hygiene therapy & prevention

Fluoride Treatment

  1. Why is Fluoride necessary?

Dental Sealants

  1. What are Dental Sealants?
  2. Who is a candidate for dental sealants?
  3. How are sealants applied?
  4. How long do sealants last for?

Pediatric Dental Care

  1. What is a Pediatric Dentist?
  2. When will my infant’s primary teeth (aka deciduous or baby teeth) grow in, and how do you care for them?
  3. What can I do to prevent my baby from developing cavities?
  4. Why are baby teeth important?
  5. When will my child’s adult teeth grow in, and how do I care for them?
  6. What can I do if I have difficulty cleaning my baby’s mouth?
  7. Is it alright to let my baby sleep with a pacifier, sippy cup or bottle?
  8. How do I control my child’s drooling and teething pain?
  9. I heard that sometimes a baby could be born with one or more teeth (natal teeth), if that happens what should I do?
  10. When should I first take my child to the dentist?
  11. How should I prepare my child for their dental visits?
  12. When does my child need fluoride and what is the right amount?
  13. Can water filters reduce the benefits a fluoridated water system would otherwise offer to my children's teeth?
  14. Is it better to use a manual toothbrush or an electric toothbrush for my child’s teeth?
  15. At what age should a child brush their teeth on their own?
  16. How often should I brush my child’s teeth, and at what times of the day?
  17. When should my child start flossing?
  18. Which foods are bad for my child’s teeth?
  19. What do I do if my toddler won’t let me brush their teeth?
  20. My baby has white patches inside the mouth. What causes this?
  21. Does it really matter if my child has a cavity in their baby tooth; they will lose it soon anyway?
  22. What happens if a baby tooth comes out too early?
  23. What are space maintainers, and are they really necessary?
  24. What can be done to address the large space (diastema) between my child’s front teeth?
  25. Why do some teeth grow behind another? What should be done when that happens?
  26. What are Peg laterals?
  27. What should be done to treat a peg shaped tooth (Peg laterals)?
  28. How many people are born missing one or more of their adult teeth?
  29. How many people are born with extra teeth?
  30. My dentist told me I have a double tooth. Why does this happen, and is there any way to make it appear more like a normal, single tooth?

Sport Mouth Guard

  1. Do I need to get a Sport Mouth Guard?
  2. What are the different kinds of Sport Mouth Guard available? Which would you recommend?

Bruxism (Teeth Grinding and Clenching)

  1. What causes Teeth Grinding and Clenching (Bruxism) and what are its manifestations?
  2. What causes teeth to get shorter over time?
  3. Is it normal for a toddler to grind their teeth? What can be done about it?
  4. What are Night Guards, and why are they important?

Bad Breath (Halitosis)top

  1. What can I do to prevent bad breath? Do mints, gums, breath sprays and mouth rinses work?

Oral Cancer Screening

  1. Who is at risk for Oral Cancers?
  2. What are the warning signs for Oral Cancer?
  3. What are the risk factors for Oral Cancer?
  4. How can you lower your risk for Oral Cancer?
  5. What can be done to detect Oral Cancers?
  6. What are some of the benign (non-cancerous) ulcerative lesions that we may find in the mouth?

 TMJ Dysfunction

  1. What is TMJ Dysfunction? How can my dentist help?
  2. What should you do if you are waking up with headaches, and your jaw starts making a popping sound when you open? Is this TMJ related? If so, what causes this, and what can be done to treat it?
  3. I was having tooth pain after a tooth chipped on the left side. Now the pain moved to the right side, along with jaw pain and extreme headaches. Is this a tooth issue or neurological?
  4. Is gum chewing is bad for your teeth?

Periodontics (Gum Disease)

  1. Who is a Periodontist?
  2. What is Periodontal Disease?
  3. What is Gingivitis?
  4. How do I know if I have early gum disease (gingivitis) or late stage gum disease (Periodontitis)?
  5. What is Periodontitis?
  6. What are the different forms of Periodontitis?
  7. How do I know if I have Periodontal Disease?
  8. What can I expect the first time I have a periodontal evaluation by my dentist or Periodontist?
  9. Is it true that there is a link between Periodontal (Gum) Disease and Heart Disease?
  10. What can I do to prevent Periodontal Disease?
  11. What is the link between Periodontal Disease and Diabetes?
  12. What precautions should I take when I see my dentist if I have diabetes?
  13. Is there a relationship between tobacco use and periodontal disease (smoking, tobacco, gum disease, periodontal disease?
  14. Is it normal for my gums to bleed when I brush my teeth?
  15. What does it mean to have receding gums? What can be done for this?
  16. What are the warning signs of gum disease (Periodontal Disease)?
  17. What does it mean to have pockets when you check for gum disease?
  18. Could my periodontal disease be genetic?
  19. What can I do to avoid periodontal disease?
  20. What kind of oral care products should I use to prevent against gum disease?
  21. If I neglected my teeth for years, am I able to get them back to a completely healthy state?
  22. My gums bleed in the same spot every time I brush my teeth. What can be done to help this?

Flouridestop

Question:
Why is Fluoride necessary?
Answer:
Fluoride helps to prevent against tooth decay by strengthening the tooth’s enamel and making it more resistant to acids and harmful bacteria. Fluoride can be administered topically to adults and children to help prevent against cavities and fluoride toothpastes and gels are also used to help control tooth sensitivity, especially when the roots are exposed due to gum recession and teeth grinding. When an individual is suffering from dry mouth (xerostomia), fluoride trays can be made to help prevent against rampant decay caused by a lack of salivary flow. A little fluoride is good for your teeth, but too much of it can lead to a condition called fluorosis, which can cause white spots on your teeth during the child’s development.

Dental Sealants

Question:
What are Dental Sealants?
Answer:
Aside from the introduction of fluoride, dental sealants have become one of the biggest breakthroughs in terms of dental prevention. They are used to protect teeth from decay and are appropriate as soon as a posterior tooth erupts. The chewing surfaces of these back teeth have many pits and grooves that can trap food debris and cause cavities. Children and adults alike can benefit from dental sealants, which are a plastic resin that flows into the cleaned out grooves of the tooth, and hardened to make a more shallow, ice-skating like surface for which the food debris can be more readily brushed away. Sealants should be checked at your regular dental visits and redone periodically if wear or breakdown is evident.

Question:
Who is a candidate for dental sealants?
Answer:
Both Children and Adults are candidates for dental sealants. Since children don’t lose their baby molars until the age of twelve, it is important to protect these teeth from developing cavities and problems that can affect the developing adult teeth. Adolescents are very prone to developing cavities due to their dietary habits and poor home care, and the sealants can help to prevent decay in the grooves of the teeth that usually get passed over during a quick brushing. Any adult can benefit from sealants as well, making it easier for cleaning out the food and plaque, and giving them an extra line of defense in the battle against tooth decay.


Question:
How are sealants applied?
Answer:
Each sealant only takes a few minutes to place. First the teeth are cleaned well, and checked to make sure that no decay is present. If there are any signs of decay in those grooves, then they must be cleaned out and filled with the sealant material or a filling material if deeper. Once the chewing surfaces are cleaned, they are roughened up with an etchant (weak acid solution), and a primer and adhesive to enable the sealant material to bond to the tooth enamel. The sealant material is hardened by a light source, operating at a certain wavelength, to set the material and make it solid.

Question:
How long do sealants last for?
Answer:
Depending on what type of material was applied, what types of food is being eaten (harder, crunchier foods can wear them down faster), and how good the home care is, sealants can last several years before they may need to be reapplied. Your dentist should be periodically checking to make sure that the sealants are still intact and serving their purpose. Reapplying the sealants will ensure that the tooth is protected against decay, and will save the expense of having a more involved restoration on that tooth in the future should cavities develop.

Pediatric Dental Care

Question:
What is a Pediatric Dentist?
Answer:
A Pediatric Dentist (formerly Pedodontist) specializes in the oral health care needs of young people, including infants, children and adolescents. Pediatric Dentists have completed an additional 2-3 years of study and hands-on training after dental school, to prepare them to aid in the unique dental needs of their younger population. If your general dentist feels your child needs unusual procedures or might be difficult to treat, you may be referred to a pediatric dentist.

Question:
When will my infant’s primary teeth (aka deciduous or baby teeth) grow in, and how do you care for them?
Answer:
A baby’s first tooth will usually erupt into the mouth by around six months of age. Some infants will be early, and some may be a few months later. If your baby still has not displayed their first tooth by the time they are 1 year old, then you can bring your child to the dentist for an exam.
From day one you should be cleaning your baby’s gums, and tongue with a washcloth, rubber finger brush, or cloth finger tender (even though no teeth are present). Clean the gums at least twice each day -- after breakfast and after the last feeding of the day. Even better -- clean your baby's gums and tongue after every feeding to keep your the breath fresh and to get them accustomed to this routine. Once the first tooth erupts, you should be cleaning these teeth, trading in your cloth wipe for an appropriate sized, soft toothbrush. In order to see the teeth more clearly when brushing, you may choose to have your child lay their head on your lap, or lay them down on a bed. Remember, only use toothpaste that does NOT contain fluoride at this time.

Baby (Primary) Teeth Development Chart

Upper Teeth

When tooth emerges

When tooth falls out

Central incisor

8 to 12 months

6 to 7 years

Lateral incisor

9 to 13 months

7 to 8 years

Canine (cuspid)

16 to 22 months

10 to 12 years

First molar

13 to 19 months

9 to 11 years

Second molar

25 to 33 months

10 to 12 years

Lower Teeth

 

 

Second molar

23 to 31 months

10 to 12 years

First molar

14 to 18 months

9 to 11 years

Canine (cuspid)

17 to 23 months

9 to 12 years

Lateral incisor

10 to 16 months

7 to 8 years

Central incisor

6 to 10 months

6 to 7 years

Question:
What can I do to prevent my baby from developing cavities?
Answer:
Parents and caregivers should realize that a baby's teeth are susceptible to developing cavities from the moment they appear in the mouth. As a result, oral care should begin soon after the baby is born, and their gums should be cleaned with a clean, damp cloth or wet gauze pad after each feeding. As early as 4 months or as late as 12 months of age, the upper and lower front teeth first begin to appear. You may begin brushing your child's teeth the moment these teeth emerge. Never let your baby or toddler fall asleep with a bottle, unless it contains only pure water and then only after the bottle is rinsed out well before being filled. A bottle containing milk, formula, fruit juices, etc., is likely to cause decay. A pacifier coated with a sugary substance is also likely to cause cavities. This condition is referred to as Baby Bottle Tooth Decay, or Nursing-Bottle Syndrome. The teeth most likely to be affected are the upper front teeth, but other teeth can become damaged as well.

Question:
Why are baby teeth important?
Answer:
Baby teeth hold the space for the permanent teeth to begin coming in at about 6 years of age. Your baby’s teeth, gums and tongue are not only very important for eating, but aid in the growth pattern of your child’s jaws and adult teeth. Note that baby teeth are also a key component in the ability to learning and perfect speech. Of course, a full complement of baby teeth will contribute to having a good self-image as your child grows older.

Question:
When will my child’s adult teeth grow in, and how do I care for them?
Answer:
Spaces for the permanent teeth begin to appear at the age of four as the jaw, supporting bone structure and facial bones begin to grow. The first baby teeth to be lost are the two lower front teeth. These come out between 6-7 years of age and are very soon replaced with the two lower adult front teeth. At the same time, the six year molars are starting to grow in. From six to twelve, it is typical for your child to have a combination of both baby teeth and permanent teeth in their mouth. Below is a chart showing when to expect the emergence of all the adult teeth.


Adult (Permanent) Teeth Development Chart

Upper Teeth

When tooth emerges

Central incisor

7 to 8 years

Lateral incisor

8 to 9 years

Canine (cuspid)

11 to 12 years

First premolar (first bicuspid)

10 to 11 years

Second premolar (second bicuspid)

10 to 12 years

First molar

6 to 7 years

Second molar

12 to 13 years

Third molar (wisdom teeth)

17 to 21 years

Lower Teeth

 

Third molar (wisdom tooth)

17 to 21 years

Second molar

11 to 13 years

First molar

6 to 7 years

Second premolar (second bicuspid)

11 to 12 years

First premolar (first bicuspid)

10 to 12 years

Canine (cuspid)

9 to 10 years

Lateral incisor

7 to 8 years

Central incisor

6 to 7 years

Question:top
What can I do if I have difficulty cleaning my baby’s mouth?
Answer:
If your baby does not want to open their mouth, place your finger near their mouth, and they will slowly open as they think that you are trying to feed them. Even if your baby tries to bite down on your finger, be patient, keep trying, and they will soon open up again. Reach inside along the cheek till you get between the upper and lower gums, and your baby will then open more to allow you to wipe the gums in the very back. In the case that one or more ulcers are found in your baby’s mouth, just clean around the ulcer until they are healed (usually within one week). Get your child accustomed to cleaning his mouth regularly and going to bed with a clean mouth.

Question:
Is it alright to let my baby sleep with a pacifier, sippy cup or bottle?
Answer:
If your child uses a pacifier, do not dip it in honey or anything that has sugar, as this can cause cavities. Do not put your child to bed with a bottle or sippy cup that contains milk, formula, fruit juices or soda, since these contain sugary substances that can cause cavities too. Plain water is the only acceptable fluid to give your child when they are going to nap or sleep.

Question:
How do I control my child’s drooling and teething pain?
Answer:
Babies are very easily agitated by the teething process. Parents should try to distract their children with activities, and allow your child to chew on a clean, chilled, liquid-filled teething ring to relieve the discomfort and irritation. Drooling during this time is normal and expected. Just wipe your child’s mouth often to keep them clean and dry. Swollen gums are normal at this time, however if the gum turns blue or red, then bring your child to the dentist to evaluate. Additionally, teething should not cause fever. Since your baby is picking up anything and everything that has germs on it, and putting it in their mouth to chew on, it is possible that their fever is due to this spreading of illness, in which case parents should bring their child to their pediatrician.

Question:
I heard that sometimes a baby could be born with one or more teeth (natal teeth), if that happens what should I do?
Answer:
Occasionally a baby may be born with teeth (natal teeth) or erupt through the gums within the first month of life (neonatal teeth). Their occurrence is about 1 in 30,000 and usually just the lower front baby teeth (posterior tooth eruption is extremely rare). These teeth are usually the normal baby lower front teeth erupting early. Due to this early eruption, the tooth will not be fully developed. If this should occur, leave them alone, unless they are very loose or causing traumatic ulcers, or causing any discomfort to the baby or mother during breast feeding, in which case you would have them removed. This is a non-traumatic procedure and painless to the infant. Because natal and neonatal teeth are usually normal baby teeth, a new baby tooth will not replace them once they are lost. The space is usually left alone until the adult teeth eventually grow into that area. Teeth that are stable after 4 months have a good prognosis, although they may be discolored and not as esthetic as the other teeth.

Question:
When should I first take my child to the dentist?
Answer:
Parents should take their children to the dentist for their first check-up by the age of 2, unless your doctor recommends and earlier exam. Subsequently, they should go for regular check-ups every 6 to 12 months, so your child’s dentist can monitor their oral hygiene, diet and growth patterns. It is best if your child's first experience occurs at a time before invasive dental work becomes necessary. A ride on the dental chair, magic tricks with "Mr. Thirsty" and visiting the toy chest should make your child's visit pleasurable and non-threatening. The first visit should also include the counting of teeth while your child looks at what is happening in a hand held mirror. Remember, early dental check-up makes it easier to build a good rapport with your child to establish a foundation of trust and comfort for future visits.

Question:
How should I prepare my child for their dental visits?
Answer:
Tell your child that the dentist is there to help take care of his/her teeth. Read your child a fun children’s book about going to the dentist. Describe to your child the surroundings of a dental office and role play the job of a dentist. It may help to tell your child the date for dental visit in advance so that they can prepare for the visit and hopefully look forward to it. Remember, NEVER use the dentist as a threat for not taking care of their teeth, this will just instill a fear in them that will last well into the future. Speak positively about dental visits, and make it something to look forward to. It is important to establish a positive relationship between your child and the dentist by starling early and continuing to see the dentist for regular check-ups. And don't forget to share this valuable knowledge with anyone else who may be helping to care for your child.

Question:
When does my child need fluoride and what is the right amount?
Answer:
Fluoride is a mineral helps prevent tooth decay by strengthening the tooth’s enamel and making it more resistant to acids and harmful bacteria. Most municipal water supplies are fortified with fluoride (check with your local water authority to find out about yours). Some bottled water companies will fortify some of their water products with fluoride, so be sure to check the labels. If the fluoride content of your water supply has less than 0.3 parts per million, ask your child's doctor whether you should give your child a fluoride supplement (the amount recommended for children from 6 months-3yrs old is 0.25 milligrams per day). Your doctor can prescribe fluoride in the form of drops that you can add to your baby's bottle or food once per day, or they can be prescribed as part of your child’s vitamin. The American Academy of Pediatrics doesn't recommend fluoride supplements for babies under 6 months old. Your child will not get any fluoride from breast milk. If you live in an area with fluoridated water, your child will get fluoride from the water you use to make the formula. A little fluoride is good for your baby's teeth, but too much of it can lead to a condition called fluorosis, which can cause white spots on your child's adult teeth. It is recommended to wait until your child is old enough to spit out before giving your child fluoridated toothpaste, and even then you should let them use only a tiny (pea-sized) amount each time. This is because young children tend to swallow their toothpaste rather than spit it out and swallowing too much toothpaste over time can lead to fluorosis, or become toxic in large quantities.


Age

Fluoride Ion Level in Drinking Water (ppm)*

 

<0.3 ppm

0.3-0.6 ppm

>0.6 ppm

Birth-6 months

None

None

None

6 months-3 years

0.25 mg/day**

None

None

3-6 years

0.50 mg/day

0.25 mg/day

None

6-16 years

1.0 mg/day

0.50 mg/day

None

  * 1.0 ppm = 1 mg/liter
** 2.2 mg sodium fluoride contains 1 mg fluoride ion.

Question:
Can water filters reduce the benefits a fluoridated water system would otherwise offer to my children's teeth?
Answer:
Yes, some types of water treatment systems that are installed in one's home can decrease the fluoride levels, thus potentially reducing the cavity-preventing effects of a water supply that has been optimally fluoridated. It has been documented that the reverse osmosis systems and distillation units remove significant amounts of fluoride. However, studies have also shown that water softeners do not cause a significant loss in fluoride levels. The concentration of fluoride found in your water will depend on the type and quality of the water filter you purchased, the current status of the filter and its age. For questions about the level of fluoride in your water supply or to arrange to have your filtered water tested, contact your local and state public health departments. Your dentist should also be contacted to determine if your children are candidates for fluoride supplementation, as it is available by prescription only. Those individuals who drink bottled water as their primary source of water may also be depriving themselves of the benefits of fluoride, as many brands fall short of the optimum levels of 0.7-1.2 ppm.

Question:
Is it better to use a manual toothbrush or an electric toothbrush for my child’s teeth?
Answer:
An electric brush has a few advantages over a manual brush. First it generates more brush strokes per second; making it more effective for the amount of time it is being used. Keep in mind that while it is recommended to brush for 2 minutes, the average person only brushes for 30 seconds. With an electric brush it is easier to clean behind the back teeth. Many of these electric brushes have certain extra bells and whistles such as a digital timer so you know when 2 minutes are up, and an indicator light to show if you are pressing too hard. There is usually less trauma to the gums and teeth when brushing with an electric brush since many over-zealous manual toothbrush users bang into their gums with the wrong technique, or scrub too hard. A manual toothbrush can be very effective with the right technique, and conversely, an electric toothbrush can be virtually useless with the wrong technique. If using a manual brush, use small, vibratory strokes on a 45 degree angle so that the bristles get in the pockets between the teeth and gums. Avoid the up and down or circular motion, as that can just traumatize the gums. If you are using an electric brush, try to spend at least 2 full seconds on each tooth surface (inside, outside and top), making sure to angle the brush between the teeth and having the bristles go between the tooth and the gums. Spin brushes are just a watered down version of an electric brush that may attract the attention of your child with its various themed versions. Whether you use a manual brush or an electric, make sure you always change your brush or brush head every three months, or sooner if you just had a cold so you don’t re-infect yourself.

Question:
At what age should a child brush their teeth on their own?
Answer:
This will depend on the child. While it is great to build up a child’s self-confidence and independence, children don’t usually develop the full coordination and understanding of what they are trying to accomplish until the age of 6 or 7. Even though they may want to do this all by themselves, it is recommended that the parent or guardian supervise, check, and when necessary, do additional brushing for their child at least up until the age of 10. Your toddler can have their toothbrush available to “pretend or play” tooth-brushing along with you. Cavities prevented during this time will save a lot of time, money and trauma in the future.

Question:
How often should I brush my child’s teeth, and at what times of the day?
Answer:
It is recommended that everyone brush at least twice each day with a soft-bristled brush or electric brush. The first time should be in the morning, after breakfast, so your child’s teeth are clean before leaving for school. It defeats the purpose of brushing if you give your child their sugary vitamin after they brush, or give them their breakfast to nibble on the bus, because these substances will stay lodged in the top grooves of their molars and in between their teeth for hours to come, contributing to the formation of cavities. The most important time to brush is right before you go to sleep at night so that nothing is left on or in between your teeth when you are sleeping. The reason is that when you are awake, your saliva helps to bathe and rinse your teeth, but while asleep, you do not salivate that much, and your teeth is more susceptible to developing cavities from the debris left on them. Additionally, if you have the chance to brush after other meals or snacks, it would be advisable. And don’t forget to brush their teeth after they are given medicine, as the acids contained in medicines may break down the tooth enamel.

Question:
When should my child start flossing?
Answer:
Parent-assisted dental flossing is recommended as soon as the teeth erupt next to each other. Independent flossing is recommended once children develop the dexterity to be able to do it on their own (often by six or seven years of age).

Question:
Which foods are bad for my child’s teeth?
Answer:
Any food or snack that can become trapped within the pits and grooves of your child’s teeth or between their teeth can become harmful if not cleaned properly. Chewy candy (i.e. Taffies, caramels, jellybeans, and licorice) are among the biggest cavity culprits. However, you may be surprised to know that nuts, raisins and dried fruits can also cause a lot of damage, since they too get readily stuck in and around the teeth. The complex carbohydrates such as pretzels and potato chips get broken down into the same sugars that are found in cakes and cookies. Any food debris left on the tooth creates an acid attack in the mouth to break it down. The less likely the food is to dissolve or rinse away, the longer the acid attacks will be. Chocolate, which is full of sugar, is actually not as bad for your teeth as dried fruit and nuts, because chocolate dissolves quickly. However, you can prolong any acid attack by eating or drinking things slowly over a longer period of time.

Question:top
What do I do if my toddler won’t let me brush their teeth?
Answer:
There are a few techniques you can pull out of your arsenal. The first is to have several different fun tooth brushes to choose from. When you go to brush their teeth with one of them, they will reach out and grab it from you. Then you pick up another brush and try to brush their teeth with that one knowing that they will now grab that brush from you with their other free hand. Now that both of their hands are occupied, you can go in with a third brush, preferably an electric one so you can get more accomplished in less time. Another technique is to say all the things you might see in there, recalling their meals and snacks that day as you brush (i.e. “I see a little pretzel there, let me get that away….oh look a piece of chicken, let me get that piece of cookie out…”, etc.). You can try brushing to music or while they are watching a show, or doing anything fun and creative. If all else fails, then try the two person technique where one person holds the legs down and the other straddles the head while pinning their straight arms along the side of their head. They will cry and scream, which is good because their mouths will now be wide open. Within several times of doing this they will start to realize that it is just easier to allow you to brush them without resistance, and they won’t remember this experience anyway.

Question:
My baby has white patches inside the mouth. What causes this?
Answer:
It most likely could be caused by a common and harmless yeast infection known as thrush. Thrush looks like cottage cheese on the sides, roof, and sometimes the tongue of a baby's mouth. Usually you will find it in babies 2 months and younger, but it can appear in older babies as well. What happens is that after your baby is born, antibiotics taken by you (if you're breastfeeding) or your baby can trigger a case of thrush. These antibiotics kill off the "good" bacteria that can prevent a yeast imbalance. Often moms and babies pass the infection back and forth: Your baby can pass thrush on to you if you're breastfeeding, resulting in a painful yeast infection on your nipples that would require a doctor's treatment. And you can trigger a case of thrush in your baby if you're breastfeeding and you develop a yeast infection on your nipples from taking antibiotics.

Question:
Does it really matter if my child has a cavity in their baby tooth; they will lose it soon anyway?
Answer:
Yes, it does matter. Baby molars enter the mouth around the age of 2 years of age. If a cavity develops early on, that cavity is only going to keep growing down deeper towards the nerve. Since these baby molars aren’t lost until the age of 10-12 years of age, there is plenty of time for unnecessary, preventable damage to occur. As the cavity grows, the child may wind up needing a baby root canal or an extraction if an infection develops or if there not enough good tooth structure to utilize for a restoration. These baby teeth are fundamental to a child’s health and development, and they also maintain the space for the adult teeth to grow into.

Question:
What happens if a baby tooth comes out too early?
Answer:
Baby teeth (dentists call them primary or deciduous teeth) aren't just for chewing. Each one also acts as a guide for the permanent tooth that replaces it. If a primary tooth is lost too early, the permanent tooth loses its guide and can drift or erupt incorrectly into the mouth. Neighboring teeth also can move or tilt into the space, so the permanent tooth can't come in. Primary teeth can be lost too early for several reasons: They can be knocked out in a fall or other accident; Extensive decay can require that a primary tooth be extracted; Primary teeth can be missing at birth; some diseases or conditions can contribute to early tooth loss. If your child loses a primary tooth before the permanent tooth is ready to come in, or if the permanent tooth is missing, your dentist may decide to use a space maintainer. The space maintainer keeps the space open until the permanent tooth comes in.

Question:
What are space maintainers, and are they really necessary?
Answer:
Space maintainer are designed to maintain the open space left behind by the premature loss of a baby tooth, so that the adult tooth will be able to erupt into that space properly. Space maintainers can be made of steel and/or plastic, and can be made to be either removable or fixed in place. These devices can have an artificial tooth to fill in the space in more esthetic areas. Not every tooth that is lost requires a space maintainer. Usually if one of the four upper front teeth is lost early, the space will be maintained on its own until the permanent tooth comes in. Your dentist will periodically take an x-ray to follow the growth progress of the adult tooth. When it is ready to erupt, the space maintainer will then be removed.

Question:
What can be done to address the large space (diastema) between my child’s front teeth?
Answer:
This gap or space, (aka diastema) most often occurs between the two upper front teeth. It is normal to have this diastema during some stages of dental development. The space eventually closes after the permanent canine teeth (eye teeth) erupt into the mouth. However, in some people, the space does not close. If that is the case orthodontic treatment may become necessary. If this gap is caused by an overly large frenum (thick gum tissue above and between your front teeth) then orthodontic treatment would not be effective here. In that case a frenectomy (removal of that tissue) would be indicated to allow the teeth to come together again. If the large space is due to undersized lateral incisors (the teeth next to the two front ones) then bonding, crowns or veneers may become indicated to help close the gaps.

Question:
Why do some teeth grow behind another? What should be done when that happens?
Answer:
Teeth are normally supposed to grow beneath the tooth it is replacing, as to slowly cause the roots of the baby teeth to be resorbed as the adult teeth grow in. As the roots are being resorbed, the baby teeth will start to loosen and come out on their own. On occasion, the adult teeth will grow in differently, usually towards the inside of the mouth when this happens. If the second set of teeth are growing inside of the teeth they are supposed to replace, then the first set would need to be removed by your dentist in order to create the space needed to allow for the adult tooth to grow into the right position. In most cases the tongue will naturally guide the tooth into the correct position. In some cases, when there is too much crowding, interceptive orthodontics may become necessary to help create the space necessary for the adult teeth that are growing in.

Question:
What are Peg laterals?
Answer:
Peg Laterals are your top lateral incisors (the teeth on either side of your upper front teeth) which on occasion, can grow in peg shaped form. It is an anomaly that happens in about 5% of the population. Peg-shaped upper lateral incisors tend to be hereditary to some extent. It is often referred to as microdontia, which means teeth that are smaller than normal. Usually this condition is bilateral (occurring on both sides of the mouth). However, occasionally, an upper lateral incisor can be missing on one side and peg-shaped lateral present on the other side.

Question:
What should be done to treat a peg shaped tooth (Peg laterals)?
Answer:
Individuals with Peg-shaped lateral incisors can have bonding, veneers or crowns placed over or around this smaller tooth to create the illusion of proper shape and proportion. Typically, it is recommended to do bonding until the patients jaw and teeth stop growing, and then place a more permanent restoration, such as a veneer or ceramic crown, once the growth has ceased.

Question:
How many people are born missing one or more of their adult teeth?
Answer:
The failure of one or more teeth to develop (partial anodontia), is an anomaly that occurs in a small percentage of the population. The most common teeth to be congenitally missing are the third molars (wisdom teeth), lower second premolars, and the upper lateral incisors (in that order). In fact, there is about a 25% chance that someone will not develop one or more of their wisdom teeth. Additionally, the congenital absence of a baby tooth is not common. However, if this were to occur, it is most likely the upper lateral baby incisor that is missing. In these cases, when a baby tooth is not present, it becomes highly unlikely that its permanent replacement will develop as well.

Question:
How many people are born with extra teeth?
Answer:
Extra teeth (referred to as supernumerary teeth), occur approximately 2% of the time in the adult set of teeth, and less than 1% in the child’s first set of teeth. Most of these extra teeth (about 90%) will occur in the upper arch of teeth (maxilla). Supernumerary teeth may also be referred to as polydontia or hyperdontia, with the most common type being the mesiodens (an extra tooth that tends to form between and just inside of the upper two front teeth. Most of the time, these extra teeth don’t even come through the gums, and they are discovered when taking an x-ray in that area. Other types of supernumerary teeth include the rare fourth molar (also referred to as paramolar or distomolar). Multiple supernumerary teeth are very rare in people that don’t have any syndrome or disease associated with it. It is more common to be missing certain teeth, than to develop extra teeth.

Question:
My dentist told me I have a double tooth. Why does this happen, and is there any way to make it appear more like a normal, single tooth?
Answer:
A double tooth, or joined tooth occurs in one of a few ways:

  • Fusion – where two separate teeth are attached together, sharing the dentin and enamel (the inner and outer layer of tooth structure) and often sharing the pulp chamber (where the nerves of the tooth are located) as well. The roots are separate.
  • Gemination – is when you have what appears to be two teeth developing from a single tooth germ, sharing the pulp chamber and the root. When you count the teeth, it would still appear that you have the correct number of teeth, unlike fusion, where the count would be reduced.
  • Concrescence – is different than germination in that the joining of tooth roots by cementum (the outer layer of the root) occurs after tooth formation is complete. This condition doesn’t have much clinical significance unless you need to have the tooth extracted. If this were to become necessary, careful examination of the x-rays would be very important.
    There are ways to make a fused tooth appear to be more like a single tooth. This may involve some reshaping of the enamel, some bonding to add better anatomy, and sometimes the use of porcelain veneers to create the individualized appearance.

 

SportMouth Guardtop

Question:
Do I need to get a Sport Mouth Guard?
Answer:
Whether you are a professional athlete, a weekend warrior, or just a participant in recreational sport activities, a mouth guard is a must have. Mouth guards are intended to protect not only the teeth and gums, but also your lips, cheeks, tongue, neck, brain, mandible (the lower jaw), and the temporo-mandibular joint (TMJ). Both the Ontario Dental Association (ODA) and the Academy of Sports Dentistry recommend mouth guard use for anyone who engages in sports such as football, softball, racquetball, in-line skating, skateboarding, martial arts, boxing, acrobatics, cycling, equestrian sports, field hockey, ice hockey, handball gymnastics, lacrosse, motor cross, rugby, skiing, shot-put, skydiving, squash, surfing, trampoline, tennis, wrestling, weightlifting and water polo which all run the risk of mouth injuries.

Question:
What are the different kinds of Sport Mouth Guard available? Which would you recommend?
Answer:
There are several different types of mouth guards, each differing in price and quality. Stock mouth guards are a preformed, U-shape piece of rubber or vinyl that you hold between your teeth. It is inexpensive (and for a very good reason), as the fit is so poor that they are usually not recommended. Mouth-formed mouth guards are available at sporting good stores (as are the stock mouth guards), and they are a step up in quality. There are two types of mouth-formed guards: the boil and bite and the shell-liner. Boil and bite mouth guards are made from a re-formable polymer material that you mold to your mouth by softening the guards in boiling water and then forming it in your mouth. The advantage of this type of guard is that it can be reformed. A shell-liner mouth guard is made by using a stock tray and a resilient liner material, which you bite into and wait for the material to harden. Unlike the boil and bite, you only have one chance to make it fit. The last class of mouth guards, and certainly the best, are the custom-fit mouth guards that are made by your dentist, impressions will be taken of your mouth, so that they can be made to fit precisely and comfortable. Quality mouth guards are relatively inexpensive, and can prevent injury and the need for costly dental restorative treatments. Naturally, the better quality the mouth guard, the more supportive it will be and the lower the risk of injury. However, the greatest risk of all is to not be wearing a mouth guard.

Teeth Grinding and Clenching (Bruxism)

Question:
What causes Teeth Grinding and Clenching (Bruxism) and what are its manifestations?
Answer:
The main causes of Teeth Grinding and Clenching (Bruxism) are stress, and a poor bite. People often take out their worries, fears and stress subconsciously, while they sleep, causing the muscles and joints associated with the mouth to become strained and over-worked. These muscles can go into spasm, and the joints can become inflamed and result in pain of the TMJ (temporomandibular joint). Teeth clenching and grinding can also result in the loss of enamel, causing teeth to become more sensitive and causing the eventual need for root canal therapy and crowns. When tooth structure is lost, the bite collapses, resulting in the face to develop an older appearance. Grinding can also cause teeth to fracture and can cause mobility of the teeth. When the bite is off, the muscles and joints can become strained, resulting in TMJ problems and jaw pain. When this happens neck problems and headaches can arise, and one’s posture can become affected. Keep in mind that a lot of force can be exerted by the chewing muscles.

Question:
What causes teeth to get shorter over time?
Answer:
People don’t often notice the subtle wearing down of their tooth structure, which over time can amount to a huge change in the appearance of their smile. Just like you may not notice the sole of your shoe wearing down until you see the hole, your bite can collapse in much the same way. Severe wearing down of the teeth’s outer layer (enamel) is often the result from grinding or bruxing of the teeth. Acidic conditions (such as acid reflux, bulimia, etc.) can also act to weaken the tooth structure accelerating this wear. Severe wear may become evident on the front teeth, the back teeth or on both, depending on the way one grinds. Excessive wear in the back of the mouth translates to even more wear in the front as the bite collapses. When the front teeth are affected, the teeth start to get more translucent at the top edges, and start to chip away. As these front teeth continue to wear down, and the teeth become shorter, the face begins to take on a much older appearance.


Question:top
Is it normal for a toddler to grind their teeth? What can be done about it?
Answer:
It is not uncommon for toddlers to grind their teeth at night. In fact, about 35% of children do grind their teeth according to some studies. There may be a variety of reasons responsible for their teeth grinding, including: teething pain, malocclusion (when teeth are not meeting properly), and just simply their trying to get used to the new sensation of having teeth. The average age when the grinding may start is at 3 years old, and usually ending by the age of 6. This grinding is not very likely to result in any real damage to their teeth, but you should mention it to your child’s dentist to prevent any possible problems from arising.
Although the noise can become quite disturbing, you may just have to wait a period of time for your child to grow out of it. Older children may be fitted with a night guard appliance, although they will probably need to go through a few of them as their teeth and jaws continue to grow.

Question:
What are Night Guards, and why are they important?
Answer:
A night guard (also known as an occlusal splint, a bite guard, and a muscle relaxation appliance) is a device most often recommended as the first line of treatment for bruxism (teeth grinding) and TMD (dysfunction of the TMJ). It is usually worn while you sleep to prevent damaging your teeth by the clenching or grinding associated with either the psychological aspects of stress, one's abnormal bite, a sleep disorder, or a combination of the above. Nightly wear significantly reduces daytime bruxism, because more sensitized, leading to a heightened awareness whenever the opposing teeth are in contact during abnormal function. A night guard can help reduce your grinding and TMJ troubles by:

  1. Helping to relax your jaw muscles, which in turn reduce muscle spasms
  2. Alleviating your headaches
  3. Enabling your jaw to find its best position, since teeth are prevented from locking together
  4. Substituting for your teeth when it comes to wear — it is better to grind the night guard than your own teeth.

During the day you should be aware that the only time the teeth should meet is when you chew and when you swallow. All other times think lips together teeth apart.
Grinding can wear away the surfaces of your teeth causing them to become painful or loose. Although maxillary (upper arch) devices are recommended as the treatment of choice, a lower arch device is indicated when a patient objects to having acrylic visible, or when they have a severe gag reflex with the upper arch device. Quality night guards are relatively inexpensive, and can prevent further wear of your national dentition. They will also help to protect your investment after undergoing a smile makeover. With night guards, it is not enough to simply wear one; they must also be routinely checked and adjusted. Ill devised or poorly adjusted night guards often do not succeed in resolving the problem. Well adjusted night guards (and the acceptable restoration of affected teeth), will allow a patient with bruxism to live a normal life, without significant tooth wear or other dental-related traumas.

Bad Breath (Halitosis)

Question:
What can I do to prevent bad breath? Do mints, gums, breath sprays and mouth rinses work?
Answer:
Bad breath, also referred to as oral malodor or halitosis, is so common a problem that it is estimated that close to a billion dollars are spent on products to combat this widespread condition. Of the 50% of the adult population affected, 90% of the odors were found to be of oral causes and therefore become the responsibility of the dentist to diagnose and treat these individuals.
Many products found in commercial markets simply try to control oral malodor by masking it with minty and fruity scents. Mint candies, gums and most mouthwashes are not powerful enough on their own to combat the foul smelling volatile sulfur compounds, the molecules primarily responsible for oral malodor. At this moment I'm sure that many of you are breathing into your hand to see if you may be one of those affected individuals. Don't bother. One problem associated with bad breath is the inability to self-diagnose. A person with a normal sense of smell usually becomes desensitized to its own stimulants. The majority of individuals with halitosis are often unaware they even have bad breath unless someone around them happens to mention it.
The most effective way to manage oral malodor is by maintaining proper oral hygiene, regular dental cleanings, and diligent brushing of the tongue. Remember, your tongue is the most retentive surface in your mouth, and is quite adept at harboring bacteria within its Velcro-like surface.
Other oral factors that can cause bad breath include food impacted between teeth, faulty restorations, throat infections, food and bacteria caught within the crypts of your tonsils, and unclean dentures. Some non-oral causes may include: post nasal drip, diabetes mellitus, kidney failure, infections of the upper respiratory tract, and, of course, foods such as garlic and onions, which are rich sources of volatile sulfur compounds. Reduced salivation, or dry mouth, has been shown to make one's halitosis more readily perceived.
Dry mouth resulting from mouth breathing or as a side effect of many medications can also be a common cause of bad breath. Sugar-free sour candies may help to stimulate the flow of your saliva, and walking around with a water bottle will help keep your mouth moist. Remember, mints and mouth rinses will mask odor only for a brief duration. If you want to eliminate bad breath, consult with your dentist.

Oral Cancer Screening

Question:
Who is at risk for Oral Cancers?
Answer:
Most people are surprised to learn that each year one person dies every hour from oral cancer, making this type of cancer deadlier than cervical, brain, ovarian or skin cancer. In fact, recent statistics published by the American Cancer Society estimates that while the incidence and death rates for cancers overall have decreased, new cases of oral cancer and deaths associated with oral cancer are increasing. We know that early detection tools such as Pap smears, PSA tests and mammograms have greatly reduced death rates for cervical, prostate and breast cancers. Since Oral cancer is one of the most curable diseases when caught early, it is extremely important to see your dentist regularly to keep your mouth under surveillance. When premalignant lesions or early stage oral cancer is found, treatment is simpler, less invasive and more than 82% successful. In continuing efforts to try and provide the most advanced technology and highest quality care available to patients, dentists are continually including new and improved types of Oral Cancer screening exams as an integral part of their regular examinations.


Question:
What are the warning signs for Oral Cancer?
Answer:
The two types of lesions that could be the precursors to cancer are White Lesions (called Leukoplakia) and Red Lesions (called Erythroplakia). The red lesions are less common, but they have a much greater potential to become cancerous. If a red or white lesion does not resolve itself within 2 weeks, it should be reevaluated and a biopsy should be considered for a definitive diagnosis. Other possible signs and symptoms of oral cancer include:
  • Difficulty in chewing or swallowing
  • Numbness of the tongue
  • Hoarseness
  • Ear pain
  • Difficulty when moving the tongue or jaw
  • A lump or a thickening of the soft tissues in the mouth

If any of the above symptoms last for more than two weeks, a thorough exam and any necessary lab tests would become indicated.

Question:
What are the risk factors for Oral Cancer?
Answer:
The risk factors for oral cancer include: tobacco and alcohol use, exposure to sunlight (especially for lip cancer), age (incidence of oral cancer rises steadily with age), gender (men are twice as likely as women to get oral cancer), and race (African Americans are twice as likely as Caucasians to get oral cancer). Note, of all the risk factors tobacco is the primary cause of oral cancer, which accounts for 90% of all cases. Smokers are 6 times more likely to develop oral cancers than nonsmokers.

Question:
How can you lower your risk for Oral Cancer?
Answer:
Most oral cancer is preventable. Approximately 75% of oral cancers are related to the use of tobacco and alcohol. If you are among those using both, your risk becomes much greater than if you were using each substance alone. In order to decrease your risk you should avoid the use of any tobacco products (including cigarettes, chew, pipes, cigars and snuff), minimize the amounts of alcohol that you take in, use an SPF lip balm to protect from sun exposure, and ear plenty of fruits and vegetables to help reduce your risks.


Question:
What can be done to detect Oral Cancers?
Answer:
With oral cancers, the earlier the detection the greater the prognosis. Oral cancer is known to spread fairly quickly, with only half of those diagnosed surviving more than 5 years. Your dentist should incorporate or request your permission to perform an Oral Cancer Screening Exam each year as part of their office protocol. If they don’t offer you the exam or perform this task, you should request the exam or seek care elsewhere. The exam should include an overall evaluation of the face, lips head and neck, with a thorough inspection of the inside of the upper and lower lips, the gums, the inside of the cheeks, the floor of the mouth, the tongue (the sides, top and underside), and the roof of the mouth. Newer types of oral cancer exams include tests that use fluorescent lights and special rinses and dyes (such as Toluidine Blue) to help dentists spot abnormal changes in the mucous membranes that line the inside of the mouth and throat.


Question:
What are some of the benign (non-cancerous) ulcerative lesions that we may find in the mouth?
Answer:
Among the most common, benign ulcerative lesions are:
  • Aphthous Stomatitis (also known as the common ulcer) – is the most common type of oral ulceration that affects about 20% of the regular population, with a 50% prevalence in those individuals experiencing some form of psychological stress. These lesions begin as reddish areas that develop into a whitish-yellow area with a red halo. The number of lesions may vary from one to hundreds, and can be quite painful for 10-14 days. Treatment includes topical antibiotics, antiseptic rinses, and dietary supplements. Sometimes topical corticosteroids are required to help resolve the symptoms and limit their recurrence.
  • Traumatic Ulcers – as the name suggests, are ulcers that are caused by some form of trauma to the superficial layers of the soft tissues in the mouth. They can arise from dental injections, biting the cheek, tongue or lip, or getting poked by a sharp crust of bread or chip, etc. They are usually seen on the tongue, lips or inside of the cheeks. They can present as a painful, single lesion with a reddish border and a yellow, pus-like center. This area will heal on its own, but can be made to feel more comfortable by using topical numbing agents or rinses.
  • Herpes Simplex - There are two strains of the herpes simplex virus, Type I (HSV-1) and Type II (HSV-2). HSV-1 is the type that is associated with the lips, mouth and face and transmitted via saliva, while HSV-2 is usually sexually transmitted. HSV-1 is the most common type of herpes virus, and many people develop the related sores (lesions) inside the mouth, such as cold sores (fever blisters). HSV is never eliminated from the body, but stays dormant and can reactivate, causing symptoms. When the virus is active, painful ulcerations can develop, but the main indicator of a primary infection is from seeing a diffuse, reddish and painful gum inflammation. Multiple pinhead reddish ulcers tend to cluster and join together over several days. It is normal to experience fever and enlarged lymph nodes during this time. Diagnosis is usually made by labs tests of the cells and tissue. Treatment of the primary infection includes fever reducing medications and fluid management. Antiviral medications such as acyclovir will help to lessen the duration and severity of the lesions. There is no known cure for HSV infection, but treatments can reduce the likelihood of the virus spreading and manifesting itself.
  • Acute Necrotizing Ulcerative Gingivitis (ANUG) – also known as Trench Mouth, as this disorder was common among the soldiers during World War I. ANUG is most often brought about by stress and a diminished resistance. Other factors that cause it include: Smoking, poor oral hygiene and inadequate nutrition. It is a painful infection with crater-like ulcerations, swelling, sloughing off of dead tissue from the mouth, and accompanied by a bad odor from the area. Fever, enlarged lymph glands and malaise (general discomfort or uneasiness) are sometime present too. Treatment includes cleaning out the bad tissue, followed by an antibacterial rinse such as chlorhexidine or dilute hydrogen peroxide. Additionally, rest, proper diet, nutritional supplements, and proper home care along with abstaining from smoking, alcohol and spicy foods.
  • Lichen Planus – Oral Lichen Planus is a chronic autoimmune inflammatory condition that can affect the lining of your mouth, and usually manifests as scattered, white, pinhead elevations that are interconnected by white lines to appear like lacy white patches. Oral Lichen planus occurs most often on the inside of your cheeks but also can affect your gums, tongue, lips and other parts of your mouth. Sometimes Oral Lichen Planus can involve your throat or esophagus. An initial episode of Oral Lichen Planus may last for weeks or months, but it is usually a chronic condition that can last for many years. Although there's no cure at this time, this condition can be managed with medications and home remedies.

TMJ Dysfunction

Question:
What is TMJ Dysfunction? How can my dentist help?
Answer:
The TMJ (temporomandibular joint) is a joint that attaches the lower jaw to your skull. If your TMJ is not functioning properly, one or more of the following may have been adversely affected: your chewing muscles, joints, ligaments or surrounding bones. It is difficult to pinpoint the exact cause of one's TMJ syndrome. It may be the result of a traumatic accident or a disease such as arthritis. The most common causes, however, are clenching and grinding of one's teeth, which can tire and strain the chewing muscles, causing them to go into spasm and cause pain. An improper bite can also result in TMJ dysfunction. Among the symptoms are: headaches (usually upon awakening), tenderness or fatigue of the jaw muscles, earaches, and pain or difficulty when chewing, yawning or opening wide. Clicking or popping sounds are very common signs, and in some extreme cases (not yours) the jaw can actually get stuck in the open or closed position.

Most cases of TMJ disorders can be treated conservatively and successfully. Only a small number of cases require surgical correction, usually with those individuals who have suffered a traumatic injury. The first step is to eliminate the pain and muscle spasms. In mild cases, such as yours, this can be done with moist heat packs, a non-chewy diet, and muscle relaxants (if necessary).
The next step would be to try to become aware of the potential sources of stress and tension that could lead to clenching and grinding. A conservative therapeutic device that may work well for you is a corrective bite plate (made by your dentist), that will help to relax the muscles, thus preventing headaches, pain and spasm. Selective filing of an uneven bite to correct the "high" spots is a final attempt to treat TMJ conservatively, because the removal of tooth structure is an irreversible process. top

Question:
What should you do if you are waking up with headaches, and your jaw starts making a popping sound when you open? Is this TMJ related? If so, what causes this, and what can be done to treat it?
Answer:
If you are among the millions of people who have been diagnosed with TMJ syndrome, these may be among the symptoms. The TMJ (temporomandibular joint) is a joint that attaches the lower jaw to your skull. The symptoms described may be a result of the TMJ not functioning properly, due to one or more of the following having been adversely affected: your chewing muscles, joints, ligaments or surrounding bones. It is difficult to pinpoint the exact cause of one's TMJ syndrome, although it is often related to stress. It also may be the result of a traumatic accident or a disease such as arthritis.


Question:
I was having tooth pain after a tooth chipped on the left side. Now the pain moved to the right side, along with jaw pain and extreme headaches. Is this a tooth issue or neurological?
Answer:
What most likely happened was that you traumatized or fractured a part of that tooth on the left side, causing you to consciously or subconsciously avoid chewing on that side. As a result of chewing everything on the right side, you are putting a lot of strain on the right TMJ (temporomandibular joint), resulting in jaw pain and headaches. Once you address the problem on the left side, you should be able to even out your chewing and allow for this discomfort to go away.

Question:
Is gum chewing is bad for your teeth?
Answer:
Chewing sugar-free gum can actually be good for your teeth. It helps to neutralize the acids in your mouth and lift out the food debris that gets trapped in the pits and grooves of your teeth. When you can’t get to a toothbrush, gum chewing is a nice alternative after having a meal or snack. It is the sugared gums that you should avoid at all costs. Additionally, you should limit the length of time you chew gum for because lengthy chewing can aggravate your TMJ and cause discomfort and strain on that joint.

Periodontics

Question:
Who is a Periodontist?
Answer:
A Periodontist (the gum specialist) is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a Periodontist when their periodontal disease is more advanced.

Question:
What is Periodontal Disease?
Answer:
Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Question:
What is Gingivitis?
Answer:
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Question:
How do I know if I have early gum disease (gingivitis) or late stage gum disease (Periodontitis)?
Answer:
In the early stages of gum disease, the plaque that remains around the teeth harden into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums. At this stage, with treatment, it is fully reversible. As gum disease progresses, the gums recede farther, destroying more bone and the periodontal ligament that surround the roots. The affected teeth become loose and may need to be extracted. Routine check-ups and periodic measuring of the pockets around the teeth are necessary to monitor and prevent gum disease from progressing.

Question:
What is Periodontitis?
Answer:
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque can irritate the gums, and stimulate a chronic inflammatory response in which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Question:top
What are the different forms of Periodontitis?
Answer:
There are many forms of periodontitis. The most common ones include the following:

  • Acute periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction.
  • Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gums. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
  • Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
  • Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Question:
How do I know if I have Periodontal Disease?
Answer:
Periodontal disease is often painless and develops slowly and progressively. Sometimes it may develop quite rapidly. Unless you see your dentist for regular checkups, you may not realize you have periodontal disease until your gums and bone have been severely damaged to the point of tooth loss. Periodontal disease can occur at any age. In fact, more than half of all people over age 18 show signs of at least the early stages of some type of periodontal disease. Gingivitis is the earliest stage of periodontal disease and affects only the gum tissue. At this stage, it is reversible. If not treated, it could lead to periodontitis, potentially damaging bone and other supporting structures. Such damage can result in loosened teeth.

Question:
What can I expect the first time I have a periodontal evaluation by my dentist or Periodontist?
Answer:
During your first visit, your dentist or periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

Question:
Is it true that there is a link between Periodontal (Gum) Disease and Heart Disease?
Answer:
Studies show Periodontal Disease can contribute to increased risk of heart attack and stroke. According to some studies, periodontal disease (which affects the bone and tissue surrounding your teeth) has proven to be a stronger risk factor than any of the other conditions usually linked to heart disease (e.g., hypertension, high cholesterol, age and gender). Researchers have concluded that the bacteria found in plaque (the primary etiological factor causing periodontal disease) is clearly linked to coronary disease. People with periodontal disease are up to two times as likely to suffer a fatal heart attack and nearly three times more likely to suffer a stroke as those individuals without this disease.

Question:
What can I do to prevent Periodontal Disease?
Answer:
Keep your teeth clean by brushing with fluoridated toothpaste at least twice daily. Use dental floss and mouth rinse. Eat a balanced diet for good general health to secure the proper amount of nutrients to build your mouth's resistance to the infection caused by bacterial plaque. Visit your dentist at least every six months for a checkup, making sure that a thorough periodontal exam is performed. Avoid other risk factors such as smoking and chewing tobacco, both of which have a detrimental effect on the severity of periodontal disease. Systemic diseases such as AIDS or diabetes can lower the oral tissue's resistance to infection, making periodontal disease more severe. Review your medical history with your dentist. Many of the medications or therapeutic drugs that you may be taking can decrease your salivary flow and adversely affect your teeth and gums.

Question:
What is the link between Periodontal Disease and Diabetes?
Answer:
More and more studies are showing a link between the mouth and the rest of the body regarding the spreading of infections. Over 400 different types of bacteria can exist in the human mouth. Many of them thrive in sugars, including glucose, the sugar linked to diabetes. Persons with diabetes have greater than normal risk of gingivitis (inflammation and bleeding of the gums) and periodontal disease, the condition that causes millions to lose their teeth. Like any infection, gum disease can make control of blood-sugar level very difficult. Diabetes causes the blood vessels to thicken, in turn slowing the flow of nutrients and the removal of harmful wastes. The result is a weakening of the resistance of the gums and bone tissue to the spread of infection. Researchers have found that diabetes predisposes a patient to periodontal disease. Moreover, recent evidence strongly suggests periodontitis can worsen the severity of one's diabetic condition.
Many diabetic patients with severe cases of periodontal disease struggle to maintain their normal blood-sugar levels, and as a result their need for insulin increases, infections originating in the mouth can easily spread, and may enter the bloodstream. In cases of severe gingivitis and periodontal disease even the simple act of brushing or flossing can introduce bacteria into the bloodstream, aggravating health troubles in other areas of the body. Experts expect that treatment of periodontal disease may lead to diminished fluctuations of blood-sugar levels, along with a decreased risk of diabetic retinopathy and the associated risk of damage to the arteries.
People with diabetes are also at risk for developing thrush, a yeast infection in the mouth that causes white spots on the tongue. This infection thrives on high glucose levels in saliva. Another oral manifestation found in uncontrolled or undetected diabetics is dry mouth (xerostomia), an ailment that may result in halitosis (bad breath). Smokers are five times more likely to develop gum disease. A smoker with diabetes aged 45 or older is 20 times more likely to get severe gum disease.

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What precautions should I take when I see my dentist if I have diabetes?
Answer:
If you have diabetes, make certain you inform your dentist and book a visit for an examination and cleaning at least every six months. You should schedule your dental appointments for about an hour and a half after breakfast and after you has taken your diabetes medication. Try to arrange shorter visits, preferably in the morning.

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Is there a relationship between tobacco use and periodontal disease (smoking, tobacco, gum disease, periodontal disease?
Answer:
Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

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Is it normal for my gums to bleed when I brush my teeth?
Answer:
No, it is not normal for your gums to bleed when you brush. Bleeding gums are one of the signs of gum disease. It is an indication of the beginning of the destructive process involving the supporting tissue around the tooth or possibly some serious underlying systemic problems. The bacteria which causes gingivitis (inflammation of the gums), can turn into tartar buildup, irritate your gums and lead to bleeding. If left unchecked, gingivitis can lead to a more serious form of gum disease called periodontitis. This long-term infection can eventually cause loss of your teeth.

Question:
What does it mean to have receding gums? What can be done for this?
Answer:
There are a few reasons why one might develop receding gums. One way is by using an improper brushing technique (i.e. brushing in an up and down or circular motion with a manual brush, rather than with small, vibratory strokes on a 45 degree angle). Another reason involves using a brush that has harder bristles or that is frayed and overdue for being replaced, which can traumatize the gums. Sometimes there may be high muscle attachments (attaching the inner part of the lips to the gums), which pull down on the gum tissue over time as one speaks, smiles, eats, etc. Additionally, gums can recede as a result of periodontal disease, due to the bone loss beneath.
While the gum tissue may not grow back on its own, there are a few things one can do to help prevent gums from receding further. Among the suggestions are:

  • Use an electric brush
  • If using a manual brush make sure to use soft bristles
  • Use the proper brushing and flossing technique
  • Consider re-attaching the muscle attachments so that they are not pulling down on the gums (frenectomy).
  • See your dental provider frequently to avoid developing periodontal disease (gum disease)

Question:
What are the warning signs of gum disease (Periodontal Disease)?
Answer:
There are a number of warning signs of gum disease, which include the following:

  • Red, swollen or tender gums or other pain in your mouth
  • Bleeding while brushing, flossing, or eating hard food
  • Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
  • Loose or separating teeth
  • Pus between your gums and teeth
  • Sores in your mouth
  • Persistent bad breath
  • A change in the way your teeth fit together when you bite
  • A change in the fit of partial dentures

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What does it mean to have pockets when you check for gum disease?
Answer:
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. 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 in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

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Could my periodontal disease be genetic?
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Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

Question:
What can I do to avoid periodontal disease?
Answer:
To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep tartar formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove tartar from places your toothbrush and floss may have missed.

Question:
What kind of oral care products should I use to prevent against gum disease?
Answer:
Begin with the right equipment — use a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn-out brush will not clean your teeth properly. In addition to manual toothbrushes, your choices include electric toothbrushes. These are safe and very effective when used properly. Oral irrigators (water spraying devices) are a great adjunct, but will not remove plaque from your teeth unless they are used in conjunction with brushing and flossing. Another aid is the rubber tip, often found on the handle end of a toothbrush used to massage the gums after brushing and flossing. Other options include interproximal toothbrushes (tiny brushes that clean plaque between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist. Prebrushing rinses, such as Plax, or post brushing rinses and fluoride rinses or treatments are encouraged. Of course dental floss, when used properly, will help to prevent against cavities and gum disease. It is also recommended to use a tongue scraper to clean the posterior third of your tongue to prevent against oral malodor.

Question:
If I neglected my teeth for years, am I able to get them back to a completely healthy state?
Answer:
If your teeth have been neglected for years, chances are you have already done some irreversible damage. Gum disease can cause a loss of bone support, which will not grow back once the mouth returns to a completely healthy state. The gum recession that follows the bone loss will remain evident, unless you are a candidate for certain gum and bone grafting procedures. The good news is that you can arrest bone loss and gum recession by taking perfect care of them. In other words, while you may not get back to where you started, you can prevent further damage from occurring. Teeth that are broken and/or have decay can often be restored and brought back to proper function and esthetics. Teeth that are beyond repair can be removed and replaced with implants and bridge work to regain chewing surfaces and enhance the mouth’s esthetics. Take one step at a time, and once you are at a completely healthy state, make sure to see your dentist regularly to maintain.

Question:
My gums bleed in the same spot every time I brush my teeth. What can be done to help this?
Answer:
Chances are, if your gums are bleeding in the same spot every time you brush, then there is an underlying reason for it. It may be that there is a piece of tartar deep within the pocket surrounding the tooth that needs to be removed to allow for the gums to reattach to the tooth and become healthy once more. Perhaps there is an overhang of a filling or a piece of cement wedged beneath the gums. Bleeding is a sign of inflammation, and inflammation is usually brought about by some outside stimulus such as a trapped piece of popcorn, a seed, a string of the floss, or simply just the bacteria from the plaque and tartar. Remove the stimulus; maintain the area and the bleeding will disappear.

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