If you see blood when you brush or floss your teeth, it generally indicates a problem with your oral health. You may think you are brushing too hard, but this is not usually why gums bleed. The usual culprit is dental plaque.

Plaque is the sticky, whitish film of bacteria that forms on your teeth every day. If you brush regularly, you probably remove most of it — but some may remain behind and accumulate where your teeth meet your gums, particularly between your teeth. As the bacteria build up, along with by-products of their metabolism (the chemical reactions that maintain their lives), they cause inflammation, called gingivitis, in the adjacent gums.

Bleeding gums are an early symptom of gingivitis. Continuing contact with plaque at the gum line can cause your gum tissue to separate from nearby teeth, creating pockets in which the inflammation becomes even worse. The process leads to periodontal disease (“peri” – meaning around, “odont” – tooth). The increasing infection can eat away the bone that anchors the teeth, leading to possible tooth loss. Periodontal disease is not an uncommon problem. About 90% of the population has bleeding gums at some time or another, and approximately 10% go on to develop periodontal disease.

When you lose bone around your teeth, the gums separate from the tooth and “pockets” form between your teeth and gums. The inflammation and infection may continue within the pockets even if your gums have stopped bleeding when you brush. That's why it is important to have regular dental exams — to check up on and stop periodontal disease before it has a chance to cause serious damage.

There may also be other reasons for bleeding gums that have to do with your general state of health. Women who have elevated levels of hormones caused by birth control pills or pregnancy may experience an increased response to plaque that makes their gums bleed more easily. Increased bleeding in your gums can also be caused by some diseases or as a side effect of some medications.

The most important way to prevent bleeding gums is to learn proper brushing and flossing techniques so that you effectively remove plaque from your teeth on a daily basis. If you are not sure you are using the right techniques, make an appointment and have us demonstrate at your next dental visit.

With all the best intentions, some plaque may remain. Plaque that is allowed to stay on your teeth hardens into a substance called tartar or calculus. This must be removed periodically with a professional cleaning by me or by our hygienist.

With not too much effort, you can ensure that your teeth are clean and plaque free, and your healthy gums no longer bleed.

Contact us today to schedule an appointment to discuss your questions about bleeding gums. You can also learn more by reading the Dear Doctor magazine article “Bleeding Gums.”

A generation ago, hearing the term, “smile makeover,” would most likely have resulted in questions and puzzled looks. However, through the power of both the media and celebrities, today it has become a common household term with over 70% of all inquiries coming from people in the 31 to 50 year old age group, according to the American Academy of Cosmetic Dentistry (AACD). While some people seek cosmetic dentistry purely to boost their self-esteem, others pursue it to improve first impressions during business and social interactions, as many studies have revealed that first impressions are the ones that typically last the longest.

The AACD study also revealed other interesting statistics that support why a smile makeover is a wise choice that can yield a life-changing return on your investment — you!

• 99.7% of Americans believe a smile is an important social asset.
• 74% feel an unattractive smile can hurt chances for career success.
• 50% of all people polled were unsatisfied with their smile.

Another important study recently conducted by Beall Research & Training, Inc., an independent marketing research firm, used before and after photos of smile makeovers for polling purposes. The research found that people who have had a smile makeover are viewed by others as more attractive, intelligent, happy, successful in their career, friendly, interesting, kind, wealthy, and appealing to the opposite sex. This evidence clearly proves just how important a first impression can be as well as what it can silently communicate about you.

Want to learn more?

Contact us today to discuss your smile makeover questions or to schedule a consultation. We look forward to meeting with you to learn about your specific concerns and to show you what we can do for you. You can also learn more by reading the Dear Doctor article, “The Impact Of A Smile Makeover.”

The eruption of your child's first permanent teeth is a milestone in his or her development. As parents, you want to help your child preserve and protect their new permanent teeth so that they can last a lifetime. Dental sealants are one easy, simple, and inexpensive way to protect them from decay.

How do cavities develop?

The back teeth (premolars and molars) are formed with deep grooves on their biting surfaces that we call “pits and fissures.” These crevices are too deep for toothbrush bristles to reach. Bacteria can therefore grow and thrive inside them. The acid produced by these bacteria begins to dissolve the tooth enamel, starting the decay process.

Are new teeth more vulnerable?

Yes, the enamel surface of newly erupted teeth is more permeable and less resistant to tooth decay. As the enamel matures, it becomes more resistant.

How can you prevent decay in these new teeth?

Good oral hygiene habits, nutrition (including low sugar consumption), together with fluoride, sealants, and regular dental visits strengthen the teeth and can dramatically reduce tooth decay.

How does fluoride protect these teeth?

Fluoride makes the enamel surface harder and more impermeable and, therefore, less susceptible to acid attack and decay. Fluoride adds some protection to the deep pits and fissures of the teeth but they are still at high risk because of their shape and they often need further protection.

What are sealants and how do they work?

Sealants are protective coatings placed in the tiny pits and fissures to seal them from the bacteria and acids that promote decay. They actually “seal” the pits and fissures to prevent decay and can be used in the treatment of very early decay by arresting it. Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may become necessary.

Contact us today to schedule an appointment or to discuss your questions about dental sealants for your children. You can learn more about them by reading the Dear Doctor magazine article “Sealants for Children.”

Planning a dream trip is something many people spend weeks, months or even years doing prior to their departure. However, in all of their excitement, they often forget about preparing for any “what if” dental emergencies that could occur while on the road. This is especially important if the trip will be overseas where you could face language barriers in addition to the concerns of finding qualified dental professionals you feel comfortable with treating an emergency.

The first and most important step you can take prior to departure is a proactive one: schedule an appointment with us for a thorough exam. (You should also do the same and schedule an appointment with your physician concerning your general health.) During this visit, be sure to let us know about your travel plans, where you will be going and what you will be doing so that we can ensure you are best prepared for your trip. For example, if you will be trying some new or high-impact activities, you may need a mouthguard to protect your teeth. Also, have any dental problems taken care of prior to traveling because pressure changes, especially during air travel, can cause pain in an untreated tooth.

As for seeking safe emergency dental care while you're traveling, here are some tips:

• Be sure to carry your travel information with you at all times, including the names and phone numbers of organizations to contact in case of a dental or medical emergency.
• Some good sources to contact in an emergency are:
• Friends or relatives that you are visiting in the area
• A local hotel concierge
• If traveling overseas, Americans living in the area or American military personnel; The International Association For Medical Assistance To Travelers, a network of doctors and medical institutions around the world (www.iamat.org; 716-754-4883); American Consulate or American Embassy in the country you are visiting; or if in Europe, the American Dental Society of Europe (ADSE; www.adse.co.uk; Phone: 011 44 141 331 0088)

And be sure to take our address with you on your trip. We would love to receive a postcard from you while you're traveling!

Being unhappy with your smile can impact your life in ways that you might not even realize. Are you awkward in social situations that require smiling? Do you shy away from becoming romantically involved? You may even miss out on a better job because you don't want to be forced to endure a live interview for fear of smiling!

If you've decided that the time is right to regain some self-confidence by having your smile redesigned, we can help. We will begin with a consultation, during which we will discuss a number of factors that will influence the process and the final result of your smile makeover including:

• What do you want from a new smile?
• How do you want your new teeth to look?
• How we can use photographs and computer simulations to show you what your new smile will look like before we even start.
• How we work with dental technicians to test shapes, sizes, and colors to personalize teeth so that they closely match your natural teeth.
• How we use “customized temporary restorations” to let you test-drive the look and feel of the final crowns and veneers so that we can guarantee success.

We can even show you “before and after” photos taken of our many patients throughout the course of their makeovers. And, of course, we will discuss the costs to you with respect to both time and money based on the extent and type of work that is necessary to give you your ideal smile.

The tools that are now at our disposal can make the entire smile redesign process an essentially painless and highly creative collaboration that includes constant interaction between you, us, and dental laboratory technicians as we all work together to create your new smile. If you think you are ready to start exploring the possibilities, please call our office to set up a consultation. To learn more about cosmetic dentistry, read the Dear Doctor magazine article “Cosmetic Dentistry: A Time For Change.”

For many people, starting a chewing tobacco habit begins as something you do with “all the guys” to be cool and fit in. It often starts when playing sports such as baseball. And because it is smokeless tobacco, many people think it is harmless; thus they slowly start “dipping” more often until they are chewing tobacco throughout each day, every day.

The truth about chewing tobacco is that it isn't harmless. It is extremely dangerous and contains more than 30 chemicals known to cause cancer. It also contains nicotine, the highly addictive-forming drug found in cigarettes. Sure, it may not have the odorous (and dangerous) impact of cigarettes, cigars and pipes that can negatively impact others nearby, but it can destroy both your oral and general health and even kill you.

Steps You Can Take to Quit

Once a person decides to stop using chewing tobacco, it can be a difficult process and even more difficult to quit cold turkey. If the latter describes your situation, try a smoking cessation program or talk with your doctor about prescription medicines available to help you kick the habit. You may also find free counseling (via telephone) or other groups and organizations created to help people break free from their tobacco addiction. This is often a great way to start the quitting process.

Two of the most important steps you can take are to involve your physician and our office in your strategy to kick this habit. In addition to encouraging and supporting your decision, we can closely monitor your oral health during the process.

Invitations, dresses, the cake, the photographer: there's so much to think about when planning your wedding. And remember to plan for one more thing, your smile. Your wedding photographs will record the magic of your wedding day forever, so you'll want your smile to look radiant. Bonus: you'll be providing for a lifetime of good oral health.

Start planning as far ahead as possible. We can help you select from the variety of treatments, therapies and procedures that can enhance your smile on that special day. Together, we'll assess your starting point, decide what needs to be changed, and create a plan of action. Remember that the bigger the changes you want to make, the longer they are likely to take.

Plan the indicated amount of time before your wedding for the following:

• Several months to three years: Orthodontics
  From minor movement using clear aligners to full braces to correct a bad bite, this treatment allows us to accurately and precisely move teeth for better appearance and function. The process can seem like magic.
• Six months to a year: Dental Implants
  Implants are natural looking, functional stand-alone tooth replacement systems. They take planning and time. An implant consists of a root replacement that permanently joins to the bone and to which a crown is attached.
• Two to four visits: Periodontal Plastic Surgery
  Consult with us to find out your needs. Today, surgical techniques can alter your gum tissues and their relationship to the teeth, improving the appearance of your smile.
• Multiple visits over one to four months: Crowns and Bridges
  A crown or “cap” is generally required when a tooth has been ravaged by decay or trauma. A crown can also be used to improve tooth color and shape. Missing teeth can be replaced by bridges, which span the space created by a missing tooth. Bridges do require crowns on the adjacent teeth to which the bridge is attached.
• At least three months: Veneers
  Porcelain veneers are bonded directly to the enamel to change the shape and color of darkened or unsightly teeth. Usually, a small amount of enamel must be removed to make room for the veneers and for them to work their magic.
• At least two months ahead of your wedding day: Bonding
  You can replace anything from small chips on your front teeth to broken discolored old fillings with the latest tooth-colored bonding composite resin materials. These procedures, generally done in one visit, provide life-like restorations that become part of the teeth and look very natural.
• Allow for one or two office appointments: Whitening
  A professional “in office” tooth bleaching procedure is quicker and more predictable than an “at-home” kit, which may brighten your smile by several shades, but requires months.
• Schedule well ahead of your wedding date: Dental Cleanings
  Remove unwanted stains and freshen your breath, so you look and feel your best on the big day. You may need more than one cleaning, depending on how much stain and tartar there is and how long it has been since your last cleaning.

We can make sure that your wedding day smile makes you look and feel great, not just for those treasured photos, but for years to come. For many of these procedures, results can last a lifetime. Contact us today to schedule an appointment to prepare for your best wedding smile. For more information read the Dear Doctor magazine article “Wedding Day Smiles.”

Of major importance in all wedding day plans is to ensure that you have your special day captured on film. And it is that fact that influences most brides and grooms to take a long and hard look in the mirror to observe their smiles. Not only do wedding dates motivate many brides and grooms to address concerns regarding their smile, it also serves as the perfect time for their parents to pursue their smile makeover dreams so that they too feel good about themselves in your wedding photos.

A proper smile makeover should have a two-fold design plan that ensures you obtain optimal functionality and oral health while creating the cosmetic look you want. Starting with the basics, a thorough dental cleaning is the least expensive way to remove stains and freshen both your smile and breath. We will also use this consultation to learn about your concerns, goals, expectations, and wedding day timeline to create the action plan for future treatments in reaching your smile makeover goals. You may also want to discuss whitening your teeth during your appointment, as whitening teeth is an effective way to brighten your smile a few shades in as few as 1 to 2 appointments plus whitening while at home.

If your smile makeover is a bit more challenging, relax. There are a wide variety of tools and techniques available that include bonding, veneers, crowns, bridges, and dental implants for restoring your smile. Or we may work closely with a specialist such as an orthodontist to straighten your teeth or a periodontist for periodontal plastic surgery that can alter your gum tissues and their relationship with your teeth. The most important tip to remember is to schedule your first dental appointment soon after you become engaged so that you have plenty of time prior to the big day to attain your picture perfect wedding day smile.

Want to learn more?

Contact us today to discuss your smile makeover questions or to schedule an appointment. You can also learn more by reading the Dear Doctor article, “Planning Your Wedding Day Smile.”

Often perceived as a cancer that only affects older adults who have a history of heavy tobacco and alcohol use, oral cancer is now on the rise among younger adults as well. New research has found a link between oral cancers, and the Human Papilloma Virus (HPV), a disease that is primarily spread through oral sex.

Importance of Screening: If you're concerned about oral cancer, rest assured that our office routinely carries out a cancer screening exam on every patient. We have several ways to painlessly detect abnormal tissues in their earliest stages. In addition, please contact our office if you experience any of the following signs or symptoms:

• White and/or red patches in the mouth or on the lips
• A bleeding or ulcerated sore in the mouth
• A sore anywhere in your mouth that doesn't heal
• Persistent difficulty swallowing, chewing, speaking, or moving your jaw or tongue

Although all of these symptoms can also be signs of less serious problems, be sure to alert our office if you notice any of the above changes.

Prevention: you can take a proactive role in preventing oral cancer by:

• Conducting an oral self-exam at least once a month. Use a bright light and a mirror, look and feel your lips and front of your gums, the roof of your mouth, and the lining of your cheeks.
• Scheduling regular exams in our office. The American Cancer Society recommends oral cancer screening exams every three years for people over age 20 and annually for those over age 40.
• Refraining from smoking or using any tobacco products and drinking alcohol only in moderation.
• Eating a well balanced diet.
• Practicing safe sex.

Contact us today to schedule an appointment to discuss any questions you may have regarding oral cancer. Read more about this topic in the Dear Doctor magazine article “Risk Factors for Oral Cancer.”

More than 2,000 years ago, an ancient Greek physician, Hippocrates, often called the father of Western medicine, devised a mouth rinse of herbs and wine to sweeten bad breath. This problem has been around a long time, and it is still a major problem for many people. According to some studies it is one of the three main reasons people seek dental treatment.

Here are some facts you may not know about bad breath:

• Bad breath is sometimes called halitosis, which comes from the Latin halitus (exhalation) and the Greek osis (a condition or disease-causing process).
• Chronic bad breath is usually caused by certain types of oral bacteria. These particular bacteria are present in about 25% of the population.
• Bad breath has spawned a major industry in the United States. Americans spend nearly three billion dollars a year on gum, mints, and mouth rinses to sweeten their breath. About 60% of women and 50% of men say they use breath freshening products.
• Diseases in the oral cavity such as tooth decay and periodontal (gum) disease can often cause bad breath. If either of these diseases are your cause for bad breath, treatment would be necessary to eliminate this problem.
• The tongue is the most common location for bad breath. Bacteria are relatively sheltered on the back of the tongue, where they live on remnants of food, dead skin cells and post-nasal drip. These bacteria can generate volatile sulfur compounds (VSCs) that are also found in decaying animal or vegetable matter. VSCs are known by an unpleasant rotten egg smell.
• Bad breath can also be caused by dry mouth (xerostomia). This condition affects millions of people and can result from smoking, alcohol or coffee drinking, and it is sometimes a side effect of medications. Another cause may be mouth breathing.
• Halitosis can also originate in other parts of the mouth besides the tongue. These include inter-dental (between teeth) and sub-gingival (under the gums) areas.
• When people are starving (and sometimes when they are dieting to lose weight), their bodies begin burning their fats causing their breath to develop the smell of ketones — which smell like acetone, similar to nail polish remover. If people are not eating or drinking the coating on their tongue increases as well, making VSCs more prominent.

At our office, we want to fight bad breath or halitosis by making sure our patients understand how to clean their teeth, gums, the back of the tongue, and dentures.

Contact us today to schedule an appointment to discuss your questions about bad breath. You can also learn more by reading the Dear Doctor magazine article “Bad Breath: More than just embarrassing.”

When you begin a smile makeover in our office, you are embarking on an exciting partnership with my laboratory technician and me. You should be full of excitement and anticipation — if you have been dissatisfied with your current smile, and you have great expectations for the results of this project. You will really like what you see in your mirror.

Being completely satisfied with your new look depends upon successful communication — between you and me and also between my dental lab technician and me. As you might expect, your perceptions of how your teeth appear are different from a dentist's perceptions. My education leads me to think of factors that untrained individuals probably won't consider, such as crown (tooth) length, midlines (how the teeth line up with other facial features) and the distance from gum to lip.

It is helpful to be able to describe what you like and don't like about your current smile, and what changes you would like to see. Using visual aids is a good idea. Bring photos and magazine illustrations to show what you have in mind. (Remember that we cannot make you look exactly like a celebrity or anyone else. The pictures are guidelines.)

Things to think about:

• The color, size, shape, alignment and spacing of your teeth.
• How much of your teeth and gum tissues show when your lips are relaxed and when you smile.
• Tooth color: bright “Hollywood” white or more natural looking off-white.

Your makeover is more likely to meet your expectations if you get an advanced view of the results. Computer imaging is one way to do this. Another is for us to make a mock-up of the proposed dental work in tooth-colored wax on models of your mouth.

Finally, a “Provisional Restoration” can be used as a test to make sure that what I envision is also what you, the patient, want to see. A provisional restoration, made from temporary materials, gives you a chance to test out the changes and make sure they work for you — that they not only look good, but they are also functional in terms of biting, chewing, speech, and gum health.

If the provisional restoration works, it is used as a blueprint to make durable and long lasting porcelains in the same design. We will take impressions of the provisional restoration and communicate the relevant information to a dental laboratory technician, who will make the final porcelain tooth replicas for your new smile.

Competent communication and a provisional restoration will put you on track to meet your expectations and obtain the most aesthetic and functional result in your Smile Makeover.

Contact us today to schedule an appointment to discuss your questions about Smile Makeovers. You can also learn more by reading the Dear Doctor magazine article “Great Expectations — Perceptions in Smile Design.”

You just came in to have your teeth cleaned, but our hygienist is asking you about your general state of health and what medications you are taking. Meanwhile you are wondering why she doesn't just get on with the cleaning.

Dental hygienists are health care professionals who are trained and licensed to preserve your general as well as your oral health. That's why our hygienist begins your visit by asking you about your health history. Some health problems or medications may require special precautions during a dental cleaning. A hygienist also needs to know about your dietary history and other general health questions.

Our hygienist will examine the skin in and around your mouth for sores, lumps, and other areas that could be signs of oral cancer or other problems. She is trained to spot this disease and others.

Dental hygiene is individualized to your own situation. There is not a “one size fits all” solution. During your cleaning, our hygienist will also evaluate the health of your gums and teeth, checking for tooth decay and for inflammation (gingivitis) and bleeding. She will measure the space between your teeth and the surrounding gums, looking for pockets that form when the gums detach from the teeth. Such pockets indicate periodontal disease and can lead to serious problems.

After your health assessment and examination, the actual cleaning will begin. Your dental hygienist will remove deposits of plaque and calculus by using a technique called scaling. Plaque is a biofilm, a film of bacteria that builds up on your teeth. The reason you brush and floss every day is to remove this film from the surfaces of your teeth and gums and from between your teeth. Plaque that is not removed hardens into a mineralized substance called tartar or calculus, and this is what the hygienist removes by scaling.

The next step is a polish to remove surface stains from your teeth and to give your teeth the slick feeling that you identify as clean.

Finally, our hygienist will discuss your state of oral health with you and make suggestions for improvement. Most hygiene appointments take about 45 minutes to an hour. As you can see, during this appointment a lot must be done to preserve your oral health.

If you are in need of a dental cleaning, contact our office today to schedule an appointment. You can learn more about your visit to the hygienist by reading the Dear Doctor magazine article “Dental Hygiene Visit.”

When it comes to cosmetic dentistry, we have numerous techniques that we can use to produce a dazzling smile while restoring or helping you maintain optimal oral health. From tooth whitening and gum contouring to bonding and veneers, see how much you really know about cosmetic dentistry by playing our matching game.

1. Whitening
2. Bonding
3. Enamel shaping
4. Orthodontics
5. Veneers
6. Crowns and bridgework
7. Implants
8. Gum contouring

1. ______ is a minor surgical procedure in which we alter the position of the gum tissue and sometimes even the underlying bone.
2. ______ is a treatment option that is not permanent and may require several applications to achieve the desired color results.
3. ______ is a restorative technique that involves applying an a tooth colored filling material (composite resin) to a tooth that is color-matched and shaped to restore a decayed or damaged tooth.
4. ______ is a treatment option for restoring heavily damaged teeth or replacing missing teeth.
5. ______ is a procedure in which small amounts of enamel, a tooth's outer layer, is removed to reshape it to improve the look of a tooth.
6. ______ is a minor cosmetic procedure in which we apply a peroxide-based material to bleach out minor stains and discoloration from teeth.
7. ______ is a procedure in which we permanently replace a missing tooth by attaching a crown (artificial tooth) to a titanium post that has been surgically placed within the jaw.
8. ______ is a treatment option in which teeth are aligned into a proper position giving a more attractive appearance. It is often used in conjunction with other cosmetic procedures.
9. ______ is a cosmetic technique where we place a custom-designed, thin shell of tooth-colored material (usually porcelain) to the front surface of a tooth.
10. ______ is the most common technique for repairing chipped, broken or decayed teeth. It may also be used to alter the shape of a small or irregular tooth.

Answers: 1) H. 2) A. 3) B. 4) F. 5) C. 6) A. 7) G. 8) D. 9) E. 10) B

To learn more about cosmetic and restorative dentistry, continue reading the Dear Doctor magazine article “Beautiful Smiles by Design.” Or you can contact us today to schedule an appointment to discuss your specific questions.

One topic we are often asked about is finger or thumb sucking and/or pacifier use — a challenge that most parents or caregivers will likely face with at least one of their children. The first and perhaps most important thing to remember is that it is totally normal for babies and young children to suck their fingers, thumb or a pacifier. It only becomes a problem when it continues as the child ages or if you unnecessarily make it a problem.

For most children, the sucking instinct starts in the womb before birth. This fact is evident, as many expectant mothers are shown their child sucking fingers or a thumb during a mid or late-term sonogram. Once the child is born, the habit may continue because it provides the child with a sense of security. Other research indicates that some babies start sucking habits as a way to make contact with, test and learn about their new world outside the womb. It is interesting to note that most children typically tend to stop finger or thumb sucking habits on their own and without much intervention between the ages of two and four. However, for others it can continue much longer. And that is the scenario that parents and caregivers need to be aware of so that they can monitor sucking habits.

Children who suck their thumbs or a pacifier after the age of two have a higher risk of developing some long term negative effects from the habit. This includes but is not limited to upper jaw development issues and “buck” teeth (upper front teeth that protrude forward out of a natural position towards the lips). For this reason, some researchers feel that children should cease thumb or finger sucking and/or pacifier use by 18 months of age. However, the Academy of Pediatric Dentistry recommends that parents and caregivers encourage children to cease this habit by age three.

If you feel your child is at risk due to his/her age and habits, please contact us today to schedule an appointment for your child. After a thorough exam, we can work with you to create a strategy for helping your child overcome finger, thumb or pacifier habits. To learn more about this topic, continue reading the Dear Doctor magazine article “Thumb Sucking in Children.”

While the long-term success rate for a dental implant is well over 95%, there are factors that can compromise their success. For this reason, our office has put together this list so that you can be prepared should you ever need a dental implant. We feel that by providing our patients with this type of easy-to-understand information, we can educate, address any concerns and help produce the best results.

The three most common categories for classifying factors that influence dental implant success are: general health concerns, local factors and maintenance issues. As you may suspect, general health concerns include factors such as:

• Whether or not you smoke or use tobacco products.
• Certain prescription and over-the-counter medications you are currently taking or have recently taken.
• If you have or have a family history of osteoporosis (“osteo” – bone; “porosis” – sponge-like).
• If your medical history includes any cancer or radiation treatment to the jaws.
• Or if you have a compromised immune (resistance) system.

The second category is “local factors” and includes bone quantity and quality — there must be sufficient bone to anchor implants. Other considerations that fall into this category include whether or not you clench or grind your teeth or have additional bite concerns, as all of these can have negative impacts on both the short and long-term success of an implant.

The last category concerns maintenance. While dental implants are superior works of technology that can last a lifetime and produce results that are nearly identical to natural teeth in looks and durability, they do require routine maintenance. This includes daily cleaning (brushing and flossing) and routine visits to our office for evaluation and professional care to make sure they are functioning properly.

To learn more on this subject, continue reading the Dear Doctor magazine article “Factors which can influence implant success.” You can also contact us today to schedule an appointment to discuss your questions about dental implants.

Nightly snoring can be a sign of a dangerous condition called sleep apnea (from “a” meaning without and “pnea” meaning breath). When someone snores the soft tissues in the back of the throat collapse onto themselves and obstruct the airway, causing the vibration known as snoring.

If the obstruction becomes serious, it is called obstructive sleep apnea, or OSA. In such cases the flow of air may be stopped for brief periods, causing the person to wake for a second or two with a loud gasp as he attempts to catch his breath. This can cause heart and blood pressure problems, related to low oxygen levels in the blood. The obstruction and mini-awakening cycle can occur as many as 50 times an hour. A person with this condition awakens tired and faces the risk of accidents at work or while driving due to fatigue.

Studies show that sleep apnea patients are much more likely to suffer from heart attack, congestive heart failure, high blood pressure, brain damage and strokes.

What can be done to treat OSA?
Snoring, apnea, and OSA occur more frequently in people who are overweight. So start with losing weight and exercising.

At our office, we can design oral appliances to wear while sleeping that will keep your airway open while you sleep. These appliances, which look like sports mouth guards, work by repositioning the lower jaw, tongue, soft palate and uvula (soft tissues in the back of the throat); stabilizing the lower jaw and tongue; and increasing the muscle tone of the tongue.

Another approach is to use a Continuous Positive Airway Pressure (CPAP) bedside machine. These machines send pressurized air through a tube connected to a mask covering the nose and sometimes the mouth. The pressurized air opens the airway so that breathing is not interrupted.

Much less frequently, jaw surgeries may be recommended to remove excess tissues in the throat. These would be done by specially trained oral surgeons or ear, nose and throat specialists.

Diagnosis and treatment of OSA is best accomplished by joint consultation with your physician and our office. Contact us today to schedule an appointment to discuss snoring and OSA. You can learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Snoring and Sleep Apnea.”

The CDC (Centers for Disease Control and Prevention) calls fluoridation of drinking water one of the ten most important public health measures of the 20th century, along with such measures as vaccination and motor-vehicle safety.

A fluoride concentration of about one milligram per liter (1 mg/L), or 1 part per million (1ppm), in the water supply is associated with substantially fewer cavities. This concentration of fluoride (equivalent to a grain of salt in a gallon of water) has been found to have no negative health effects.

The connection between fluoride and oral health was confirmed in the first half of the 20th century, and by 1955 the first clinically proven fluoride toothpaste was launched. Fluoride-containing toothpastes are common today, along with other fluoride-containing products.

Protective Effects of Fluoride
Ongoing studies have shown that fluoride has both a systemic (through the body) effect and a local effect at the tooth surfaces. Tooth decay takes place as part of a kind of active war between de-mineralization and re-mineralization, in which acids produced by bacteria in plaque (a biofilm in your mouth) soften and dissolve the minerals (de-mineralization) in the tooth's surface. At the same time, the saliva bathing the tooth acts to re-harden the tooth's surface by adding minerals back (re-mineralization). If fluoride is present in the biofilm and in the saliva, it protects against de-mineralization.

The fluoride you drink in your water is deposited in your bones. Bone is an active living substance that is constantly broken down and rebuilt as a normal body process. As this happens the fluoride is released into the blood, from which it can enter the saliva and act on the tooth surface. The fluoride in toothpastes and products like rinses is delivered directly to the tooth surface. Fluorides can also be eaten in foods with high fluoride content such as teas, dry infant cereals and processed chicken, fish and seafood products.

Problems with Over-use
Eating or swallowing too much fluoride can contribute to a discoloration of teeth called dental fluorosis, which varies in appearance from small white striations to stained pitting and severe brown mottling of the enamel. To avoid this effect, monitor children's tooth brushing to make sure they use only a small amount of fluoride toothpaste and do not swallow it.

Adding fluoride to water has been controversial because some people believe that it may cause other harmful effects. However, most health experts believe that fluoridated water carries no significant health risks and significantly contributes to public health by preventing tooth decay.

Contact us today to schedule an appointment to discuss your questions about fluoride. You can also learn more by reading the Dear Doctor magazine article “Fluoride & Fluoridation in Dentistry.”

Nearly everyone has snored at some point in life. However, if your sleeping partner routinely tells you that you suffer from this problem, you really should take action to confirm or deny your suspicions. You may be like one of the 50 to 70 million people in the US alone that suffer from Obstructive Sleep Apnea (OSA), a medical condition in which the upper airway (the back of your throat) collapses during sleep thus limiting your intake of oxygen. And this condition is serious. If left untreated, OSA can lead to a stroke, impotence, an irregular heartbeat, heart attacks, high blood pressure, and other forms of heart disease.

The first and most important step you should take if you snore is to obtain a thorough examination by both your primary-care physician and our office. We have completed specialized training in sleep medicine so that we can not only diagnose but also thoroughly treat your sleep disorders.

If you are diagnosed with this problem, relax. We have many ways we can treat your condition. One of the most common methods is to provide you with oral appliance therapy. This first line of treatment involves our making a customized oral appliance (mouthpiece) that will hold your lower jaw forward. By doing this, we can move your tongue away from the back of your throat so that your airway is less likely to get blocked while you sleep. (It is this blockage that causes the infamous snoring sound.)

Another option we may consider using to treat your sleep apnea if it is moderate to advanced is a Continuous Positive Airway Pressure (CPAP) machine. These machines require you to sleep with a mask over your nose and/or mouth and produce continuous pressure in your windpipe so that your tongue is forced forward away from your airway. Not only can these machines potentially eliminate your snoring, but they can also give you the restful night's sleep that you have been missing.

The last and most permanent solution for treating certain non-responsive cases of sleep apnea is surgery. This option is typically reserved for the most advanced cases to eliminate or reduce an obstruction to the airway.

Contact us today to discuss your questions about sleep apnea or to schedule an appointment. You can also learn more about sleep apnea when you continue reading the Dear Doctor magazine article “Sleep Disorders & Dentistry.”

If you believe you need a crown or if we have already confirmed this fact, you need to understand that there are several options. The most common are gold crowns, porcelain-fused-to-metal crowns and all porcelain crowns. Each has both pros and cons; thus we will work with you to determine which will work best for your specific needs. However, to help you learn more now, here are some facts.

Gold Crowns

Made from cast gold, this type of crown has been around for over 100 years and is the most successful type of crown. It can last more than 50 years and thus many dentists prefer gold restorations for their own teeth, where cosmetics is not a concern.

All Porcelain Crowns

All porcelain crowns can produce an incredible, life-like appearance. However, because they are made purely from dental porcelain (a type of glass), they tend to be more fragile than gold crowns and may be more at risk with certain high biting forces. Thus they may not be as durable. Porcelain can also cause wear to the natural teeth they bite against. Therefore they are typically preferred for front teeth, rather than back teeth. They have an aesthetic longevity of about 10 years and a functional longevity of about 20 years.

Porcelain-Fused-To-Metal Crowns

As the name states, porcelain-fused-to-metal (PFM) crowns provide the best of both worlds. They are made of natural tooth-colored dental porcelain that is fused on top of a precious or noble metal (usually gold or platinum). They are stronger than porcelain alone and are a good option for back teeth because they offer a better cosmetic result than gold crowns. This is also true for front teeth, however the gold support beneath the porcelain can compromise its life-like qualities. These crowns also have a proven track record and have been used with excellent results for over 40 years.

Learn more about crowns when you read, “Gold or Porcelain Crowns.” Or you can contact us today to discuss your questions or to schedule a consultation.

Oral sedation can be an ideal and safe solution for someone who suffers from fear and anxiety regarding dental appointments — the very reason we offer it to our patients. However, there are some things you need to do prior to and following your treatment for optimal oral sedation benefits and treatment results.

• Being completely honest about your health history and any medication you are taking is a critical aspect, as it lets us know that oral sedation medication is safe and will work for you. We also ask you to let us know about any over-the-counter (OTC) medications, remedies, or vitamins and/or supplements you are taking. The reason this is so vital is that some can negatively impact your treatment, recovery, and the effectiveness of the oral sedation medications.
• You should not eat or drink anything six hours prior to your appointment unless we instruct you otherwise.
• You should make arrangements to have someone drive you to and from your appointment, as it may not be safe for you to drive or operate any heavy machinery until the effects of oral sedation have worn off. It is important to note that this will vary depending on what medication is used, so do not assume your reaction/response will always be the same.
• Drink plenty of fluids (especially water) to stay hydrated after your appointment.

To learn more ways you can prepare, read the article “Oral Sedation Dentistry.” Or you can contact us today to discuss your questions or to schedule an appointment.

Parenthood comes with no manual — if it did it would surely include many essential tips to make your job easier while improving your children's lives. One important fact that surprises many people, is the age you should take your children to the dentist for their first dental appointment, age one. The reason that the age one dental visit is so important is that it establishes the foundation of oral healthcare for the rest of their lives. Unfortunately, some parents wrongly assume that because primary teeth “fall out anyway,” they do not need to worry about them. Nothing could be further from the truth!

One problem children may face is Early Childhood Caries (ECC) tooth decay. This is a type of tooth decay that occurs from sucking on a bottle filled with sugary liquids such as formula, juices and fruity drinks for extended periods of time and from a sleep-time bottle. ECC can affect all the primary (baby) teeth in infants soon after they come into the mouth.

Bringing your children into our office for their age one dental visit enables us to establish a friendly, trusting relationship with the whole family while we assess your children's oral health. During this consultation we will identify if the teeth and jaws are developing correctly, whether habits such as sucking on baby bottles are causing tooth decay or if there are other underlying issues that may indicate future problems. And this ounce of prevention often enables us to stop an anticipated problem before it even starts.

Research has revealed that over 12 million Americans suffer from Obstructive Sleep Apnea (OSA), a condition that occurs when the upper airway (tissues at the back of the mouth and throat) collapse causing significant airflow disruption or even no airflow whatsoever for 10 seconds or more. It can leave you feeling tired, depressed, irritable, as well as cause memory loss and poor concentration. But, did you know that we can help treat your sleep apnea?

The primary method dentists who are trained in sleep medicine use to treat OSA is through the use of an oral appliance. Similar in look to an orthodontic retainer or sports mouthguard, oral appliances are designed to maintain an opened, unobstructed, upper airway during sleep. And while there are many different oral appliances available in the marketplace, less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. The key to success is to avoid those over-the-counter (OTC), generic mouthguards and instead use a professionally made and custom-fitted oral appliance, made from a precise models of your teeth and mouth. They are best at keeping your airway open and preventing the muscles and soft tissues from sagging down when relaxed during sleep. Other advantages of custom-fit oral appliances are that they can reposition your lower jaw, tongue, soft palate and uvula (the tissue in the back of the throat that dangles like a punching bag); stabilize your lower jaw and tongue; and increase the muscle tone of your tongue.

But Is Treatment Really That Important?

Absolutely! If undiagnosed and/or left untreated, sleep apnea can be life threatening. It can cause heart attacks, strokes, impotence, irregular heartbeat, high blood pressure, and heart disease — many of which can kill you.

Want To Learn More?

To learn more about sleep apnea, read the Dear Doctor article, “Snoring & Sleep Apnea.” Or if you are ready for a thorough examination and to discuss your snoring, contact us today to schedule an appointment.

Expectant mothers expect to deal with tooth-related milestones in their child's early years, such as teething and even the eventual shedding of those baby teeth to the Tooth Fairy. But there are many facets of children's oral health that may not be as well known. For example, did you know that using sugary fluids in your baby's bottle too frequently could promote constant acid production in your child's mouth leading to early childhood decay? Did you know that parents and caregivers who have decay transmit the bacteria that cause decay to their children?

Baby or primary teeth serve as guides for permanent teeth and, therefore, their health sets the stage for the health and proper function of their permanent successors. A comprehensive examination during a child's first visit can help uncover any underlying conditions that might be indicative of future problems, like tooth decay that can start as early as the age of six months when their first teeth appear. So the “Age One Visit” is the right time for a first dental visit.

What else do you know or want to know? Take our short quiz to help your child. The answers are listed at the bottom of this article.

The Quiz

1. Mounting evidence suggests that a child's oral health is most closely tied to which relative?
1. Mother
2. Father
3. Brother
4. Sister
2. Parents should bring their children to see a pediatric dentist:
1. Once they turn two?
2. Before they start kindergarten?
3. Preferably before their first birthday?
4. When they start to lose their baby teeth?
3. Tooth decay that occurs in infants and young children is referred to as what?
1. Primary tooth decay
2. Early Childhood Caries
3. Diapers to Decay Disease
4. Pediatric Dental Caries Syndrome
4. To help diminish the likelihood that your baby/infant will develop a cavity, you should:
1. Restrict the amount of sugary fluids your child drinks to mealtimes
2. Maintain proper oral hygiene to reduce harmful bacteria
3. Use fluoride to make the teeth more resistant to acid attack
4. All of the above
5. Infants are most susceptible to tooth decay when:
1. Breast feeding
2. Drinking milk from a bottle during meal times
3. Sucking on a pacifier that has been dipped in jam
4. Sleeping on their sides

The Answers

1) a = mother 2) c = before their first birthday 3) b = early childhood caries 4) d = all of the above 5) c = sucking on a pacifier that has been dipped in jam

Your baby's first visit to the dentist will cover a lot of ground, including diagnosis, prevention, education, and treatment as we help start him or her on the path to long-lasting oral and dental health. Call our office to schedule an appointment now. You can also learn more about pediatric tooth decay by reading the Dear Doctor magazine article “Age One Dental Visit — Why It's Important For Your Baby.”

The best method for permanently replacing a missing tooth is with a dental implant. But did you know that there are two main techniques for placing implants? Implants can be placed either using a one stage or a two stage surgical technique, and as their names suggests, one is performed in one step while the other requires a second surgery.

With a one-stage procedure, a healing abutment is placed at the time of surgery. An abutment is a connector that attaches the implant from the bone into the mouth and which protrudes through the gum tissues. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good, guaranteeing good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.

Under special conditions an implant can be placed and a crown placed on top of it at the same time. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as crown fabrication know-how. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone.

A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. They are not exposed to the mouth, but stay buried and left to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity. This may make it necessary to regenerate bone around the implant at the time of its placement. There may also be other health considerations dictating that a two-stage approach may be indicated.

Depending on your individual situation and medical status, our implant team will determine which approach is best for you. To learn more about these two procedures, read the Dear Doctor article, “Staging Surgery In Implant Dentistry.” You are also welcome to contact us to discuss your questions or to schedule an appointment.

Quiz: What Is Smile Design?

All cultures worldwide recognize a smile as positive nonverbal communication. Yet many people are insecure about the way their smile looks. Modern cosmetic dentistry can completely change your smile through a comprehensive technique called Smile Design.

Take the following quiz to find out how much you know about your smile and smile design.

1. What is the basic reason we consider straight, healthy teeth to be attractive?
1. An article in a beauty magazine.
2. An instinctive understanding of health and survival.
3. Our first grade teacher said so.
4. A talk show on television.
2. What must we take into account in designing an attractive, balanced smile?
1. The shape of your face.
2. Your skin color and complexion.
3. The form of your lips.
4. All of the above.
3. As your dentist, we consider each of the following in evaluating your current smile except:
1. Your marital status.
2. The health of your bone and gum tissues.
3. How your jaw joints function.
4. The stability of your bite.
4. What do we use to evaluate your smile?
1. X-rays and photographs.
2. Models of your teeth and gums.
3. Photographs and computer graphics.
4. All of the above.
5. Bonding is one method that may be used to test or enhance your smile. It is used as:
1. A way of making friends with your dentist.
2. A way of training secret agents.
3. A method of repairing chipped, broken or decayed teeth and testing changes before they are made permanent.
4. None of the above.

Answers

1. b. What we consider an attractive smile is rooted in instinctive understanding of health and survival. We value straight, white, healthy teeth — only a few centuries ago, a person with few or no teeth was likely to starve.
2. d. All of these factors must be taken into consideration in order to design a smile that is in balance with your face.
3. a. While satisfaction with your life partner may make you smile, our priority in smile design is to make sure that the basic structures of your teeth are healthy and function properly.
4. d. All of the above are used in evaluating your current condition to design a new smile.
5. c. In bonding, a composite resin tooth colored material is shaped and physically bonded to a tooth or teeth that are chipped, broken, or decayed to restore both aesthetics and function.

After careful analysis and planning, a variety of techniques can be used to redesign an attractive and healthy new smile, so you can feel confident about smiling and sharing it with the world. To learn more about Smile Design, read “Beautiful Smiles by Design.” Or contact us to discuss your questions or to schedule an appointment.

Did you know that recent research has shown diabetes is a risk factor for increased severity of periodontal (gum) disease and that periodontitis is a risk factor for worsening blood glucose (sugar) control in people with diabetes? Periodontitis can even increase the risk of diabetic complications for people diagnosed with diabetes. When you combine these facts with the following, you will clearly see how important it is to understand and manage these two diseases.

• Over 23 million people in the United States currently have diabetes and over 170 million worldwide.
• 14+ million Americans have a condition called pre-diabetes.
• Another estimated 6 million people in the US have diabetes but are unaware and thus not diagnosed.
• Periodontal disease is the second most common disease known to man, only surpassed by tooth decay.
• Diabetic individuals with periodontal disease have a greater risk for cardiovascular and kidney complications than those diabetics not having periodontal disease.

What You Can Do

One of the most important steps you can take if you have either of these conditions or suspect that you might have one or both is to make an appointment with your physician or with our office for a thorough examination. You should schedule an appointment with your physician for an exam and blood work so that your general health and well-being are monitored. Be certain to share your medical information and any family history of diabetes with our office, as it tends to occur in families.

Learn More

Learn the risks and how to take care of types 1 and 2 diabetes, as well as the stages of periodontal disease (with detailed full-color illustrations) when you read the Dear Doctor article, “Diabetes & Periodontal Disease.” Or if you want to schedule an appointment to discuss your questions, contact us today.

Millions of people suffer from mouth dryness, but most people just never talk about it. As your dental care providers, we don't want you to keep it a secret anymore and mouth dryness really can be a problem.

Why? Saliva is a very important fluid that moisturizes, lubricates, and aids in the first stages of chewing and digestion. A normal flow of saliva provides antibacterial benefits that even protect against cavities by buffering the effects of acids. It can also make the surfaces of your teeth more vulnerable to abrasion and erosion. Without enough saliva, you may be especially at risk for not only tooth decay, but even yeast infections.

Causes of dryness include dehydration and even morning breath, both of which are normal. Smoking, alcohol and coffee drinking also cause dryness. It is also a side effect of many medications. Although mouth dryness is not a disease in itself, it could be a symptom of salivary gland or other systemic (general body) disease.

As a first step in the treatment, we will assess your situation by taking a detailed habit, diet, medical, and drug history to properly assess the cause and establish whether this is a local condition affecting only your mouth or an indication of a generalized bodily problem.

It's always helpful to keep yourself well hydrated by simply drinking a sufficient amount of water every day and by using good daily oral hygiene to remove dental bacterial plaque. Chewing gum, especially containing Xylitol, will also help promote saliva flow and keep your mouth moist. Be careful not to suck on candy or mints, because they are likely to cause decay. There are also prescription medications that can be used to promote more saliva flow.

Contact us today to schedule an appointment or to discuss your dry mouth and what we can do to help. For more information read the article on Dry Mouth in Dear Doctor magazine.

We are often asked about the role the tongue plays with bad breath or halitosis, as it is known medically. The truth is that everyone will experience it at some point in life; however, there can be a number of reasons for its cause. Some of these include:

• Consuming odorous foods and/or drinks such as coffee, onions and garlic. This is usually just a temporary condition that can be resolved by brushing and flossing your teeth and using mouthwash. Also consider chewing gum containing xylitol, a sugar-free gum that both promotes saliva flow and reduces tooth decay.
• Diabetes, a disease caused by a faulty metabolism of sugar, as well as diseases of the liver and kidneys can also cause bad breath. Be sure to always let all your health care professionals know if you have any unusual symptoms or you been diagnosed with any of these or other illnesses.
• Poor oral hygiene, which causes gingivitis (gum disease), is one of the most common reasons for bad breath. And if your gum disease is progressive, you could eventually lose your teeth.
• If you use tobacco and regularly drink large amounts of alcohol, you are dramatically increasing the likelihood of having halitosis.
• And lastly, if you do not drink enough water to maintain proper hydration, you can develop bad breath.

There are more than 600 types of bacteria found in the average mouth, many of which can cause bad breath. And the back of the tongue is where these bacteria typically produce Volatile Sulfur Compounds (VSC), the culprits responsible for the worst odors attributed to halitosis.

As for cleaning your tongue, there are two common methods. You can use your toothbrush to brush your tongue, or you can use a tongue-scraper. The latter can generally be purchased at a drug or discount store. The keys to remember are that a clean, healthy tongue should be pink in color and not have a yellow or brownish coating.

Tooth sensitivity is an issue that can range from a slight twinge at times to downright excruciating pain. However, before we continue, understanding the cause of tooth sensitivity is helpful to both relieving and treating it.

Tooth enamel is inert in that it has no nerve supply and thus it protects the teeth from temperature and pressure changes — the main cause of sensitivity. Once it is compromised, worn thin, or exposed due to gum recession, it leaves the delicate nerve fibers within the dentin vulnerable to touch, acid, and temperature change. These nerve fibers most often grab your attention when they come in contact with heat, cold, or a “double whammy” combination of both cold and sweet. They also become sensitive to touch — even the bristles of a soft toothbrush can irritate exposed dentin.

As for the causes of tooth sensitivity, one common cause we see is aggressive brushing. Yes, too much brushing can be bad for you! To be more specific, excessive, improper brushing with a sawing back and forth motion can erode the gum tissues, expose, wear, and even groove the dentin. Another cause for sensitivity can be from the destructive process of tooth decay that eats through the enamel and into the dentin.

If you are experiencing tooth sensitivity or have questions about this condition, please contact us to schedule an appointment. Or you can learn more about this topic by reading the Dear Doctor magazine article “Sensitive Teeth.”

Yes, dental x-rays are a safe and vital tool we use for measuring and monitoring your oral health. We feel it is imperative to ensure that our patients have the facts — especially when it comes to their oral healthcare. This is why we want to respond to this important question about the safety of dental x-rays.

We want you to know what they are, how they are used, what makes them a safe and effective tool, and why they are so important to dentistry and your health. X-rays are a form of electromagnetic radiation, in fact, just like natural daylight, except they have a much shorter wavelength. And because they are a form of ionizing radiation, they can easily penetrate bodily tissues without causing any harm when used properly. The reasons we use them are obvious; they help us literally see what is unseen. For example, they enable us to see bone structure and roots of teeth among other things, and are commonly used for diagnosing tooth decay. Furthermore, today's x-ray machines and other image capturing techniques are so sophisticated and sensitive that the amount of radiation required for diagnosis is almost nothing when compared to what you get from the background radiation present in everyday living. In fact, the average single digital periapical (“peri” – around; “apical” – root end of a tooth) film is equal to 1/10 the amount of everyday natural environmental exposure. These facts make it clear that dental x-rays are completely safe and, thus, are nothing you need to be concerned about.

Learn more about this topic by reading the Dear Doctor magazine article “X-ray Frequency And Safety.” If you need to schedule an appointment, contact us today.

CAMBRA — Caries Management By Risk Assessment

Worried about tooth decay? Dental Decay is one of the most common and infectious diseases known to man, but it is also very preventable. Today, it is even possible to determine your risk for getting tooth decay. There are disease indicators and risk indicators that can be assessed and used to determine your chances of getting tooth decay. And more importantly, they can be used to prevent and reverse early decay.

Essentially, the difference between healthy teeth and tooth decay is a matter of balance and keeping the balance tipped toward health. That means controlling the factors that tip it toward health and away from disease. Here's a little about how it works:

Disease indicators, as the name implies, are indicators of disease. For example, the presence of white spots on the enamel of your teeth, early signs of decay, which can be detected by your dentist, your past experience of cavities, and whether you currently have tooth decay.

Today, with a “simple saliva sample,” we can test the bacteria in your mouth to determine your decay risk with a simple meter reading.

There are also certain risk factors for tooth decay that you can change by modifying what you do. The ways in which you can help yourself include:

• Reduce the amount of bacterial plaque (biofilm) build-up on your teeth. If plaque is actually visible on your teeth with the naked eye, it means there is a large amount that needs to be removed professionally. High levels of bacteria leave teeth more susceptible to attack from acid-producing bacteria that cause decay.
• Stop snacking on foods containing sugar between meals. Reducing the number of times your teeth are exposed to sugary snacks, and those that contain high amounts of refined carbohydrates, will help lower your risk of tooth decay. Stop feeding the bacteria sugar, which is turned into acid.
• Use fluoride toothpaste. This toothpaste will help strengthen your teeth, making them more resistant to acid attack. Deep grooves in the biting surfaces of your teeth, which we call pits and fissures, increase the likelihood of tooth decay making it impossible to reach with just a toothbrush. However, sealing these areas with “sealants” will prevent these areas from decaying.
• Always ask your doctors about the potential side effects of all medications. Certain drugs reduce the production of saliva and lead to dry mouth, which is one of the main contributors to tooth decay. Saliva has important buffering properties, neutralizing acids in the mouth, helping to reduce risk of decay.
• If you have an eating disorder, get professional help. People suffering from both bulimia and anorexia frequently vomit after meals, which creates a highly acidic condition in the mouth. Getting control over these conditions can help you also gain control over your risk for tooth decay.

We can further help assess your risk for tooth decay by using low dosage x-rays, microscopes, innovative laser technology, and other modern means. Call our office today to schedule a screening. To learn more about the diagnosis and prognosis of tooth decay, read the exclusive Dear Doctor magazine article “Tooth Decay: How To Assess Your Risk.”

Do you constantly feel like you are running on empty? Do you snore, feel like napping every day, or even drink multiple cups of coffee just for the caffeine boost? You may have a sleep related breathing disorder (SRBD) or Sleep Apnea (“a” – without; “pnea” – breath) in which your airways become obstructed causing chronic loud snoring. The good news is that we can help both diagnose and treat this disorder, which means you will be able to finally get the rest that you (and your sleeping partner) so desperately need.

The reason that sleep apnea is so disruptive to daily living is that it causes awakening for a few seconds up to 50 times per night, significantly decreasing the amount of deep sleep that is necessary for full rejuvenation. Airway blockage during sleep commonly results from obesity, an enlarged tongue or tonsils, and other factors that can cause your airway to close off when you lie down, all increasing the likelihood that you will suffer from sleep apnea. These conditions are dangerous and impair the brain and heart from receiving adequate oxygen, increasing your risk for both stroke and heart attack.

The study of sleep and its disorders is relatively new. One successful way to treat sleep apnea is with a “CPAP” machine which uses a Continuous Positive Airway Pressure mask overnight to keep air passages open while sleeping. Another more comfortable, less noisy, and unobtrusive method is to use Oral Appliance Therapy, which features an appliance like a retainer that can be custom fitted to your mouth made by a dentist trained in sleep medicine.

And yes, dentists are increasingly being recruited to help study and treat sleep disorders. There are actually several ways in which we can help. Because we see our patients on a regular basis, we are uniquely qualified to diagnose early signs of SRBDs. For example, if you start to snore almost immediately after falling asleep in the dental chair, we will be able to discuss this important warning sign with you. We can also examine the back of your mouth to see if you possess any of the traits that point to SRBDs, including large tonsils and/or an elongated uvula — the tissue in the back of your throat that looks like a little punching bag.

So, if you want to stop snoring and start sleeping well or you think you may have a SRBD, call our office to schedule a basic oral exam and consultation. If you would like to learn more about the link between dentistry and the treatment of sleep disorders, read the Dear Doctor magazine article “Sleep Disorders & Dentistry.”

At some point in every person's life, they will experience bleeding gums or gingivitis, a mild inflammation of the gingiva (gums), which is the first stage of periodontal (gum) disease. For example, when was the last time you were brushing or flossing your teeth and noticed that your gums were bleeding or that when you spit and rinsed there was some blood? When this occurs, it is a sign that you have gum disease, as healthy gum tissues do not bleed. And no, it is highly unlikely that your bleeding is from brushing too hard. You would have to use extreme force to make healthy gum tissues bleed. However, this is exactly how most people discount or ignore this warning sign.

If this sounds like you or another member of your family, here's what you can expect when you see us for treatment. Depending on the severity of your periodontal disease, all of these treatment options may not be necessary.

Behavior change: We will collect a thorough medical history to obtain facts about your oral hygiene, eating and other personal habits such as alcohol and tobacco use to determine their impact on your periodontal disease. Proper brushing and flossing techniques are necessary for everyone, whether you have early or late stage gum disease; however, you must commit to a good daily oral health routine if you want to achieve success and thus keep you mouth and teeth healthy.

Calculus (tartar) removal: Cleaning is not just your responsibility. We'll clean and polish your teeth to remove calculus (tartar), the calcified deposits of bacterial products that become glued to the teeth and roots that you can’t remove. In fact, routine visits to see us for a thorough cleaning will help ensure that all the unhealthy calculus (tartar) is removed from your teeth.

Evaluation: Usually after three or four weeks, we will want to see you to evaluate your progress and to see the response of your gingival tissues to the treatment thus far. And depending on the severity of your gum disease, we may need another follow-up exam to decide the best maintenance and monitoring regimen necessary to keep your mouth healthy.

Occlusal or Bite Therapy: This treatment, if necessary, usually occurs once your gum tissues have been stabilized and the inflammation and infection have been controlled. It is during this phase that we will address loose teeth or teeth that have shifted or drifted in position.

Surgical Therapy: For more severe cases of gum disease, you may need periodontal plastic surgery to repair and regenerate gum and bone tissue and their attachment to the teeth. It may also be necessary to replace missing teeth with dental implants.

If you are ready to talk to us about the current state of your mouth (or the mouth of another member of your family), contact us today to schedule an appointment. The first step towards achieving optimal oral health could start with this simple call. Or, you can learn more by reading, “Understanding Gum Disease.”

No one participates in sports or recreational activities with the goal of oral or facial injury. However, the facts reveal two things: sports injuries are the number one cause, impacting thousands of adults and children annually and many of them can be prevented or at least minimized with education and the use of a properly fitted professional mouthguard.

In addition to the obvious negative of the physical injury to the mouth and face, oral-facial injuries can also be both emotional and psychological. And while these injuries can occur due to a multitude of reasons, a recent study found that approximately 25% occur while playing sports. The following poignant facts should raise your awareness of dental injuries.

Did you know…?

• On average, 22,000 dental injuries occur annually in children under the age of 18.
• Outdoor activities and products are associated with the largest number of dental injuries to baby (primary) teeth in children aged 7 to 12 with 50% of these incidents related to bicycle accidents.
• Outdoor activities and products are also associated with the largest number of dental injuries to permanent teeth in adolescents aged 13 to 17.
• Of all sports, baseball and basketball consistently produce the largest number of dental injuries each year.
• Over 80% of all dental injuries involve the upper front teeth.
• Age, gender, condition and position of the teeth, as well as the type of sport being played are all key risk factors associated with the likelihood of experiencing a sports injury.
• Studies show that teenage boys involved in contact sports, collision sports, and high-velocity non-contact sports are at the highest risks for dental injuries.
• Young girls are starting to participate in many of these same sports, and thus their risks for injuries are climbing.
• Home furniture is the main culprit in over 50% of the dental injuries in children under the age of 7.

We encourage you to take a moment to assess your own as well as your family's risk of dental injury and to think about how you can treat and prevent them. To learn more, read the Dear Doctor article, “An Introduction To Sports Injuries & Dentistry.” Or, feel free to contact us to discuss your questions or to schedule a consultation.

In a recent online poll conducted by Dear Doctor, the premier oral healthcare resource for consumers, 77% of those polled planned on visiting their dentist prior to their wedding. For some, this includes a thorough cleaning to remove stains and freshen both their smile and breath. However, a growing number of brides, grooms, and parents of the couple are seeking cosmetic dentistry or more specifically, a smile makeover, to transform their smile for their special day as well as their future.

If this describes your situation, take the first step towards the smile you have always wanted. To create your ideal smile, we will first meet with you to get to know you better and hear your concerns, goals, expectations and wedding day timeline. Bringing in photos or magazine images of smiles that you consider beautiful will help to ensure that we understand what you find attractive, as beauty can vary greatly from individual to individual. During this initial consultation, you will also learn about your smile makeover treatment options and what you could expect immediately prior, during and following each option.

Some subtle improvements we may consider are teeth whitening and bonding. Both of these options can take place in just a few office visits and produce very attractive results. Porcelain veneers and crowns can provide you with longer-term results that can last from 10 to 20 years. However, because they typically require 1 to 4 months advance notice, it is important to see us as soon as possible to ensure you have enough time before your special day. Another procedure that can play a dramatic role in your smile makeover is periodontal plastic surgery to improve and alter your gum tissues and their relationship to your teeth. For example, the appearance of “short” teeth can be corrected by lengthening them during a surgical procedure that has minor discomfort yet results in a life-long change.

Want to learn more?

Contact us today to discuss your smile makeover questions or to schedule an appointment. You can also learn more by reading the Dear Doctor article, “Planning Your Wedding Day Smile.”

Thanks to technological advances, today there are more than 40 types of traditional or standard implants. A traditional dental implant actually replaces the root of a tooth, upon which a crown is built — the part you see in the mouth. There are 2 others types that are quite similar to standard implants. Mini implants are most like traditional implants except they are smaller in diameter. Micro-mini implants are an even smaller variation with an even narrower, more screw-like appearance. Micro-mini implants are also designed to be used on a temporary basis, thus can easily be removed. Together all of these types of implants provide us with a wide variety of options for permanently replacing missing teeth.

The following list details the types of implant restorations:

• Single tooth replacements: As the name suggests, these implants are used to replace single teeth.
• Multiple tooth replacements: Implants can be used to replace multiple teeth in a variety of ways. This includes acting as bridge supports to permanently replace missing teeth.
• Combinations of fixed and removable bridgework: Dental implants can be used to support permanently fixed in teeth, bridgework or removable bridges or dentures. Their biggest advantage over dentures alone is that they stabilize the dentures and preserve the jawbone to which they attach, thus preventing the jawbone from melting away under the pressure of dentures.
• Over-dentures: These restorations are now considered the new gold standard. In this application two or more standard implants (or multiple mini-implants) are used to attach and stabilize full dentures. Over-dentures are especially useful for tooth replacement in the lower jaw, where denture stability is often problematic.
• Temporary Anchorage Devices (TADS): These special implants are a tool that orthodontists can use to obtain a stable, non-movable anchor for moving teeth more quickly and easily. They are small, easy to place and easy to remove once their job is done.
• Temporary bridgework: In this case, mini-implants are used to support temporary bridgework. They are placed between permanent implants and later removed when the permanent implants have healed and teeth are permanently placed on them. Mini-implants ensure that a person is never without teeth during the process of teeth replacement.

To learn more on this topic, read the Dear Doctor article, “Dental Implants, Your Third Set Of Teeth.” Or if you prefer, you can contact us to discuss your questions or to schedule an appointment.

If you're looking for a dazzling smile, veneers could be the answer. Veneers are tooth-colored shells made to cover your natural teeth and produce a bright, beautiful smile.

Veneers can correct a multitude of cosmetic defects, from discolored teeth to slightly crooked teeth to gaps in your smile. And advances in cosmetic dentistry have made veneers look even better today.

"The translucent quality of today's veneers gives a more natural look than what's been available in the past," says Kimberly Harms, DDS, a dentist in Farmington, Minn. and consumer advisor and spokesperson for the American Dental Association (ADA).

How Veneers Work

Dental veneers are very thin shells made from tooth-like material designed to cover the front surface of teeth. They can be made of porcelain or resin composite materials. Most veneers today are made of porcelain because this material resists stains better and has a light-reflecting quality similar to that of natural teeth. The veneers are placed on the front of the teeth, concealing imperfections and sometimes changing the size, shape, and length of teeth.

How Veneers Are Applied

Veneers usually require three dental visits. At the first visit, your dentist will discuss whether this cosmetic dentistry procedure will work for you. On the second visit, your dentist will remove a small amount of enamel (the outer coating of your teeth) to make room for the veneer. Usually only one-half millimeter is removed, but this may require local anesthesia.

"The enamel needs to be trimmed down so the tooth doesn't look too bulky," explains Dr. Harms.

An impression is then taken of your teeth and sent to a dental lab where the veneers are custom made. At the third visit, your dentist will attach the veneers to your teeth with special adhesive material.

Pros and Cons of Veneers

Veneers are among the most expensive cosmetic dentistry procedures, so it's important to weigh the pros and cons carefully when considering them.

Advantages of veneers:

• Because veneers are made of material that mimics natural teeth and are individually shaped for each patient, it's nearly impossible to tell the difference between veneers and natural teeth.
• Unlike other cosmetic options, porcelain veneers won't be stained by cigarette smoke, coffee, tea, and red wine.
• The color of veneers can be selected from many whiteness shades. But you may want to resist the temptation to choose the lightest shade, cautions Harms. "Blinding-white veneers often don't look natural," she says.
• For healthy teeth, veneers can be a good substitute for crowns (also called caps), which require removal of more of your natural tooth structure.

Disadvantages of veneers:

• Depending on where you live, veneers can cost $1,000 to $2,500 per tooth, and they're rarely covered by insurance. To save money, you can opt to have veneers placed only on the teeth that show when you smile. Your dentist can then bleach the rest. "I just did six veneers for a patient yesterday," says Harms. "Many of my patients choose to get veneers only on the top 6 to 10 teeth."
• After veneers are applied, your teeth may be more sensitive since some of the protective enamel is removed.
• Also, keep in mind that once the teeth are prepared for veneers, the process cannot be reversed.

Are Veneers Right for You?

If you have gaps between your teeth, veneers can be a good alternative to braces. Veneers can also conceal chipping, cracks, or uneven teeth. In addition, veneers are perfect for teeth that don't respond to whitening.

"Some people have dark stains that don't bleach well, but a veneer will cover the stain," explains Harms.

Veneers are not appropriate for teeth that have been weakened by decay, fractures, or large fillings, however. You may need crowns instead if your teeth are significantly weakened, or if you have missing teeth.

People who clench their jaws and grind their teeth are also poor candidates for veneers since this can cause veneers to crack or chip.

Maintaining Your Veneers

With proper care, veneers can last 10 years or longer. But because veneers are so thin, they can break or even fall off if abused. To minimize the chance of this happening, avoid biting your nails and chewing on pencils, ice, and other hard objects. Brushing and flossing won't harm them, however.

In addition, it's important to practice good dental hygiene because teeth with veneers can still become decayed, possibly making it necessary to totally cover the tooth with a crown. Regular dental checkups will also help ensure that your veneers stay strong and flawless-looking.

With proper care of your veneers and good dental health habits, you can enjoy a superstar smile for years to come.

Perfect Smiles Of Reston and Veneers

Here at the Perfect Smiles Of Reston, Dr. Darvishian has successfully transformed numerous smile makeover cases from ordinary to extraordinary with methodically redesigning a patients' smile utilizing the latest in Veneer design techniques and material. These beautiful smiles are the reflection of our pride in giving our patient the dream of a life time....a perfect smile! Consider us your Reston Veneer Dentist and let us help you in achieving that perfect smile! For a Free Consultation on your case please make a no obligation appointment today.

For many brides and grooms, planning for their wedding is something they start weeks, months or even years in advance. Obviously for most couples, these plans include finding the perfect location, dress, reception area, florist and caterer. However, a growing number of couples (and parents of the bride and groom) are also looking to cosmetic dentistry prior to the wedding. A smile makeover to correct an issue and boost self-confidence makes sure that your wedding pictures are truly memorable.

If this sounds like you, take the first step towards the smile you have always wanted. To create your ideal smile, we will first meet with you to hear your concerns, goals, expectations and wedding day timeline. Feel free to bring in photos or magazine images of smiles that illustrate exactly what you want, do not want, as well as images of smiles that you consider beautiful. We will give you a thorough examination, review photos you bring with you and ensure that everyone understands and agrees with your smile makeover treatment decisions. You will also be informed about what you should expect immediately prior, during, and following your treatment.

We pride ourselves on using the latest technologies and techniques to restore natural-looking smiles. Our smile makeovers have a two-fold design plan in that we artistically create the cosmetic look you want while ensuring you obtain optimal functionality and oral health. After all, we all on the same team for helping you achieve the look you want for your wedding and maintaining your smile for years to come.

Want to learn more?

Contact us today to discuss your smile makeover questions or to schedule an appointment. You can also learn more when you continue reading the Dear Doctor article, “Wedding Day Smiles.”

"Current evidence supports a recommendation of a diet rich in fresh fruits and vegetables as part of a whole-foods, plant-based diet with limited consumption of meat, particularly processed meat," wrote Nita Chainani-Wu, DMD, PhD; Joel Epstein, DMD; and Riva Touger-Decker, PhD, in the JADA article.

In addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillomavirus (HPV), clinicians should provide dietary advice for preventing oral cancer as part of routine patient education practices, they recommended.

Why fruits and vegetables?

Over the past 50 years, researchers have conducted more than 40 epidemiologic studies of the relationship between fruits and vegetable consumption and oral cancer risk, the JADA authors noted. A 2006 meta-analysis identified strong evidence of the protective role of vegetables and fruits, particularly citrus fruits, in the prevention of oral cancer (American Journal of Clinical Nutrition, May 2006, Vol. 83:5, pp. 1126-1134).

Similarly, a cohort study of risk factors for second primary cancers in patients with a history of oral and pharyngeal cancer (OPC), researchers at the National Cancer Institute of the National Institutes of Health found that eating fruits and vegetables has a protective effect (Nutrition and Cancer, 1994, Vol. 21:3, pp. 223-232). In another study, researchers at the School of Dentistry in San Juan, Puerto Rico, found fruit consumption to be protective against oral premalignant lesions (American Journal of Epidemiology, September 15, 2006, Vol. 164:6, pp. 556-566).

While the mechanisms by which diet influences cancer risk are not fully understood, the JADA authors wrote, certain compounds in food may be protective against cancer. Vitamins C and E have antioxidant properties and may prevent DNA damage by reducing exposure to free radicals of oxygen. Terpenes, a group of compounds present in certain plants such as citrus fruits, can influence cell cycle progression and induce apoptosis. In addition, fruits and vegetablescontain micronutrients -- also known as phytonutrients -- that may act synergistically to prevent cancers, including OPC, the researchers noted.

Fruits, particularly berries that are high in ellagic acid, help prevent oral cancer, as do the isothiocyanates in cruciferous vegetables such as broccoli, cauliflower, cabbage, and Brussels sprouts, according to Tieraona Low Dog, MD, a clinical associate professor of medicine at the University of Arizona Health Sciences Center.

"We should all be helping our patients learn how to incorporate a minimum of five servings per day of fruits and vegetables into their diet," Dr. Low Dog told DrBicuspid.com.

In addition to cancer prevention, a growing body of data demonstrates the beneficial effects of omega-3 fatty acids, probiotics, and vitamin D for preventing periodontal disease, she added.

Other food components, such as nitrites in processed meats, which may form carcinogenic nitrosamines, may increase the risk of developing cancer, the JADA authors noted. In addition, eating salted meat, processed meat, and animal fat increases the risk of developing oral cancer. A 2008 study conducted at the Louisiana State University Health Sciences School of Public Health showed that high consumption of dairy products is a risk factor for head and neck squamous cell cancers and also has been associated with an increased risk of developing prostate cancer and ovarian cancer (Head & Neck, September 2008, Vol. 30:9, pp. 1193-1205).

Education is key

In addition to performing thorough head and neck and oral mucosal examinations to identify precancerous changes, oral healthcare professionals should educate patients about oral cancer prevention, including nutrition, the JADA authors concluded. This is particularly important for patients at an increased risk of developing OPC, including:

• Those who use tobacco or have a history of tobacco use
• Those who consume alcohol, betel nut, or gutka
• Patients with oral premalignant conditions such as leukoplakia, erythroplakia, submucous fibrosis, or lichen planus
• Those with a history of head and neck or upper aerodigestive tract cancers

• Over 23 million people in the United States currently have diabetes and over 170 million worldwide.
• 14+ million Americans have a condition called pre-diabetes.
• Another estimated 6 million people in the US have diabetes but are unaware and thus not diagnosed.
• Periodontal disease is the second most common disease known to man, only surpassed by tooth decay.
• Diabetic individuals with periodontal disease have a greater risk for cardiovascular and kidney complications than those diabetics not having periodontal disease.

What You Can Do

One of the most important steps you can take if you have either of these conditions or suspect that you might have one or both is to make an appointment with your physician or with our office for a thorough examination. You should schedule an appointment with your physician for an exam and blood work so that your general health and well-being are monitored. Be certain to share your medical information and any family history of diabetes with our office, as it tends to occur in families.

Learn More

Learn the risks and how to take care of types 1 and 2 diabetes, as well as the stages of periodontal disease (with detailed full-color illustrations) when you read the Dear Doctor article, “Diabetes & Periodontal Disease.” Or if you want to schedule an appointment to discuss your questions, contact us today.

1. Rinse your mouth after every meal or glass of wine - red or white. "White wine has acids that penetrate the enamel, allowing staining and decaying food particles to penetrate more easily," says New York City dentist and Supersmile creator Irwin Smigel, D.D.S. Red, by contrast, creates only superficial staining. But whatever you eat or drink, a subtle swishing and swallowing of water right away at the table helps minimize residue, staining, and tooth decay, says Smigel.

2. Chew sugarless gum. "As you age, your salivary glands shrink and produce less saliva, which is a natural antimicrobial that helps prevent decay," says Smigel. "But gum chewing restimulates the flow."

3. Floss down into your gums, not just between your teeth. Plaque and bacteria can get stuck in those voids, causing inflammation and decay.

4. Ask your dentist to check the state of your fillings. "Every filling eventually has to be replaced," says New York City dentist Marc Lowenberg, D.D.S. Silver, or amalgam, lasts between 10 and 20 years, so your childhood dental work may be overdue for replacement. Fresh fillings can help prevent tooth decay and loss - and, down the road, root canals and implants.

5. Consider orthodontics if your teeth have shifted significantly. "Your jaw is shifting along with your teeth," says Apa. "Left unchecked, the situation can create a collapsed look" (think Disney's Evil Queen disguised as the old lady in Snow White). Invisalign or behind-the-teeth braces are the subtlest options for grown-ups. Ranging from $3,500 to $8,000, the investment for them isn't small. But the long-term payoff is big.

Anytime you are considering an implant surgery to replace missing teeth, you should take the time to gather the facts so that you have clear understanding of the procedure, your options and any potential risks. You should also feel comfortable with the dental team who is treating you. For these reasons, we created the following comprehensive list of questions so that you can obtain the answers you need to help you feel at ease prior to treatment.

• Am I a good candidate for dental implants?
• What is the success rate for dental implants?
• How long have you been placing implants and how many do you place each year?
• Can you show me some before and after photos that illustrate your work?
• What are the risks, benefits and alternatives to dental implants?
• Are dental implants ever rejected?
• How do you assess whether I have enough bone to anchor dental implants?
• Can you tell me about the surgical procedure for implant placement?
• How long will the entire process take from my first appointment until I have my implant(s) and crown(s) in place?
• Do I have to go without teeth while my implants are healing?
• What type of anesthesia will you use during my implant surgery?
• What can I expect in the hours and days following my implant surgery?
• How long will it take my implants to heal?
• How long can I expect my implants to last?
• Will there be any maintenance required with my implant(s)?
• How much will dental implant(s) cost?
• Will my insurance cover all or a portion of the cost?

To learn more, read “Dental Implants, Evaluating Your Professional Options For Care.” Or, you can contact us to discuss your questions or to schedule an appointment.

In times of stress, people have many ways to comfort themselves. For adults, it can be habits such as eating, drinking, or smoking. For children, it is often sucking their thumb, fingers, or a pacifier. Babies have been observed in scans to suck on their fingers and thumbs even before they are born. It makes them feel secure.

When is thumb sucking a problem?
Sucking on fingers or thumbs can be a problem when it is done too vigorously and too long. A young child's jaws are soft and can change their shape to make room for the thumb if the child sucks too hard and too often. If thumb, finger or pacifier habits continue too long, the upper front teeth may tip toward the lip or not come into the correct position in the mouth.

How do you know if your child falls into the group that will suffer from the results of too much thumb sucking? It's best to visit our office so we can check on how the child's teeth and jaws are developing.

What can be done about thumb and finger sucking?
Most children naturally stop sucking their thumbs, fingers, or pacifiers between the age of two and four. The pacifier habit is easier to break than the thumb or finger sucking habit, probably because it is always easier to find their fingers or thumbs. It is a good idea to try to transfer your child's habit to a pacifier at an early age. The next steps are to cut down pacifier usage and gradually stop by 18 months.

If your child is still engaging in these habits at age three, we can recommend strategies for cutting back and stopping. Remember that positive reinforcement, in which a child is rewarded for the desired behavior, always works better than punishment for the behavior you don't like.

Also remember that finger and thumb sucking is normal. Help your child to feel safe, secure, and comfortable as the behavior will probably disappear by itself. If you are worried about your child's sucking a pacifier, thumb or fingers, please visit us to put your mind at rest.

Contact us today to schedule an appointment to discuss your questions about children's thumb sucking. For more information, read “Thumb Sucking in Children” in Dear Doctor magazine.

Did you know that studies have shown a relationship between gum disease and heart disease?

The common link is inflammation. This means that if you reduce inflammation caused by gum disease (periodontal disease), you also reduce your risk for heart attacks and strokes. The methods we stress for good dental hygiene — consistent effective brushing and flossing, regular professional cleanings by a hygienist, and dental treatment when needed — are also important for the maintenance of a healthy cardiovascular system (from cardio, meaning heart, and vascular, meaning blood vessels).

Here's how it works. Dental plaque is a film of bacteria that settles on your teeth near the gum line every day. When you brush and floss, you remove as much of this bacterial film, or biofilm, as you can. Bacteria that are not removed multiply and produce acid products that begin to dissolve the enamel of your teeth. They also irritate your gum tissues.

Your immune system tries to remove the bacteria and their byproducts through inflammation, your body's way of attacking substances that shouldn't be there (such as bacteria). However, long-term inflammation can be harmful to your own tissues as well. Inflammation in your gums, a symptom of periodontal disease, can destroy gum tissue, bone and the ligaments that hold your teeth in place.

Ongoing inflammation can also increase your risk for heart disease and stroke. Bacterial byproducts of periodontal inflammation have been shown to cause the liver to manufacture a protein called CRP (C-reactive protein) that spreads the inflammation to the arteries, where it promotes formation of blood clots.

Of course, other factors are also related to an increased incidence of cardiovascular disease. These include smoking, diabetes, obesity, high blood pressure, and physical inactivity. Family history and depression can also influence gum disease and heart disease.

Diet is another factor. You have probably heard of “good” cholesterol (HDL) and “bad” cholesterol (LDL). The bad one, low-density lipoprotein or LDL, is found in animal fats. It can cause an accumulation of fat breakdown products (also called plaque, but a different substance from dental plaque) inside your arteries. The arteries become narrow, so that they can be easily blocked, resulting in heart attacks and strokes. Studies have shown that inflammation of the lining of the blood vessels accelerates this effect.

If tests show that you have high levels of LDL, your doctor may advise you to modify your diet and take specific medication to reduce arterial plaque. You will also be advised to make lifestyle changes to reduce your risk factors. Lowering your weight, getting more exercise, and stopping smoking can have a positive effect on your heart health — and so can improving your dental hygiene to combat periodontal disease.

Contact us today to schedule an appointment to discuss your questions about the relationship between gum disease and heart disease. You can also learn more by reading the Dear Doctor magazine article “The Link Between Heart & Gum Diseases.”

Losing a baby tooth is an important milestone in a child's life. Be sure to take a photo of that toothless smile — it will be something you treasure as your child grows up.

You may be wondering what is really happening when a baby tooth becomes loose and eventually falls or is pulled out. Read on for some answers.

What are baby teeth?
An infant's teeth begin to form before birth, by the fifth to sixth week after conception. When the baby is born, 20 primary (baby) teeth are almost completely formed inside the jaws. These first teeth, also called deciduous teeth, begin to erupt through the gums at about the time the baby begins to eat solid food. The front teeth (incisors) are usually the first to come in, at age six months to a year.

Why are they called deciduous teeth?
Deciduous means “falling off at maturity.” The same term refers to trees that lose their leaves every fall. In many mammals, including humans, it refers to the first teeth, which need to come out to make room for the larger permanent teeth to come in.

What causes the deciduous teeth to become loose?
While your child is using his primary teeth to bite and chew, his adult (permanent) teeth are quietly growing inside his jawbone. Starting with tooth “germs” (the word comes from germination, meaning the start of growth), the top part of each tooth, called the crown, grows first. Then the bottom part, or root, begins to grow and elongate. As the roots develop and the permanent teeth take up more room in the child's jaw, they begin to push against the baby teeth. This causes the roots of the baby teeth to melt away or resorb. Eventually little or nothing is left to hold the baby teeth inside the child's gums, they become wiggly, and finally they can easily be pulled out. This may leave a little bleeding gum tissue that quickly heals.

What should you watch for in the transition from primary to permanent teeth?
As the permanent teeth erupt (push through the gums and become visible), you may notice that they are too crowded, have too much space between them, or are crooked. It's a good idea to have an orthodontic (from ortho, meaning straight and dont, meaning tooth) evaluation at age five to seven. Watch to see that the baby teeth are lost in the right sequence. If one is lost prematurely, for example from decay, make sure that the space that it occupied is maintained to make room for the adult tooth that will replace it. We can help you with this.

Contact us today to schedule an appointment to discuss whether your child's baby teeth are being lost in the right sequence and if the adult teeth are coming in correctly. For more information see the Dear Doctor magazine article “Losing a Baby Tooth.”

When it comes to sensitive gums during pregnancy, Nancy O'Dell, the former co-anchor of Access Hollywood and new co-anchor of Entertainment Tonight, can speak from her own experience. In an interview with Dear Doctor magazine, she described the gum sensitivity she developed when pregnant with her daughter, Ashby. She said her dentist diagnosed her with pregnancy gingivitis, a condition that occurs during pregnancy and is the result of hormonal changes that increases blood flow to the gums. And based on her own experiences, Nancy shares this advice with mothers-to-be: use a softer bristled toothbrush, a gentle flossing and brushing technique and mild salt water rinses.

Before we continue we must share one important fact: our goal here is not to scare mothers-to-be, but rather to educate them on some of the common, real-world conditions that can occur during pregnancy. This is why we urge all mothers-to-be to contact us to schedule an appointment for a thorough examination as soon as they know they are pregnant to determine if any special dental care is necessary.

Periodontal (gum) disease can impact anyone; however, during pregnancy the tiny blood vessels of the gum tissues can become dilated (widened) in response to the elevated hormone levels of which progesterone is one example. This, in turn, causes the gum tissues to become more susceptible to the effects of plaque bacteria and their toxins. The warning signs of periodontal disease and pregnancy gingivitis include: swelling, redness, bleeding and sensitivity of the gum tissues. It is quite common during the second to eighth months of pregnancy.

Early gum disease, if left untreated, can progress to destructive periodontitis, which causes inflammation and infection of the supporting structures of the teeth. This can result in the eventual loss of teeth — again, if left untreated. Furthermore, there have been a variety of studies that show a positive link between preterm delivery and the presence of gum disease. There has also been a link between an increased rate of pre-eclampsia (high blood pressure during pregnancy) and periodontal disease. Researchers feel this suggests that periodontal disease may cause stress to the blood vessels of the mother, placenta and fetus.

To learn more about this topic, continue reading the Dear Doctor magazine article “Pregnancy and Oral Health.” And if you want to read the entire feature article on Nancy O'Dell, continue reading “Nancy O'Dell.”

Describing Vanna White, co-host of the hit television game show Wheel of Fortune as friendly is an understatement. Yes, a good portion of the credit goes to her bubbly personality; however, you can't look at her without noticing her world-famous smile.

During an interview with Dear Doctor magazine, Vanna shared some of the secrets to her trademark smile. Secrets that she is instilling in her children.

“I floss every day and I brush my teeth at least twice a day — morning and night — and sometimes after lunch.” She added, “I think that flossing is the most important thing. I believe that dental floss helps a lot, as it keeps your gums strong and looking younger.” And when asked about how often she has her teeth professionally cleaned she replied, “...every four to five months because I get a lot of plaque buildup.”

A typical dental hygiene visit is one that involves prophylaxis, a dental (and insurance) term for scaling and or polishing procedures to remove plaque and calculus (tartar) from the crown or portion of the tooth that you can see. Scaling is a procedure where we use special hand-held instruments and/or ultrasonic scalers to remove plaque, bacteria and tartar that can coat your teeth causing them to feel rough or fuzzy. To polish your teeth, we use a rubber polishing cup, prophy paste and a motorized instrument that removes bacterial plaque and surface stains. This is usually the last portion of a routine cleaning because it leaves your teeth feeling smooth and shiny.

However, if you have been seeing blood when you brush your teeth or while flossing, you have the telltale signs of periodontal (gum) disease. During your cleaning appointment, we will clean below the gum line to treat and manage your periodontal disease (an infection of the gum and jaw bones). We may also discover that additional, deep-cleaning treatments (such as root planing) may be needed to treat and manage your periodontal disease.

To learn more about this topic, continue reading the Dear Doctor magazine article “Teeth Polishing.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and cleaning. And if you want to read the entire feature article on Vanna White, continue reading “Vanna White.”

Here's an interesting tidbit of information on Wheel of Fortune host Vanna White: like many people, she grinds her teeth at night. In a detailed interview with Dear Doctor magazine, Vanna explained how she had to replace a filling in a back tooth several times because of her grinding habit. Eventually, she had her dentist make her a nightguard to protect her famous smile.

“I really try to sleep with it every night,” Vanna told the magazine. “I try to keep it on my nightstand so when I go to bed, I remember to put it in. Or I will put it by my toothbrush so I can put it in after brushing my teeth at night.”

The habit of teeth grinding or clenching is often associated with stress and/or sleep deprivation. It is referred to as “parafunctional” (“para” – outside, “function” – normal), meaning it can generate biting forces well outside the normal range — perhaps 10 times normal. This excessive force can affect many areas of the oral system. Teeth may become worn, chipped or loose; jaw joints or muscles can go into spasm; and some grinders (or “bruxers” as they are also called) may even experience discomfort of the head, ears, neck or back. Many times, a person with a grinding habit does not become aware of it until it is pointed out by a sleep partner or dental professional.

Like Vanna White's dentist, we often recommend a nightguard to those with nocturnal bruxing habits. It is made of a very thin, wear-resistant plastic that fits over the biting surfaces of the upper teeth only. The lower teeth are then free to glide or skate over the guard, which prevents them from biting into the upper teeth. Some people wear their guards during the day if they tend to clench their teeth when under stress.

If you are concerned about teeth grinding or interested in learning more about nightguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Vanna White, please see “Vanna White.” Dear Doctor also has more on “Stress & Tooth Habits.”

According to NFL football legend Jerry Rice, “Football can be brutal—injuries, including those to the face and mouth, are a common risk for any player.” And if anyone should know, it would be Jerry.

During an interview with Dear Doctor magazine, the retired NFL pro discussed his good fortune to have had just a few minor dental injuries during his pro playing days. He credits this success to the trainers and protective equipment professional football teams have to keep the players off the injured list. However, this was not the case during his earlier years in football. “There wasn't a lot of focus on protecting your teeth in high school,” he said. “You had to buy your own mouthguard.” He continued, “Things changed, though, when I went to college.”

Unfortunately, not much has changed since Jerry's high school days for young athletes. This is why we feel it is so important that parents and caregivers understand the risks and take proactive steps towards protecting the teeth, gums, bone and soft tissues of their children with a mouthguard. This is especially true for anyone — adults included — participating in high-contact sports such as basketball, baseball, hockey (field and ice), football, soccer, wrestling, martial arts, boxing and activities such as skateboarding, in-line skating and skydiving.

But all mouthguards are not the same. The best mouthguard, based upon evidence-based research, is one that is custom-designed and made by a dental professional, with the athlete's individual needs taken into account.

We make our custom mouthguards from precise and exact molds of your teeth, and we use resilient and tear-resistant materials. Once completed, it should be comfortable yet fit snugly so that you are able to talk and breathe easily with it in place. It should also be odorless, tasteless, not bulky and have excellent retention, fit and sufficient thickness in critical areas.

And while mouthguards may seem indestructible, they do require proper care. You should clean it before and after each use with a toothbrush and toothpaste, transport and store the mouthguard in a sturdy container that has vents, make sure not to leave it in the sun or in hot water and rinse it with cold, soapy water or mouthwash after each use. And last but not least, you should periodically check it for wear and tear so that you will know when replacement is needed.

To learn more about mouthguards, continue reading the Dear Doctor magazine article “Athletic Mouthguards.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and make molds of your teeth for your custom mouthguard. And if you want to read the entire feature article on Jerry Rice continue reading “Jerry Rice — An Unbelievable Rise To NFL Stardom.”

Anytime you have a tooth that does not erupt (surface) correctly but rather stays submerged below the gum you have a problem. Sometimes this situation can cause significant pain, while other times it can be totally pain-free. When this occurs to a wisdom tooth (third molar), you have what is commonly referred to as an impacted wisdom tooth. This generally occurs when there is insufficient room in the mouth, and the wisdom tooth “impacts” or butts up against an adjacent tooth.

Third molars come in typically between the ages of 17 and 25, when a moderate amount of “wisdom” is supposedly achieved. Most people have four wisdom teeth; however, it is possible to have more or less. The key to not having issues generally depends upon one main factor: having adequate space for them to grow and erupt into proper position.

The most common consequence of having an impacted wisdom tooth is gum (periodontal) disease and damage to adjacent healthy teeth. This makes removing the impacted tooth so important. Another problem with impacted wisdom teeth is that they can affect other adjacent structures like gum, bone, nerves, blood vessels and sinuses. They can also become cystic, a condition in which the submerged tooth is surrounded by a closed sac or membrane that can cause possible infection and loss of bone.

We stress the importance of routine dental exams between the ages of 17 and 25 to catch problems with wisdom teeth before they start. The best time to remove a wisdom tooth is when it is not causing problems and the sooner and younger you are the better!

To learn more about the symptoms and treatment options of impacted wisdom teeth, continue reading the Dear Doctor magazine article “Wisdom Teeth.” Or, you can contact us today to schedule an appointment to discuss your questions.

Dental decay is an infectious and very common disease, but it's also very preventable. Today's dentistry has many tools at its disposal to accurately determine your risk for tooth decay, lower it, turn it around, and completely prevent it. What's more, we can even reverse early decay. You might never have to see or hear the drill again.

Striking the right balance between factors that promote oral health and those that cause disease is of the utmost importance. And knowing whether or not you have indicators of disease or risk for tooth decay is a great place to start.

We will scientifically calculate your risk for tooth decay by:

1. Recording and monitoring your oral and dental health: Our risk assessment/evaluation form allows us to gather information about critical dental health habits. Oral hygiene habits, use of fluoride toothpaste, tobacco smoking, frequent snacking on sugary foods and beverages, and past experience of decay are all examples of disease indicators that will help gauge your level of risk. For example, using fluoride toothpaste decreases your risk, but smoking and between-meal snacking increases it.
2. Testing for decay producing bacteria: You've probably heard of dental bacterial plaque, the biofilm that sticks to your teeth, forming in the tiny little grooves on the biting surfaces of the teeth where decay starts (and along the gum line). Today, acid-producing bacteria responsible for causing decay can be tested by simply sampling your biofilm on a swab, and placing it in a meter to accurately determine acid-producing activity. A high number indicates high risk. You can see it for yourself in less than a minute.
3. Saliva testing: A simple history will tell us whether your mouth is dry or moist most of the time. A saliva test will tell us if your saliva is acidic or neutral. A dry acidic mouth promotes decay, while a moist neutral mouth with healthy saliva promotes health. Measuring salivary “pH,” the measure of acidity, is another factor for determining your risk for decay and reversing it. Special rinses can help reduce decay-producing bacteria and reduce acidity.
4. Very early decay detection: Modern ultra-low-dosage x-ray equipment allows us to determine the very earliest signs of decay. Decay that is detectable with the naked eye (or feel with a dentist's instrument, an explorer) is already at an advanced stage. Catching the disease very early with the help of this sophisticated equipment can allow us to reverse early decay before it has even turned into cavities. It can actually be reversed with remineralizing fluids, rinses that put calcium back into the tooth surfaces reforming and hardening them.

This is a new and exciting era in the fight against tooth decay and we have all the tools to determine your decay risk and reverse it.

If you would like us to determine your risk for tooth decay, please call the office to schedule an appointment. To read more about disease indicators and risk factors for dental caries, read the Dear Doctor magazine article “Tooth Decay: How To Assess Your Risk.”

Since the dawn of man, periodontal (gum) disease has impacted humans. And while dental health has dramatically improved over the generations, the facts are still clear — millions of Americans are suffering from gum disease and probably do not even know that they have a problem. This is because periodontal disease most often starts without any symptoms or ones that most people tend to discount or ignore.

Stage 1: Gingivitis. The first stage of gum disease is inflammation of the gingiva (gums) without bone loss. While nearly all people will develop gingivitis in the absence of good oral hygiene, only 10 to 15% of them will go on to develop more advanced stages of the disease.

Stage 2: Early periodontitis. With this stage, gingivitis progresses into the deeper periodontal structures — the tissues that attach the teeth to the bone resulting in early or beginning bone loss. About 10% of the population develops full-blown periodontitis with progressive bone loss.

Stage 3: Moderate periodontitis. The third stage of gum disease results in moderate bone loss (20 to 50%) of root surfaces of the teeth due to continued destruction of the surrounding tissues and bone. Periodontal disease is “cyclical” — it goes in cycles with bursts of activity, followed by a period in which the body tries to recover. This is called chronic inflammation, or frustrated healing.

Stage 4: Advanced periodontitis. With the final stage of gum disease, there is severe bone loss (50 to 85%) from the tooth's root. This stage includes looseness of teeth, moving teeth, abscess formation with red, swollen and painful gums. The end results — eating and even smiling is difficult and uncomfortable, and you could lose all your teeth.

You can learn more about gum disease in the Dear Doctor article, “Understanding Gum Disease.”

Have We Described Your Mouth?

If any of the above stages sounds like we are talking about your mouth, contact us today to schedule a consultation, discuss your questions and receive a thorough exam. If addressed promptly and with commitment to following your treatment plan, your mouth can return to good oral health.

While the goal of restorative dentistry is to return all of the destroyed or lost dental tissues of the teeth to full form (shape) and function, when you blend this goal with the artistry of cosmetic dentistry, the results can be dazzling. Today's modern techniques and materials enable replacement of missing tooth structure that allows bonding directly to the tooth so that it not only is an exact color match but also actually strengthens the tooth. And tooth-colored fillings are not just for front teeth. They can dramatically improve the appearance of all teeth — even your back molars — so that it appears you've never had tooth decay at all!

All of this is accomplished through the use of either tooth-colored dental porcelain or composite resins. Porcelains are a form of ceramic material formed by the action of heat. They are available in many colors and shades made from a powder corresponding to the primary color of the natural tooth structure that is mixed with water and placed into an oven for firing (hence their ceramic nature). When built up in layers by highly trained dental ceramicists, they can be made to mimic the exact natural translucency, staining and contours of tooth enamel.

Dental composite resins are the most common materials used for tooth-colored adhesive restorations today and have properties similar to tooth structure. They consist of resin or special plastics and fillers that are made of silica, a form of glass. The fillers give the composites wear resistance and translucency (see through properties).

It is important to note that besides providing the appearance of beautiful teeth, properly restored teeth function and wear better. But most important to you, they appear indistinguishable from natural teeth! Furthermore, scientific studies and clinical experience have validated their use as both safe and predictable. In fact, these techniques are also suitable for children's teeth and can incorporate fluoride to reduce decay. Together, all of these changes have so significantly impacted the way modern dentistry is practiced that many believe we may have entered into the so-called “post-amalgam (silver metal-colored dental fillings) era.”

Contact us today to schedule an appointment to discuss your questions about tooth-colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.

Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.

The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.

The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.

Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today to schedule an appointment to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”

Temporomandibular Disorder (TMD), which was formerly known as Temporomandibular Joint Disorder (TMJ), is an interesting condition because it can be hard to diagnose and often mimics many other conditions. It arises when there are problems inside the temporomandibular joint, and the muscles attached to it, causing pain. When treating TMD, we typically start by relieving the symptoms of pain and discomfort with heat, mild pain medications, a diet of soft foods, and some simple jaw exercises. We feel that it is critical to address your pain issues as soon as possible before preceding any further with treatment.

Once we have provided some pain relief and after having completed a thorough history and examination, we can move to the next phase of treatment. This may include the introduction of a bite guard or some form of oral appliance therapy. A bite guard is an unobtrusive yet rigid plastic horseshoe-shaped appliance that fits snuggly over the biting surfaces of the upper teeth. When in place and properly adjusted, this custom-made appliance allows your muscles and therefore jaw joints to relax. And it will prevent you from grinding your teeth, another contributing factor to TMD. We will probably ask you to wear it when sleeping or in times when you are feeling stressed when clenching or grinding habits may be active. We may also suggest that you obtain some relaxation therapy and/or biofeedback from a licensed therapist, as this can prove helpful in treating TMD.

If you have suffered from frequent jaw pain in the past and suspect that you may have TMD, please let us know so that we can address it at your next appointment. Or if you are currently in constant or severe pain, contact us immediately to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

When dentists talk to patients, they often use specialized vocabulary referring to various dental conditions. Do you understand what they mean when they use these words — or are you wondering what they are talking about?

Here's your chance to test your knowledge of ten words that have a particular meaning in the context of dentistry. If you already know them, congratulations! If you don't, here's your chance to learn what these words mean in the dental world.

Enamel
In dentistry, enamel is the hard outer coating of your teeth. It is the hardest substance produced by living animals. It is a non-living, mineralized, and composed of a crystalline form of calcium and phosphate.

Dentin
The dentin is the layer of a tooth that is just beneath the enamel. It is living tissue similar to bone tissue.

Pulp
When dentists speak of pulp, we mean the tissues in the central chamber of a tooth (the root canal) that nourish the dentin layer and contain the nerves of the tooth.

Bruxism
Many people exert excess pressure on their teeth by clenching or grinding them. This is called bruxism, a habit that can be very damaging to teeth.

Occlusion
By this we mean how the upper and lower teeth are aligned, and how they fit together. This can also be referred to as your bite.

Dental caries
This term refers to tooth decay. Dental caries and periodontal disease (see below) are two of the most common diseases known to man. Today, these diseases are not only treatable, but they are also largely preventable.

Periodontal disease
A term for gum disease, this term comes from “peri,” meaning around and “odont,” meaning tooth. It is used to describe a process of inflammation and infection leading to the progressive loss of attachment between the fibers that connect the bone and gum tissues to the teeth. This can lead to loss of teeth and of the bone itself.

Erosion
When you consume acidic foods or drinks, the acids in your mouth react directly with minerals in the outer enamel of your teeth, causing chemical erosion. This is not the same as tooth decay, which is caused by acids released by bacterial film that forms on your teeth (see below).

Dental implant
A dental implant is a permanent replacement for a missing tooth. It replaces the root portion of the tooth and is most often composed of a titanium alloy. The titanium root fuses with the jaw bone, making the implant very stable. A crown is attached to the implant and can be crafted to match your natural teeth.

Plaque
Dental plaque is the whitish film of bacteria (a biofilm) that collects on your teeth. Your goal in daily brushing and flossing is to remove plaque.

Contact us today to schedule an appointment to discuss any questions you may have about your teeth and gums. You can also learn more by reading Dear Doctor magazine article “How and Why Teeth Wear.”

A pregnant woman has a lot to think about while preparing to welcome a new member of her family. It's important to think about her oral health as well. She is sharing her body with the developing infant, so problems with her health — including her dental health — can affect the baby. The following facts will help you understand the relationship between oral health and pregnancy.

1. A baby's primary (baby) teeth begin to form during the sixth week of pregnancy. They begin to form their enamel (the hard outer layer of the teeth) and dentin layer (just under the enamel) at about the third or fourth month. The calcium, phosphorous, and protein that are needed for these structures must all be provided by the mother's diet.
2. A good diet for a pregnant mother, in order to provide for both her needs and those of the fetus (the developing baby), includes whole grains, fruits, vegetables — including green leafy vegetables — proteins and dairy products. A doctor may also recommend iron and/or folic acid supplements.
3. If the mother's diet does not provide enough calcium for the baby's bones and teeth, it will come from calcium stored in her bones — not from her teeth. The old idea that a mother's teeth lose calcium during pregnancy has been found to be a myth.
4. Progesterone, a normal female hormone, is elevated during pregnancy. This hormone stimulates production of prostaglandins, substances that cause inflammation in gum tissues if the bacteria that cause periodontal (gum) disease are present. The resulting swelling, redness, and sensitive gum tissues, called pregnancy gingivitis, are common during the second to eighth months of pregnancy.
5. The bacteria involved in periodontal disease can affect whole body conditions such as heart disease and strokes, diabetes, and respiratory diseases. The inflammation resulting from such bacteria can also cause premature delivery (birth before 37 weeks of pregnancy) or low birth weight in the baby.
6. Periodontal disease is also related to pre-eclampsia, or high blood pressure, during pregnancy.
7. Dental x-rays do not expose the mother to very high radiation, but in any case every precaution is taken to minimize exposure to the fetus. These include a leaded apron that shields the baby from exposure.
8. Most drugs commonly used in dentistry, including local anesthetics, can safely be given to pregnant women without affecting the fetus. However, it is important to let your dentist know you are pregnant before embarking on any treatment to make sure anything that is done will be safe for the fetus and its developing teeth.

Contact us today to schedule an appointment to discuss your questions about pregnancy and your oral health. You can also learn more by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”

Most people think of bone as rock-solid, but it's actually a living tissue that's constantly changing. This has significant implications for your oral health, general health, and appearance — if you are one of the 70% of Americans missing at least one tooth.

Throughout the day, your top and bottom teeth make hundreds of fleeting contacts with each other. These small stresses are transmitted though the periodontal ligament (“peri” – around; “odont” – tooth) that supports each tooth in its socket like a hammock. Think of it as a gentle push on the hammock, which causes the tooth to gently bump the underlying bone. The bone then builds up in the spot that's receiving stress to counteract it. This constant remodeling of bone is what allows bone to stay healthy and strong.

When a tooth is lost, the bone does not receive that gentle stress. It reacts by literally melting away. Sometimes this happens fairly quickly — in a matter of months. After the tooth-supporting bone is lost, the jawbone itself begins the same process of deterioration. This could eventually change the shape of the face, as the distance from nose to chin can decrease — even if only a few back teeth are missing. The results aren't pretty. But the good news is, there's a way to prevent all this.

Dental implants, which function as substitute tooth roots, actually save underlying bone when teeth are lost. They do this because they are made of titanium, which fuses to the bone in which it's set, stabilizing it. The implant is topped by a realistic-looking crown, which replaces the part of the missing tooth that was visible in the mouth. Together, they look and function just as your natural tooth did.

If you are missing a lot of teeth, implants can also be used to anchor bridges or even removable dentures while providing that same bone-saving benefit. And when you consider that they are so durable they should never need replacement, implants are a great investment.

If you have any questions about dental implants, please contact us, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

There's a lot to like about dental implants, today's state-of-the-art tooth-replacement system. We consider them the best choice for replacing missing teeth because implants are:

Healthy
You may not realize this, but when a tooth is missing, the bone underneath it begins to melt away. That's because bone needs constant stimulation to rebuild itself and stay healthy, and it receives this stimulation from teeth. It's a delicate balance that's disrupted by the loss of even one tooth. Because implants are made of biocompatible titanium, they actually fuse to the bone and prevent bone loss.

Strong
The fusion of implant to bone is an extremely solid connection. Not only does it offer a strong replacement for a missing tooth, but it can also offer support to other tooth-replacement methods such as fixed bridges or dentures. By themselves, these other methods would not preserve bone and might even hasten its loss in the case of dentures. But with implants, bone-loss is prevented — as is embarrassing and uncomfortable slippage of dentures.

Aesthetically Pleasing
When you receive your implant, it is left alone for a few months to complete the fusion process described above. Then it is topped with a crown made of a realistic tooth-like material. The result is so convincing as a tooth replacement, only you and your dentist may be able to tell it's not a natural tooth.

Long-Lasting
Dental implants have an amazing success rate — over 97%. And once they fuse to the jawbone, they should never need replacement. In fact, they will likely outlast the crowns to which they are attached, but this is not a problem. Implant crowns are precision components that detach for easy replacement, should the need arise.

Economical
Implants have a higher initial cost than other forms of tooth replacement, but when you consider how long they last, they are very economical. Consider it an investment in your health, appearance and self-confidence.

If you have any questions about dental implants, contact us today to schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

Many youngsters look forward to finding a surprise under their pillow after a visit from the “tooth fairy.” This fable may comfort children who wonder why their first teeth come out. Parents need to know that losing baby teeth, also called primary or deciduous teeth, is completely normal, but at the right time and the right “space.”

A child's first set of teeth must be lost to create room for the adult or permanent teeth that have been forming beneath them. The buds of the permanent teeth grow within a child's jawbone just under the baby teeth. The tops, or crowns, grow first, followed by the roots. Then as the roots develop, the permanent teeth push the baby teeth above them up through the gum tissues. As this happens, the roots of the baby teeth are resorbed, or melted away.

With their roots gone, eventually the baby teeth become so loose that they can be easily removed or fall out on their own, making room for the adult teeth to appear. Sometimes, when a baby tooth is so loose, it can be wiggled out. It leaves a little bleeding gum tissue that heals easily. This is also normal.

Besides making sure the tooth fairy comes, parents need to be sure that their children are evaluated to determine whether baby teeth are being lost in the right sequence so they will act as guides for the adult teeth. If teeth are lost prematurely because of decay or trauma, it is important that space is maintained for the adult teeth when they come in.

Contact us today to schedule an appointment or to discuss whether your child's baby teeth are being lost in the right sequence and the adult teeth are coming in correctly. To read more about losing baby teeth, see the article “Losing a Baby Tooth: Understanding an important process in your child's development.”

Gum or periodontal disease is a condition in which “biofilms” or dental bacterial plaque sticks to teeth around the gum line in the absence of good oral hygiene. If left untreated, it causes inflammation of the gums and surrounding tissues of the teeth that can result in “pocketing,” gum recession and bone loss that eventually leads to loose teeth, followed by no teeth! And for about 10 to 15% of those having gingivitis or stage 1 periodontal disease, it can get worse by progressing into chronic periodontal disease. However, the good news is that a conservative and simple treatment called root planing combined with good daily oral hygiene may return your gum tissues to health, and even eliminate the need for gum surgery.

Most of the time, root planing is performed with local anesthesia (numbing shots) in the areas requiring treatment. Anesthesia is an important part because you should always feel relaxed and comfortable during treatment. Because inflamed gum tissues may be quite sensitive, these numbing shots enable us to accomplish our goals and thoroughly remove the problematic material from your teeth's roots.

Root planing or deep cleaning is a routine dental procedure usually done in conjunction with scaling, the removal of the more superficial deposits on the tooth surfaces. Root planing involves physically planing (scraping) the root surfaces of the teeth to remove calculus, bacteria and toxins that are ingrained into their surfaces so that the attached gum tissues can heal. It is carried out with manual hand instruments, ultrasonic electronic instruments or a combination of both for your comfort and best results.

You can learn more about this procedure by reading, “Root Planing.” Or if you want to schedule an appointment to discuss your questions, contact us today.

Snoring and other sleeping disorders impact between 50 and 70 million Americans each year. However, did you know that our office can help when it comes to diagnosing and treating sleeping disorders? For this reason, we have put together this list to highlight how we can have a positive impact on your snoring.

1. Many people are surprised to learn that physician training is lacking and very slowly evolving in the area of sleep related breathing disorders. Therefore, there is limited public and medical awareness. The American Academy of Sleep Medicine (AASM) has acknowledged that properly trained dentists are the first line of therapy for treating mild to moderate sleep apnea effectively.
2. Because we see our patients on a more regular basis than many primary-care physicians, we dentists are in a unique position to identify and/or detect a SRBD. However, for us to accomplish this, you must share the facts about your sleeping habits and issues related to breathing. In other words, do not be embarrassed to let us know that your spouse, sleeping partner or family complain to you about your snoring!
3. When it comes to treating complications associated with Oral Appliance Therapy (OAT) used in managing Sleep Related Breathing Disorders (SRBD), dentists are the primary professionals who are specifically trained to create, fit, adjust, monitor and treat any complications associated with a mouthpiece (oral appliance).
4. Did you know that dentists help identify the approximately 90% of misdiagnosed cases of patients suffering from a SRBD? Well, it is true. We play a critical role in diagnosing and treating these patients.
5. Another reason why it is much easier for us to diagnose and treat these problems is because the core of our training is centered upon the oral cavity, mouth and parts of the upper airway — the very areas where your snoring and SRBDs occur.

If you suffer from snoring or any other Sleep Related Breathing Disorder, it is imperative that you seek and obtain treatment. Ignoring these problems can lead to issues such as: an irregular heartbeat, heart attacks, high blood pressure, and other forms of heart disease as well as strokes and impotence. Contact us today to discuss your questions about snoring or to schedule an appointment. You can also learn more about snoring and sleep disorders when you continue reading the Dear Doctor magazine article “Sleep Disorders & Dentistry.”

Your self-image has a lot to do with how you feel about your appearance — and particularly your smile. If you are unhappy with the way you look, cosmetic dentistry may be the answer to your problems.

1. What do we mean by cosmetic dentistry? The word “cosmetic” refers to beneficial changes in appearance. Thus cosmetic dentistry is all dental work that restores or improves a person's appearance.
2. What is a cosmetic dentist? Every dentist learns to do procedures in a way that conserves or improves a patient's appearance. Some dentists continue to study and specialize in procedures that are done specifically for the purpose of enhancing a person's appearance.
3. What is a smile analysis? The first step to improving your smile, this analysis involves a study of all the elements of your smile — teeth appearance and alignment, gums, jaws — and also your facial features and how they all fit together.
4. How can I choose the right cosmetic dentist? Ask your dentist about his or her training and experience. Ask for photos of previous work. You may need to select more than one person, working as a team to take best advantage of each one's experience, skills, and training.
5. What can be done to improve a smile using 21st century techniques? We are fortunate to live in times in which numerous options are available. These include making teeth whiter; altering their size, shape, balance, color, and alignment; filling in parts of teeth that are missing because of decay or injury; and even replacing teeth that are missing entirely.
6. How can chipped or discolored front teeth be restored? This can often be done by bonding with composite resin.
7. How can damaged back teeth be restored? Back teeth with cavities or traumatic injuries can now be repaired with non-metallic tooth-colored material that bonds to the tooth substance.
8. What techniques can be used to correct more severe problems? Porcelain veneers, thin layers of porcelain material, can be used to change the appearance of misshapen or undersized teeth. Porcelain crowns can be used to replace the part of the tooth that rises above the gums.
9. How can we change the position of teeth that do not meet together well? Orthodontists are dentists who specialize in correcting malocclusions (bad bites). They use traditional braces or clear aligners to move teeth into more attractive and functional positions.
10. What if some teeth are missing? A dental implant replaces the root of a missing tooth. A porcelain crown that looks just like a natural tooth can then be connected to the implant.

Contact us today to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”

Of all the of amazing procedures in today's dentistry, surgery that causes new bone to grow — in places where it had previously been lost — is high on the list of the most extraordinary. (When bone is lost or resorbed, it is broken down into its mineral components, which are dissolved into the bloodstream. Resorption of tooth-supporting bone often takes place after teeth are lost.) Dental techniques that cause new bone growth are important because a certain amount of bone is needed to replace lost teeth with dental implants.

Today's dental implants themselves are an amazing innovation. Implants consist of a replacement for the tooth's root, usually made of a metal called titanium. A replacement for the crown, the part of the tooth that is visible above the gums, is attached to the titanium root. Titanium has the remarkable quality of being able to fuse with the bone in which it is anchored. This process, first discovered in the 1950s, is called osseointegration.

In the case of missing upper back teeth, many people who wanted dental implants in the past were told that they did not have enough bone to anchor the implants and that they had to get removable dentures instead.

But now a new surgery called maxillary sinus augmentation can cause your body to regenerate bone where it was lost and is needed to anchor dental implants.

Bone in the upper jaw or maxilla usually supports your upper back teeth. Inside the maxilla, on either side of your upper jaw, are air spaces in the bone, which are lined with a membrane. These spaces, called the maxillary sinuses, are generally shaped like pyramids; but their shape and size is different in each person. The new surgical procedures involve lifting up the sinus membrane in the area where bone is needed and filling the space thus created with a bone grafting material. Your body then creates new bone to fill the space. This usually takes about six months. If you have almost enough bone to stabilize the implants, they can be placed simultaneously with the graft, thus saving time and avoiding a second surgical procedure.

All grafting materials used today are approved by the Food and Drug Administration (FDA) and must be prepared according to their guidelines. They are specially treated to render them completely safe for human use.

After the surgery there is usually no more than mild to moderate swelling and some discomfort, about the same as having a tooth removed.

If you are missing upper back teeth, contact us to schedule an appointment to evaluate your upper jaw. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery.”

Humans naturally react with pleasure to a beautiful smile. Starting with our mother's joy at seeing our first smile, we have learned throughout our lives that a smile is an invitation to a positive interaction. But are some smiles more beautiful than others? What is it that makes a smile beautiful?

As with art and music, people's perceptions of beauty differ with their backgrounds and culture. Most people respond well to an appearance of healthy teeth and gums. Some feel that teeth must be very white and bright, while others look for even alignment and proportionally sized teeth. With today's dentistry, all of these factors can be changed and enhanced.

Let's look at the components of a smile, starting with the teeth. Evenly sized, white teeth are generally considered to be the basis of an attractive smile. Chipped or discolored front teeth can be repaired by bonding tooth-colored composite resin restorations. Thin porcelain veneers can be applied to teeth that are too small, misshapen or discolored. Tooth colored fillings can be used to repair damaged or decayed back teeth, or porcelain crowns may be used to replace the top part of a tooth that has been seriously damaged. If teeth are missing because of trauma or loss due to decay, today they can be replaced by dental implants, topped with crowns that are colored and shaped exactly like the natural teeth.

Of course, if your teeth emerge from inflamed, infected gums, your smile needs improvement. Healthy teeth and gums result from good dental hygiene habits and regular professional dental cleanings and checkups. Teeth can be whitened and brightened both through home methods and in the dental office. Ask us about the options available for tooth whitening.

Another factor that goes into a smile is the relation of the upper to the lower jaw, or the bite. A poor bite is called a malocclusion. Orthodontic treatment, with the use of traditional braces or clear aligners, can move the teeth into a better bite position so that they look and function better.

Repairing parts of your smile that make you feel self conscious will help your smile in more ways than one. If you feel good about yourself, you look better. We get the process started, and you do the rest.

Contact us today to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”