Adult Orthodontics

Orthodontics involves the diagnosis, prevention and treatment of structural problems involving the jaws and malocclusion commonly known as bad bites. Orthodontic problems can affect your dental and general health as well as your personal appearance.

 

Every patient wants to have an attractive smile. When you smile with confidence, you look your best and feel good about yourself. Straight teeth and a broad smile are very important to a person’s positive self- image. Everyone wants straight white teeth. We always recommend that patient’s get their teeth whitened after they are straightened with braces. As your teeth, jaws and lips become properly aligned through orthodontic therapy, your self-image can improve. This is just one of the many benefits.

 

If the teeth are out of position, they are more difficult to clean, increasing the risk of tooth decay and periodontal (gum) disease. If chewing is difficult, people may not eat the foods needed for good nutrition. If your bite is poor, extra strain may be placed on the chewing muscles, possibly causing pain and problems with your jaw joint. Some of the symptoms of jaw joint problems include headaches, neck aches, ringing in the ears, dizziness, fainting, pain behind the eyes and difficulty swallowing.

 

Orthodontic treatment can be beneficial at any age and approximately 25% of today’s orthodontic patients are adults. Teeth can be moved at any age and therefore more adults are proceeding with orthodontic treatment today in an effort to achieve straight teeth, a beautiful smile and healthy jaw joints. Many adults today prefer the clear or gold braces, which are more esthetically pleasing than the standard metal braces.

 

No two smiles are alike, and therefore no two orthodontic treatment programs are either. Typically, active treatment times range from one to two years and vary with the degree of tooth movement and the severity of the problem

 

You are never too old to improve your smile. We also have options for invisible braces with clear plastic trays that are worn in cases with minor crowding. If you have crooked teeth or you don’t like your smile, come in for a consultation appointment to see what treatment options are possible.

Cosmetic Dentistry

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.

Veneers

Teeth that are badly stained, shaped or crooked may be improved by a veneer placed on the surface of the affected teeth.

 

Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth to change their color or shape. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Little or no anesthesia is needed. Veneers have a longer life expectancy and color stability than bonding, and highly resist permanent staining from coffee, tea, or even cigarette smoking.

 

Veneers are usually made by a dental lab technician working from a model provided by your dentist. Veneers are usually irreversible because it`s necessary to remove a small amount of enamel from your teeth to accommodate the shell.

 

Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers.

 

Typically, veneers entail at least three appointments: diagnosis and treatment planning, preparation, and bonding.

 

During the tooth preparation visit, usually lasting one to two hours, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which may require a local anesthetic. During the same visit, a mold is taken of the teeth, and sent to the laboratory for the fabrication of the veneers.

 

During the final “bonding” visit, also about one or two hours, the veneers are placed on the tooth surface with water or glycerin on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, they can be adjusted with various shades of cement to match the color of your teeth. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a visible light beam, or laser, causes a catalyst to be released, hardening the cement.

 

During a two-week period of adjustment that follows, you may notice the change of size and shape in your teeth. It is important to brush and floss daily. After one or two weeks, you`ll return for a follow-up appointment. Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It`s not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth.

 

For certain patients no preparation of the teeth may be necessary. Please see our specialties page for more information.

Teeth Whitening

Whitening procedures have effectively restored the smile of people with stained, dull, or discolored teeth.

 

The darker tissue of your teeth, the dentin, can become exposed as the outer layer of enamel is worn away by the effects of aging or things like caffeine and tobacco.

 

Food particles are naturally attracted to a tooth’s enamel by a certain protein. Products like coffee and tea, berries and soy sauce are notorious for staining teeth. Over time, teeth actually become more absorbent and vulnerable to staining from food and other substances.

 

One type of stain—caused by traumatic injuries, medications and fluorosis—actually begins inside the tooth; brushing and flossing don’t help. Another type of stain—one that can be more easily attacked by brushing, flossing and rinsing—is caused by external factors such as foods.

 

More and more people today are choosing tooth-whitening procedures to reverse the effects of aging and abuse from food and tobacco stains.

 

Some commercially available “whitening toothpastes” can be somewhat effective at removing stains and making teeth a few shades brighter. However, many of these products have abrasive substances that can actually wear away your tooth’s enamel.

 

Whitening agents actually change the color of your teeth, but only are effective on certain types of stains. For example, bleaching agents have a difficult time removing brownish or grayish stains. These products also are not as effective on pitted or badly discolored teeth, or on restorations such as crowns, bridges, bonding and tooth-colored fillings (porcelain veneers or dental bonding may be more appropriate in this case).

 

Professional whitening performed by our office is considered to be the most effective and safest method; done properly, tooth whitening can last as long as five years. Over-the-counter whitening systems are somewhat effective as long as they are monitored and directions followed closely.

Ridge Augmentation

If you lose one or more permanent teeth, an indentation may result in the gums and jawbone where the tooth used to be. When no longer holding a tooth in place, the jawbone recedes and the resulting indentation looks unnatural. Ridge augmentation is a procedure that can recapture the natural contour of the gums and jaw. A new tooth can then be created that is natural looking and complements your smile.

Old and Unsightly Fillings

Newer kinds of fillings made from composite resins and porcelain can restore unsightly fillings; many people are surprised how natural these kinds of filling materials can make a tooth once covered by the old-fashioned silver amalgams.

Implants

Before development of dental implants, dentures were the only alternative to replacing a missing tooth or teeth.

 

Implants are synthetic structures that are placed in the area of the tooth normally occupied by the root. Implants are anchored to the jawbone or metal framework on the bone and act as a foundation for an artificial tooth or permanent bridge. In some cases, implants can be used to attach dentures.

 

Not everyone is a candidate for a dental implant, however. For a successful implant to take hold, a candidate must have proper bone density and have a strong immune system. In all cases, dental implants require strict oral hygiene.

 

Implants are so well designed that they mimic the look and feel of natural teeth. Implants are usually made of a synthetic yet biocompatible material like metal or ceramic.

 

Surgery is necessary to prepare the area for an implant and place the implant in the mouth. Following the procedure, a period of time is required for the implant to take hold and for bone tissue to build up and anchor the device. In some cases, metal posts are inserted into the implant during a follow-up procedure to connect the tooth.

 

Because implants require surgery, patients are administered anesthesia and, if necessary, antibiotics to stave off infection following the procedure.

 

Like any restoration, implants require diligent oral hygiene and proper care to ensure they last a long time.

Grafts

Soft tissue grafts are sometimes performed to treat gum disease, or correct other abnormalities.

 

The procedure involves taking gum tissue from the palate or another donor source to cover an exposed root in order to even the gum line and reduce sensitivity.

 

Periodontal procedures are available to stop further dental problems and gum recession, and to improve the aesthetics of your gum line.  For example, an exposed tooth root resulting from gum recession may not be causing you pain or sensitivity, but is causing one or more of your teeth to look longer than the others. In other cases, an exposed tooth root causes severe pain because it is exposed to extremes in temperatures or different kinds of food and liquids.

 

Once contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.

 

Excessive or Uneven Gums

Many people inherit the problem of excessive or uneven gums. An aesthetic surgical procedure called a gum lift can be used to correct this problem.

 

Chipped, Cracked, and Worn Teeth

Special thin laminates, called veneers, can often be used to correct discolored, worn down, cracked and chipped teeth. Veneers can also be used to close unsightly gaps between teeth. Stronger types of veneers made of porcelain, also called composite veneers, typically last longer because they are bonded to the tooth.

 

Another process called bonding can accomplish some of the same things, but it does not last as long. Material that looks much like the enamel on your teeth is used during a bonding procedure. The material is shaped to the tooth, and when it becomes hard it is polished.

 

In addition, dental contouring and reshaping can correct chipped, cracked, crooked, or even overlapping teeth. This procedure can alter the shape, length, or position of teeth.

Bonding

Bonding is a process in which an enamel-like material is applied to a tooth`s surface, sculpted to an ideal shape, hardened, and then polished for an ideal smile. This procedure usually can be accomplished in a single visit.

 

Bonding is often performed in order to fill in gaps or change the color of your teeth. It typically only entails one office visit, and the results last for several years.

 

Bonding is more susceptible to staining or chipping than other forms of restoration such as veneers. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities and broken or chipped surfaces.

 

In addition, bonding can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape. Crowns, also known as caps, are used in cases where other procedures will not be effective. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time consuming.

Bleaching

Bleaching and non-bleaching products are the two basic kinds of whitening products available today.

 

Non-bleaching products normally use abrasives or chemicals and only remove surface stains on teeth.

 

Bleaching products work with a chemical called peroxide and can brighten your teeth several shades.

 

Another process employs the use of a special gel that is placed inside a flexible device you wear around your teeth for a certain period of time. After you remove the device, you must use a second bleaching agent, followed by a special light to activate the chemical action.

 

Mildly stained teeth usually only require one session of bleaching.

Abscessed Tooth

Treatment of an abscessed tooth

An abscessed tooth is a pocket of pus, usually caused by some kind of infection and the spread of bacteria from the root of the tooth to the tissue just below or near the tooth.

 

In general, a tooth that has become abscessed is one whose underlying pulp (the tooth’s soft core) has become infected or swollen. The pulp contains nerves, blood vessels and connective tissue, and lies within the tooth. It extends from the crown of the tooth, to the tip of the root, in the bone of the jaws.

 

An abscessed tooth can be an extremely painful condition.

 

In some cases, antibiotics are administered in an attempt to kill an infection. If antibiotics are ineffective and an abscess is shown to be damaging the pulp or lower bony structures, a root canal procedure may be needed to remove the dead pulp and restore the tooth to a healthy state.

 

Bulimia Nervosa

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.

Canker/Cold Sores

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.

Cavities and Tooth Decay

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.

Diabetes

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.

Dry Mouth

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.

Gum Disease (Gingivitis)

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.

 

Fluorosis

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.

 

Jaw Disorders

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.

Lacerations and Cuts

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

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

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.

 

Sensitive Teeth

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 (Bruxism)

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.

Toothaches

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.

Bad Breath (halitosis)

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.

 

Age and Oral Health

Oral changes with age

Is tooth loss inevitable in your later years? How much should adults be concerned about cavities? Here you will find helpful answers to some frequently asked questions about oral health questions you may have as you get older.

 

National survey reveals baby boomers miss links between oral and overall health

Baby boomers looking for the warning signs of adult-onset diseases may be overlooking key symptoms in their mouth that should signal alarms about their overall health. According to a survey commissioned by the Academy of General Dentistry, 63 percent of baby boomers (ages 45-64) with an oral symptom considered to be a key indicator of a more serious health condition, were unaware of the symptom`s link to the condition. Boomers` failure to recognize that oral health holds valuable clues could negatively impact their overall health.

Fillings

Frequently asked questions: dental fillings

Are dental amalgams safe? Is it possible to have an allergic reaction to amalgam? Is it true that dental amalgams have been banned in other countries? Is there a filling material that matches tooth color? If my tooth doesn’t hurt and my filling is still in place, why would the filling need to be replaced? Read this interesting and informative discussion from the American Dental Association.

 

FDA consumer update: dental amalgams

The Food and Drug Administration and other organizations of the U.S. Public Health Service (USPHS) continue to investigate the safety of amalgams used in dental restorations (fillings). However, no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergic reactions.

 

ATSDR – public health statements: mercury

The Centers for Disease Control and Prevention offers some scientific background on mercury (contained within silver-colored fillings), and whether it believes the substance presents any health hazards.

 

Analysis reveals significant drop in children’s tooth decay

Children have significantly less tooth decay in their primary (baby) and permanent teeth today than they did in the early 1970s, according to the Journal of the American Dental Association (JADA). The analysis reveals that among children between the ages of six and 18 years, the percentage of decayed permanent teeth decreased by 57.2 percent over a 20-year period. In addition, children between the ages of two and 10 years experienced a drop of nearly 40 percent in diseased or decayed primary teeth.

 

Alternative Materials

Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural-looking smiles. Researchers are continuing their often decades-long work developing esthetic materials, such as ceramic and plastic compounds that mimic the appearance of natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials used to repair missing, worn, damaged or decayed teeth.

 

The advent of these new materials has not eliminated the usefulness of more traditional dental restoratives, which include gold, base metal alloys and dental amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.

 

Alternatives to amalgam, such as cast gold restorations, porcelain, and composite resins are more expensive. Gold and porcelain restorations take longer to make and can require two appointments. Composite resins, or white fillings, are esthetically appealing, but require a longer time to place.

 

Here’s a look at some of the more common kinds of alternatives to silver amalgam:

 

Composite fillings – Composite fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth-colored restoration. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be “bonded” or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth. In teeth where chewing loads are high, composite fillings are less resistant to wear than silver amalgams. It also takes longer to place a composite filling.

Ionomers – Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for non-load bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

Porcelain (ceramic) dental materials – All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. Their strength depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.

Sealants

Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

 

Sealants were developed in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity.

 

Sealants act as a barrier to prevent bacteria and food from collecting and sitting on the grooves and pits of teeth. Sealants are best suited for permanent first molars, which erupt around the age of 6, and second molars, which erupt around the age of 12.

 

Sealants are most effective when applied as soon as the tooth has fully come in. Because of this, children derive the greatest benefit from sealants because of the newness of their teeth. Research has shown that more than 65% of all cavities occur in the narrow pits and grooves of a child`s newly erupted teeth because of trapped food particles and bacteria.

 

Application

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light.

 

Sealants normally last about five years. Sealants should always be examined at the child`s regular checkup. Sealants are extremely effective in preventing decay in the chewing surfaces of the back teeth.

 

Insurance coverage for sealant procedures is increasing, but still minimal. Many dentists expect this trend to change as insurers become more convinced that sealants can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

 

Fluoride

Does mercury in the silver fillings in your mouth pose any long-term health risks? Does fluoride, in spite of everything we’ve been told since childhood, actually cause more harm than good? What does the latest research reveal about tobacco use on your overall oral health?

 

This section is dedicated to the latest information about these and other oral health topics, pulled from authoritative sources such as the American Dental Association.

 

Click here for the latest news from the American Dental Association. Fluoride

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

 

Water fluoridation is endorsed by nearly every major health and safety-related organization in the world. Communities make it a common practice to “fluoridate” their drinking supplies in order for the general population to benefit from this inexpensive and effective preventative treatment. According to the American Dental Association, more than 144 million U.S. residents in more than 10,000 communities drink fluoridated water, most from public water supplies with sodium fluoride added artificially.

 

 

Bottled water, home water treatment systems, and fluoride exposure

Can the consistent use of bottled water result in individuals missing the benefits of optimally fluoridated water? Can home water treatment systems (e.g., water filters) affect optimally fluoridated water supplies? The answer is yes to both. Read how you can avoid some of the pitfalls that may be preventing you from getting the maximum value of fluoride, in this article from the American Dental Association.

 

ADA statement on FDA toothpaste warning labels

The American Dental Association`s Council on Scientific Affairs believes that one part of the warning now required on fluoride toothpastes by the Food and Drug Administration (FDA) could unnecessarily frighten parents and children, and that the label greatly overstates any demonstrated or potential danger posed by fluoride toothpastes. The label language, “If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately,” is now required on all fluoride toothpastes. But the ADA, in a letter sent to the FDA last year, pointed out that a child could not absorb enough fluoride from toothpaste to cause a serious problem and that the excellent safety record on fluoride toothpaste argues against any unnecessary regulation.

 

Enamel fluorosis

According to the American Academy of Pediatric Dentistry, a child may face a condition called enamel fluorosis if he or she receives too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

 

CDC web site provides information on community water fluoridation

People seeking information on whether their water system is fluoridated can now find out by visiting a new Web site at the Centers for Disease Control and Prevention (CDC). The new feature, “My Water`s Fluoride,” allows consumers in participating states to check out basic information about their water system, including the number of people served by the system and the target fluoridation level. Optimal levels recommended by the U.S. Public Health Service and CDC for drinking water range from 0.7 parts per million (ppm) for warmer climates, to 1.2 ppm for cooler climates accounting for the tendency to drink more water in warmer climates. States that are currently participating include Arizona, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, Nevada, North Dakota, Oklahoma, Pennsylvania and Wisconsin.

Infection Control

Standards and Best Practice

With all of the increased media attention on infection outbreaks such as AIDS and multi-drug resistant strains of viruses, it’s no wonder people have heightened concerns about infection control during a medical procedure.

 

Gloves, gowns and masks are required to be worn in all dentist offices today—a far cry from just a few decades ago—when fewer than one-third of all dentists even wore such personal protective equipment, or PPE.  After each patient visit, disposable PPE-such as gloves, drapes, needles, and scalpel blades-are thrown away, hands are washed, and a new pair of gloves used for the next patient.

 

All hand instruments used on patients are washed, disinfected and/or sterilized with chemicals or steam after each use.

 

One of the most effective methods for preventing disease transmission—washing one’s hands—is practiced in our office.  It is routine procedure to wash hands at the beginning of the day, before and after glove use, and after touching any surfaces that may have become contaminated.

 

Water Quality and Biofilms

Concerns about the quality of water used in a dentist’s office are unfounded, provided the dentist follows the infection control guidelines of the Centers for Disease Control and the American Dental Association.

 

Some health “experts” in recent years have called into question the risks associated with so-called “biofilms,” which are thin layers of microscopic germs that collect on virtually any surface. Essentially, these bacteria and fungi occur everywhere, including faucets in your home; your body is no less accustomed to being exposed to them than in any other situations.

 

In fact, no scientific evidence has linked biofilms with disease. If you have a compromised or weakened immune system, you are susceptible to germs everywhere. Consequently, let our office know if you have such a condition so additional precautions, if any, can be taken.

Oral Health Introduction

Does mercury in the silver fillings in your mouth pose any long-term health risks? Does fluoride, in spite of everything we’ve been told since childhood, actually cause more harm than good? What does the latest research reveal about tobacco use on your overall oral health?

 

This section is dedicated to the latest information about these and other oral health topics, pulled from authoritative sources such as the American Dental Association.

 

Click here for the latest news from the American Dental Association.

Latex Allergy

Naturally occurring latex has been linked in recent years to allergic reactions in people who use such products as latex gloves. The proteins in the latex, which can also become airborne, can cause problems in vulnerable people such as breathing problems and contact dermatitis. Some allergic reactions, including anaphylactic shock, have been more severe.

 

Many health experts have rightly attributed the dramatic increase of allergic reactions to latex in the health care community to the increased use of gloves and other personal protection equipment in light of the AIDS epidemic.

 

Latex is a pervasive substance in many household items—from toys and balloons to rubber bands and condoms.

 

Latex allergies could cause the following symptoms:

 

Dry skin

Hives

Low blood pressure

Nausea

Respiratory problems

Tingling sensations

People with high-risk factors for latex allergy include those who have undergone multiple surgical operations, have spina bifida, or are persistently exposed to latex products.

 

If you are vulnerable to latex or have allergies related to it, please notify our office and, by all means, seek medical attention from your family physician.

 

Medication and Heart Disease

Certain kinds of medications can have an adverse effect on your teeth.

Long ago, children exposed to tetracycline developed tooth problems, including discoloration, later in life. The medication fell out of use, however, and is not an issue today.

The best precaution is to ask your family physician if any medications he or she has prescribed can have a detrimental effect on your teeth or other oral structures.

A condition called dry mouth is commonly associated with certain medications, including antihistamines, diuretics, decongestants and pain killers. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems. Garlic and tobacco use are other known culprits.

Dry mouth occurs when saliva production drops. 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.

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.

Heart Disease

Poor dental hygiene can cause a host of problems outside your mouth—including your heart.

Medical research has uncovered a definitive link between heart disease and certain kinds of oral infections such as periodontal disease. Some have even suggested that gum disease may be as dangerous as or more dangerous than other factors such as tobacco use.

A condition called chronic periodontitis, or persistent gum disease, has been linked to cardiovascular problems by medical researchers.

In short, infections and harmful bacteria in your mouth can spread through the bloodstream to your liver, which produces harmful proteins that can lead to systemic cardiac problems. That’s why it’s critical to practice good oral hygiene to keep infections at bay—this includes a daily regimen of brushing, flossing and rinsing.

Antibiotic Prophylaxis

In some cases, patients with compromised immune systems or who fear an infection from a dental procedure may take antibiotics before visiting the dentist.

It is possible for bacteria from your mouth to enter your bloodstream during a dental procedure in which tissues are cut or bleeding occurs. A healthy immune system will normally fight such bacteria before they result in an infection.

However, certain cardiovascular conditions in patients with weakened hearts could be at risk for an infection or heart muscle inflammation (bacterial endocarditis) resulting from a dental procedure.

Patients with heart conditions (including weakened heart valves) are strongly advised to inform our office before undergoing any dental procedure. The proper antibiotic will prevent any unnecessary complications.

 

Oral Piercing

Oral piercings (usually in the tongue or around the lips) have quickly become a popular trend in today’s society.  With this popular trend, it is important to realize that sometimes even precautions taken during the installation of the piercing jewelry are not enough to stave off harmful, long-term consequences such as cracked or chipped teeth, swelling, problems with swallowing and taste, and scars. There is also a possibility of choking on a piece of dislodged jewelry, which makes it important to ask if the risks are warranted.

 

One of the most serious long-term health problems that may occur from oral piercings come in the form of damage to the soft tissues such as the cheeks, gums and palate, as well as opportunistic infections. When performed in an unsterile environment, any kind of body piercing may also put you at risk of contracting deadly infectious diseases such as HIV and hepatitis.

 

A tongue piercing is a common form of body piercing. However, tongue piercings have been known to cause blocked airways (from a swollen tongue). In some cases, a tongue piercing can cause uncontrolled bleeding.

 

The Preventive Program

Both natural teeth and teeth with restorations survive best in an oral environment that is clean and where the intake of harmful foods is controlled. Our program is designed to help prevent new cavities, preserve teeth that have been restored and manage periodontal disease. At the initial visit oral hygiene instructions are reviewed and are reinforced at subsequent recall visits. The following are helpful recommendations:

 

Brush your teeth twice a day in a circular motion with a soft bristled toothbrush aimed at the gum.

Floss every night in an up-and-down motion while keeping the floss in a U-shape and against the tooth surface.

• Avoid smoking.
• Avoid sticky sugary foods.
• Eat a balanced diet.
• Use antiseptic and fluoride rinses as directed.
• Have sealants placed on young permanent teeth.

Tobacco

Dentistry health care that works: tobacco

The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.

 

Frequently asked questions: tobacco products

What effects can smoking have on my oral health? Are cigars a safe alternative to cigarettes? Are smokeless tobacco products safe? The American Dental Association has some alarming news that you should know.

 

Smoking and Implants

Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking.

 

Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.

 

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.

 

Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.

Appliance Therapy

Functional Appliances are used mainly in growing children to help solve the problem of narrow upper and lower jaws, which could cause crowding of the permanent teeth. When the narrow upper and lower jaws are developed to normal shape and size with functional appliances, in the majority of cases it is not necessary to extract permanent teeth.

 

 

Most children with crowded teeth and bad bites have narrow jaws and underdeveloped lower jaws, which could be corrected with functional appliances. Functional appliances help correct the bone problems, while the tooth problems are corrected with the orthodontic braces.

 

The ideal age for the use of functional appliances is between ages seven and eleven, when the cooperation level is the highest. However, functional appliances can be utilized as early as age 4, if the upper jaw is too narrow and is having a negative effect on the child’s breathing and speech. Arch Development (functional appliances) can also be used in adults to develop the arch to a more normal shape and size before applying the braces.

 

The use of functional appliances can reduce the time the child must wear fixed braces and also can reduce the need for the extraction of permanent teeth. Functional appliances develop the dental arches so that all the permanent teeth can erupt, which ensures an outstanding profile, broad smile and healthy jaw joints.

Early Treatment

Early interceptive orthodontic treatment usually starts before the eruption of the permanent teeth or when the child has very few permanent teeth present. The goal at our office is to guide the growth of the upper and/or lower jaw to make adequate space for the eruption of all the permanent teeth. We feel that children should be evaluated by the age of four to see if there is a bone problem (orthopedic) or a tooth problem (orthodontic).

If the patient has a problem such as the upper jaw being too narrow, or an underdeveloped lower jaw, this will require a special appliance called a functional jaw orthopedic appliance to correct the problem. Minor tooth crowding can also be corrected early if it appears as though it may compromise the eruption of other permanent teeth.

It is always less expensive to correct a problem when the patient is younger rather than wait for the problem to become more serious in the future.

Other benefits of early treatment:

• Improve profiles, smiles and self-esteem
• Correct harmful habits, such as thumb sucking and tongue thrusting. Functional appliances develop the arches and make more room for the tongue.
• Improved speech
• Reduction of the time in fixed braces and frequently eliminates the need for the extraction of permanent teeth
• Increases nasal breathing which improves health
• Eliminates airway constriction
• Creates beautiful broad smiles by developing the arches
• Eliminates grinding of the teeth at night
• Prevents headaches and earaches

 

FUNCTIONAL HABITS

Functional habits include thum sucking, mouth breathing or a tongue thrust habit which can contribute to the unfavorable growth of the jaws. Oral habits can commonly cause the upper front teeth to stick out and can contribute to speech problems. The best way to intercept a habit is to first make certain that the child has a proper size airway and can breath through the nose. In cases where there are serious allergies, swollen adenoids or tonsils, a referral to an Ear, Nose & Throat Specialist must be done.

After airway considerations are addressed an upper fixed habit- breaking appliance could be made to stop the oral habit. Most parents prefer the fixed appliances, which cannot be removed by the child. A tiny patient friendly crib at the front of the appliance helps to remind the patient not to place their tongue, finger of thumb in this area of the mouth. Active treatment usually takes 4 to 5 months. Then if an arch development appliance was used, the crib could be removed, and the child wears the appliance as a retainer for another 6 months to prevent a relapse.

 

 

 

Early Warning Signs

 

Deep Bite

Do the upper teeth completely hide the lower teeth when you bite down, or does your child bite on the roof of their mouth?

 

Open Bite

Do the upper and lower teeth not meet in the front when your child bites together?

 

Overjet

Do the upper front teeth seem to be more noticeable and stick out quite a bit, compared to the lower front teeth?

 

Facial Asymmetry

When looking at your child from the front does it appear that their face, or chin are shifted to one side. Are they growing crooked?

 

Crossbite

When you look into your child’s mouth are the upper teeth on the inside of the lower teeth? If you think of the upper jaw as the garage and the lower jaw as the car the garage should be bigger than the car!

 

Habits

Does your child suck their finger or their thumb? Do they breathe through their mouth instead of their nose? Do they stick their tongue between their teeth when they swallow?

 

Crowding

Are the permanent teeth starting to come in crowded?

 

Headaches

Does your child complain frequently of headaches? If your child grinds their teeth, or has a deep bite, the muscles may be over worked and can contribute to headaches in children.

 

Earaches

Sometimes a bad bite or a deep bite can cause undue pressure on the small membranes of the ear, contributing to earaches.

These are all sign that your child may need early intervention!

 

Functional Appliances work with your child’s growth and development to guide the jaws to their proper size.

 

Contact us for an assessment of your child, if you have noticed any of the above symptoms.

Orthodontics Phase I – Frequently Asked Questions

Why would my child need early treatment?

 

Early treatment, or Phase I, would be recommended if there are certain discrepancies in the development of the upper and lower jaws. Early treatment can correct these problems in the early growth phase of your child (utilizing a functional appliance), which develops the bone to a more normal size, to allow enough room for the permanent teeth to erupt.

 

What are the benefits of early treatment?

 

• Improve profiles, smiles and self-esteem
• Correct harmful habits
• Improved speech from expanding the arches and making more room for the tongue.
• Reduction of the time in fixed braces and frequently eliminates the need for the extraction of permanent teeth.
• Prevent the fang look. Upper eye teeth (cuspids) are the last teeth to erupt on the upper arch. If the jaw is too narrow, patient will get the fang look.
• Prevent possibility of facial asymmetry with the expansion of the upper arch and the correction of the posterior crossbite.
• Improves head posture which helps eliminate neck pain
• Prevents grinding of the teeth at night
• Improves nasal breathing
• Prevents gum recession

 

What is a functional appliance?

 

Once a thorough and proper diagnosis has been made, the best appliance to be used to correct your child’s problems will be selected. A functional appliance is a tiny device designed like a mouth retainer, with micro-screws, to make the appliance able to activate and stimulate the change in bone, therefore making the jaw grow to its potential. The initial records and x-rays, taken at the beginning of treatment, determine growth potential.

 

How long does Phase I treatment last?

 

Phase I treatment usually lasts approximately 10-12 months depending on the severity of the case. The appliance is usually active (making changes to the jaw) for 4-6 months then the appliance should be used as a holding appliance for 6 months or as a retainer to prevent any relapse in the treatment. As the permanent teeth erupt, it will be determined when it is no longer necessary to wear the holding appliance.

 

At what point will my child need orthodontics?

 

Once the early phase of treatment is finished your child will be evaluated on an ongoing basis to monitor the eruption of the permanent teeth. Once the permanent teeth are all present. We will set up a consultation appointment to determine whether there is a need for braces. Usually orthodontics, which means fixed braces, does not begin until the patent has all their permanent teeth (age 11 to 13). While braces are the most popular among younger patients, they can be worn as a teenager or an adult. More adults these days are asking for braces to help improve their smile and appearance. Set up an initial screening appointment for your child today!

 

 

What is Orthodontics?

 

The area of dentistry called orthodontics involves straightening of teeth with the use of braces. Orthodontics is also indicated when the patient has a bad bite, which can make you feel self conscious and can cause digestive or other health problems. Braces are now less conspicuous and more comfortable than ever before, due to the use of new high performance arch wires, which exert light continuous forces on the teeth. Children should have an orthodontic assessment before the age of five so that early treatment with functional appliances can reduce the time spent wearing braces.

 

How long does orthodontic treatment last?

 

The average length of time for orthodontic fixed braces would be 1½ to 2 years when all the permanent teeth have erupted. The treatment time obviously depends on the seriousness of the problem and when treatment is started. Our office recommends that children be evaluated before age five to see if the problem is a bone problem or a tooth problem. If the problem involves the bone, such as the upper or the lower jaw being too narrow or the lower jaw being underdeveloped, then we recommend this problem be treated immediately with functional appliances. The use of functional appliances can reduce the time the child must wear fixed braces and reduce the need for the extraction of permanent teeth. If the problem is merely crooked teeth, many times treatment will be delayed until all the permanent teeth erupt.

 

Are there different kinds of braces?

 

Most patients today think braces are “cool” because of all the different colours. In fact, there are more that 40 different combinations of coloured elastics, which fit over the braces to keep the wires in place. Every month the patient has their choice of coloured elastics. Most children pick the metal braces, which are much smaller today. Adults and teenagers prefer the clear braces because they blend in with the colour of the teeth and are harder to see. We have some females who prefer gold braces since they look like jewelry. The newest and latest trend is toward invisible braces, where trays that are changed periodically and move the teeth into a better position. For more information on clear braces, click here.

 

 

Clear Retainer

 

Will teeth move when the braces come off?

 

A clear retainer will be made to wear when your braces are removed. The roots of the teeth need enough time to settle in the bone, so it’s absolutely imperative that you follow the instructions on wearing the retainer to maintain your beautiful smile at the end of treatment.

 

How long do I have to wear my retainers?

 

The length of time in retainers varies depending on the amount of tooth movement that was necessary. However, as a general rule of thumb, we recommend full time wear of the upper clear retainer for 1 full year and 1 year at night only. We generally like to make the lower retainer fixed, behind the lower front teeth, and it remains in place for 3-5 years.

 

 

Exciting news regarding new clear retainers! The newest retainer now has a clear labial bow which makes the retainer practically invisible. Patients love these new clear retainers.

Headaches In Children

Numerous children today suffer from headaches, which are frequently caused by a structural imbalance between the upper and lower jaws. The three main types of structural imbalances include a narrow upper arch, a deficient lower jaw and patients who have a vertical problem, evidenced by a deep overbite. A high percentage of these children who suffer from these structural imbalances will have some of the following:

 

• Tired Jaws
• Sore Teeth
• Headaches
• Worn Teeth
• Neck Ache
• Clicking Jaw Joints
• Ear Ache
• Ringing in the Ears
• Facial Deformity
• Dizziness
• Tired Jaws

 

If the jaws become tired after chewing gum or eating chewy foods, this is one of the earliest signs that something is wrong with the functioning of the chewing system. The human jaw is so well designed that it is impossible for the jaws to become tired unless the jaws are not properly aligned. The most common problem is a lower jaw, which is deficient or well behind the upper jaw. These patients appear to have protruding upper teeth but in the majority of these cases the lower jaw is positioned behind the upper jaw. If any tiredness of the lower jaw should occur, the child should be examined by a dentist trained in the area of TM Dysfunction (TMJ) a jaw joint problem.

 

Headaches

Jaw joint (TMJ) problems are beginning to develop when a child experiences headaches. Pain from headaches is not normal, especially in young children. Normal children are healthy, pain-free and have relatively low stress levels. Therefore, headaches that do occur are a sign that the system is overloaded. Headaches of once or twice a month can easily be an early warning sign that should be taken seriously.

 

Neck Aches

Poor posture combined with a jaw problem significantly overloads neck muscles creating pain and discomfort. These problems tend to get worse as the children get older if the structural problems, as discussed previously, are not corrected. Early evaluation and treatment can go a long way to providing a lifetime of better health and comfort for our young patients.

 

If your children have any of the above problems, please consider making an appointment with a dentist. For an assessment appointment please call our office.

 

Orthodontics Phase II – Frequently Asked Questions

Why would my child need early treatment?

 

Early treatment, or Phase I, would be recommended if there are certain discrepancies in the development of the upper and lower jaws. Early treatment can correct these problems in the early growth phase of your child (utilizing a functional appliance), which develops the bone to a more normal size, to allow enough room for the permanent teeth to erupt.

 

What are the benefits of early treatment?

 

• Improve profiles, smiles and self-esteem
• Correct harmful habits
• Improved speech from expanding the arches and making more room for the tongue.
• Reduction of the time in fixed braces and frequently eliminates the need for the extraction of permanent teeth.
• Prevent the fang look. Upper eye teeth (cuspids) are the last teeth to erupt on the upper arch. If the jaw is too narrow, patient will get the fang look.
• Prevent possibility of facial asymmetry with the expansion of the upper arch and the correction of the posterior crossbite.
• Improves head posture which helps eliminate neck pain
• Prevents grinding of the teeth at night
• Improves nasal breathing
• Prevents gum recession

 

What is a functional appliance?

Once a thorough and proper diagnosis has been made, the best appliance to be used to correct your child’s problems will be selected. A functional appliance is a tiny device designed like a mouth retainer, with micro-screws, to make the appliance able to activate and stimulate the change in bone, therefore making the jaw grow to its potential. The initial records and x-rays, taken at the beginning of treatment, determine growth potential.

 

How long does Phase I treatment last?

Phase I treatment usually lasts approximately 10-12 months depending on the severity of the case. The appliance is usually active (making changes to the jaw) for 4-6 months then the appliance should be used as a holding appliance for 6 months or as a retainer to prevent any relapse in the treatment. As the permanent teeth erupt, it will be determined when it is no longer necessary to wear the holding appliance.

 

At what point will my child need orthodontics?

Once the early phase of treatment is finished your child will be evaluated on an ongoing basis to monitor the eruption of the permanent teeth. Once the permanent teeth are all present. We will set up a consultation appointment to determine whether there is a need for braces. Usually orthodontics, which means fixed braces, does not begin until the patent has all their permanent teeth (age 11 to 13). While braces are the most popular among younger patients, they can be worn as a teenager or an adult. More adults these days are asking for braces to help improve their smile and appearance. Set up an initial screening appointment for your child today!

 

 

What is Orthodontics?

The area of dentistry called orthodontics involves straightening of teeth with the use of braces. Orthodontics is also indicated when the patient has a bad bite, which can make you feel self conscious and can cause digestive or other health problems. Braces are now less conspicuous and more comfortable than ever before, due to the use of new high performance arch wires, which exert light continuous forces on the teeth. Children should have an orthodontic assessment before the age of five so that early treatment with functional appliances can reduce the time spent wearing braces.

 

How long does orthodontic treatment last?

The average length of time for orthodontic fixed braces would be 1½ to 2 years when all the permanent teeth have erupted. The treatment time obviously depends on the seriousness of the problem and when treatment is started. Our office recommends that children be evaluated before age five to see if the problem is a bone problem or a tooth problem. If the problem involves the bone, such as the upper or the lower jaw being too narrow or the lower jaw being underdeveloped, then we recommend this problem be treated immediately with functional appliances. The use of functional appliances can reduce the time the child must wear fixed braces and reduce the need for the extraction of permanent teeth. If the problem is merely crooked teeth, many times treatment will be delayed until all the permanent teeth erupt.

 

Are there different kinds of braces?

 

Most patients today think braces are “cool” because of all the different colours. In fact, there are more that 40 different combinations of coloured elastics, which fit over the braces to keep the wires in place. Every month the patient has their choice of coloured elastics. Most children pick the metal braces, which are much smaller today. Adults and teenagers prefer the clear braces because they blend in with the colour of the teeth and are harder to see. We have some females who prefer gold braces since they look like jewelry. The newest and latest trend is toward invisible braces, where trays that are changed periodically and move the teeth into a better position. For more information on clear braces, click here.

 

Will teeth move when the braces come off?

A clear retainer will be made to wear when your braces are removed. The roots of the teeth need enough time to settle in the bone, so it’s absolutely imperative that you follow the instructions on wearing the retainer to maintain your beautiful smile at the end of treatment.

 

How long do I have to wear my retainers?

The length of time in retainers varies depending on the amount of tooth movement that was necessary. However, as a general rule of thumb, we recommend full time wear of the upper clear retainer for 1 full year and 1 year at night only. We generally like to make the lower retainer fixed, behind the lower front teeth, and it remains in place for 3-5 years.

 

 

Exciting news regarding new clear retainers! The newest retainer now has a clear labial bow which makes the retainer practically invisible. Patients love these new clear retainers.

 

Invisible Braces

The value of an attractive smile should not be underestimated!

 

Our office offers the latest advancements in invisible orthodontic braces. This newest development in orthodontic technology allows you to smile with confidence throughout treatment.

 

Correcting your smile is possible at any age. Some patients may choose the new clear braces or invisible tooth aligners.

 

CLEAR BRACES vs. METAL BRACES

Mystique, which uses the latest aesthetic ceramic technology, provides outstanding results and high translucency. The clear braces are bonded to the tooth just like the ordinary metal braces. Treatment time with the mystique is approximately 12-14 months depending on the difficulty of tooth movement. Adults are asking for invisible (clear) braces today.

 

NEW E-Z ALIGN

Aligning your teeth could be as easy as 1-2-3

 

The easy three tray tooth aligner series, is designed for minor tooth alignment of the upper and/or lower front teeth. A slight amount of the outside part of the tooth may have to be removed between the teeth, creating a tiny space between the teeth and allows to tooth to be lined up while wearing the tray. The tray is to be worn 24 hours per day and only removed when you are eating.

 

The dentist will determine the length of time necessary for tray A, B or C.

 

If you have some minor crowding and have always wondered whether you could have them straightened without braces, contact our office today to see if you may be a candidate.

 

Orthodontics Phase II

Orthodontics is usually our Second Phase of treatment, following the use of functional appliances. The braces would now be placed to move the teeth into alignment to support the development of the bone achieved in the first phase of treatment. The second phase of treatment is initiated when most of the permanent teeth have erupted.

 

Braces are the small, square metal attachments (called brackets) that are bonded with special orthodontic adhesive to the teeth. There is a small slot in the in the middle of the bracket into which the orthodontic wire fits. In order to hold the wire in place, small tiny elastics are wrapped around the outside of the braces. It is the combination of the braces, the wire and the elastic that help the tooth move into is proper position.

To help make the wearing of braces more fun, patients have a choice of at least 40 different colored elastics.

This phase of treatment usually last between 12-24 months depending of the amount of tooth movement necessary to align the teeth and to establish a proper bite. It is important to remember that treatment time is estimated. Our dentist has specific treatment goals in mind and will usually continue treatment until these goals have been achieved. Patient cooperation is the best way to keep on time with your treatment. Be sure to take care of your braces and to wear your rubber bands as instructed and we will both be able to achieve our desired result.

After phase II is completed it is necessary to wear retainers to hold the final result. The great part about our retainers is that they are virtually invisible which helps guarantee patient acceptance and ensures they will be worn at the appropriate times.

 

 

Whitening

Get that Bright White Smile you’ve always wanted…

Sometimes it seems that no matter how much you brush you can’t seem to brighten your smile. The problem is not that your teeth are unclean, it’s actually staining or the natural discoloration of your teeth. Teeth can darken for a number of reasons. The most common is the natural tooth-yellowing effect from aging. Your teeth may also be stained from drinking coffee; tea or caffeine based soft drinks. Some time the tooth also has varying shades of white, due to the growth process of the tooth or to trauma when the tooth bud was being formed.

 

Don’t be discouraged. If you feel that your teeth are looking less than their best, our office can offer you the latest in tooth whitening techniques.

 

Whiten your teeth at night, during the day or over the weekend!! The dentist will help you choose the whitening system that is right for you!!

 

 

Common Questions

What is tooth whitening?

Tooth whitening is a process where a mild bleaching solution is applied to the tooth, using a custom fit tray, to whiten tooth discolorations of the enamel and dentin.

 

 

What causes tooth discoloration?

Commonly, discoloration can be caused by, aging, consumption of coffees, teas, caffeine soft drinks, red wines etc. Tooth discoloration can also occur during tooth formation due to trauma and medications taken during this time.

 

 

How long does it take to get results?

If you follow your dentist’s recommendations, you will see results in 10-14 days. The type of whitening selected for you will determine how often you will apply the solution. Nite White is worn once per day for 2 hours. Day White is worn 1-3 times per day for 30 minutes. Zoom Whitening is worn 4-8 hours while sleeping for only 3 days.

 

 

Will my fillings change color?

No. If you have some original tooth colored filling that are noticeable when you smile, they will not change color with the whitening solution.

 

How long will it last?

Your teeth will always be lighter than they were initially. Your teeth may need to be “touched up” 1-2 applications, once or twice a year. In order to maintain the whitest tooth shade possible, it is best to avoid substances like coffee, tea or tobacco. To keep your teeth looking their best we recommend flossing, and brushing twice daily with professional whitening toothpaste, specifically designed to keep your teeth looking there brightest.

 

 

How does it work?

As the carbamide peroxide (active ingredient) is broken down, oxygen will enter the enamel and the dentin and dissolves the stains. The tooth structure has not changed and the tooth is made lighter.

 

 

Is tooth whitening safe?

Studies indicate that tooth whitening under the supervision of a dentist is safe for the teeth and the gums. However, it is not recommended for anyone under the age of thirteen or pregnant or lactating women.

 

 

What about sensitivity?

Majority of patients do not experience sensitivity, however if you experience mild, temporary sensitivity it should subside within a few hours after the treatment. If sensitivity does persist, wear times can be varied or teeth can be treated with desensitizing toothpaste. Lingering sensitivity will subside after 1-3 days of completion of the treatment.

Air Abrasion

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.

 

Anesthesia

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.

Managing Pain

There are many methods for relieving oral pain. They include:

 

Ice packs on the affected area.

Avoiding hard candy or ice.

Avoiding sleeping on your stomach.

Dentists use a wide array of pain management tools, including:

 

Anesthetics such as Novocaine.

Analgesics such as aspirin or ibuprofen.

Sedatives, including a procedure known as “conscious sedation” or general sedation (also known as “deep sedation”).

Medications

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.

Managing Pain – Overview

Pain can occur in any number of places in your mouth: teeth, gums, roots, the palate, tongue and jaw.

 

Cavities are a common culprit causing pain. Untreated cavities can impact nerves because of infections of the tooth and gums. Impacted and abscessed teeth and sore jaws from teeth grinding are other common causes of pain.

 

Improper bite relationships and jaw disorders can also cause pain. Other sources of pain include sleep disorders, and headaches and neck aches.

 

Special splints can sometimes be applied to stabilize a bite. Bites can also be corrected with special orthodontic procedures, appliances and restoration techniques.

Dental Emergencies

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.

Your First Dental Visit

Your first dental visit promises to be a pleasant experience.

 

Making sound decisions about your dental care and oral health is an easy thing to do with the right preparation beforehand:

 

Make a list of questions to ask our office, so you don’t forget anything on the day of your appointment. This includes any concerns you have, or oral problems you’ve been experiencing.

If you have dental insurance, remember to bring your insurance card with you.

Cycles of Sleep

SLEEP ARCHITECTURE

 

This describes the stages and cycles of sleep. There are two main categories of sleep:

 

1. Non-Rapid Eye Movement (NREM)
2. Rapid Eye Movement (REM)

 

Non Rapid Eye Movement (NREM)

 

Transitional Phase – Between wakefulness and sleep. This lasts for one to seven minutes and is 5% of the total sleep time.

Light Sleep Phase – This is 50% of the total sleep time.

Slow Wave Phase (Delta Phase) – A deeper and more relaxed sleep associated with 20% of the total sleep time.

Rapid Eye Movement (REM)

 

This is a period of deep, refreshing sleep. Eyes move side to side and the skeletal muscles are nearly paralysed which results in a loss of muscle tone in the upper airway. This represents 25% of the total sleep time and is the stage where dreaming occurs.

 

Excessive Daytime Sleepiness (EDS)

 

People who suffer from obstructive sleep apnea have a fragmented sleep architecture which causes them to spend an excessive amount of time in the lighter stages of sleep at the expense of the Delta Phase and REM stage. This causes them to have excessive daytime sleepiness due to their lack of sleep at night.

 

Apnea and Hypoapnea

 

Apnea is defined as a period of cessation of breathing during sleep for ten seconds or longer. If the patient has more than five episodes of apnea per hour of sleep, this is considered clinically significant and helps confirm the diagnosis of obstructive sleep apnea. Hypoapnea occurs when the decrease in airflow results in a 4% decrease in oxyhemoglobin concentration in the blood.

Diagnosis

SLEEP DIAGNOSTIC CENTER

 

Most hospitals have sleep diagnostic centers which are being run by sleep technicians working with physicians. Sleep centers have sophisticated equipment in an adjoining room where an intercom and video camera allow communication between the technician and the patient. The patient comes in at night and is hooked up to a number of machines which are used to monitor the activities of the brain, the eyes and the muscles. The recordings are done in a private room and there is no discomfort to the patient. The patient is not confined to a fixed position and can turn freely. Recordings are done during the night in a seven hour sleep period and the patient is discharged in the morning.

 

POLYSOMNOGRAM

 

The purpose of a polysomnogram is to evaluate the individual sleep architecture including the stages and cycles of sleep as well as to record the electrical activity of the brain, the eyes, muscles and heart.

 

1. Electroencephalogram (EEG)

 

Records the activity of the brain. This verifies and records the different stages of sleep.

 

2. Electro-occulogram (EOG)

 

Records the movement of the eyes and measures the periods of rapid eye movement (REM).

 

3. Electromyogram (EMG)

 

Records muscle activity throughout the body.

 

4. Electrocardiogram (EKG)

 

Measures cardiovascular abnormalities during sleep.

 

It also uses a finger or ear oximeter to measure the amount of oxyhemoglobin (oxygen saturation) in the blood. Patients suffering from OSA have a decreased amount of oxygen in the system.

 

Treatments

COMMON METHODS OF OSA TREATMENT

 

1.Oral Appliance Therapy

2. Continuous Positive Air pressure (CPAP)
3. Surgical Removal of Excess Palatal Tissue (UPPP) or the Laser Assisted Removal of the Uvula (LAUP)

 

Clearly, the largest number of patients suffering from obstructive sleep apnea are in the mild to moderate categories and should be treated with oral appliances. Despite the fact that treatment with the CPAP unit is extremely successful, there are a number of patients who cannot or choose not to wear the face mask with the attached air compressor. These patients are excellent candidates for oral appliances. Some patients either do not want surgery or have had surgery and the procedure has been unsuccessful in solving the problem of OSA. These patients prefer a non-surgical, non-invasive plastic intra-oral appliance that can be worn at night only to help solve their problem.

 

Today there are basically three types of appliances:

 

Soft Palatal Life Appliance

Tongue Retraining Device

Mandibular Repositioner

It should be noted that since 1987 all medical devices, including oral appliances for the treatment of snoring and obstructive sleep apnea, are required to have marketing clearance from the FDA.

 

Types of Appliances

 

1. Snore Free

 

A prefabricated appliance constructed by the clinician at the chair. It is a relatively inexpensive, good diagnostic, temporary appliance and is used if the patient breaks or loses the permanent snoring appliance. .

 

2. Silent Nite

 

This two piece appliance is consists of two plastic parts which cover the upper and lower teeth and are joined together with a plastic plunger. The advantage of this appliance is that it is extremely comfortable

 

3. Modified Herbst

 

This removable appliance is highly effective. The upper and lower acrylic components are held together by a plunger mechanism which holds the mandible forward in both the open and closed positions. The Modified Herbst has the advantage of allowing the patient to open and close as well as providing some limited side to side jaw movement.

 

4. Nocturnal Airway Patency Appliance ( NAPA )

 

This is a rigid appliance which stabilizes the jaw in the horizontal and vertical dimension.

 

5. Klearway Appliance

 

This is a one-piece appliance attached to the upper and lower teeth with a screw capable of advancing the jaw.

 

6. Silencer Appliance

 

This is a two piece appliance held together with a special titanium hinge. This is one of the most comfortable appliances since it allows for jaw movements.

 

After the oral appliance has been used for a few months and the treatment appears to be working, then a second polysomnogram must be taken to confirm that the snoring and obstructive sleep apnea have been corrected. If the polysomnogram reveals that there is still a problem, then it is advantageous to have an adjustable appliance.

 

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

 

The current gold standard utilized by the medical profession for the treatment of OSA is continuous positive airway pressure (CPAP). The patient wears a tightly fitting nose mask which is strapped to the head and connected by a hose to an air compressor pump. The air is forced into the airway through the nasal passages in order to open up the airway.

 

Complaints about the use of this air blower include pump noise, voice changes, skin irritations from the mask, nose and throat dryness, headaches from the strap around the head, tinnitus, difficulty getting to sleep, sinus infections, and difficulty breathing out against the air being forced through the nose.

 

The patients who should use CPAP are the severe cases of obstructive sleep apnea as the device may indeed be a life saver. In cases of mild to moderate OSA, or in cases where patients refuse to wear the CPAP, perhaps oral appliances may be the treatment of choice.

 

MOST COMMON SURGICAL TECHNIQUES

 

Laser Assisted Uvulaplasty (LAUP)

This is a very popular form of surgery now being performed. The purpose is to surgically remove the uvula when it is excessive and deemed to be causing the problem.

Uvulopalatopharyngoplasty (UPPP)

This is the surgical removal of excess palatal tissue which is thought to be causing the problem.

The disadvantage is that these surgeries can be quite painful during the healing period. Following the surgery, patients report voice changes and difficulty in swallowing their food.

 

Patients should be informed of all their options prior to any treatment whether surgical or non-surgical.

What is Sleep Apnea?

SNORING AND SLEEP APNEA

 

In September 1995 the American Sleep Disorder Association (ASDA) endorsed oral appliance therapy as the third currently acceptable treatment modality for snoring and sleep apnea. The two most common solutions include continuous positive air pressure or the removal of either the excess palatal tissue or the uvula.

It has been estimated that 60% of men and 40% of women between the ages of 40 and 60 years of age snore. Snoring occurs when there is a partial obstruction of the airway which causes the palatal tissues to vibrate. Obstructive sleep apnea occurs when the airway is completely blocked for certain periods of time. As many as 20 million people in North America may have sleep apnea. Snoring is a social problem, particularly for the spouse, but obstructive sleep apnea poses a significant health risk for the patient in that it can lead to irregular heartbeat, high blood pressure, heart attacks and strokes.

 

 

SLEEP APNEA

 

Sleep apnea is a type of breathing disorder which is a serious, potentially life-threatening condition characterized by brief interruptions of breathing during sleep. There are basically three types of apnea:

 

1. Central Apnea

 

The upper airway is open, but no oxygen is getting into the system. This occurs because the patient is not getting a chemical response from the brain to stimulate the lungs and the diaphragm to assist with breathing.

 

2. Obstructive Sleep Apnea

 

The lungs and the diaphragm are functioning normally, but no oxygen is entering the system because there is an obstruction in the upper airway.

 

3. Mixed Apnea

 

This is a combination of central and obstructive sleep apnea.

 

Oral appliances are only indicated for use in patients suffering from obstructive sleep apnea (OSA). The signs and symptoms of OSA include snoring, excessive daytime sleepiness, gasping or choking during the night, non-refreshed sleep, fragmented sleep, clouded memory, irritability, personality changes, decreased sex drive, impotence, and morning headaches.

 

Factors that affect obstructive sleep apnea are as follows:

 

Age

Obesity

Alcohol

Sedative Hypnotics (sleeping pills)

Children can also snore and suffer from obstructive sleep apnea. Often they are highly allergic and their airway is blocked due to enlarged adenoids, tonsils or swollen nasal mucosa. Clinical signs would indicate a turned up nose, allergic shiners under the eyes, mucous draining out of the nose, mouth breathing, and a nasal sound to the voice. Other signs are bed wetting, irritability, difficulty in concentrating at school and hyperactivity

 

At the present time, obstructive sleep apnea is defined as a medical problem and the diagnosis must be made by a medical doctor or sleep physician (pulmonologist) who is specially trained in the area of sleep medicine.

 

The dental profession has an important role to play in the treatment of patients with snoring and sleep apnea. If 60% of men and 40% of women between forty and sixty years of age snore, this is a huge problem. Snoring is a serious social problem for the spouse, but obstructive sleep apnea can be a life threatening situation for the patient in that it can lead to irregular heartbeat, high blood pressure and strokes.

 

At the present time, obstructive sleep apnea is a medical condition that is being controlled and treated mainly by the medical profession. Despite the fact that in September 1995, the American Sleep Disorder Association finally endorsed oral appliance therapy as the third currently acceptable treatment method for snoring and sleep apnea, the vast majority of the medical doctors are not aware of the value of oral appliances

 

As time goes on, the public is going to become more aware of the health risks associated with snoring and sleep apnea. It is the dental professionals responsibility to educate their members, the public and the medical profession about the important role that dentists and oral appliances play in the treatment of snoring and obstructive sleep apnea.

 Causes of TMJ

The temporomandibular joints are among the most utilized joints in the body, due to their prolonged use during chewing, talking, singing, yawning, etc. Jaw dysfunction (TM dysfunction) means that the lower jaw is not in its proper relationship to the upper jaw. This frequently results in a dislocation of the protective disc anteriorly as the lower jaw assumes a position further back than normal.

 

 

SOME OF THE MOST COMMON CAUSES

• Lower Jaw Too Far Back
• Deep dental overbite
• Upper front teeth tipped backwards
• Back teeth missing
• Result: causes dislocation of the protective disc anteriorly
• Unbalanced Muscles
• Clenching or grinding habits
• Bad posture
• Trauma
• Automobile accidents
• Whiplash injury
• Intubation procedures in hospitals
• Trauma to the head or jaw
• Condyles Too Far Back: The Main Cause of TMD

• Normal Joint
• Dislocated Jaw Joint
• Disc Displaced Anteriorly

 

The temporomandibular joint is affected like no other joint in the body. Behind the condyle (top of lower jaw), there are several structures that affect the health of the jaw joint itself. One is the posterior ligament which acts as a rubber band to pull the disc backward during closing of the jaw. Like all joints, the TM joints contain a large amount of nerves and blood vessels that on a subconscious level give the brain information about the position and condition of the joint. When the jaw is closed, the disc, which has no feeling, acts as a shock absorber to prevent the nerves and blood vessels from being compressed. When the mouth opens and the condyle and the disc move forward, the blood vessels expand to fill the vacated space. When the condyle is pushed too far backwards in the joint, it can slip off the cartilage disc and into these nerves and blood vessels. When nerves and blood vessels are compressed, the whole structure is unbalanced, affecting the nerves, the ligaments and the muscles of the head, neck and face. This dislocated jaw causes pain and other symptoms, which affect health and a person’s quality of life.

 

DISLOCATED JAW JOINT, DISC DISPLACED ANTERIORLY

The treatment of choice for a patient with a dislocated jaw due to the lower jaw (condyle) being positioned too far back would be to use a lower splint, orthotic or functional jaw orthopedic appliance to reposition the lower jaw forward.

 

UNBALANCED MUSCLES

Unbalanced muscles can be a result of clenching or grinding of the teeth. If a muscle is overworked or becomes fatigued due to a structural imbalance, other muscles must compensate. This compensation causes the body to adjust to an abnormal postural state. Compensation means the body adapts to a state that is unhealthy. The body will start to experience symptoms on a mild level, such as occasional headaches. Slowly the symptoms start to occur on a more frequent level until eventually you are experiencing pain on a daily basis.

 

Whether you have a slightly displaced disc, a dislocated disc, unfavorable head posture or body posture, the abnormal forces and strain produced by tired, spastic muscles can refer pain into the neck, face or head. These muscle tension headaches can be so severe that they are confused with migraine headaches. Unfortunately, patients are often not examined for TMJ disorder and the “migraine” treatment works poorly.

 

The treatment for patients with migraine headaches is often the prescribing of pain medications such as Imitrex. This medication is ineffective in solving problems relating to dislocated jaw joints (TM dysfunction). Patients are advised to contact a dentist who utilizes appliances designed to reposition the lower jaw forward or to control parafunctional habits to try and solve the problem as early as it is diagnosed.

 

An overwhelming majority of patients who sustain whiplash injuries in motor vehicle accidents (MVA) also dislocated one or both temporomandibular joints at the same time without having impacted their face or head against the steering wheel, door column, windshield or other parts of the car.

 

Whiplash typically occurs if the head is thrown backward and forward while riding in a car that is hit from behind or the side. Extensive research has well documented the fact that most flexion-extension injuries occur following what is called “minor head injuries.” This means that it is not necessary to suffer a fracture or even a direct head impact. In fact, most patients report that their head was simply snapped backward and forward or side to side. This motion causes damage to the muscles and ligaments which support the jaw joint. When these muscles and ligaments are injured, this can cause an anterior displacement of the protective disc and result in a dislocated jaw joint on one or both sides.

 

 

INTUBATION PROCEDURES

Patients that undergo surgical procedures with general anesthetic are usually intubated through the mouth. Intubation is the procedure by which a tube is placed down the throat to keep the airway open during surgical procedures. Occasionally, the jaw can be dislocated during this procedure due to the forced opening of the mouth and the hyperextension of the ligaments and tissues in order to insert the tube. Some patients may experience clicking in the jaw, limited opening of the mouth, facial pain, and headaches post surgically. Those patients who have already been diagnosed with a TM disorder should advise the anesthetist that they wish to be intubated through the nose during any surgical procedure to prevent further damage to the joint and its surrounding structures.

 

 

TRAUMA TO THE HEAD AND JAW

A severe blow the head or the jaw can cause the disc to be dislocated due to the force of the impact on the jaw. Patients may experience swelling, limited opening and clicking in the joint. Patients with this acute injury should seek emergency treatment immediately to avoid further damage to the joint.

 

FOODS AND DRINKS KNOWN TO AGGRAVATE HEADACHES FOR SOME PATIENTS

• Alcohol
• Tobacco
• Caffeine Coffee,tea, soft drinks, chocolate
• M.S.G. Flavor enhancer user to preserve foods
• Artificial Sweeteners Aspartame, Nutrasweet
• Vegetable Oil Fried or greasy foods should be avoided
• Milk and Cheese
• Nuts
• Raw Beans
• Pork

TMJ – Home Care for your Splint

To Remove

With your fingertips, pull up or down on the back outside edges of the splint, just under the plastic layer.

 

To Place in Your Mouth

Place the splint over your teeth in the correct alignment and push into place with your thumbs or forefingers.

 

To Clean

Remove the splint when brushing your teeth and brush it with the brush provided. Be sure to support the splint evenly while brushing. For removal of odor and stains, soak the splint in any of the following solutions:

 

Vinegar and cool tap water for 20-30 minutes.

2 tablespoons of baking soda in ½ cup tap water for 20-30 minutes.

Cool tap water and a denture cleaning solution like Polident or Efferdent for 15 minutes.

Note: Heat will cause your splint to warp. Therefore, do not use hot water when cleaning the splint. If the water is too hot for your fingers, it is too hot for your splint. Do not leave your splint in a car or next to a heater. However, as long as your splint is in position in your mouth, hot food or drink will not damage it.

 

Special Notes

 

1. You must wear your splint all the time and remove it only to brush your teeth (unless told otherwise). It is especially important to wear your splint when you are concentrating on something such as driving, exercising, paperwork, etc. These times are when you are most likely to subconsciously grind your teeth.

 

2. At all times try to condition yourself to keep your teeth slightly apart, even when wearing the splint. Your teeth should only touch when you swallow or eat. Separating the teeth will help your muscles to relax and reduce the stress on the jaw joints.

 

3. In the beginning, you may find that you have more saliva in your mouth. This is your mouth getting used to having something in it all the time. After awhile, this should return to normal.

 

4. You probably will have sore teeth, a sore tongue and some muscle pain after getting your splint. This is only the muscles and your teeth becoming accustomed to the splint. These symptoms should subside in a few days.

 

5. The best way to learn to speak with your splint is to start right away enunciating more dramatically and reading or singing aloud to practice. It may take a few days to become accustomed to speaking with it. Remember, you sound worse to yourself than you do to others.

 

6. You should brush after every meal. Since your teeth and gums are covered by the splint, your tongue is unable to remove any food particles and we do not want you to develop cavities or gum problems. When you brush your teeth, also take the time to clean your appliance.

 

7. Be careful with your splint. Keep your splint away from dogs!!! Dogs love to chew on splints. Try not to drop your splint as it may break. Never wrap your splint in a paper napkin or tissue and lay it on the table. Someone may throw it away. Don’t put it in your pocket because you might break it. Avoid flipping the splint with your tongue as that can damage your splint.

 

If you have any additional questions, please feel free to call us. We want this to be as pleasant an experience for you as possible and are anxious to assist you in adjusting to this therapy.

TMJ – Self-Assesssment Test

Here are a few questions you may want to ask yourself, to help determine if you have any symptoms:

Do you get an unusual amount of headaches?

 

Do you have a grating, clicking or popping sound in either or both jaw joints, when you chew or open and close your mouth?

 

Do you have pain or soreness in any of the following areas: jaw joints, upper jaw, lower jaw, side of neck, back of head, forehead, behind the eyes or temples?

 

Do you have sensations of stuffiness, pressure or blockage in your ears? Is there excessive wax buildup?

 

Do you ever have ringing, roaring, hissing or buzzing sounds in your ears?

 

Do you ever feel dizzy or faint?

 

Do your fingers, hands or arms sometimes tingle or go numb?

 

Are you tired all the time, fatigue easily or consider yourself chronically fatigued?

 

Are there imprints of your teeth on the sides of your tongue?

 

Does your tongue go between your teeth when you swallow?

 

Do you have difficulty in chewing your food?

 

Do you have any missing back teeth?

 

Do you clench your teeth during the day or at night?

 

Do you grind your teeth at night? (Ask your family.)

 

Do you ever awaken with a headache?

 

Have you ever had a whiplash injury?

 

Have you ever experienced a blow to the chin, face or head?

 

Have you reached the point where drugs no longer relieve your symptoms?

 

Does chewing gum worsen your symptoms?

 

Is it painful to stick your “pinky” fingers into your ears with your mouth open wide and then close your mouth while pressing forward with your “pinky” fingers?

 

Does your jaw slide to the left or right when you open wide?

(Look in a mirror.)

 

Are you unable to insert your first three fingers vertically into your mouth when it is open wide?

 

Is your face crooked and not symmetrical?

 

 

If you answered yes to some of these systoms, you may have a TMJ disorder (TMD) Consult your dentist for an examination.

Here are some ways you can visually check your TM joint:

Put your fingers inside your ears. Open and close several times. If the jaw clicks or cracks, or if you feel a grinding sensation.

While looking in a mirror, open very slowly, notice whether or not your jaw swings to one side while opening and closing. Is there any pain present?

Slide your jaw from side to side, make note of any pain you may experience.

Check for muscle sensitivity:

Place your fingers in front of your ears on the joint and apply pressure.

 

Also apply pressure to the cheek area

If you notice discomfort or pain have your jaw joint checked by a dentist who treats patients with jaw joint disorders!

Symptoms of TMJ

TMJ disorders have been called the “Great Impostors” due to the fact that many of the symptoms have overlapping characteristics, which often mimic other conditions. Because these symptoms masquerade so many other conditions, many people travel from medical doctor to medical specialist in search of a cure. Most patients never think to contact a dentist since the symptoms are primarily medical in nature.

 

 

TMJ symptoms may include any of the following:

• Headaches
• Earaches, congestion or ringing in the ears
• Clicking, popping or grating sounds when opening and closing the mouth
• Limited jaw opening or locking
• Neck pain or stiffness
• Dizziness and fainting
• Pain when chewing
• Facial pain
• Difficulty closing the teeth together
• Tired jaws when chewing
• Numbness in hands
• Difficulty in swallowing

 

Signs that you may have a TMJ problem:

Clenching and grinding of the teeth (bruxism) is a common sign of TMJ disorder. The clenching and grinding of the teeth put additional stress on already tired, overworked muscles and can result in pain being referred to the head, neck, face, shoulder or back.

Headaches are one of the most common complaints of TMJ sufferers and these headaches are frequently so severe they can be confused with migraine headaches. TMJ headaches are most often felt in the temple area, behind the eyes and at the back of the head with pain radiating to the neck and shoulders. Migraine headaches are mainly on one side with the patient suffering from visual disturbances and being extremely sensitive to light. The treatment for migraine headaches is much different from headaches caused by dislocated joints.

If you suspect a migraine headache, then a referral should be made to a neurologist. If the TMJ (jaw joint) is the problem, a referral should be made to a dentist or dental specialist with training in the diagnosis and treatment of these disorders. An excellent reference for dentists experienced in the treatment of patients with TM joint disorders would be to consult the website of the American Academy of Craniofacial Pain.

One of the most common signs of a TMJ problem is a jaw joint making noise such as clicking, popping or grating sounds. This clicking sound occurs when the condyle (top of the lower jaw) moves forward when the patient opens the mouth and the condyle slips on and off the dislocated disc. The grating sound, called crepitus, is the sound of bone rubbing on bone and occurs later on when the dislocated discs become completely deformed. The purpose of the disc is to act like a protective cushion between the two bones of the lower jaw (condyle) and the skull (glenoid fossa). When the protective disc is permanently dislocated or distorted, the two bones contact each other and this causes loud noises, which are referred to as crepitus.

 

Another sign of TM joint dysfunction occurs when the jaw either locks open or closed. Our objective in the treatment of TMJ disorders is to try and correct the problem of the dislocated disc early when the jaw is clicking and not wait until the later stages when the grating sound is louder and the patient may experience an extremely painful situation if the jaw locks open or closed.

If the patient suffers from ear pain, ringing or buzzing in the ears, fullness or a stuffy feeling without any ear infection, then this could be related to a structural problem within the TM joint. Other symptoms include a loss of hearing, dizziness and loss of balance. If the condyle is too far back and the disc dislocated forward, this can cause some of the muscles of mastication to go into spasm which can cause any of the symptoms as mentioned above. If your medical doctor or ENT (ear, nose and throat) specialist can find no apparent reason for the ear problems, these patients should be referred to a dentist with training in the diagnosis and treatment of patients with these problems.

Sleep disturbances are common in patients suffering from dislocated jaw joints. The brain frequently does not allow the patient to reach the deep stages of sleep and they are awakened many times during the night. The patient does not awaken feeling well rested and refreshed, but rather they often feel tired and listless with an obvious lack of energy to face the new day. Often, the reason the patient cannot sleep is that they are awakened due to the pain they are suffering from severe muscle contractions, muscle spasms and trigger points caused by the dislocated jaw joints or clenching and bruxing habits.

Depression is another common sign of patients who suffer from TM joint dysfunction for an extended period of time. These patients suffer constantly from chronic pain with no obvious solution in sight. Depression is a problem for both the medical and dental profession to try and solve. If the pain is originating from a tumor (very rare), an infection, systemic disease, nutritional deficiency, allergies or traumatic injuries, then the medical profession should be consulted. However, if the problem is a dislocated jaw or clenching or grinding habits causing TM joint pain, a properly trained member of the dental profession should be involved in the diagnosis and treatment.

 

If you have any of the above symptoms, you could possibly have a problem with your jaw (TMJ).

Treatment of TMJ

Discussion and examination take place at the initial consultation appointment when the patient reports time of onset, duration and intensity of pain in the affected area. The examination explores the pattern of jaw movement to detect sounds and tenderness to gentle pressure.

 

Further diagnostic testing is indicated the presence of jaw joint dysfunction is suspected. Further testing is designed to properly diagnose the patient’s problem and to try to reduce the signs and symptoms of the dysfunction. To determine if the lower jaw and the disc of the TM joints are in the correct position, the following diagnostic tests are used:

 

Medical and Dental History as well as an examination of the teeth and the dental arches

 

TMJ Health Questionnaire

Patients are asked questions regarding possible TM dysfunction symptoms. If the patient answers “yes” to any of the symptoms and “yes” to clenching and bruxing, then further tests are required to confirm the presence of a jaw joint problem (TM disorder).

 

Range of Motion

Patients are checked for how wide they can open, slide left and right, move the jaw forward, and whether or not there is a deviation or deflection of the jaw upon opening. If there is a problem achieving normal range of motion, there is usually a structural problem within the joint.

 

Muscle Palpation

Excessive muscle contractions and trigger points indicate a problem with the chewing muscles of mastication. This causes the muscles of the head and neck to be sore when pressed by the dentist. This usually means that the lower jaw is not in the correct position.

 

TMJ X-Rays

TMJ x-rays are important to see if the condyles (top of the lower jaw bone) are too far back where they would be impinging on the nerves and blood vessels at the back of the socket where the jaw bone fits into the skull. In cases where the lower jaw is too far back, dentists find a significant reduction in the signs and symptoms of TM disorders when the jaw is repositioned forward with a splint or a functional orthopedic appliance.

This is specialized equipment used to take readings of the noises or vibrations occurring within the jaw joints upon opening and closing movements. The JVA is simply a 3-minute, non-invasive test where headphones are placed on both jaw joints and the patient is instructed to open and close six times. An abnormal or dislocated joint has distinctive vibrations which can be analyzed to help diagnose the seriousness of the problem.

There are basically 5 stages of disc displacement. Ideally, if there is a jaw problem you would hope that the patient is in Stage 1 or Stage 2 where the disc can be recaptured. If the JVA reveals that the patient is in Stage 3, 4 or 5, this is a much more serious problem and the prognosis is not as good for resolution of all the symptoms.

 

 

Joint Vibration Analysis Test

 

Our office has the knowledge and experience needed for proper, thorough diagnosis and treatment of temporomandibular joint dysfunction.

 

TREATMENT

Since the teeth, jaw joints and muscles can all be involved, treatment for this condition varies. Typically, treatment will involve several phases. The first goal is to relieve the muscle spasm and pain as well as establish normal range of motion of the lower jaw. Then, your dentist must correct the way the teeth fit together. Often a temporary device known as an orthotic or splint is worn over the teeth until the bite is stabilized. Permanent correction may involve selective reshaping of the teeth, building crowns on the teeth, orthodontics or a permanent appliance to cover the teeth. If the jaw joint itself is damaged, it must be specifically treated. Although infrequent, surgery is sometimes required to correct a damaged joint. Ultimately, your dentist will stabilize your bite so that the teeth, muscles and joints all work together without strain.

 

Once a thorough diagnosis has been made, the dentist will begin a personalized treatment program. Patients benefit from the non-surgical, conservative treatment our office provides. Individualized therapy will include muscle spasm reduction treatments in conjunction with an easy to wear, comfortable dental orthotic, referred to as a splint. The orthotic covers the lower teeth holding the jaw in proper alignment, reducing tension in the muscles of the jaw joint, allowing healing to take place. Once pain is controlled and the jaw joint is stabilized, the bite is balanced so the teeth, muscles and joints all work together in harmony.

 

It is important to assess the posture of each patient to determine whether or not the shoulders, pelvis and hips are level. Photos are taken of each patient to check for the above as well as to check for forward head posture. If there is a problem with the shoulders, hips or pelvis or if one leg is longer than the other, then a referral to a chiropractor would be necessary.

 

To solve the problem of forward head posture which can cause cervical (neck) problems, referral to a dentist or orthodontist who uses functional jaw orthopedic appliances should be made. These appliances such as the Twin Block, MARA or Herbst Appliance successfully reposition the lower jaw forward and eliminate the forward head posture.

 

 

 

 

 

 

For most patients, treatment is divided into two stages:

1. Phase I Diagnostic Phase – Temporary Solution

Diagnostic Splints

 

2. Phase II Treatment Phase – Permanent Solution

a)Orthodontics

b)Crown & Bridge

c)Prosthetics

Full Dentures

Partial Dentures

d)Composite buildups posterior teeth

 

PHASE I DIAGNOSTIC PHASE (Temporary Solution)

 

Diagnostic Splints

 

If there is an improper relationship between the upper and lower jaws and/or the upper and lower teeth, the patient will be required to wear temporary oral appliances (orthotic or splint). This TMJ splint is usually worn over the lower teeth until the bite and position of the lower jaw is stabilized. The objective of the lower splint is to try and establish the correct position of the mandible to the maxilla in three dimensions; namely, transverse, sagittal and vertical. The goal is to try and find a comfortable position for the lower jaw so that the patient can get some relief from the pain and muscle spasms. If the patient has a denture or a partial denture, the splint may be constructed over them similar to the method with natural teeth.

 

HOME CARE FOR YOUR SPLINT

Since most head, neck and shoulder pain originates from muscle instability or swelling and inflammation of the joints, we may employ various physical modalities to treat and help normalize these structures. This includes such things as transcutaneous electrical nerve stimulation (TENS), moist heat therapy, vapor coolant sprays, and infrared treatments. These joints often get very tight in people with dysfunctions and various types of mobilization or stretching techniques are employed to gain normal function of these tissues.

 

 

 

Infrared Treatment for TMJ

Sometimes it will be necessary to refer patients to other health care practitioners to help relieve some of the muscle spasms including chiropractors, massage therapists, physical therapists, craniosacral therapists, etc. The patient must be made aware of the fact that, although the majority of patients do improve substantially, there are still a small number of patients whose treatment is not effective. The longer the disc is out of position anteriorly, the more the posterior ligaments get stretched and the more difficult it becomes for the posterior ligaments to reposition the disc to its correct position on the head of the condyle.

 

Some of these patients may have suffered traumatic injuries such as a blow to the head or have been involved in a car accident, which caused a whiplash injury. If the posterior ligaments, which help position the disc between the condyle and the temporal bone, have become stretched or torn as a result of a serious injury, then the prognosis for successful treatment is diminished. Obviously, the sooner the patient can be treated, the higher the success rate.

 

Near the end of Phase I, which usually lasts four months, the clinician and the patient will evaluate the success of the treatment. The patient will take the same diagnostic tests, clinical examinations, and fill out the appropriate TMJ progress report to see what improvement there is in the signs and symptoms of TM dysfunction. If the tests, including the Joint Vibration Analysis and the tomograms (TMJ x-rays), reveal that the condyle is related properly to the glenoid fossa of the temporal bone and the disc has been restored to its proper position, we would assume there would be a reduction of the signs and symptoms. A consultation appointment is held with the patient to discuss the success of Phase I and the various options for Phase II.

 

The vast majority of symptoms must be resolved in Phase I Diagnostic Phase prior to the initiation of Phase II Treatment Phase.

 

PHASE II TREATMENT PHASE JAW STABILIZATION

(Permanent Solution)

Orthodontics

Crown & Bridge

Overlay Partial Dentures

Complete Dentures

Partial Dentures

1.Orthodontics

 

Following diagnostic splint therapy to solve the problem of dislocated jaw joints, most patients have a space between their back teeth. The jaw has been moved to a temporary position where it is pain free. If the patient moves the jaw back to the original pretreatment position, the pain will come back. Therefore, to obtain a more permanent solution, orthodontics is often the treatment of choice, placing braces on the teeth and using up and down elastics to allow the back teeth to touch so the patient will be able to chew properly and with no pain. This is a more permanent solution to jaw stabilization and TMJ health. This stage can last from 12 months to 18 months depending on the severity of the case. If the space between the back teeth is large (more than 3 mm.), then this is often the treatment of choice.

2.Crown & Bridge

 

If the space between the back teeth is minimal (less than 3 mm.) or if the back teeth have large restorations or missing teeth, then the best option might be to close the spaces between the back teeth with crowns and bridges.

3.Overlay Partial Dentures

 

If the patient has limited financial resources, often the treatment of choice would be the placement of an overlay partial denture over the lower back teeth in order to fill the spaces between the back teeth and to stabilize the jaw (TMJ).

4.Complete Dentures

 

If the patient has an old denture or dentures with the teeth all worn down, new dentures could be made with longer back teeth to fill in the spaces between the back teeth.

5.Partial Dentures

 

If the patient has missing back teeth, partial dentures could be made to fill in the spaces between the back teeth.

The important aim of correcting your bite is to ensure optimal long-term health. If you have any of the signs or symptoms mentioned, discuss them with your dentist.

 

Your health is your most priceless possession. It is worth the investment!

What is TMJ/TMD?

The temporomandibular joint (TMJ) is the joint connecting the lower jaw (mandible) to the skull (temporal bone). The lower jaw and the skull are connected by a number of muscles and ligaments, which function in harmony with each other if the lower jaw is in the correct position. The head of the jaw bone (lower jaw) is called the condyle and it fits into the concavity of the temporal bone called the glenoid fossa. The TM joint resembles a ball and socket with the round condyle being the ball and the glenoid fossa of the temporal bone being the socket. For normal joint function to occur, a piece of cartilage called an articular disc acts as a cushion or shock absorber between the two bones.

When the lower jaw opens and closes, the disc stays between the condyle and the glenoid fossa of the temporal bone at all times. When this happens, this is a normal healthy TMJ and the patient can open wide without any discomfort and without any noise. With a normal opening, the patient should be able to get three fingers between the upper and lower front teeth when the mouth is open as wide as possible. In cases where the TM joint is functioning normally with the disc in the proper position, the muscles of the head, neck and shoulders function relatively pain-free.

 

What is TMD?

Temporomandibular disorder (TMD) is the condition referring to a joint that is not normal.

 

The position of your teeth can affect the position of your jaw joints. Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscles and ligaments. If your bite is not right, as in cases where the following may occur: deep overbite, lower jaw too far back, narrow upper jaw or upper front teeth crooked and tipped backwards, this can cause the jaw to become dislocated. Typically the disc is pulled forward. The lower jaw then has a tendency to go back too far and the top of the lower jaw, which resembles a ball (condyle), presses on the nerves and blood vessels at the back of the socket and causes pain.

 

Usually, the protective disc (cartilage) is displaced forward and no longer serves as a cushion between the condyle (lower jaw) and the bony socket (skull) and eventually this can lead to the condyle rubbing against the bony socket. This can cause a problem called osteoarthritis.

Mild displacements cause a clicking or popping sounds in the jaw joint.

When the disc becomes displaced, this is what causes the various noises within the jaw joints such as clicking and popping sounds. Patients must be aware that any noises or pain that occur during the opening and closing of the jaw is an indication that the jaw joints have become dislocated. Patients are advised to seek treatment as soon as possible to avoid allowing the problem to get worse.

 

More severe displacement can be very painful and eventually can cause permanent damage to the joint. An unstable bite can cause both jaw joint displacement and muscle strain and pain. Many seemingly unrelated symptoms results, which are collectively known as craniomandibular dysfunction. These symptoms include headaches, neck aches, ringing in the ears, stuffiness in the ears, pain behind the eyes, ear pain, shoulder and lower back pain, dizziness and fainting, difficulty swallowing, and tingling of the fingers and hands. These symptoms include:

 

• Headaches
• Neck aches
• Ringing in the ears
• Stuffiness in the ears
• Pain behind the eyes
• Ear pain
• Shoulder and lower back pain
• Dizziness and fainting
• Difficulty swallowing
• Tingling of the fingers and hands

Tooth Care – Brushing

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.

Tooth Care – Denture Care

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.

Tooth Care – Emergency

 

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.

 

Tooth Care – Flossing

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.

 

 

Tooth Care – Fluoride Facts

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.

Tooth Care – Mouth Rinses

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.

Tooth Care – Nutrition and Your Teeth

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.

Tooth Care – Prevention Tips for Children

 

 

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.

Tooth Care – Sealants

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.

 

Tooth Care – Seniors and Oral Health

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.

Tooth Care – What is Tooth Decay?

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.

Tooth Care – Women and Tooth Care

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.

Tooth Care – X-Rays

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.

Treatment – Braces (Orthodontia)

Braces are applied to teeth for various reasons, including poorly aligned jaws, crooked, crowded and missing teeth, or a bad bite (also called malocclusion).

 

Various things can cause teeth to become crooked or jaws misaligned, including thumb-sucking or a traumatic injury. Some conditions are inherited.

 

Children between the ages of 7 and 14 are typical candidates for braces because their facial structures are still developing. Adult braces usually entail additional procedures because their faces have already fully developed.

 

About Braces

Orthodontics is a field of dentistry that deals with corrections involving jaw and teeth alignment.

 

Braces employ the use of wires and are usually one of three types:

 

Old-fashioned, conventional braces, which employ the use of metal strips, or bands.

Metal or plastic brackets that are cemented or bonded to teeth.

Brackets that attach to the back teeth (also called lingual braces).

Procedures

Orthodontic procedures, also called orthodontia, are complex processes.

 

In most cases, a dentist will need to make a plaster cast of the individual’s teeth and perform full X-rays of the head and mouth.

 

After orthodontic appliances are placed, they need to be adjusted from time to time to ensure that they continue to move the teeth into their correct position.

 

Retainers are used following braces to ensure that teeth remain in position.

 

Aesthetic and Comfort Issues

Advances in technology have vastly improved appearance issues with orthodontia.

 

Braces today are made from extremely lightweight and natural-colored materials. The materials that braces attach to-brackets-are bonded to the surfaces of teeth but can be later removed.

 

People can expect to wear braces for about two years—less or more in some cases. Adults are usually required to wear braces for longer periods of time.

 

Because orthodontic appliances need to be adjusted from time to time to ensure they continue to move the teeth into their correct position, they can create pressure on the teeth and jaws. This mild discomfort usually subsides following each orthodontia adjustment.

 

Hygiene issues

People who wear braces must be diligent in ensuring that food particles and other debris do not get trapped in the network of brackets and wires. In addition, brackets can leave stains on enamel if the area surrounding them is not cleaned on a daily basis.

 

Daily oral hygiene such as brushing, flossing and rinsing are a necessity. Some people with orthodontic appliances can benefit from using water picks, which emit small pressurized bursts of water that can effectively rinse away such debris.

 

Another caveat: Braces and sticky foods don’t mix. Crunchy snacks and chewy substances should be avoided at all costs because they can cause orthodontia to be loosened or damaged.

 

Space Maintainers

Space maintainers are helpful dental devices that can help teeth grow in normally following premature tooth loss, injury or other problems.

 

The devices can help ensure that proper spaces are maintained to allow future permanent teeth to erupt.

 

If your child loses a baby tooth early through decay or injury, his or her other teeth could shift and begin to fill the vacant space. When your child’s permanent teeth emerge, there’s not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.

Treatment – Bridges

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.

Treatment – Crowns

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.

 

Treatment – Dentures

 

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.

Treatment – Extractions

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

Treatment – Flap Surgery

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.

Treatment – Jaw/TMJ

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.

Treatment – Maxillofacial Surgery

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.

Treatment – Missing Teeth

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.

 

Treatment – Root Canal Therapy

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.

Treatment – Scaling and Root Planing

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.

 

Treatment – Sealants

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.

Links

American Dental Association
Academy of General Dentistry
American Association of Public Health Dentistry
Federation of Special Care Organizations in Dentistry
Centers for Disease Control/Oral Health Resources
Healthfinder.gov
KidsHealth
National Health Information Center

Choosing a Toothbrush

Never before has there been such a dizzying array of toothbrushes on the market. Consumers are inundated with new designs, materials, attachments, and colors. Whatever toothbrush design you choose, the most important thing is that you use the toothbrush at least 2-3 times a day. Moreover, how long you spend brushing your teeth is as critical as how often you brush.  This ensures complete plaque removal in hard to reach areas.

 

Mechanical and manual toothbrushes

Our dental team highly recommends a mechanical (electric) toothbrush. The pulsations break up plaque efficiently. Many models now have timers to remind you to brush longer.

 

It is always nice to have a backup manual toothbrush. When choosing a manual toothbrush, look for a compact head with very soft, rounded bristles.

Mouth Guards

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.

Oral Health Products

Visit any pharmacy or the health and beauty section of a supermarket today, and you are faced with a large, and many say confusing, array of over-the-counter remedies and devices designed to help you tend to your hygiene and health-care needs.

 

There are many high-quality products on the market today. There also are many products of dubious value.

 

Whatever over-the-counter dental product you buy, it is strongly advised that you ensure it has the American Dental Association’s Seal of Acceptance.

 

Over-the-counter dental instruments are fraught with danger. These include scaling devices and picks. Use of the products, even when following the instructions, can put your teeth and the soft tissue of your mouth at risk of tearing, bruising and other injury. You also may accidentally chip a tooth.

 

It is best to consult our office instead of trying to do a repair job yourself.

Types of Floss

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.

 

Water Picks

 

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.

 

Glossary

 

A

Amalgam – Material made from mercury and other alloy mixtures used to restore a drilled portion of a tooth.

Anesthesia – Medications used to relieve pain.

Anterior teeth – Front teeth. Also called incisors and cuspids.

Arch – The upper or lower jaw.

 

 

B

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

Bicuspids -A premolar tooth; tooth with two cusps, which are pointed or rounded eminences on or near the masticating surface of a tooth.

Bitewings – X-rays that help a dentist diagnose cavities.

Bonding – Application of tooth-colored resin materials to the surface of the teeth.

Bridge – A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements.

Bruxism – Teeth grinding.

 

 

C

Calculus – A hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.

Canal – The narrow chamber inside the tooth’s root.

Canines – Also called cuspids.

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

Caries – A commonly used term for tooth decay, or cavities.

Cold sore – 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.

Composite filling – Tooth colored restorations, also known as resin fillings.

Composite resin – A tooth colored resin combined with silica or porcelain and used as a restoration material.

Contouring – The process of reshaping teeth.

Crown – An artificial tooth replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure. It is also placed on a dental implant.

Cusps – The pointed parts on top of the back teeth’s chewing surface.

Cuspids – Front teeth that typically have a protruding edge.

 

 

D

Dentin – The tooth layer underneath the enamel.

Denture – A removable set of teeth.

 

 

E

Endodontics – A form of dentistry that addresses problems affecting the tooth’s root or nerve.

 

 

F

Fluoride – Fluoride is often called nature’s cavity fighter and for good reason. Fluoride, a naturally-occurring mineral, helps prevent cavities in children and adults by making the outer surface of your teeth (enamel) more resistant to the acid attacks that cause tooth decay.

Fluorosis – A harmless over-exposure to fluoride and resulting sometimes in tooth discoloration.

 

 

G

Gingiva – Another word for gum tissue.

Gingivitis – A minor disease of the gums caused by plaque.

Gum disease – An infection of the gum tissues. Also called periodontal disease.

 

 

I

Impacted teeth – A condition in which a tooth fails to erupt or only partially erupts.

Implant – A permanent appliance used to replace a missing tooth.

Incisor – Front teeth with cutting edges; located in the center or on the sides near the front.

Inlay – An artificial filling made of various materials, including porcelain, resin, or gold.

 

 

L

Laminate veneer – A shell that is bonded to the enamel of a front tooth. The shell is usually thin and made from porcelain resin.

 

 

M

Malocclusion – Bad bite relationship.

Mandible – The lower jaw.

Maxilla – The upper jaw.

Molar – Usually the largest teeth, near the rear of the mouth. Molars have large chewing surfaces.

 

 

 

N

Neuromuscular Dentistry – Addresses more than the aches and pains felt in and around the neck and head that are associated with your teeth and jaw.

 

 

 

O

Onlay – A filling designed to protect the chewing surface of a tooth.

Orthodontics – A field of dentistry that deals with tooth and jaw alignment.

Overdenture – A non-fixed dental appliance applied to a small number of natural teeth or implants.

 

 

P

Palate – Roof of the mouth.

Partial denture – A removable appliance that replaces missing teeth.

Pediatric Dentistry – A field of dentistry that deals with children’s teeth

Perio pocket – An opening formed by receding gums.

Periodontal disease – Infection of the gum tissues. Also called gum disease.

Periodontist – A dentist who treats diseases of the gums.

Permanent teeth – The teeth that erupt after primary teeth. Also called adult teeth.

Plaque – A sticky, colorless substance that covers the teeth after sleep or periods between brushing.

Posterior teeth – The bicuspids and molars. Also called the back teeth.

Primary teeth – A person’s first set of teeth. Also called baby teeth or temporary teeth.

Prophylaxis – The act of cleaning the teeth.

Prosthodontics – The field of dentistry that deals with artificial dental appliances.

Pulp – The inner tissues of the tooth containing blood, nerves and connective tissue.

 

 

R

Receding gum – A condition in which the gums separate from the tooth, allowing bacteria and other substances to attack the tooth’s enamel and surrounding bone.

Resin filling – An artificial filling used to restore teeth. Also called a composite filling.

Root canal – A procedure in which a tooth’s nerve is removed and an inner canal cleansed and later filled.

Root planing – Scraping or cleansing of teeth to remove heavy buildup of tartar below the gum line.

 

 

S

Sealant – A synthetic material placed on the tooth’s surface that protects the enamel and chewing surfaces.

 

 

T

TMJ – Temporomandibular joint disorder. Health problems related to the jaw joint just in front of the ear.

Tarter – A hardened substance (also called calculus) that sticks to the tooth’s surface.

 

 

V

Veneer – A laminate applied or bonded to the tooth.

 

 

W

Whitening – A process that employs special bleaching agents for restoring the color of teeth.

Wisdom tooth – Third set of molars that erupt last in adolescence.