Braces can either be fixed on the teeth or they can be removable. The removable type of braces usually are for more minor tooth movement so most orthodontic work is done with non-removable braces. If the orthodontist makes a removable appliance for you, you must still wear it almost all the time, except when eating, in order for it to create the tooth movement you want. Taking it in and out frequently lets the teeth move back and it will take a much longer time to get the results you want.
A typical orthodontic case takes around two years but can vary considerably due to the specifics of the individual case. Sometimes young children are treated in two stages, for example, with one to several years in between.
In the past, many patients had some permanent teeth removed in the process of braces. Now, modern orthodontic treatment prefers to keep all of the permanent teeth unless there is severe crowding and there is just no room for all of the teeth.
Braces do not cause decay. Too much sugar and plaque accumulation cause decay. However, braces make it a lot harder to effectively clean your teeth. As a result, we recommend adults and children with braces get their teeth cleaned every three months, use a Water Pik orHydrofloss irrigator to assist in home care and prescription strength home fluoride daily.
The objective of braces is to move teeth into a position where the bite is good, the smile looks great and the teeth are stable so they won’t shift back. Sometimes this is not done and long-term retainers need to be used or the teeth will tend to shift.
There is no easy way to keep teeth clean with braces. We recommend that anyone with braces come for professional cleanings every 3 months, and in addition to a special Prodentec tooth-brush, use a Hydrofloss irrigator.
Many people have strong fears associated with dental care that makes it hard for them to get their work done. Other patients need a lot of work and do not want to have to come for many visits. They want to get it done in the fewest visits possible. In either case, being sedated makes the patients unaware of what is going on and they can get through their appointments with ease and comfort.
Anyone who wants to have dental work done in a state of comfort and relaxation is a candidate for sedation dentistry. Here are some examples of pat
<strong>People who have:</strong>
<li>Had traumatic dental experiences</li>
<li>Difficulty getting numb</li>
<li>A bad gag reflex</li>
<li>Very sensitive teeth</li>
<li>Limited time to complete their dental care</li>
<li>Complex dental problems</li>
<strong>People who …</strong>
<li>Hate needles and shots!</li>
<li>Hate the noises, smells and tastes associated with dental care</li>
<li>Are afraid or embarrassed about their teeth</li>
<li>Disabilities that preclude them from receiving traditional dental services</li>
Oral conscious sedation dentistry works by taking a pill that relaxes you and puts you in a twilight state of consciousness. You alternate between being conscious and drifting off to sleep. And best of all, most people have very little if any memory of the entire dental visit. When you arrive in our office, you will be escorted into the sleep room, covered with a thick, warm blanket and placed on a monitor to watch your vital signs. After you are comfortable, the staff at Dental Care will take care of your dental needs. Then, when your treatment is completed your companion will return you home to finish your relaxing sleep.
With IV sedation our board certified dental anesthesiologist places a small IV in your arm. This allows the doctor to inject the anesthesia medicines that put you to sleep. Just like in a medical procedure, you will be sound asleep the entire time and safely monitored by our team. You are comfortable, pain free and you will have no memory of your dental visit.
With both oral conscious sedation (pill) and IV sedation you will need someone to drive you to our office and home again. They will also need to stay with you for several hours because even though you might feel awake you will be drowsy and if left alone might slip and fall.
You have nothing to eat or drink from midnight on the day prior to your visits. If you take routine medicines you MUST discuss this with the doctor at your consultation visit. Different medicines can interact with each other and it is important that we know anything you take. That includes all vitamins, mineral and herbal supplements of any kind and especially nicotine (in tobacco products) and caffeine (in tea or coffee). Grapefruit juice is to be avoided as well since it contains chemicals that interfere with sedation and many other medicines.
You will be brought to the office by your companion who will receive their instructions as well. They don’t have to stay at the office for the entire time but they will need to give us a phone number so we can call them to come and pick you up when your appointment is complete.
You will be escorted from the office directly home by your companion who must seat belt you into your car and take you into your home and get you comfortable and settled to sleep and rest for the balance of the day. You cannot be left alone because you will still be sleepy for several hours and might slip and fall if unattended. It is very important that you drink lots of water or fruit juice and when any numbness is gone, soft and easy to digest foods are suggested.
We will review the post operative instructions with your companion before you leave the office.
The medicines that we use for sedation are designed to make you comfortable and not aware of your environment. As such you cannot drive a car, operate machinery, stand on a ladder, ride a bicycle or any activity that requires fully conscious awareness or judgment until the next day after sedation dentistry.
That includes making important business or personal decisions. You will need to be accompanied to and from the office directly home where you will spend the remainder of the day sleeping and letting the sedation medicines pass out of your system.
When they return to the office, after the first visit for follow up care most of our patients say something like, “That was so amazing. If I knew it would be so easy, I would have done it years ago.” All of your work can be done with sedation if that is what you prefer. But we will say that many of our patients feel so much better after the first visit that they feel great about having subsequent visits done without sedation. That is of course entirely up to you.
Placing dental implants is a surgical procedure, so there is definitely some mild discomfort after the surgical phase, but generally less than a tooth extraction because it is a precise, gentle controlled procedure. After the initial healing phase passes, there is nothing to be fearful of in so far as pain is concerned.
Placing an implant requires one surgical visit and several follow up visits to check the healing and remove the sutures. The purpose of the dental implant(s) is to replace missing teeth, so in addition to the surgical placement of the implants, the patient must wait 3 to 6 months while the bone heals and then another month or two for the final dental bridgework.
You cannot be too old for dental implants. The issue is your health. As long as you are a candidate for elective surgery, you can have dental implants. A person with medical conditions such as uncontrolled diabetes, heart disease, severe hypertension etc., would not be an appropriate candidate for dental implants.
With regards to being too young, dental implants are usually done for patients whose jaw bones are fully formed, so that would be late teenage years. If you are not ready yet for implants there are temporary options so you don’t have to go without teeth
Medical conditions that would preclude the placement of dental implants would include people with problems healing, such as people with AIDS and people who are not candidates for elective surgery, such as people who have uncontrolled diabetes, severe high blood pressure or heart disease.
Placing dental implants and then putting a cap on it is a great way to replace a missing tooth if you do not want to put caps on the teeth adjacent to the missing tooth, or if there aren’t enough strong teeth to support a fixed bridge near the missing tooth. This is especially true if the adjacent teeth are perfectly healthy, straight, decay free-teeth and the patient would rather avoid capping them.
The disadvantage of the implant is that two surgical procedures need to be done to place the implant and then place the supporting post in the implant so that a cap can be placed to replace the missing tooth. This takes several months. And the cost for a dental implant, plus the post and crown, might be greater than a conventional fixed bridge. If the patient has perfectly good teeth adjacent to the missing tooth, the benefits of not having to cap those teeth may be worth the extra time and expense.
If the teeth adjacent to the missing tooth are crooked, decayed or already have big leaking fillings, and need to be capped anyway, it makes no sense to go through the time and expense of a dental implant and then have to cap the adjacent teeth anyway. Also, if there is not an adequate amount of jaw bone to hold the dental implant, bone grafting procedures may need to be done and the patient would need to evaluate the benefits of the implant approach versus the time and expense of the implants and bone graft.
Dental Implants are way to improve your comfort, health and appearance and that is why at Dental Care of Stamford we have a whole team of cosmetic dentists and surgeons to see what is best for your individual situation and why we offer free consultations. There are times when dental conditions such as bone loss or gum recession may allow a dentist to use a dental implant to adequately replace a missing tooth but not restore the normal shape and contour of the gum tissue. In the back of the mouth, where it doesn’t show, this may not matter. In the front of the mouth, it could result in a chewing success but an appearance failure. That is one reason why dental implants, as great as they are, are not a panacea for the replacement of all missing teeth.
Plaque is a film that accumulates on the teeth and contains bacteria, bacterial by-products and food particles.
Calculus or tartar are the same thing. If plaque builds up on the teeth and is not removed every day, calcium in the saliva may be deposited into the plaque, creating a hard layer on the teeth, not unlike barnacles on the bottom of a ship. If that is not cleaned off by your dentist or hygienist, it encourages more plaque to form and leads to gum disease.
The frequency of professional cleanings depends on the individual. Everyone is different. Some people need more sleep than others to be properly rested, and cleanings are no different. People with good plaque control, daily brushing and flossing and high natural resistance can have cleanings twice a year and still maintain optimal dental health. People with less effective plaque control at home and lower natural resistance need cleanings three or four times a year.
Unfortunately, dental insurance is not designed for optimal health for each person. Two cleanings a year is the insurance minimum. If you need to have four cleanings a year to maintain optimal health, you need to do what is best for you, not the insurance company. To put it into perspective, based on the cost of a typical periodontal cleaning visit, the two extra visits per year will cost less than two cokes or one Cafe Mocha Latte a week.
If you don’t stop the gum problems, it is likely that you will lose teeth. However, gum disease can be successfully treated and controlled with modern state-of-the-art periodontal care as long as you catch it soon enough. Do not wait till it gets so bad that it is too late.
Everything, to some extent, is hereditary including gum problems. But your parents probably didn’t get the best dental care either. Today much more can be done than years ago, so even if you inherited low resistance, you can have healthy gums.
Hormonal changes affect all of the body, including the reaction of our gums to the germs in plaque. In other words, the plaque causes gum problems. The hormonal changes lower the body’s resistance to plaque. Extra flossing and brushing should stop bleeding gums during menstrual cycles and pregnancy.
The best type of brush to use is a soft brush with round ended bristles in the case of a manual brush. Electric brushes are good too, such as the Rotadent. To learn more visit our recommended products for patients.
Today, the most effective toothpastes and mouth washes to fight periodontal disease are the ones that contain chlorine dioxide. There are several brands, most of which have been developed by a dentist and dispensed directly from dentist offices. They are designed to neutralize and break up the volatile sulfur compounds that are made by bacteria to break down the gum tissue. To learn more visit our recommended products for patients.
In the short run, especially for acute gum infections with abscess or pus, you can take antibiotics, but in the long run, antibiotics are not the solution. Effective brushing, flossing and, most importantly, regular dental care is the best answer.
Gum disease rarely hurts. In fact, sometimes the only sign of gum disease is when a patient notices a tooth has become loose or a bad taste develops in their mouth. At that point, it may be too late to save the tooth. Regular cleanings and check-ups are the key to discover these problems before they get too bad.
Yes, it could. Bacteria and bacterial products such as sulfur compounds can accumulate and putrefy. These compounds taste and smell like rotting meat – a most unpleasant taste and smell. Unfortunately, most people cannot smell their own breath and don’t notice the foul taste of gum disease because they get used to it.
Pain in the gums is the result of an acute gum infection. Causes could be gum abscess, or an abscess originating from a tooth. Virus infections such as herpes can make gums sore. Canker sores, cold sores and trench mouth (ANUG) can also make the gums hurt.
No, they don’t cause gums to bleed. Germs cause gums to bleed. However, certain medicines, like anti-convulsion drugs such as Dilantin and blood pressure drugs such as Norvasc, do make your gums more sensitive to plaque that is already there, resulting in more bleeding.
Bleeding gums is a sign of infection but bleeding gums alone do not tell us how extensive the damage is or what treatment is needed. Unless there is an acute abscess, we always start with cleanings, scaling and root planing and, especially, home care instructions. Sometimes that is all that is needed to treat the gum infection.
It could be a sign of a gum infection called ANUG. This also used be called Trench Mouth and typically occurs in teenagers and young adults who don’t brush and floss regularly when they are going through a period of high stress.
Gum recession can usually be prevented by detecting a condition that could cause the recession and then stopping it before recession occurs. Examples of causes of gum recession are gum inflammation that could lead to recession and bone loss, tooth clenching and grinding that can lead to bone loss, developmental defects in the gum tissue or cheek muscles and, rarely, people who brush compulsively with a very hard tooth brush.
Hard brushing with a hard toothbrush could cause gum recession over a long period of time but hard brushing is usually not the problem, especially if you use a soft brush. Gum recession is usually due to other factors such as tooth grinding. To learn more visit our recommended products for patients.
The sensitivity can be treated by fluoride treatment, repairing the gum recession or placing a bonded filling in the tooth, depending on the situation. Finding the cause of the recession is very important so the process can be stopped or it will continue.
Even if there is a filling in the tooth in the receded area, it probably can be fixed. You’ll need to consult with a Periodontist to be sure. The procedure is to remove the old filling or even a crown, graft the gum tissue to fix the recession and, in the case of a crown, make a new one. In the case of a filling, a replacement is usually not needed.
Gum disease can be controlled and slowed down, but in cannot be permanently cured. Anyone with teeth can develop gum disease. If you have already had problems with your gums, you know you have the potential for future problems. However, you do not need to lose your teeth because of it. If you can control the cause of gum disease, your gums can be returned to a state of health and you can consider yourself a “healed periodontal patient”.
Periodontal surgery is done in a case where there is extensive gum disease, bone loss or gum recession. In cases where the gum disease is more moderate, more conservative procedures such as scaling and root planing may be performed.
Loose teeth are a sign of bone loss. A tooth with healthy bone will never be obviously loose. If the damage is not too severe, especially if it is due to tooth clenching or grinding, the damage can usually be reversed by fixing the bite. If the tooth is moderately loose due to bone loss, it is often possible to join it to a stronger adjacent tooth, often with a cap to strengthen it. If it is very loose due to severe bone loss, it may not be treatable at all.
Headaches are a very broad category of problems and include dozens of potential causes. Dental causes of head, neck or facial pain could include cavities, abscessed teeth, gum infection, cysts, tumors of the jaw bones or swollen glands, broken or cracked teeth and TMJ dysfunction syndrome.
TMJ dysfunction is any pain that results from a conflict between the biting surfaces of the teeth and the jaw joints. It is only one specific problem that can occur with the jaw joint. Unless it can be proven that the pain is caused by a conflict between the teeth and jaw joint, it is not TMJ dysfunction.
It could be TMJ dysfunction, but it might not. The only way to be sure is to go to a dentist who has specific training in treating TMJ dysfunction and be tested. TMJ dysfunction is easy to misdiagnose and so you need to be sure the dentist has the pre-requisite training.
Stress does not cause TMJ dysfunction. A conflict between the biting surfaces of the teeth and jaw joint is the cause. Stress can take a patient, who has been tolerating this discomfort, and reduce their tolerance to the point that the pre-existing dental condition begins to cause pain.
Earaches have nothing to do with your teeth or TMJ dysfunction. However, if you put your finger in your ear, you can see how close it is to your jaw joint and teeth. If you open and close your mouth while your finger is in your ear, you can actually feel your jaw joint move. As a result, what may feel like a ear ache may in fact be a jaw joint problem.
If the dentist has ruled out tooth problems, then you need to be checked for TMJ dysfunction by a dentist who is specifically trained in the diagnosis and treatment of TMJ dysfunction. Most dentists have not had this training.
Braces are great but they have limitations. First, your teeth may be straight but there still could be a conflict between your teeth and jaw joints even after braces. Second, things may have shifted since the braces were taken off.
TMJ dysfunction is the pain that results, and can be proven to be caused, by a conflict between the teeth and jaw joints. The pain is actually muscle pain or cramping from the jaw muscles. These jaw muscles wrap around the entire head.
Taking a pill to mask the pain of a headache does nothing to solve the problem. Symptoms can continue to worsen even if it doesn’t hurt. Many patients who wind up with severe jaw problems that may require major surgery started out as a TMJ problem caused by the bite that was not properly treated.
You need to find a dentist with specific training in diagnosing and treating TMJ dysfunction. Most dentists do not have this training so you will need to be very specific in questioning the dentist to determine their qualifications.
If your bite is the problem, braces could be the solution but may not be needed. The objective is to eliminate the conflict between the teeth and the jaw joints and other methods include a bite splint as a temporary measure and reshaping the biting surfaces of the teeth (bite equilibration) as a long term solution.
A bite guard, if it is properly made, will definitely take away pain that is due to TMJ dysfunction, as long as it eliminates the conflict between the teeth and the jaw joint. However, it only works when you are wearing it. As soon as you take the bite splint out, your bite goes back to where it was before, so it is not a long-term solution.
The bite guard they sell in a sports store is designed to act as a cushion to protect your teeth in case of a blow to the face. The TMJ bite splint is not designed to act as a cushion but as a substitute for a properly fitting bite. A properly made bite splint is like when you have a wobbly table in a restaurant. The waiter puts a matchbook under the leg of the table so you have a temporarily stable table. However, when the matchbook is removed, the legs are not equal and the table will wobble again. The solution is to shorten the legs of the table until they are all equal. This is the equivalent of evening the bite by equilbration.
Just as there are many types of periodontal diseases, there are many treatment options. Your periodontist looks upon you as an individual and develops a treatment plan that is tailored to your needs. The goal of periodontal therapy is to reestablish good periodontal health.
Surgery is recommended to correct or improve a periodontal problem that affects your oral health. The choice of surgical technique depends on the type and severity of the disease and other conditions in your mouth.
The following are some of the reasons why surgery may be necessary:
To clean and reduce periodontal pockets
As you probably have learned by now, the main cause of periodontal diseases is plaque, a sticky, colorless film that constantly forms on your teeth. If the plaque is not removed thoroughly, toxins or poisons produced by bacteria in the plaque irritate the gums and destroy supporting tissues around the teeth, forming pockets. Eventually the plaque hardens into a rough deposit called calculus or tartar. Over time, as more plaque and calculus build up, the gums continue to pull away from the teeth. Gum and bone attachment is lost and pockets deepen.
You cannot predictably keep deep pockets clean and free of plaque just by brushing and flossing. The pockets may have become too deep even for your dentist or hygienist to clean them adequately. Therefore, your periodontist may decide that surgery is necessary to remove plaque and calculus below the gumline. Your periodontist will reduce the pockets and position the gums to eliminate areas where disease-causing bacteria can hide.
To regenerate or “regrow” tissue
If the disease goes untreated, gum and bone attachment to the teeth continues to be destroyed. Plaque moves down the roots of the teeth, resulting in infection which may cause more serious damage to the bone that supports the teeth. Affected teeth can become loose and eventually may be lost.
Your periodontist may recommend surgery to attempt to regenerate or “regrow” gum and bone tissue so you can keep your natural teeth.
To expose more of the tooth structure to make dental repair possible
Many times a tooth is decayed or broken below the gumline. Often periodontal surgery is needed to adjust the gum level and expose more of the tooth so the dentist can repair the damage.
To improve appearance
In certain instances, aesthetics can be improved with periodontal surgery. For example, a “toothy” smile, caused by gum recession, or shrinkage, often can be corrected by gum grafting techniques. Gum grafting also helps prevent further gum recession. Likewise, teeth can be made to look longer for a patient with a “gummy” smile. These are just two examples of how periodontal surgery can improve your appearance.
You should feel little or no discomfort during the procedure. Your periodontist will use an anesthetic to numb the surgical area. There are many techniques available for relieving anxiety during surgery. You can speak to your periodontist about these options.
Following surgery, the affected area will be tender or sore. Swelling of the surgical area may occur. Your periodontist will probably prescribe a medication to relieve post-surgical discomfort. Antibiotics or antibacterial rinses also may be prescribed. If you take your medications as directed and follow your periodontist’s instruction, you probably will experience only minor discomfort. Most patients resume their normal routines the day after surgery
You should be able to speak normally after the anesthetic has worn off. It is important to eat a well-balanced, nutritious diet after surgery. You may need to avoid chewing some foods in the surgical area for a few days.
Following some types of periodontal surgery, the teeth may be more sensitive to hot and cold. This will diminish considerably during the first few weeks after surgery.
Usually patients return for post-surgical treatment in five to 10 days. At this time, it may be necessary to remove any stitches and cleanse the surgical area. Additional follow-up appointments may be required to evaluate your healing response and review proper or oral hygiene procedures.
In most instances, you will not need surgery in the same area again. However, in certain cases, retreatment or additional surgery may be needed. As you have learned, you may be prone to periodontal diseases that require constant and careful attention. Like other chronic diseases, such as diabetes, hypertension and asthma, there is no cure. Periodontal surgery helps control disease an prevent further destruction to the gums and bone, thereby minimizing tooth loss.
Periodontal diseases can and will recur if you do not follow a strict program of supportive periodontal therapy. You play the major role in preventing further outbreaks of disease. Nothing will help you maintain the results of professional treatment better than daily removal of plaque by proper brushing, flossing and other cleaning methods recommended for you.
There are many benefits to safeguarding your periodontal health. By retaining your natural teeth, you can chew more comfortably and enjoy better digestion. You also keep a healthy smile which is a natural asset to your appearance. For feeling good and looking good, nothing works better than your natural teeth. When your efforts are combined with regular visits to your dentist and periodontist, you have an excellent chance of keeping your teeth for a lifetime.
A root canal is needed due to an infection in the tooth. This is usually due to an extremely deep cavity or, less often, due to a blow to the tooth. A tooth could have a deep cavity and the doctor might not know that the tooth needs a root canal because nothing shows in an x-ray and the patient has no pain. Then, a week or a year or many years later, something may show up in an x-ray or the patient could report pain. If that happens, root canal treatment would be done at that time.
Root canal treatment is done in the case of an infected nerve. Usually a tooth having root canal treatment can be made numb with a local anesthetic and it doesn’t hurt at all. Sometimes, a tooth with an infected nerve does not react to Novocain as well as a normal tooth and takes more work to get it completely not sensitive.
A root canal is done to remove the infection and seal the canals in the tooth. This can often be done in one visit. Sometimes two or three visits are needed depending on the individual tooth and degree of infection.
The root canal treatment was fine. The problem is the tooth was weakened by prior decay and required a cap to fix the tooth. If that was not done, even with a successful root canal, the tooth can break.
Cosmetic dental procedures can be accomplished in as few as two visits over as little as a week or two. Of course, every patient’s situation is different so you need to discuss your specific requirements and circumstances with us prior to starting any cosmetic work.
A dentist trained in proper cosmetic dental procedures does not create the “white chicklet” tooth look you may have seen. We can discuss the shape, color and arrangement of your teeth so you get a great “natural” looking smile.
Yes, you absolutely can get a preview before your work is done. Cosmetic Imaging is a system where we take a picture of your smile and then, in our computer, change your teeth so you can see how great you would look with cosmetic dental treatment.
In addition to fixed and removable braces (like Invisalign), teeth can be straightened by using porcelain veneers or crowns. This method is especially useful with adults who want a result in two weeks, instead of two years. In addition, if the teeth are dark or have decay or unattractive old fillings, that can all be corrected at the same time.
Pain is a good indicator that there is a problem, but it is also a late indicator. All dental problems start small and don’t hurt. That is the time to fix them, before they hurt. When a tooth hurts, it may already be abscessed and require a root canal. Don’t wait for pain.
From a decay point of view, two good brushings a day will clean the places a brush can reach. The problem is that the brush can’t go between the teeth where most decay forms. No amount of brushing will replace flossing. They just don’t do the same spots. Just like cleaning the kitchen 6 times a day doesn’t make the bedroom clean. You need to brush and floss.
To help your kids avoid decay, make sure they are getting optimal fluoride in water or by prescription and minimal sugar. In addition, make sure they are getting dental check-ups twice a year to catch problems while they are small and practice effective plaque removal at home.
Most commonly, teeth break due to large cavities weakening the remaining tooth structure. That is why, with large cavities, they usually need to be fixed with a material that can strengthen the tooth, such as a crown. The other reason teeth sometimes break is from the pressure of tooth clenching or grinding, which is far more common than most people think.
A tooth with a cap is much less likely to decay than one with a big silver filling that is more prone to cracking and leaking. However, a cap is not a permanent solution to prevent decay. You still have to brush and floss and avoid sugar foods because where the cap ends the tooth can still decay.
Yes. A tooth that is filled is actually weaker than a tooth that has not been filled because the seam between a filling and a tooth is not as good as a solid undecayed tooth. Teeth that are filled can get more decay if the filling chips or cracks open and starts to leak. That is why the material selected must be strong enough. In addition, if the person does not practice effective plaque control and continues to eat too much sugar for their own system, decay can start in the remaining unfilled tooth structure.
To check for decay, you need to use a combination of dental x-rays to “look” in between the teeth where you cannot see. In addition, it is necessary to use a video enhanced system to magnify the size of the image so small cracks or chips in the filling that allow decay can be found. Very large cavities often form under what appears to be acceptable old fillings. These cavities can easily be missed unless the teeth are carefully evaluated.
You need dental x-rays because there are some areas like in between the teeth or under the gum line that are just not visible any other way. If the doctor does not catch decay, infection or bone tumors while they are small, and waits for the patient to complain of pain or other symptoms, little cavities can grow to the point where root canal is needed.
X-rays, when used properly, are definitely safe. Over the years, the amount of radiation has been going down as better systems have been developed. Today, the average set of dental x-rays provides far less radiation than a day in the sun. And remember, the dental technician uses a lead apron to cover your neck, chest and stomach to minimize radiation exposure.
At Dental Care of Stamford, we believe that we must strike a reasonable compromise between making sure that problems are detected and minimizing x-ray exposure of our patients. Therefore, in the absence of any specific problems, we take cavity-detecting x-rays once a year and a low dose panoramic x-ray, which checks all the tooth roots and jaw bones, once every two years.
If you have decay, an x-ray may not find it depending on where the decay is located on the tooth and whether there is a metal filling in the tooth that could block the x-rays. That is why you need to combine dental x-rays and a careful, video enhanced dental examination.
Just like the three little pig’s houses, some people’s teeth are definitely stronger than others. However, even the little pig with the straw house was doing fine until the Big Bad Wolf came along. People with naturally harder teeth, like the pig living in the brick house, can take more sugar without crumbling, but people with naturally weaker teeth won’t get decay either if they limit their sugar contacts.
Yes, it does. Adults can get great benefits from fluorides applied to their teeth on a daily or weekly basis because fluoride hardens the outside of the tooth. If the outside is harder, decay can’t start.
No. The body cannot turn table sugar directly into energy. The body must convert table sugar (sucrose) into glucose to burn it for energy. This is exactly what happens to all carbohydrates and fats we eat, like breads, pasta and potatoes, as well as fruit sugar (fructose) and sugar from grains (maltose). You actually never need any table sugar at all. Ever.!
If you cut the number of sugar contacts down below your own threshold, you won’t get decay. Period. Since you don’t know the number for yourself, you can make a simple food diary. Simply write down everything you eat or drink for four consecutive days including weekends and weekdays. Then circle anything that either has sugar in it or that you add sugar to. Then count them up. If you are decay prone, cut the number of times you eat sugar down to three times a day. You’ll watch decay disappear.
This is one of the biggest lies of all. Natural just means grown from the soil. There are other “natural” substances like alcohol, tobacco and cocaine that aren’t very good for you either. The only difference between brown or “natural” sugar and white processed sugar is the color. Sugar is sugar.
More frequent sugar contacts cause much more decay. The truth is that the number of times per day that you eat sugar is more significant than the total amount of sugar you eat. Follow this logic. The germs in the plaque are very small. In the first bite of a sugar food, they get all the sugar they can eat. It takes the germs about 30 minutes to digest the sugar and turn it to acid before they are ready to eat more sugar. After the first bite of sugar, they are full. If you eat a pie in one sitting, that’s one sugar contact. If you cut it up into 24 pieces and eat one per hour, it is 24 sugar contacts. It may be no less fattening, but it is twenty- four times as decay causing as eating it in one sitting.
Most of the sugar consumed in America, about 150 pounds per person per year, is not in candy and cakes. The problem is that manufacturers put sugar into all sorts of things like ketchup, white bread, spaghetti sauce, mayonnaise and most processed foods. That Big Mac with special sauce on a bun is just as decay producing as the ice cream shake.
That is like saying that you can outgrow the damaging effects of bullets. In our office, the real truth is that the number of cavities per adult patient is much higher than the number of cavities per child patient.
The filling doesn’t seal the tooth as well as a solid tooth that has no filling. Sugar can seep into these cracks more easily so filled teeth are actually more likely to decay again than unfilled teeth. Always ask the dentist if a cavity is a new one, and caused by sugar, or due to a broken old filling so you understand what your problem is.
You don’t have to keep getting cavities. You have to stop what is causing them. Cavities are due to either eating too much sugar relative to the strength of your teeth and not flossing, or due to old fillings leaking and letting decay under them. You need to discover the problem and then cut down your sugar, start flossing and fix leaking old fillings. Using a prescription strength fluoride is helpful too.
No one likes the numb feeling, but most people prefer numbness to pain. If the cavity is small, you may be able to do it without Novocain. Also, air abrasion, which does not use a drill, can sometimes be used for smaller cavities without Novocain.
The heart pounding is an annoying but temporary effect of a chemical in the local anesthetic that helps it work better. If it is a problem for you, there are local anesthetics that do not have that chemical. Often those don’t last as long, so for a longer procedure, the numbness might not last long enough, requiring re-injection of additional local anesthesia. Ask your dentist what would be best for you.
Today, you do not need to have old fashioned metal fillings in your mouth. Bonded fillings, inlays and crowns are all natural tooth color and can be used to replace old fillings to give you a younger, natural look.
The safety of mercury fillings is very controversial. The American Dental Association and many other organizations says it is. Many other people are concerned that it may not be safe. Several European countries do not permit its use in children. The instructions supplied by manufacture of silver mercury fillings in the USA say not to use it in patients with kidney disease or compromised immune systems. The Environmental Protection Agency says that when dentists do a silver mercury filling in a patients tooth, any unused filling material must be stored in a covered container and disposed of as medical waste. Dentists are not allowed to store scrap filling material in an open container. This leads us to believe that there may be a problem, so we do not use silver mercury fillings at all.
We do not use silver mercury fillings for several reasons. First, they tend to corrode and leak, permitting further decay. Second, they have a tendency to expand over time like ice cubes and can cause otherwise healthy teeth to fracture. Third, they are unattractive and tend to darken teeth. Fourth, although the ADA says that they are acceptable for continued use, there is some concern about the safety of mercury and some people are intolerant to mercury in fillings
Gold is a very excellent material but some people object to its appearance, even in back teeth. Now there are several choices of materials to repair decayed or broken teeth. Laser bonded composite fillings are used for small-to-medium-sized cavities. They are natural tooth color. Gold or porcelain inlays are used for very large cavities. The traditional gold, while an excellent material in terms of durability and strength, is generally not selected in areas where it would be visible. Porcelain, on the other hand is very natural looking. In the case of even more extreme tooth damage, a porcelain crown can be used.
There are three reasons why a restoration in a tooth could fail. First, the material could break or wear out. Second, the remaining tooth could break or start to decay. And third, some conditions such as gum disease could damage the support of a tooth or cause gum recession that would cause a cosmetic problem with an otherwise successful restoration. Based on this, considering that people bite, chew and swallow 24 hours a day, eat cold foods and drinks as low as 35 to 40 degrees (F) to hot beverages as warm as 150 degrees (F), there is nothing that could be considered “permanent”. That said, if the material selected is appropriate for the size of the cavity and the individual brushes and flosses daily, eats minimal sugar and uses prescription strength fluoride, most dental repairs will be very long-lasting.
You don’t have to keep getting cavities. You have to stop what is causing them. Cavities are due to either eating too much sugar relative to the strength of your teeth and not flossing, or due to old fillings leaking and letting decay under them. You need to discover the problem and then cut down your sugar, start flossing and fix leaking old fillings. Using a prescription strength fluoride is helpful too.
Sensitivity to cold means that the nerve of the tooth is inflamed. If the sensitivity goes right away after the cold food or beverage is swallowed, the inflammation is usually reversible by fixing the cause, such as a deep cavity, grinding your teeth or gum recession. If the cold sensitivity lingers, the tooth may need a root canal.
Sensitivity to hot is usually more serious. That often means that the tooth inflammation is more advanced and may not be reversible unless root canal is done.
Usually these sensitive areas are caused by tooth clenching or grinding. The solution is to try to desensitize them by using a prescription-strength fluoride product, such as Prevident, if over the counter products like Sensodyne don’t help. Also, you need to determine the cause, such as tooth clenching or grinding or gum recession, and correct that to prevent the problem from getting worse.
Generalized sensitivity of teeth is usually due to gum recession caused by gum disease or tooth grinding due to a bite problem. You need to find the source of the problem and fix it. If it is only one tooth, then it could also be due to decay.
Biting down on hard foods means that there is inflammation at the top of the root, just like walking with a stone in your shoe would cause your foot to hurt. If it is due to biting too hard on the tooth, such as would be the case with a new filling that is too high, or tooth clenching or grinding, fixing the bite will help. If it is due to an infection in the tooth, a root canal is probably needed.
Chips in teeth are caused by mechanical trauma such as a blow to the tooth or, more commonly, tooth grinding. You can see if the chipping is due to tooth grinding by putting your top and bottom teeth together edge to edge, and seeing if the chips or worn spots on the top and bottom teeth line up. See the article by Dr. Simon on Bio Mechanical Dental Disease on the web page.
We used to think that little notches in teeth along the gum line were due to brushing too hard. Now we know that they are actually due to tooth grinding or clenching that literally bends the tooth breaking off the enamel.
Except for wisdom teeth, teeth that are lost should generally be replaced because when a tooth is lost, several things happen. The other teeth may start to shift, causing food traps which can lead to more decay or gum disease. In addition, it can throw the bite off leading to bite problems. The last problem is difficulty with chewing, leading to poor digestion and eating processed foods which aren’t as healthy as harder to chew fresh fruits and vegetable and high fiber breads and cereals.
Food traps between your teeth may be due to cavities between the teeth, fillings that are breaking or your teeth may be shifting if you have lost and not replaced missing teeth. It is important to fix these problems because the trapped food can cause gum disease in addition to being annoying.
If you have fillings that do not match the color of your teeth, you can have them replaced with new bonded fillings. Over time, tooth-colored fillings, especially the older ones, can discolor, or the color of your teeth may have darkened due to food or beverage stains. Modern bonded fillings hold their color for much longer than older materials.
Silver mercury fillings can be removed easily and replaced with tooth colored materials. The dentist does it all the time if there is decay or if they are leaking or broken. They can be removed for cosmetic reasons to lighten dark teeth as well, as if the patient requests it.
Yellow teeth can be whitened by bleaching them or by putting porcelain veneers or crowns on them. If the teeth are not extensively decayed or filled and generally good looking, except for the yellow color, bleaching is the easier, most conservative and least expensive option.
The bleaching materials we use today were actually developed originally as a treatment for periodontal disease. Researchers noticed that, while they had no long term benefits for gum disease, the oxygen released during the bleaching process did help kill certain types of bacteria during the actual bleaching sessions.
You cannot be too old to whiten your teeth. Some of our most excited tooth-whitening patients have been in their seventies and eighties as they found that tooth whitening quickly and easily takes years off their appearance.
Bleaching is an inexpensive process that is designed to take the dark pigments out of the teeth. It will not whiten fillings or crowns on teeth. In addition, certain types of discolorations tend to respond better to bleaching than others. Based on our experience bleaching several thousand people’s teeth, we can give patients a reasonably accurate predication of the results they can expect with tooth bleaching, but there can be no guarantee of results.
It depends on how they are whitened. The same process that lets us bleach teeth can let them darken again. Teeth are permeable. That means stains can go in and out. Generally teeth that have been bleached will darken a little over time but it would take at least several years for them to return to their original color. If the teeth are whitened with veneers or crowns, they will not darken significantly at all.
If they darken more than you want, you can bleach them again. As long as you save your models and bleaching trays, you can do a touch up bleaching for a few days at any time in the future by purchasing an inexpensive touch-up kit of bleach material.
Some people simply start out with darker teeth than other people. Anything that could stain a white cloth can cause your teeth to darken. The worst offenders are smoking of any kind, dark beverages like red wine and cokes, and dark gravies and sauces. Skipping regular cleanings also lets deposits build up and penetrate into the tooth to darken them.
Regardless of your habits, you can have whiter teeth. If your teeth are dark and your habits tend to stain your teeth, you will get a less than desirable result from the tooth bleaching and will have to do it longer and more frequently. You do have other options, such as porcelain veneers, that can give you the color you want without relying on tooth bleaching.
You can always start with bleaching and then use veneers later. In your consultation with the doctors, they will let you know what results you can expect from bleaching and then you can decide what you want to do. Some people may decide to start with bleaching and contouring and then do veneers in the future.
Porcelain veneers last for many years. As long as the patient exercises proper home care to prevent decay or gum problems, gets regular professional cleanings at least twice a year and avoids unreasonable force on their teeth, they can expect many years of service from porcelain veneers. You cannot abuse them by using your veneered teeth to crack open nuts, pull pins out of shirts, or as one of our patients said, “use your teeth like a Swiss Army Knife”. Doing so would likely cause breakage.
Porcelain veneers are very strong and the glazed surface is generally impervious to stains. Just like a porcelain dinner plate can be washed, porcelain veneers can be cleaned and professionally polished to keep them looking great.
You can eat normally with veneers. Foods like corn, apples, chicken, ribs, fresh fruits and vegetables, carrots, etc., are all fine. So are sandwiches and bagels. You cannot use your teeth to break open nuts or eat stale breads that would require a hacksaw without causing veneers to develop cracks or actually break. Repeated abuse of veneered teeth will weaken them and then, one day, something might break while you are eating a tuna fish sandwich on white bread. This would only happen if the veneers had been damaged by prior abuse.
A classical porcelain veneer covers just the outside and biting edge of a tooth and requires a minimal amount of tooth reduction. A crown would go completely around a tooth and require more then twice the amount of tooth reduction. That is why we recommend porcelain veneers unless the tooth is extensively decayed beyond the point where a crown is necessary. Sometimes, in one patient, we use a combination of porcelain veneers and crowns to get the best most conservative result.
The dark area at the gum line with traditional caps is usually due to metal in the crowns. At Dental Care of Stamford, with teeth that show when you smile, we avoid metal in crowns whenever possible and use all ceramic crowns.
Not everyone has to get their wisdom teeth removed but the majority of people simply do not have room for their wisdom teeth to grow in straight and assume a healthy position in their mouth. If they can’t grow in all the way, there is a gum flap that tends to trap food and bacteria. This area is highly prone to infection, and due to the poor blood supply in the area, the infections can get nasty.
Many people with impacted wisdom teeth – wisdom teeth that have no room to grown in all the way experience chronic infections. It doesn’t necessarily get serious, but it doesn’t get better either. If they sometimes bother you, it is very likely that they are infected and should be removed before a serious infection develops.
If your wisdom teeth hurt, the best thing to do is to seek professional care. If you just take pain medicine, the infection can worsen and get out of control, causing severe pain and swelling. Until you can get to a dentist, you can use warm salt water rinses of 1/2 teaspoon of salt and 8 ounces of water. Rinse every hour or two until the symptoms get a lot better and get professional help.
To make wisdom tooth extraction easier, don’t wait for them to get really infected. At the first sign that they are impacted or could become problematic, schedule a time to remove them. In addition, take extra vitamins and minerals to enhance healing. This can be started 1 – 2 weeks prior to surgery. And lastly, make sure the dentist is experienced in wisdom tooth extractions.
Faster healing depends on following the doctors instructions of rest after the surgery, using ice on the outside of your jaw, keeping pressure with gauze on the extraction site and keeping your head elevated. In addition, extra vitamins and minerals will aid the body to repair the surgical site.
Stitches or sutures after wisdom teeth extractions are often used to securely position the tissues to speed up post extraction healing. Sometimes they are not needed, so it depends on your individual situation.
After a tooth is extracted a blood clot forms in the socket. Then, over the next several weeks and months, the new gum and bone grows into the blood clot and replaces the blood clot. If the blood clot dissolves prematurely, the extraction socket is left empty, so it is called a dry socket. This leaves the bone uncovered and can be quite painful. This is not an infection so antibiotics are rarely needed.
A dry socket, if it occurs is treated to keep the interior walls of the tooth extraction site, under the gum line, covered to take away the pain. Once the blood clot breaks down, there is nothing that can be done except to place medicine in the extraction site until it starts to heal on its own. Some people might need this done once and others might need it done every day or two for a week or more along with appropriate medicine for pain. Although it is quite uncomfortable, it almost always heals uneventfully.
Studies have shown that premature loss of blood clots happens in 8% to 10% of wisdom teeth extractions. To get the odds in your favor, follow the instructions of the doctor and take extra vitamins and minerals to enhance the healing potential of your body.
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