FAQs

FAQs - General Dentistry

COSMETIC CARE

My old fillings in the front have turned dark, can they be bleached?

Unfortunately, dental bondings, composite resin fillings (tooth colored fillings) and old crowns cannot be bleached. Fillings that have discolored indicate that they are either leaking or have secondary decay, so it is best to replace them. A better choice may be to replace them with porcelain laminate/veneers for longer lasting results. Remember; only replace these fillings after bleaching in order to match the new improved color of your teeth. How long does bleaching or laser teeth whitening really last? It depends on many factors including your diet, the original color of your teeth, and your personal habits like smoking, drinking red wine, etc. Also darker teeth will need more than one whitening session to achieve the desired result. What's most important is what you do for maintenance. Professional office visits are not enough. You must incorporate an effective maintenance regimen at home such as using whitening toothpaste which is specifically designed to non-abrasively remove surf ace stains like coffee, tea, tobacco and red wine, as well as remove plaque and bacteria. Also use the touch up kit given by your dentist to keep bleached teeth at their whitest.

I have one dark tooth in the front. Will regular at-home bleaching makes it lighter?

First of all, the cause of the dark tooth must be determined. It could be due to an earlier trauma to the tooth or previous root canal treatment. In such a case external teeth whitening treatments may not help. Your dentist may try internal bleaching which may take several sessions. If not, consider dental bonding, porcelain veneers, or capping the tooth to mask the darkness.

Will my teeth be sensitive following Bleaching?

Teeth may be sensitive during the week following the in–office bleaching. This can be dramatically reduced by using Sensodyne toothpaste to brush your teeth the week prior to and the week following the bleaching process. Also, your dentist may recommend fluoride treatment following the bleaching process.

What is the difference between dental bonding and porcelain veneers?

Dental bonding is a plastic tooth colored (composite) resin material that is molded onto your teeth and hardened with a blue light. It is usually done in one visit. Little tooth reduction and usually no anesthesia is required. The disadvantages of dental bonding are:

  1. They stain over time, may chip and may need to be replaced more often.
  2. Porcelain veneers are thin layers of stacked porcelain that are fabricated in the lab and bonded to teeth.
  3. It usually takes 2 visits. Little tooth reduction and some anesthesia are required.
  4. Porcelain veneers are stronger than dental bondings and less prone to staining.

I have a space between my two front teeth. How can it be closed?

There are several ways to correct it. Your Dentist may advice Dental Bondings, Veneers or Orthodontics. Again, seek the advice of your dental health professional to choose the procedure that's best for you.

If I require fillings, what type should I get?

In the past, Silver or amalgam fillings were extensively used. They are not tooth colored, stain teeth over time and healthier tooth structure may have to be removed to retain them since they do not bond to your teeth. Also, since they are a alloy of silver with mercury, there is a risk of mercury poisoning. Now, depending on the extent of decay and amount of tooth structure that is lost, your dentist may advice composite (tooth colored fillings) or porcelain inlays or onlays. Since tooth colored fillings bond to your teeth, there is no need for removal of healthy tooth structure.

I have a gummy smile... can anything be done?

With the advent of laser dentistry, this can be done very easily and painlessly in most cases. Tissue sculpting (gingivectomy) is done in adjunct to any required cosmetic work to achieve beautiful, healthy smile.

RESTORATIVE CARE

What is tooth decay (caries or cavities)?

Tooth decay is the disease known as caries or cavities -- a highly Preventable disease caused by many factors.

Who is at risk for tooth decay?

The answer is... everyone who has a mouth. We all host bacteria in our mouths which make everyone a potential target for cavities. Risk factors that put a person at a higher risk for tooth decay include:

  • Persons with diets high in sweets, carbohydrates, and sugars
  • Persons who live in communities with limited or no fluoridated water supplies
  • Children and senior citizens

Why should I spend a lot of money on a root canal? Why not just pull the tooth?

Losing a tooth can be the beginning of many more lost teeth. Saving the Tooth maintains space, keeps other teeth from shifting, and eliminates the need and cost of a bridge or implant. Although seemingly expensive, it is actually quite cost effective.

What are dental implants?

Dental Implants are made of titanium and placed directly into your jawbone surgically. Once they integrate with your bone, a crown, bridge or denture is placed over the implants.

GUM CARE (PERIODONTALCARE)

What is 'plaque' and how does it affect my teeth?

Plaque is a colorless, sticky film of bacteria that constantly forms on teeth. If left undisturbed, it hardens to form tartar. The bacteria in the plaque produce byproducts that can not only irritate the gums and make them bleed, but it can also lead to periodontal disease. A daily regimen of proper brushing, flossing and rinsing (plus, regular dental visits), will help you keep your teeth healthy.

My gums bleed when I brush or floss. Is this normal?

Healthy tissue doesn't bleed. This is most likely a sign of early gingivitis. If you experience bleeding gums, see your dental health professional to review proper brushing and flossing techniques. Schedule a soft tissue evaluation with your dentist that will include x-rays and prophylaxis cleaning. Gum bleeding must be taken seriously because if left untreated, it will lead to periodontal disease.

How often should I have my teeth cleaned?

People accumulate plaque at different rates. Although most insurance plan coverage is for a twice a year schedule, it's sensible to get your teeth professionally cleaned as often as your dental health professional advises you, even if it's every 3 months.

How many times should I floss my teeth?

At least once a day. There's an old adage among dentists:Floss only the teeth you want to keep. If you don't want to lose your teeth, floss every day. Otherwise, you'll be 75% more susceptible to periodontal disease that has been documented to have serious health consequences, e.g. a higher likelihood of heart disease, diabetes, pneumonia and infections. About 45% of American adults have some form of gingivitis, and most adults over 60 have already lost their teeth. Don't be one of them. Floss at least once a day.

How Bad Breath Occurs ?

Bad breath occurs when sulfur compounds are produced in the body and released into the air. The most common source of this sulfur is anaerobic (without oxygen) bacteria that live in the grooves or fibers at the back of the tongue. These bacteria produce the sulfur that gives off an unpleasant smell. This frequently occurs when the mouth is dry, creating an ideal environment for anaerobic bacteria to thrive. Sulfur compounds are also produced when certain types of food are consumed. The compounds make their way into the bloodstream and then to the lungs, where they are excreted into the air we exhale.

Causes of Bad Breath

Bad breath is caused by many factors. Normally, saliva helps wash away the natural buildup of bacteria in the mouth and on the tongue. Yet, when saliva sits on the back of the tongue and is digested by bacteria, it shows up as a white film on the tongue. This is a major source of bad breath. Bad breath is also caused by postnasal drip, a condition where the back of the tongue and throat accumulate high amounts of protein, which bacteria thrive on. Foods that are high in protein or acidity, such as fish, milk, cheese or coffee, also cause bad breath. Dieting or fasting, both of which involve a low intake of calories, causes bad breath by reducing the saliva in the mouth. Contrary to popular belief, stomach problems do not cause bad breath.

More Serious Causes

More persistent problems with unpleasant breath can indicate diseases such as diabetes, liver dysfunction, pulmonary disease, and respiratory disease. Periodontal pockets, the spaces that form between the teeth and gums, are another source of bad breath. These pockets, which occur in the latter stage of periodontal disease, create spaces for bacteria to grow, and give off a chronic unpleasant odor. Dental work may be required in order to remove these pockets of bacteria. Periodontal disease is detected by the presence of bleeding gums, loose teeth, receding gums, or pain when chewing.

For more information on this condition, please refer to the Periodontal Disease section of our Patient Education Library.

Prevention

Proper oral hygiene eliminates many cases of bad breath. Daily brushing and flossing removes the plaque and bacteria that often cause bad breath. While brushing, take special care to thoroughly brush the back of the tongue where bacteria normally collect. Mints and mouthwashes can hide bad breath, but do not eliminate this condition. Avoid foods that have powerful odors and drink lots of water to insure that the mouth is cleansed and full of oxygen (an environment in which bacteria do not thrive). For information on current treatments, contact a dentist in your area regarding current products on the market that can eliminate bad breath

ORTHODONTICS/BRACES

What is orthodontics?

Orthodontics is the dental specialty that focuses on the development, prevention, and correction of irregularities of the teeth, bite, and jaws. A patient may consult an orthodontist after receiving a referral from his/her general dentist -- recommending orthodontic treatment to improve the patient's physical "orofacial" appearance. However, the American Dental Association recommends that every child receive an orthodontic evaluation by the age of seven.

Why choose orthodontic treatment?

Any orthodontic problem may be classified as a malocclusion, or "bad bite." The following problems may be helped or minimized with proper orthodontic treatment: misaligned, crooked, or crowed teeth, missing teeth, extra teeth, an overbite, an openbite and misaligned or incorrect jaw position.

At what age do braces become appropriate?

Moving and correcting the alignment of the teeth follows the same biological and physical process no matter what the age. However, an adult mouth must overcome already-positioned facial bones and jaw structure. Thus, overcoming most types of malocclusions may require more than one type of orthodontic treatment for adults. In most cases, the ideal age for braces, and other orthodontic treatments, are between 10 and 14 years of age; although, persons of any age can benefit from treatment.

What are the different types of braces available?

Braces, also called fixed orthodontic appliances, generally come in three varieties:

  1. Brackets, metal or plastic, clear or tooth-colored, that is bonded to teeth.
  2. Lingual-type brackets that attach to the back of teeth, hidden from view.
  3. Bands that cover most of the teeth with metal bands that wrap around the teeth.
All three types use wires to move the teeth to the desired position.

What is Invisalign?

Invisalign is proven technology designed to give you the smile you've always wanted, without the pain and anxiety associated with metal braces. Invisalign uses a series of clear, removable aligners to gradually move your teeth. You wear a set of aligners for about two weeks, removing them only to eat, drink, brush and floss. As you replace each set of aligners with the next in the series, your teeth will gradually move until they reach the position your doctor has prescribed for you. The average treatment time is about a year. Contact your Orthodontist to find out if Invisalign is an option for you.

Oral health care and braces:

The following recommendations will help to eliminate, or reduce, any oral health problems while your teeth are in braces: Brush your teeth carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush, as food becomes easily lodged in the braces. Floss daily between the teeth and the braces. Maintain every 6 month cleanings by an oral health professional. Limit your sugar and starch intake, as debris left behind from these types of foods may turn into damaging acids, which, in addition to promoting plaque formation, may also be harmful to teeth and gums. Avoid hard and/or sticky snacks that may be difficult to remove from the orthodontic equipment in your mouth. This includes foods such as popcorn, hard or chew candy, caramel, and/or nuts.

ORAL SURGERY

What are wisdom teeth?

Also called third molars, wisdom teeth usually make their first appearance in young adults between the ages of 15 to 25. Because most mouths are too small for these four additional molars, an extraction procedure, sometimes immediately after they surface, is often necessary.

When should wisdom teeth be removed?

The following symptoms may indicate that the wisdom teeth have erupted and surfaced, and should be removed before they become impacted -- meaning, the teeth have surfaced and have no room in the mouth to grow. However, each individual may experience symptoms differently. Symptoms may include: pain infection in the mouth, facial swelling, swelling of the gum line in the back of the mouth. Most oral health specialists will recommend an immediate removal of the wisdom teeth, as early removal will help to eliminate problems, such as an impacted tooth that destroys the second molar.

What problems are often associated with impacted third molars?

  • Bacteria and plaque build-up
  • Cysts development (a fluid-filled sac)
  • Tumor development
  • Infection
  • Jaw and gum disease

What is involved in the extraction procedure?

Wisdom tooth extraction surgery involves removing the gum tissue that presides over the tooth, gently detaching the connective tissue between the tooth and the bone, removing the tooth, and suturing the opening in the gum line.

What is a Dry Socket?

Dry Socket is the most common complication of extraction. (removing a tooth) Most commonly associated with wisdom teeth extractions & lower molar extraction. Dry Socket is one in which the patient is having pain due to the loss of the blood clot from the socket following extraction, thus exposing the bone to air, food, and fluids. Patient experiences excruciating pain along with an offensive odor. This often occurs two or more days after an extraction and can last about 5-6 days. This condition occurs most commonly -

  1. In individuals who smoke before their recommended time. Smoking: decreases healing, decrease blood supply to the protective blood clot, brings toxic products to the area, injuries the gum tissue and the negative pressure of sucking removes the blood clot from the surgery site.
  2. If you do not care for your extraction site as instructed by staff.
  3. Not following your home care instructions.
  4. Sucking action from smoking, sneezing, coughing, spitting or sucking, within the first 24 hours.
  5. Women taking oral contraceptives are more susceptible.

DENTAL EMERGENCIES

How to handle a Dental Emergency?

According to the American Dental Association, the difference between saving and losing a knocked out tooth, is the thirty minutes following the incident. To save the tooth, follow these steps:

  • Rinse the tooth in tap water.
  • Avoid scrubbing the tooth.
  • Insert the tooth into the empty socket quickly.
  • If you are uncomfortable inserting the tooth, put the tooth in milk or water Get to the dentist immediately.

Common Dental Emergencies

Broken tooth/Fractured tooth

Although teeth are the strongest substance in the whole body, they may chip or break due to various reasons. Some of the most common reasons are biting into something hard accidentally, tooth with a large filling, root canal treated tooth that is not capped and tooth undermined due to decay.

What to expect

Depending on the extent of fracture your tooth may be sensitive to temperature and pressure changes. Rinse your mouth gently with lukewarm water. Take a pain reliever if needed. See your dentist as soon as possible so he can determine the course of treatment.

How is it treated?

Fractures may involve only the superficial outer part of the tooth (enamel). In such a case your dentist may lightly polish the area to smooth the rough surfaces or place a filling and observe the tooth for further changes. If the fracture involves the enamel and the inner sensitive dentin your dentist may have to place a crown due to the extent of involvement. This will protect the tooth and prevent further damage. Sometimes fractures may involve the enamel, dentin and the nerve tissue inside the tooth. This will necessitate a root canal treatment and a crown. If the crack extends beyond the gum line it may require a crown lengthening procedure, which involves removal of bone to grasp enough healthy structure for the crown. However, if the crack extends to the root the tooth cannot be saved and will have to be removed.

Canker sores

Canker sores are shallow, painful sores in your mouth. They are usually red or may sometimes have a white coating over them. You may get them on the inside of your lips, the insides of your cheeks, the base of your gums or under your tongue. Canker sores are different from fever blisters, which usually are on the outside of your lips or the corners of your mouth.

Anyone can get canker sores, but women people in their teens and 20s get them more often. Canker sores may run in families, but they aren't contagious. Causes of canker sores are unknown but they may be triggered by stress, poor nutrition, food allergies, spicy foods and menstrual periods.

Treatment
Canker sores usually go away without treatment. However, for pain relief your dentist may recommend medicines such as Anbesol, Oragel, Orabase and Zilactin-B, which may prevent your canker sores from becoming irritated by eating, drinking or brushing your teeth. These medicines can be applied directing on the sore with your finger tip or a Q-tip. Gently dry the sore with a swab before applying. Do not eat or drink anything for 30 minutes after applying.

Prevention
Unfortunately, causes of canker sore formation are unknown. However, using toothpaste that does not contain SLS (sodium lauryl sulphate), avoiding hard, crunchy or spicy foods and chewing gum may help reduce mouth irritation. Brushing your teeth after meals, using a soft toothbrush and flossing every day will also keep your mouth free of food that might cause a canker sore. If you get canker sores often, or if they're very painful, talk to your dentist.

Operculitis

Operculitis is an inflammation of the gum tissue found over partially erupted teeth. The most frequent site is the mandibular third molar region. The heavy flap of gingival tissues covering portions of the tooth crown of the tooth makes an ideal pocket for debris accumulation and bacterial incubation. In the acute phase, pain and swelling in the area are prominent features. Symptoms of a sore throat and difficulty in swallowing may be present. A partial contraction of muscles of mastication, causing difficulty in opening the mouth (trismus), may also be experienced. Abscess formation in the area may occur, leading to marked systemic symptoms of general malaise and fever.

Treatment involves careful cleaning below the flap and saline irrigation. It may also require antibiotic therapy if the condition warrants. Your dentist may decide to incise the gingival flap to make the area self cleansable. If in the third molar area it may require the extraction of the tooth.

MISCELLANEOUS

BRUXISM – (Paranormal tooth grinding)

What is bruxism?

Bruxism is the term that refers to an incessant grinding and clenching of the teeth, unintentionally, and at inappropriate times. Bruxers (persons with bruxism) are often unaware that they have developed this habit, and often do not know that treatment is available until damage to the mouth and teeth have been done. Damage caused by bruxism often includes the following symptoms. However, each individual may experience symptoms differently.

Symptoms may include:
  • Abraded teeth
  • Facial pain
  • Oversensitive teeth
  • Tense facial and jaw muscles
  • Headaches
  • Dislocation of the jaw
  • Damage to the tooth enamel, exposing the inside of the tooth (dentin)
  • A popping or clicking in the TemporoMandibular Joint (TMJ)
  • Tongue indentations
  • Damage to the inside of the cheek
The symptoms of bruxism may resemble other conditions or medical problems. Consult a dentist or your physician for a diagnosis.

What causes bruxism?

Although this habit is unintentional, oral health specialists often point to excessive stress and certain personality types as typical causes of bruxism. Bruxism often affects persons with nervous tension such as anger, pain, or frustration, and/or persons with aggressive, hurried, or overly-competitive tendencies.

Treatment for bruxism:

Treatment may involve:

  • Behavior modification
  • Night Guard
  • A specially-fitted plastic mouth appliance may be worn at night to absorb the force of biting. This appliance may help to prevent future damage to the teeth.
  • Biofeedback involves an electronic instrument that measures the amount of muscle activity of the mouth and jaw -- indicating to the patient when too much muscle activity is taking place so that the behavior can be changed. This is especially helpful for daytime bruxers.

FAQs - Pediatric Dentistry

RESTORATIVE CARE

Who is a Pediatric Dentist?

The pediatric dentist has an extra two to three years of specialized training after dental school, and is dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.

When should I schedule my childs first dental visit?

According to the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by his/her 1st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.

It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child such as sleepy juice for the anesthetic, vacuum for the suction and so forth.

What is tooth decay (caries or cavities)?

Tooth decay is the disease known as caries or cavities -- a highly Preventable disease caused by many factors.

Who is at risk for tooth decay?

The answer is... everyone who has a mouth. We all host bacteria in our mouths which make everyone a potential target for cavities.

Risk factors that put a person at a higher risk for tooth decay include:

  • Persons with diets high in sweets, carbohydrates, and sugars
  • Persons who live in communities with limited or no fluoridated water supplies
  • Children and senior citizens

Are baby teeth really that important to my child?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for

  1. proper chewing and eating
  2. providing space for the permanent teeth and guiding them into the correct position
  3. and permitting normal development of the jaw bones and muscles

Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) are not replaced until age 10-13.

What is Baby Bottle Tooth Decay (Early Childhood Caries)? How can it be prevented?

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infants teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the childs teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child would not fall asleep without the bottle and its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks.

After each feeding, wipe the babys gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the childs head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the childs mouth easily.

What is Pulp Therapy / Pulpotomy or Baby root canal?

The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost).

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a "nerve treatment", "children's root canal", "pulpectomy" or "pulpotomy". The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable material. Then a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

When Will My Baby Start Getting Teeth?

Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general the first baby teeth are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See Eruption of Your Childs Teeth for more details.

Eruption Of Your Childs Teeth

Childrens teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

Tooth Development

PREVENTIVE CARE

When should I begin brushing my childs teeth?

Begin daily brushing as soon as the childs first tooth erupts. A pea size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush can not reach. Flossing should begin when any two teeth touch. You should floss the childs teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Do not forget the backs of the last four teeth.

How do I Prevent Cavities?

Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.

For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.

The American Academy of Pediatric Dentistry recommends six month visits to the pediatric dentist beginning at your childs first birthday. Routine visits will start your child on a lifetime of good dental health.

Your pediatric dentist may also recommend protective sealants or home fluoride treatments for your child. Sealants can be applied to your childs molars to prevent decay on hard to clean surfaces.

How do I make my child's diet safe for his teeth?

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children teeth.

What is a sealant and how does it help prevent decay?

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.

How long do sealants last?

Research shows that sealants can last for many years if properly cared for. So, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Your pediatric dentist will check the sealants during routine dental visits and can recommend reapplication or repair when necessary.

How are sealants placed?

The application of a sealant is quick and comfortable. It takes only one visit. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden or hardened with a special light. Your child will be able to eat right after the appointment.

What are the benefits of fluoride?

When used in appropriate amounts it encourages "remineralization," a strengthening of weak areas on the teeth such as the pits and the fissures on the teeth. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is effective when combined with a healthy diet and good oral hygiene.

How do I determine if my child needs fluoride supplements?

Children between the ages of six months and 16 years may require fluoride supplements. The pediatric dentist considers many different factors before recommending a fluoride supplement. Your child's age, risk of developing dental decay and the different liquids your child drinks are important considerations. Bottled, filtered and well waters vary in their fluoride amount, so a water analysis may be necessary to ensure your child is receiving the proper amount.

Which is the Best Toothpaste for my Child?

Tooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives which can wear away young tooth enamel. When looking for a toothpaste for your child make sure to pick one that is recommended by the American Dental Association. These toothpastes have undergone testing to insure they are safe to use.

Remember, children should spit out toothpaste after brushing to avoid getting too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. If your child is too young or unable to spit out toothpaste, consider providing them with a fluoride free toothpaste, using no toothpaste, or using only a "pea size" amount of toothpaste.

What is dental fluorosis? How does it affect my childs teeth? How can it be prevented?

Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a childs potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources are:

  • Too much fluoridated toothpaste at an early age
  • The inappropriate use of fluoride supplements
  • Hidden sources of fluoride in the childs diet

Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities. Another source of fluoride can be found in soft drinks at fast food restaurants, when blending the syrup and carbonation with the city water supply.

Parents can take the following steps to decrease the risk of fluorosis in their children teeth:

  • Use baby tooth cleanser on the toothbrush of the very young child
  • Place only a pea sized drop of children toothpaste on the brush when brushing
  • Account for all of the sources of ingested fluoride before requesting fluoride supplements from your childs physician or pediatric dentist
  • Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities)

What is topical fluoride?

Topical fluoride is applied on cleaned tooth surfaces to strenghten teeth and help fight decay.

Children who benefit the most from fluoride are those at highest risk for dental decay. Riskfactors include a history of decay, high sucrose carbohydrate diet, orthodontic appliances and certain medical conditions such as dry mouth.

Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal(night time) grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.

Why do children indulge in Thumb Sucking?

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

How does Thumb sucking affect a childs dentition?

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Do children eventually give up the habit?

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Do Pacifiers help break the habit?

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

How can I help my child stop the habit?

Below are some suggestions :

  • Instead of scolding children for thumb sucking, praise them when they are not
  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking
  • Children who are sucking for comfort will feel less of a need when their parents provide comfort
  • Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents
  • Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue
  • If these approaches do not work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance

Tongue Piercing – Is it Really Cool?

You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.

There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.

How can I educate my teenager on the ill-effects of tobacco use?

Tobacco in any form can jeopardize your childs health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

A sore that would not heal White or red leathery patches on the lips, and on or under the tongue Pain, tenderness or numbness anywhere in the mouth or lips Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together

Because the early signs of oral cancer usually are not painful, people often ignore them. If it is not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill. Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek

Who is at risk for tooth decay?

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your childs hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

How can I protect my childs teeth from sport injuries?

When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your childs smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your pediatric dentist about custom and store-bought mouth protectors.

EARLY ORTHODONTIC CARE

What is the Best Time for Orthodontic Treatment?

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your childs hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

What causes crowding and spacing of teeth?

The alignments of teeth are often genetically determined. The child inherits the tooth size from one parent and the jaw size from the other parent. This may cause a discrepancy in the jaw and tooth size and lead to spacing or crowding of teeth. Orthodontic problems can also be caused by habits that apply forces on the developing dentition such as thumb sucking and finger sucking. Early loss of baby teeth can cause drifting of the adjacent teeth and prevent the permanent teeth to take the normal path of eruption and causing crowding and collapsed jaws.

Your pediatric dentist can help your child avoid oral habits that may create orthodontic problems.

Why is early orthodontic care important? Why cannot I wait till all the permanent teeth have erupted?

Pediatric orthodontics can straighten crooked teeth, guide erupting teeth into position, correct bite problems, even prevent the need for tooth extractions if treatment is started at an early age. If your child has collapsed or narrow jaws, jaw expansion can be easily accomplished and help prevent extensive surgeries in future. Moreover, straight teeth are easier to keep clean and less susceptible to tooth decay and gum disease.

What are the different types of braces available?

Braces, also called fixed orthodontic appliances, generally come in three varieties:

Brackets, metal or plastic, clear or tooth-colored, that is bonded to teeth, Lingual-type brackets that attach to the back of teeth, hidden from view, and Bands that cover most of the teeth with metal bands that wrap around the teeth. All three types use wires to move the teeth to the desired position.

What is Invisalign?

Invisalign is proven technology designed to give you the smile you've always wanted, without the pain and anxiety associated with metal braces. Invisalign uses a series of clear, removable aligners to gradually move your teeth. You wear a set of aligners for about two weeks, removing them only to eat, drink, brush and floss. As you replace each set of aligners with the next in the series, your teeth will gradually move until they reach the position your doctor has prescribed for you. The average treatment time is about a year. Contact your Orthodontist to find out if Invisalign is an option for you.

What care is recommended during orthodontic treatment?

Maintaining good oral hygiene is the key for successful orthodontic treatment. Brush your teeth carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush, as food becomes easily lodged in the braces. Floss daily between the teeth and the braces. Maintain every 6 month cleanings by an oral health professional. Limit your sugar and starch intake, as debris left behind from these types of foods may turn into damaging acids, which, in addition to promoting plaque formation, may also be harmful to teeth and gums. Avoid hard and/or sticky snacks that may be difficult to remove from the orthodontic equipment in your mouth. This includes foods such as popcorn, hard or chew candy, caramel, and/or nuts.

Promptly contact with your pediatric dentist when an appliance breaks to keep orthodontic treatment on-time and on-track.

EMERGENCY CARE

What should I do if my childs permanent tooth is knocked out?

According to the American Dental Association, the difference between saving and losing a knocked out tooth, is the thirty minutes following the incident.

To save the tooth, follow these steps:

  • Avoid scrubbing the tooth
  • Insert the tooth into the empty socket quickly
  • If you are uncomfortable inserting the tooth, put the tooth in milk or water Get to the dentist immediately

Common dental emergencies

Chipped or Fractured teeth

Although teeth are the strongest substance in the whole body, they may chip or break due to various reasons. Some of the most common reasons are biting into something hard accidentally, tooth with a large filling, root canal treated tooth that is not capped and tooth undermined due to decay.

What to expect?

Depending on the extent of fracture your tooth may be sensitive to temperature and pressure changes. Rinse your mouth gently with lukewarm water. Take a pain reliever if needed. See your dentist as soon as possible so he can determine the course of treatment.

How is it treated?

Fractures may involve only the superficial outer part of the tooth (enamel). In such a case your dentist may lightly polish the area to smooth the rough surfaces or place a filling and observe the tooth for further changes.

If the fracture involves the enamel and the inner sensitive dentin your dentist may have to place a crown due to the extent of involvement. This will protect the tooth and prevent further damage. Sometimes fractures may involve the enamel, dentin and the nerve tissue inside the tooth. This will necessitate a root canal treatment and a crown. If the crack extends beyond the gum line it may require a crown lengthening procedure, which involves removal of bone to grasp enough healthy structure for the crown.

However, if the crack extends to the root the tooth cannot be saved and will have to be removed.

Canker Sores

What are canker sores? How are they treated?

Canker sores are shallow, painful sores in your mouth. They are usually red or may sometimes have a white coating over them. You may get them on the inside of your lips, the insides of your cheeks, the base of your gums or under your tongue. Canker sores are different from fever blisters, which usually are on the outside of your lips or the corners of your mouth.

Anyone can get canker sores, but women people in their teens and 20s get them more often. Canker sores may run in families, but they aren't contagious. Causes of canker sores are unknown but they may be triggered by stress, poor nutrition, food allergies, spicy foods and menstrual periods.

Treatment

Canker sores usually go away without treatment. However, for pain relief your dentist may recommend medicines such as Anbesol, Oragel, Orabase and Zilactin-B, which may prevent your canker sores from becoming irritated by eating, drinking or brushing your teeth. These medicines can be applied directing on the sore with your finger tip or a Q-tip. Gently dry the sore with a swab before applying. Do not eat or drink anything for 30 minutes after applying.

Prevention

Unfortunately, causes of canker sore formation are unknown. However, using toothpaste that does not contain SLS (sodium lauryl sulphate), avoiding hard, crunchy or spicy foods and chewing gum may help reduce mouth irritation. Brushing your teeth after meals, using a soft toothbrush and flossing every day will also keep your mouth free of food that might cause a canker sore. If you get canker sores often, or if they're very painful, talk to your dentist.

Operculitis

Operculitis is an inflammation of the gum tissue found over partially erupted teeth. The most frequent site is the mandibular third molar region. The heavy flap of gingival tissues covering portions of the tooth crown of the tooth makes an ideal pocket for debris accumulation and bacterial incubation. In the acute phase, pain and swelling in the area are prominent features. Symptoms of a sore throat and difficulty in swallowing may be present. A partial contraction of muscles of mastication, causing difficulty in opening the mouth (trismus), may also be experienced. Abscess formation in the area may occur, leading to marked systemic symptoms of general malaise and fever.

Treatment involves careful cleaning below the flap and saline irrigation. It may also require antibiotic therapy if the condition warrants. Your dentist may decide to incise the gingival flap to make the area self cleansable. If in the third molar area it may require the extraction of the tooth.

What about a severe blow to the head or jaw fracture?

Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening.

What if my child has a toothache?

Call your pediatric dentist and visit the office promptly. To comfort your child, rinse the mouth with water. Apply a cold compress or ice wrapped in a cloth. Do not put heat or aspirin on the sore area.

Office Hours

Monday 8:00 AM 5:00 PM
Tuesday 9:00 AM 6:00 PM
Wednesday 8:00 AM 5:00 PM
Thursday 9:00 AM 6:00 PM
Friday 8:00 AM 1:00 PM
Saturday 8:00 AM 1:00 PM
Every month of 2nd saturday
Sunday Closed

Our Address

Smiles of Cary

1150 Northwest Maynard Road,
Suite #120,
Cary,
North Carolina 27513

919-462-3350

919-462-3360

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