of processes to mediate disputes about your treatment.

(Adopted by the American Dental Association in 2009)

Your Responsibilities as a Patient

• You have the responsibility to provide, to the best of your ability, accurate, honest and complete information about your medical history and current health status.
• You have the responsibility to report changes in your medical status and provide feedback about your needs and expectations.
• You have the responsibility to participate in your health care decisions and ask questions if you are uncertain about your dental treatment or plan.
• You have the responsibility to inquire about your treatment options and acknowledge the benefits and limitations of any treatment that you choose.
• You have the responsibilityfor consequences resulting from declining treatment or from not following the agreed upon treatment plan.
• You have the responsibilityto keep your scheduled appointments.
• You have the responsibilityto be available for treatment upon reasonable notice.
• You have the responsibilityto adhere to regular home oral health care recommendations.
• You have the responsibilityto assure that your financial obligations for health care received are fulfilled.

(Adopted by the American Dental Association in 2009)
American Dental Association Leads Fight for Patient Rights
The American Dental Association has supported legislation that will set a few basic rules to promote high-quality care and protect patients in an increasingly bottom line-driven health care system.
ADA member dentists have been instrumental in moving the patients' rights issue into the national spotlight. The nation appears closer than ever to finally seeing a comprehensive patients' bill of rights passed into law.
While Congress debates various versions of patient rights legislation, the insurance and managed care industries have long supported legislation that would fail to protect all privately insured Americans against unfair delays and denials of coverage by their health plans, according to the ADA. Some ill-fated bills left out critical protections, such as guaranteeing people the option of choosing their own doctors or creating mechanisms to address patients' grievances against health plans. One proposal even omitted freestanding dental plans, which could have left more than 120 million dental patients without these vital protections.
The American Dental Association continues to lobby for the enactment of bipartisan legislation to help ensure that health plans treat patients fairly and do not discriminate against dentists. Here are some of the key issues identified by the ADA:

• Coverage for freestanding dental plans, which account for the vast majority of Americans who have dental coverage.
• Patient choice, by guaranteeing access to at least one plan with a point-of-service option that allows patients the opportunity to choose their own doctors.
• Health plan accountability, through the availability of impartial, external review and by holding plans accountable when their decisions to delay or deny care harm patients.

Dental floss comes in a variety of colors, materials and even flavors. Waxed varieties slide through the teeth, allowing people with extremely tight spaces to floss more easily. Popular flavors of floss include wintergreen and cinnamon. Waxed floss does tend to fray more than unwaxed floss.

A type of material called dental tape can be effective for people with large spaces between their teeth, or for people with bridge work.

Floss can be purchased in small self-dispensing boxes. Floss can also be purchased in special, single-use holders, which are useful for people who have a hard time wrapping floss around their fingers, including those with dexterity problems or arthritis.

There is never a suitable substitute for daily brushing and flossing.

While some products, including water irrigation devices (or “water picks”), may be useful for specific applications, they may not be as effective as traditional flossing in the removal of plaque.

Water picks use powerful tiny bursts of water to blast away food particles and other debris in hard-to-reach areas of your mouth. Dentists use professional-grade water picks when preparing a tooth for restoration, or in general cleaning and exams.

People with painful gum disease or highly sensitive gums may find water picks useful for supplementing their brushing regimen. People with orthodontia, including braces, have found water picks quite useful because toothbrush bristles often get stuck.

Anyone who participates in a sport that carries a significant risk of injury should wear a mouth protector. Sports like basketball, baseball, gymnastics, and volleyball all pose risks to your gum tissues, as well as your teeth. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.

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

Mouth protectors, which typically cover the upper teeth, can cushion a blow to the face, minimizing the risk of broken teeth and injuries to the soft tissues of the mouth. If you wear braces or another fixed dental appliance on your lower jaw, a mouth protector is available for these teeth as well.

A properly fitted mouth protector may be especially important for people who wear braces or have fixed bridge work. A blow to the face could damage the brackets or other fixed orthodontic appliances. A mouth protector also provides a barrier between the braces and your cheek or lips, limiting the risk of soft tissue injuries. Although mouth protectors typically only cover the upper teeth, your dentist or orthodontist may suggest that you use a mouth protector on the lower teeth if you have braces on these teeth too. If you have a retainer or other removable appliance, do not wear it during any contact sports.

Types of mouth guards

There are three types of mouth protectors:

• Stock - Inexpensive and come pre-formed, ready to wear. Unfortunately, they often don't fit very well. They can be bulky and can make breathing and talking difficult.

• Boil and bite - Can be bought at many sporting goods stores and may offer a better fit than stock mouth protectors. They should be softened in water, then inserted and allowed to adapt to the shape of your mouth. If you don't follow the directions carefully you can wind up with a poor-fitting mouth protector.

• Custom-fitted - Made by your dentist for you personally. They are more expensive than the other versions, but because they are customized, they can offer a better fit than anything you can buy off the shelf.