As we move forward with our blog, we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Kusek and his staff.

We hope you find our blog to be helpful, engaging and informational to ensure your best dental health. As always, feel free to contact us with any dental questions or concerns.

We pride ourselves on using the latest, scientifically proven technologies so that we can obtain and maintain optimal oral health for our patients. The word “laser” is an acronym for “Light Amplification by Stimulated Emission of Radiation” and, within the world of dentistry, lasers are used for a variety of procedures and therapies. Simply put, this means that light from a particular crystalline source is stimulated electronically and by the use of mirrors to high energy levels, which can penetrate living tissue. Specific lasers with different light emitting capabilities can be used in dentistry — some on hard tissues and others for soft tissues like gum and oral mucous (skin) membranes within the mouth. Uses include diagnosing cavities, others for removing diseased gum tissues, for example. But best of all, lasers are minimally invasive and can result in less tissue removal, less bleeding, and less discomfort for patients after surgery. For example, using a laser, allows preparation of smaller cavities for fillings by vaporizing away tooth decay often without any anesthesia (numbing of the teeth) or a drill.

If you want to learn more about lasers and how they are used in dentistry, read the article “Lasers Shine A Light On Dentistry.” And if you want to schedule an appointment, contact us today.

While lasers have been effective (and safe) tools for healthcare professionals in the medical field for years, did you know that they are fast becoming a vital tool in the field of dentistry for diagnosing dental disease? Lasers, named from “Light Amplification by Stimulated Emission of Radiation,” are beams of light that are of a single color and wavelength. They also have the unique ability to help dental professionals detect disease in much earlier stages than they have ever before.

Diagnostic lasers are very effective in diagnosing pit and fissure decay — the tiny grooves of the biting surfaces that cannot be seen by visual inspection or reached by a traditional dental tool. They are able to accomplish this by producing a glowing effect known as fluorescence, which is produced by the optical properties of early tooth decay. This enables us to treat tooth decay in its earliest stages as well as monitor teeth from visit to visit.

Another area where lasers have proven valuable is in the detection and localization of dental calculus (tartar) beneath the gums. Calculus is hardened or calcified bacterial plaque that attaches to the teeth. Using lasers, we can find and remove this calculus during periodontal (gum) therapy. Lasers are also helpful in detecting dysplastic (“dys” – altered; “plasia” – growth) or precancerous tissue as well as cancerous tissues. And should we find any of these conditions, lasers are extremely useful in removing tissue close to the margins or edges of where diseased tissue meets healthy tissue. But best of all, lasers are minimally invasive and can result in less tissue removal, less bleeding, and less discomfort for patients after surgery.

To learn more about lasers and how they are used in dentistry, read the article “Lasers Shine A Light On Dentistry.” Or if you want to schedule an appointment, contact us today.

“Smile, and the world smiles with you,” the old saying goes. For people who are afraid to smile because they don't like how their smile looks, the twenty-first century offers a myriad of solutions. Smiling shows your teeth in their various shapes, colors, and sizes, your gums and gum line, your tooth alignment, spacing, and bite all in relation to the rest of your face. Any of these can now be improved.

Through the knowledge, skills, and combined experience of our dental team, it is now possible to make teeth whiter, brighter, and more evenly aligned, to alter tooth shape and size, and to make the teeth and gum line more proportionally balanced. Here are some options for cosmetic dentistry:

• Polish. Remove unwanted stains on outside tooth surfaces by having your teeth polished.
• Teeth Whitening. If teeth are stained or have just lost their luster, whitening is a safe and effective way to lighten a smile.
• Porcelain veneers. Applying a thin layer of dental porcelain restorative material to replace stained or damaged tooth enamel can truly change a smile.
• Porcelain crowns. If teeth are damaged by decay or trauma, porcelain crowns can replace the parts of the teeth that show above the gum line.
• Orthodontics. For teeth that are not in their correct and functional position, a variety of orthodontic techniques can be used including traditional braces, clear aligners and more—to improve crooked teeth or a malaligned bite.
• Dental implants. Nothing ruins a smile more than missing teeth. Entire teeth can be replaced, including the roots and the crowns, using dental implants. These are exact replicas of the natural teeth and can be made to match their neighbors exactly.

To learn more about all types of cosmetic dentistry, read “Cosmetic Dentistry, a Time for Change.” Or if you prefer, you can contact us to discuss your questions or to schedule an appointment.

We pride ourselves on educating our patients regarding oral health and dental treatment. This is why we are providing you with these frequently asked questions (FAQs) regarding root canals. Our belief is that by being informed about this important dental treatment, you will be more comfortable should you ever require a root canal.

Exactly what is root canal treatment?

A root canal treatment is an endodontic procedure (“endo” – inside: “dont” – tooth) in which the living pulp tissues are housed, including the nerves. When a severely decayed or damaged tooth begins to hurt, it is because the pulpal tissues are inflamed or infected, and the response of the nerves is varying degrees of pain — letting you know something is wrong. If the pulp is dead or dying it must be removed and the root canal of the tooth is filled and sealed to stop infection and to save the tooth.

Who typically performs them?

Endodontics is a specialty within dentistry that specifically deals with the diagnosis and treatment of diseases and disorders of root canal issues affecting a tooth's root or nerve. While endodontists are dentists who specialize in root canal treatment, general dentists may also perform root canal treatment and are usually the dentists you will consult with when you first have tooth pain and who will refer you to an endodontist if necessary.

What are the symptoms of a root canal infection?

Root canal symptoms and the character of the pain may vary depending on the cause. For example, symptoms may be:

• Sharp, acute pain that is difficult to pinpoint
• Intense pain that occurs when biting down on the tooth or food
• Lingering pain after eating either hot or cold foods
• Dull ache and pressure
• Tenderness accompanied by swelling in the nearby gums

Does root canal treatment hurt?

A common misconception is that a root canal treatment is painful when, in actuality, it is quite the opposite. The pain associated with a root canal occurs prior to treatment and is relieved by it — not visa versa.

If you have tooth pain, you may or may not need a root canal treatment. Contact us today (before your symptoms get worse) and schedule an appointment to find out what's causing the problem. And to learn more about the signs, symptoms, and treatments for a root canal, read the article “Common Concerns About Root Canal Treatment.”

Whitening your teeth is an easy way for most people to achieve a brighter, more appealing smile. And for older adults, it can also contribute to a more youthful appearance. We are often asked how our tooth whitening products and services stack up when compared to the many over-the-counter (OTC) products available at discount and drug stores. The following are some key facts to understand about teeth whitening so that you can receive the results you want.

What is the real difference between professional products and ones I can buy over-the-counter?

Whether you purchase over-the-counter whitening strips, toothpaste, mouthrinses, or “paint on” tooth whitening products, you are basically receiving the same product, but with a lower concentration of carbamide peroxide, the chemical responsible for teeth whitening. And while some of the products may contain a slightly higher concentration of this solution, they all are under strict governmental guidelines for ensuring you experience little to no side-effects as long as you follow the instructions. However, with our bleaching products and services, you are under the care of a trained professional and thus can receive much higher concentrations without compromising your health or the health of your teeth. This fact means that under our care you can achieve more dramatic results faster.

How long will the results last?

Bleaching is not a permanent solution; thus, your results will diminish over a six-month to one year period of time. However, it doesn't take much to touch up or maintain your white smile in a single visit, or with custom-made whitening trays that we can provide for home use. You can also keep your brighter smile a little longer by avoiding food that stains your teeth. And when drinking coffee, tea, cola, wine and other drinks like these, sip them using a straw so that they are less likely to discolor your teeth.

Is bleaching safe for my teeth?

We pride ourselves on providing and promoting optimal oral healthcare and thus would never offer any products or services that are unsafe. Additionally, there are numerous studies supporting the overall safety of whitening your teeth. We are careful to avoid sensitivity, which is an occasional side effect of intensive bleaching, and we suggest protecting the teeth with fluoride.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”

Temporomandibular Disorder (TMD), which was formerly known as Temporomandibular Joint Disorder (TMJ), is a condition that is unusual in that it frequently is quite hard to diagnose, because it often mimics many other conditions. For this reason, many healthcare professionals refer to it as “the great imposter.” The condition arises when there are problems inside the temporomandibular joint and the muscles that attach to it causing pain. The pain is most often due to muscle spasm, thereby limiting the ability to open and close the jaw and to function normally. TMD can impact anyone and has a wide range of similar symptoms.

One of the common causes of TMD is stress, and it may manifest itself through clenching or grinding of teeth while awake or asleep. These habits are often completely subconscious until pointed out by a dental professional or sleeping partner. With stress-induced TMD, the pain often comes and goes in cycles. In other words, it may be present when you are stressed, seem to disappear for a while, and then reappear when you are stressed again. Another cause of TMD can be from an injury or trauma, such as a blow to the jaw. However, regardless of the cause of TMD, the pain is real and needs to be treated properly.

If you feel that you might have TMD, please let us know so that we can address your concerns, starting with a full history and conducting a thorough examination. Or if you are in constant or severe pain, contact us immediately to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

Some of the most popular smile enhancers on the market today are both over-the-counter (OTC) and professional teeth whitening products. And while studies indicate that bleaching can successfully achieve noticeable increases in whitening of stained teeth, there are some facts you need to know about these products and the results that they can deliver.

• Nearly all bleaching products contain the same basic ingredient, carbamide peroxide or its breakdown product, hydrogen peroxide. However, the products our office uses to professionally whiten your teeth are much stronger without compromising the health and safety of your teeth, gums, and mouth.
• OTC bleaches typically contain no more that 10% carbamide peroxide while professional bleaches can contain between 15% and 35%. And to make professional bleaching even more effective, we may use them in combination with specialized lights or lasers.
• Bleaching is NOT a permanent solution and thus results will diminish over time. The “fade rate” begins to occur 6 to 12 months after treatment.
• While you can't avoid the fading process, you can extend your bleaching results by avoiding foods and drinks that stain your teeth, such as red wine, red (tomato-based) sauces, coffee, tea, sodas/colas, and blueberries to name a few.
• Another method for extending your results is to use a straw when drinking beverages that can stain your teeth so that the liquid does not come in contact with your teeth.
• If you have visible crowns and/or veneers mixed with your natural front teeth, it may be quite difficult for you to bleach your natural teeth so that they perfectly match your veneers or crowns. Remember, tooth whitening is not effective on crowns, veneers, bridgework, or any type of artificial tooth.
• One of the most common side effects of whitening teeth is tooth sensitivity and irritation of the gum tissues. They both are usually temporary and often occur when you start bleaching; however, they generally subside after a few days.

Overall, bleaching your teeth is an effective way to brighten your smile with minimal side effects. If it is something you are interested in pursuing, talk it over with us first — even if you plan to use OTC products — so that you have a clear understanding about your specific options and projected outcomes. Or, learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”

While some people associate the need for root canal treatment with an injury or trauma to a tooth (which is a valid cause), it can also most commonly be caused by tooth decay that is left untreated. This is the reason why we have put together this brief guide to explain the three common stages of tooth decay that lead up to the need for a root canal.

Stage 1: During this stage, decay begins to form in the tiny grooves on the biting surface of a tooth or where the teeth contact each other. The result is loss of the surface enamel of the tooth.

Stage 2: Left untreated, the disease progresses through the enamel and into the dentin, which forms the body of the tooth. Once in the dentin, it progresses more rapidly until it reaches the pulp — the living tissue within the root canals of the tooth. The decay infects the pulp tissues, which contain the nerves of the teeth, causing pain. The end result of inflammation and infection of the pulp is that it dies.

Stage 3: As the nerve dies an infection results, which causes pain and swelling. For some people who do not regularly visit our office, this may be the first physical sign that they have a problem. But all is not lost, a successful root canal treatment, whereby the infected pulpal tissue is removed and the root canals are cleaned and sealed will not only relieve the pain, but save your tooth. So the good news is that once a tooth has had the appropriate endodontic treatment (“endo” – inside; “dont” – tooth) followed by a proper restoration, the tooth can last as long as your other teeth. The key is to take proper care of your teeth, have routine cleanings, and visit our office as soon as you feel you have a problem with a tooth.

If you are having pain or symptoms from a tooth or teeth, check it out with us — you may or may not need a root canal treatment. Contact our office to schedule an appointment and find out. Don't wait until it's too late. And to learn more about the signs, symptoms, and treatments for a root canal, read the article “I'd Rather Have A Root Canal....”

When speaking about veneers in dentistry, many people wonder what they are really made from and how they produce such natural results. The answer is dental porcelain...and yes, it really is a type of porcelain or glass. Even though they are made of porcelain, not all porcelains are the same. This is one reason there can be such a wide price range when comparing porcelain veneer pricing from one dentist to another. For example, the quality of the dental porcelain used and the expertise of the dental lab artisans greatly impact the price of a veneer — just like other pieces of fine art, pricing depends upon the materials used and the artistry of the person creating them.

Dental porcelains are used to create veneers because of their near ideal optical properties in mimicking natural teeth in shine, opacity, and translucence. And when you combine these facts with the artistry of the lab technician and your dentist skill's in placing the veneers, you begin to understand how veneers are virtually undetectable in cosmetically-enhanced teeth. Another reason for using dental porcelain is that they can be made in many colors, shades and translucencies to enhance the optical properties and natural beauty of whiter, brighter, and visually appealing teeth. However, do not let the word porcelain, fool you when it comes to durability. While veneers are not as strong as natural teeth they are not so fragile that you should worry about breaking or damaging them with normal wear and tear. However, you should avoid biting into extremely hard substances; using your veneers as a tool in lieu of scissors, tweezers, or pliers (you should not use your natural teeth as a tool either!); and twisting your veneers when biting into harder substances.

To learn more about veneers, continue reading, “Smile Design Enhanced With Porcelain Veneers.” Or, contact us today to discuss your questions or to schedule a consultation.

What causes stains on teeth?

Staining can occur on the outside surfaces of teeth and is caused by foods such as red wine, coffee, and tea, as well as by tobacco use. They can also be developmental, affecting the structure of the teeth due to excessive fluoride levels or from tetracycline antibiotics given during childhood to name a few. Changes in a tooth's enamel or dentin during tooth formation, or as teeth age, can also cause discoloration.

What is going on inside a tooth's structure that makes it look stained?

Most of a tooth's covering (95 percent) is composed of highly mineralized enamel. The crystals of enamel are contained in a framework, or matrix, of organic matter. Dentists believe that various organic compounds that get into this matrix can cause staining.

How do whiteners work?

Tooth whiteners or bleaches expose the teeth to a peroxide compound. This creates reactive oxygen that breaks down highly colored organic compounds within the tooth's sub-surface matrix, making the tooth look whiter, but without changing its internal structure.

What professional in-office whitening techniques are available?

During treatment, a high concentration of peroxide solution in the form of a gel is applied directly on the teeth, often with activation by a heat or light source. These systems use custom tailored trays fitted to an individual's mouth. Silicone barriers or protective gels are used to keep the peroxide gel away from the gums or sensitive membranes in the mouth.

How are professional home whiteners different?

Home whiteners involve a less concentrated solution of peroxide in a gel form. It is delivered to the tooth surface by a bleaching tray that is custom-made in your dentist's office. Over-the-counter whiteners such as whitening strips or paint-on formulas can also be used, but they take longer and they're not as effective — the more diluted solutions are used for safety.

Can toothpastes really whiten teeth?

Mild abrasives in toothpastes clean surface stains but cannot change the underlying tooth color or remove significant staining.

How long do the results last?

Usually, the results last from six months to two years, but effects will diminish over time. You can make them last longer by avoiding the foods and habits that cause staining.

Are teeth whiteners safe to use?

Teeth whitening products are safe if used according to our recommendations or the product manufacturer's directions. Peroxide products may be toxic if used in excess of recommended intervals and amounts.

Read more about teeth whitening in the article “Teeth Whitening, Brighter, Lighter, Whiter...” Contact us today to schedule an appointment or to discuss whether tooth whitening is right for you.

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

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

What You Can Do

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

Learn More

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

In modern society, a bright, white smile conveys optimal health, youth and sound teeth. However, various influences including age, wear, diet, and lifestyle may prevent you from having and maintaining the glistening smile you long to share with the world. Luckily, there are many safe, inexpensive, and successful treatment options for discolored or stained teeth.

We can perform a “power bleaching” in our office to whiten teeth that are severely stained or discolored. This procedure whitens the external surfaces of the teeth by using a high concentration (35-45%) hydrogen peroxide solution, which is sometimes activated by a specialized light. To prevent irritation of the mouth's soft tissue lining during this procedure, we will isolate your gums and membranes with a rubber dam, a silicone or other effective barrier. Professionally applied in-office power bleaching provides control, speed, and predictability capable of lightening teeth up to ten shades in an hour. Don't try this at home! Our staff will take precautions in the office to avoid side effects and possible tooth sensitivity.

We can also provide you with custom-made, vacuum-formed, plastic bleaching trays for use with a take-home whitening application. In this instance, a gel made from carbamide peroxide (4-7% hydrogen peroxide, safe for home use) is delivered to the tooth surfaces in the bleaching trays. You will need to wear the tray for 30 minutes twice a day, which is a longer process than in-office bleaching. The first subjective signs of whitening will occur after three or four sessions, allowing whitening of up to eight shade units.

Another home-based option, whitening strips, essentially look like band-aids for the teeth. They are capable of lightening teeth by about three shades after being worn directly on the surface of the teeth for 30 minutes twice a day for one week.

If you have always wanted whiter teeth, schedule an appointment so we can determine which of these treatment options would work best for you. For more information on the fundamentals of teeth whitening, read the informative Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter...”

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

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

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

We in dentistry, advise parents to have an orthodontic evaluation some time before your child is 7 years of age. At this time, some of your child's adult teeth have come in and some primary (baby) teeth remain. This is a good time to check for developing problems. Treatment that begins while your child's teeth are coming in is called “interceptive orthodontics.” It provides an opportunity to achieve the best results in orthodontic treatment.

Once this evaluation takes place, it may mean that orthodontic treatment may need to take place in two-stages. A first phase of orthodontic treatment may prevent, intercept or minimize future orthodontic treatment. The first stage may be a process of guiding the growth of the jawbones that support the teeth. This is called “growth modification.” Then when the adult teeth have erupted through the gums, it may be time to do the second and final stage.

If a second phase of treatment is necessary it will probably require braces. These are small metal brackets that are bonded to the teeth. Thin flexible wires are threaded through them, and the wires are designed to push or pull on the teeth to provide a small amount of pressure that makes the teeth slowly reposition themselves within the jawbone. A light and controlled force pulling on a tooth causes new bone and ligament (the fibers that hold teeth in place) to be formed. These are living tissues that are constantly changing and remodeling themselves.

If you wait until your child's permanent (adult) teeth have all come in to start this process, it will be too late to correct some types of orthodontic problems, such as some types of malocclusions (“mal” – bad, “occlusion” – bite). It's better to work together with your child's stages of growth and development in order to have an optimum correction, both in looks and function.

You may be wondering whether a two-stage treatment costs twice as much. In fact, it is likely to be less expensive than a late one-stage treatment would be. Sometimes, the first stage may correct an underlying problem and make further treatment unnecessary. If a second phase is needed, it is likely to be easier and less costly.

Contact us today to schedule an appointment to discuss your questions about orthodontia for your child. You can also learn more by reading the Dear Doctor magazine article “Preventative & Cost Saving Orthodontics.”

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

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

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

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

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

Having someone tell you that you have bad breath can be humiliating, but it can also be a sign that you need to see your dentist. Bad breath (or halitosis) can be a sign of an underlying dental or health problem, so before you run out and stock up on breath mints, make an appointment with our office. Using breath fresheners will only disguise the problem and not treat the root cause.

It's important to remember that if you have bad breath, you're not alone — it's the third most common reason people seek a dental consult. We use a systematic approach to determine the cause of your halitosis and offer a solution.

Causes: Ninety percent of mouth odors come from mouth itself — either from the food you eat or bacteria that may be present. Most unpleasant odors originate from proteins trapped in the mouth that are processed by oral bacteria. When left on the tongue, these bacteria can cause an unpleasant smell. Dry mouth, sinus problems, diet and poor oral hygiene can also cause bad breath. In rare cases, a medical condition may be the cause.

Treatment: The best solution will depend on determining the real cause of your halitosis. If bad breath emanates from the mouth, it most commonly is caused by gum disease or even tooth decay, which need to be treated to correct the problem. If halitosis is of systemic (general body) origin, a more detailed examination might be needed from a physician. But the solution may also be as simple as demonstrating how to effectively remove bacterial plaque from your teeth, or offer instruction on proper tongue cleaning. If the cause is gum disease, we may suggest a deep cleaning and possible antibiotic therapy.

Contact us today to schedule an appointment to discuss any questions you may have regarding bad breath. Read more about this topic in the Dear Doctor magazine article “Bad Breath: More Than Just Embarrassing.”

How many of these questions can you answer correctly? The more you know about nutrition and oral health, the healthier you are likely to be.

What are free sugars?
“Free sugars” is a term for sugars including refined cane, beet and corn sugar, which are added to foods or occur naturally in honey, syrups or fruit juices.

You probably know that foods with added sugars are not healthy for your teeth. What is the maximum recommended sugar intake for oral health?
The recommended daily limit for free sugar is 10 teaspoons per day. Note that one can of soda contains over 6 teaspoons.

If a sugary snack is bad for your teeth, what could you substitute that would be better?
Fresh fruits and vegetables would be a better snack. Fresh fruits contain fructose, a sugar that has not been shown to be harmful to teeth if eaten in reasonable amounts.

How can you get enough fluoride to guard your teeth against decay?
If your water supply does not contain fluoride, or if you usually drink bottled water, you may or may not be receiving enough fluoride from your toothpaste. We can assess if you are receiving enough fluoride by examining your teeth, testing your plaque and reviewing your past history of tooth decay. If you are having a problem with tooth decay, we can create fluoride trays for you so you can apply a fluoride solution to your teeth daily.

What is dental erosion and how is it different from tooth decay?
Some acidic foods, particularly drinks such as juices and sodas, wear away your teeth's outer coating (the enamel) when exposed to the teeth's surface. Erosion does not involve bacteria, the cause of dental caries (tooth decay).

Can certain foods stop acidity from attacking your teeth?
Yes, there are foods that reverse the increase in acidity that comes from eating free sugars. One of these is cheese. Cheese stimulates saliva in your mouth, and it contains high levels of calcium, allowing calcium to be added back to your teeth. Many vegetables and starchy whole grain foods require thorough chewing, which also stimulates production of saliva and guards against tooth decay.

We hope you learned some useful facts from this nutrition quiz. If you modify your habits so that you eat less free sugar; drink more water (preferably fluoridated), drink fewer juices and sodas; and snack on fresh fruits, vegetables, and cheese, you can count on having healthy teeth and gums.

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

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

What does the term “two-implant overdentures” mean?
For more than a century, complete dentures were the only care option for edentulous (toothless) people. As a solution, these left a lot to be desired, particularly for the lower jaw. Now dental technology has developed a better alternative that combines two strategically placed dental implants and a traditional lower denture that has been modified to fit over the two implants — thus the term.

What are the problems with traditional dentures?
The problem is that when you lose teeth, the bone that supported the missing teeth begins to shrink away. This is known as resorption, and it is the reason that dentures fitted too soon after teeth are lost quickly become loose. Bone loss happens most rapidly during the first year and is four times greater in the lower jaw than in the upper.

Why not just use dental adhesives to hold dentures tightly to the lower jaw?
Zinc, a major ingredient in most dental adhesives, has been associated with neurological disorders and may be unsafe. In addition, dental adhesives are expensive and the cost of frequent usage adds up.

Besides dental adhesives, are other health problems associated with dentures?
Yes, edentulism has been related to poor nutrition. Many edentulous people switch to soft foods with high fat content because they find healthier foods like vegetables and proteins difficult to chew.

What are dental implants?
Dental implants are replacements for the roots of teeth, the parts that are below the gumline and anchored in bone. They are usually covered with a crown that shows above the line of the gums.

What are the benefits of implants?
Most importantly, implants reduce the amount of bone resorption. Studies have shown about 75% less resorption in parts of the jaw with implants compared to areas without them. Since most of the bone loss occurs within the first year after tooth loss, it is important to place implants within this time period.

Is a complete set of dental implants a good solution for edentulism?
Yes, it can be a good solution, but it is not for everyone. Some patients, who have lost a great deal of bone support, need another solution for cosmetic reasons that offer more facial support like an implant overdenture. In addition, depending on their resources and insurance, some people require a less expensive solution.

Why does the two-implant overdenture work better for the lower jaw?
Based on differences in bone volume, density and other factors, we think that four to six implants are needed to retain an upper implant overdenture. Thus a two-implant overdenture is a good solution to consider for a lower jaw, but other options might be preferred for an upper jaw.

Contact us today to schedule an appointment to discuss your questions about dentures and implants. You can also learn more by reading the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”

Dental implants are in much demand when it comes to replacing missing teeth. And although they have long-term success rates of well over 95% when properly placed, the dental profession's current rule-of-thumb is to not use them as a treatment option for teenagers because jaw and facial growth are not complete.

As with most things in life, timing can be everything. However, having missing teeth as a teen can contribute to significant loss of self-esteem and psychological issues. All this means is that we must review each patient's needs on a case-by-case basis so that we can determine the optimal time to place implants while maintaining your teen's self-esteem. However, the good news is that there are some temporary tooth replacements available until the timing is right for implants.

Unlike natural teeth, which move and change position along with normal growth and jaw development, implants don't. Because implants replace tooth roots by fusing with the jawbone, their position is fixed. If placed before normal jaw growth and maturity are complete, they appear to sink as the jaws grow and leave them behind!

Given the above details, you can clearly see why it is critical for jaw and facial growth to be complete prior to placing a dental implant. To determine this timeline, we will work with our dental team, which include orthodontists (specialist in the study of the growth, development and moving teeth into the right positions). Working together, we will best be able to assess when the time is right to plan and place dental implants — usually around late teens.

To learn more on this subject, continue reading the Dear Doctor magazine article “Teenagers & Dental Implants.” You can also contact us today to schedule an appointment for your teenager or to discuss your questions about dental implants or other treatment options.

It used to be that when it came to treating tooth decay (cavities), your primary option was to have the tooth decay removed and filled with a metal amalgam (silver-colored filling). This treatment sometimes requires a special shape cut called an “undercut” to be drilled into the tooth to hold it in. Unfortunately, it can also involve removal of some healthy tooth structure. Silver amalgam fillings still have limited applications and are still used in back teeth where they don't show in the smile. This is because they are strong and resist biting well; however, over time they can fatigue and fracture.

Older restorative concepts were based upon the development of strong and stiff materials such as gold, which tends to be unyielding and therefore contributed to failures of the remaining tooth substance around restorations (e.g., decay or cracking). Newer concepts tend to get away from the “stronger and stiffer is better” concept and have moved towards safety principles using materials that involve mimicking the properties of natural tooth structure. In fact, it is now clearly established that a new “biomimetic approach” (“bio” – life; “mimetic” – mimicking) to dentistry is possible through the use of tooth-like materials such as composite resins and porcelains. And unlike metal alloys, these newer materials bond directly to the remaining enamel and dentin of which the teeth themselves are made, which both stabilize and strengthen teeth.

These techniques are also suitable for children's teeth and can incorporate fluoride to reduce further decay. But perhaps best of all, using these materials and more modern technologies can restore proper tooth function and normal wear while producing results that appear indistinguishable from natural teeth.

To learn more, continue reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.” You can also contact us today to schedule an appointment to discuss your specific questions about replacing your metal fillings with tooth-colored ones.

For years, lasers have revolutionized the medical industry and now they are beginning to do the same within the field of dentistry. However, anytime new technologies are introduced, people naturally will have questions. Here is a list of frequently asked questions (FAQs).

What is a laser?

Lasers are beams of light that are a single wavelength and color. Laser is an acronym derived from “Light Amplification by Stimulated Emission of Radiation.”

How are they different from regular sunlight?

White light is made up of light with many wavelengths corresponding to the visible spectrum comprising the rainbow (red, orange, yellow, green, blue, indigo, and violet). Laser light consists of beams of a single color and hence a single wavelength of light, concentrated to a high energy level, which can penetrate living tissue.

How are they used in dentistry?

Dental laser usage typically falls into three categories: disease diagnosis; soft tissue procedures of the gums, lips and tongue; and hard tissue procedures of the bone or tooth enamel and dentin. Examples of the most common hard tissue treatments include the diagnosis and removal of tooth decay, while the most common soft tissue treatments include the removal of gum tissue as it relates to cosmetic dentistry and the treatment of gum disease.

Are they safe?

Absolutely! Before blazing a trail in the field of dentistry, lasers have been used for years in the medical field with research evidence and the FDA approving both their safety and efficacy. In fact, they are minimally invasive and can result in less tissue removal, less bleeding and less discomfort for patients after surgery. And what could be better than that?

Want to learn more?

To learn more about lasers and how they are used in dentistry, read the article “Lasers Shine A Light On Dentistry.” And if you want to schedule an appointment, contact us today.

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

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

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

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

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

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

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

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

Did you know…?

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

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

It is important to brush your teeth every day to remove plaque (that sticky white film, composed of bacteria, on your teeth near your gums), but it is possible to overdo it — particularly if you find that your teeth are becoming sensitive to hot and cold or to variations in pressure.

Brushing your teeth too hard or too many times per day can aggravate tooth sensitivity, which can range from a mild twinge to a severe pain. You can accomplish the goal of tooth brushing — plaque removal — by using a soft brush with a very gentle action. Repeated aggressive brushing with a hard brush is not required and can even be harmful to your teeth and gums.

To understand how teeth become sensitive, you need to know about the internal structure of your teeth. Teeth are covered by enamel, a hard mineralized coating that protects them from changes in temperature and pressure. If the enamel is worn away, it exposes the next lower layer of the tooth, the dentin. The dentin is a living tissue containing nerve fibers that connect to the nerves in the tooth's root.

Excessive tooth brushing can irritate your gums and cause them to shrink away from your teeth, particularly if you have thin gum tissues. The thickness or thinness of your gum tissues is something you inherit from your parents, so you can't change it. Hard brushing can begin to wear away the enamel covering of your teeth. Exposure to acids or sugars in the foods you eat and drink can continue the damage.

Acidic foods and drinks such as fruit juices dissolve some of the minerals in your teeth by a process called “demineralization.” Fortunately, your saliva can interact with the enamel and bring back minerals that are leaving the tooth's surface. This process is called “remineralization.” It is important to let your healthy saliva wash your teeth's surfaces for a while before brushing so that dissolved minerals get a chance to be returned to your enamel. It takes between twelve and twenty-four hours for plaque to form on your teeth, so you don't need to brush more than twice a day.

The best way to make sure you are brushing your teeth properly is to have us evaluate your brushing technique at your next dental appointment. We will be able to tell you whether you need to change the angle of your brush or the pressure you are applying for the most effective removal of plaque with the least wear on your teeth and gums. Tooth brushing serves an important purpose, but remember that you can actually have too much of a good thing.

Contact us today to schedule an appointment to discuss your questions about tooth brushing and oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Sensitive Teeth.”

If you have ever had halitosis (bad breath), you know it can cause you to feel self-conscious and embarrassed. And while the odor is typically a primary concern, determining what is causing it is a task we can assist you with resolving. This is especially true when you experience bad breath outside of those times when you've just consumed pungent foods and drinks such as coffee, garlic or raw onions. For example, it is quite a different scenario to have family members, friends, co-workers or even total strangers consistently complaining or using body language to denote your bad breath. If the later best describes your situation — and be honest with yourself — then you need a thorough dental exam to discover the ultimate cause (or causes) of your halitosis. This is especially important because so many people are unaware that there can be numerous oral and/or general health concerns triggering their bad breath.

Most unpleasant mouth odors arise from the more than 600 types of bacteria found in the average mouth, with several dozens of these bacteria being the primary culprits for producing foul odors. And while food particles left between teeth can be key contributors to bad breath, the tongue or more specifically, the back of the tongue, is the most common location. Dry mouth is another cause for bad breath, as evident by the dreaded morning breath we all experience from mouth breathing as we sleep. Bad breath is also caused by certain medical conditions such as liver disease, lung infections, diabetes, kidney infections or failure and cancer.

The good news is that we can work with you to develop an effective treatment for your bad breath. And if necessary, we can work with your physician on a total treatment plan should your condition be due to health conditions outside your mouth. However, if your bad breath originates in your mouth, we may recommend any or all of the following to return your mouth to optimal oral health:

• Oral hygiene instruction to learn the proper ways to brush, floss, scrape your tongue and use mouthwashes
• Denture hygiene instruction for proper cleaning and maintenance of both full and partial dentures and bridgework
• Periodontal (gum) therapy that includes professionally cleaning your teeth (scaling), smoothing your teeth's root surfaces (root planning) and possible antibiotic therapy
• Removal of tooth decay where large, open cavities (caries) are present
• Repair of broken fillings
• Removal of wisdom teeth (third molars) with gum flaps
• Treatment of yeast infections (candidasis)

To learn more about the causes and treatments for halitosis, read the Dear Doctor article, “Bad Breath — More Than Just Embarrassing.”

Ready To Take The Next Step?

If you want to address your own concerns with bad breath, contact us today to schedule a consultation for an examination and treatment plan. You will find yourself smiling and laughing more once you are confident you have a clean, healthy mouth.

Tooth decay is not trivial. It's a worldwide epidemic, one of the most common of all diseases — second only to the common cold. It affects more than one fourth of U.S. children of ages 2 to 5 and half of those 12 to 15. Among adults, tooth decay affects more than ninety percent of those over age 40.

Prevention of cavities starts with a healthy diet and effective brushing and flossing, but it is much more complex than that. Three strategies for reducing dental caries (tooth decay) include:

Protect with Fluoride and Sealants
This works best when fluoride is applied to the crystalline coating of your child's teeth just after they push through the gums (erupt). The fluoride becomes incorporated into the tooth's surface and acts as a barrier to decay. Studies have shown that low doses of fluoride are safe and effective.

Dental sealants are used as a companion to fluoride because they seal tiny pits and fissures in the tooth's structure, creating an even stronger barrier.

Modify Oral Bacteria
Every mouth contains bacteria, no matter how well you clean your teeth. Not all bacteria cause tooth decay. The problem bacteria are those that produce acid as a byproduct of their life processes. We can identify acid-producing bacteria in your mouth, you can reduce their concentrations using antibacterial mouthrinses such as chlorhexidine, and pH neutralizing agents (substances that reduce the amount of acid).

Reduce Sugars in Your Diet
Bacteria in your mouth ferment sugars and other carbohydrates, producing acids that eat into the mineralized outside structure of your teeth, the enamel. So eating fewer sugars — particularly added sugars such as those in juices, sodas, candy and other sweets — will help prevent decay. Your total sugar intake should be less than fifty grams, or about ten teaspoons, per day. If you begin to read labels showing sugar content of common foods, you may be surprised at the amount you consume without knowing it.

If you must snack between meals, non-sugary snacks like raw vegetables and fresh fruits create a better environment for your teeth.

Xylitol, an “alcohol sugar” used in some chewing gums and dental products, has been shown to reduce decay-producing bacteria.

Try these easy strategies to keep your teeth healthy and functional throughout your lifetime.

Contact us today to schedule an appointment to discuss your questions about tooth decay. You can learn more by reading the Dear Doctor magazine article “Tooth Decay.”

Did you know that Americans spend nearly 3 billion dollars each year on fresh breath remedies including gum, mints and mouthrinses to address their fears of halitosis (bad breath)? This simple fact clearly reveals that Americans are obsessed with having pleasant breath. Some other interesting statistics on this subject include:

• 60% of women and 50% of men say they use breath freshening products like candy, chewing gum and sprays
• 50% of middle-aged and older adults have bad breath
• 25% of the population has chronic bad breath
• 20 to 25% of adults have bad breath due to their smoking habits

However, the best way to determine what is causing your bad breath is to have a thorough dental exam followed by a professional cleaning. The first important step of this process begins when we obtain a thorough medical history. This includes asking you questions so that we can:

• Identify your chief complaint and whether or not your bad breath is noticed by others or just a concern you have
• Learn about your medical history as well as what medications (prescription and over-the-counter), supplements, and vitamins you are currently taking
• Learn about your dietary history to see if pungent foods such as garlic and onions are foods you often eat that are contributing to the problem
• Conduct a psychosocial assessment to learn if you suffer from depression, anxiety, sleep or work problems
• Identify personal habits such as smoking cigarettes, cigars or a pipe that contribute to your bad breath

To learn more about the causes and treatments for halitosis, read the Dear Doctor article, “Bad Breath — More Than Just Embarrassing.” Or you can contact us today to schedule a consultation for an examination, cleaning and treatment plan.

The term TMD means “Temporomandibular Disorder.” But if you suffer from this disorder, it means pain. The pain can be mild or severe, acute or chronic, and it can appear to be centered in different locations, making it difficult to diagnose.

People who clench or grind their teeth because of stress often experience the pain of TMD. They might not even know they are engaging in these habits, because they do them subconsciously, for example when driving in traffic or engaging in vigorous exercise. Another cause of TMD might be an injury such as a blow to the jaw.

You can feel your temporomandibular joints working if you place your fingers in front of your ears and move your lower jaw up and down. On each side the joint is composed of an almond shaped structure at the end of the lower jaw, called the condyle, which fits neatly into a depression in the temporal bone (the bone on the side of your skull near your ear). A small disc between the two bones allows the lower jaw to move forward and sideways. The joints are stabilized by ligaments and moved by muscles.

TMD pain is the result of a process that begins when a stimulus such as psychological stress or an injury to the joint causes spasms (involuntary muscle contractions) in the muscles that move the joint. Blood vessels in the muscle begin to accumulate waste products, causing chemical changes and lactic acid buildup in the muscle. Nerves in the muscle then signal the brain to stop the movement of the jaw by registering pain.

TMD pain can appear to originate from various locations in your jaw, head, or neck. This is why it's important to make an appointment with our office for a professional assessment and diagnosis.

Treatment aims to relieve the symptoms of pain and discomfort and to prevent them from recurring in the future. Treatment can include heat, mild painkillers, muscle relaxants, soft diet, and simple jaw exercises, as well as education regarding the causes of TMD. To prevent further pain you may be provided with a “bite guard,” or referred to relaxation training with a licensed therapist. A bite guard is designed to prevent the lower teeth from biting hard into the upper teeth. It is commonly worn at night, but can also be worn during the day if clenching and grinding are apparent.

If these simpler treatments do not solve the problem, we may recommend more complex procedures such as bite adjustment or, as a last resort, surgical treatment may be needed.

Contact us today to discuss your questions about TMD. You can also learn more by reading the Dear Doctor magazine article “TMD: Understanding the Great Imposter.”

One of the most common treatments we are asked about is a root canal and the unfortunate bad reputation associated with it. The truth is that the procedure actually relieves the pain associated with the problem and not visa versa. And here's why.

A root canal or endodontic treatment (“endo” – inside; “dont” – tooth) is a necessary procedure in which diseased pulp tissue — and the nerve, which responds by causing the pain — is removed. This is followed by cleaning and sealing the root canals. This usually results from pulp inflammation and infection as a result of a severe decay or in a heavily filled tooth. Root canal treatment is typically performed by general dentists who have taken specialized training or by endodontists, dentists who specialize in the diagnosis and treatment of root canal problems. We perform them here in our practice to save a tooth, literally, from further damage and/or loss.

Here is a quick overview of the procedure. We will begin by making a small opening in the chewing surface of your tooth so that we can access the tooth's root canal. We use small instruments to remove the dead and dying tissues of the pulp. The root canals are cleaned and disinfected. The canals are then sealed with a biocompatible filling material. Lastly, we will seal the access hole with a filling material. You will then need to get a permanent restoration or crown to protect the tooth fully.

If you feel that you have the symptoms of a root canal problem and may need a root canal treatment, contact us to schedule an appointment. And to learn more about the signs, symptoms, and what to expect after root canal treatment, read the article “Common Concerns About Root Canal Treatment.”

When it comes to tooth pain, it is important to identify two things: what is causing your pain and what can be done about it. In some instances you can handle it yourself at home; however, for others, you should contact us so that we can diagnose and treat the problem. See how much you really know about tooth pain by taking our true/false test.

To learn more, continue reading the Dear Doctor magazine article “Tooth Pain? Don't Wait!” Or contact us today to schedule an appointment to discuss your questions.

FAQs About This New and Miraculous Procedure

How can sinus surgery contribute to the replacement of missing back teeth with dental implants?
Dental implants must be anchored the in bone to be successful. Maxillary sinus surgery can help regenerate bone that has been lost and is critically needed to anchor dental implants.

What are the maxillary air sinuses?
Inside the upper jaw, or “maxilla,” are structures known as the maxillary air sinuses, one on either side of the upper jaw. Each sinus is an air-filled space lined by a membrane. Upper back teeth are normally encased in the bone of the maxilla, below the sinuses.

Why is it important to replace missing back teeth?
Replacing back teeth restores the ability to eat, chew, and talk properly. The back teeth also provide facial and cheek support.

Why use dental implants?
Dental implants are the state-of-the-art method for replacing missing teeth.

Why does bone loss occur?
Unless special precautions are taken to prevent it, when teeth are lost, the bone supporting them is also lost.

If there is insufficient bone to anchor dental implants, what are the alternatives?
If all the back teeth are lost and dental implants cannot be placed, removable upper dentures may be the only alternative.

How do you determine whether a sinus surgical procedure is necessary?
The size, shape, and remaining bone of the maxillary sinuses influence whether you can have dental implants with or without a sinus surgical procedure.

How does surgery grow bone?
A small window is created in the sinus wall above where implants need to be placed. The sinus membrane is lifted and the space thus created filled with bone grafting and biologically active bone generating materials. The window is then closed and simply heals.

How is the surgery done?
The surgical procedures are performed from inside the mouth in the area just above the missing back teeth. They are generally carried out under local anesthesia (small shots, just like for a filling), sometimes with the addition of sedation or anti-anxiety medication.

How do bone grafts work?
Bone grafts act as scaffolds that the body replaces with its own bone. The most well researched bone substitute grafting material is currently bovine (cow) bone. All grafting materials are approved by the Food and Drug Administration. They are specially treated to render them completely sterile, non-contagious, and free of rejection factors.

What can I expect after surgery?
Moderate swelling and discomfort after surgery generally lasts for a few days to a week, about the same as having an upper impacted wisdom tooth removed. Supportive treatment usually includes a course of antibiotics to prevent infection and prescription strength medication of the aspirin or ibuprofen type. A decongestant may also be prescribed, if necessary. Healing is generally uneventful.

Who performs this surgery?
Maxillary sinus augmentations are usually carried out by oral surgeons, periodontists, or appropriately trained general dentists. Proper assessment of your situation and diagnosis are critical pre-requisites to the right procedure.

If you are missing upper back teeth, contact us today to schedule an appointment and discuss maxillary sinus augmentation. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery: Creating Bone for Dental Implants out of Thin Air.”

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

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

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

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

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

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

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

You may have seen Kathy Ireland on the cover of Sports Illustrated, but did you know that she is now a business mogul?

Through it all, Ireland has kept her model good looks, and that includes a bright, glowing smile. In a recent interview with Dear Doctor magazine she said that keeping her smile has required ongoing maintenance and more.

It seems that Ireland is a bit of a daredevil. She described a moment of fun with her children when she tried to stand in their wagon and “wagon surf” across her driveway. It ended badly when she crashed into her parked car and suffered a broken nose, split forehead and several broken teeth. “I learned that my love of adventure exceeds my coordination,” she commented.

Ireland was born in Glendale, California in 1963. She demonstrated her drive to succeed early in life, starting at age 4 when she and her sister sold painted rocks from their wagon. Later she had a paper route. She began modeling at 17, with the goal of earning enough to pay for college or to start a business. In her successful modeling career she graced the covers of Glamour, Cosmopolitan, Harper's Bazaar and Sports Illustrated. Her first cover for Sports Illustrated, the publication's 25th Anniversary Swimsuit Edition, was the magazine's best-selling swimsuit issue to date.

In 1993 she founded her marketing and design firm, kathy ireland Worldwide. Now a billion-dollar industry, the firm sells fashions such as wedding gowns and bridesmaid dresses, as well as a wide range of items for home and family.

She has also written a number of books teaching others how to be successful — based on her own experience — as well as three children's books.

Discussing her oral health, Ireland says that she required serious professional assistance on more than one occasion. When she was a child she knocked out a tooth and later knocked it loose again. As an adolescent she wore braces for about three years. After the driveway incident she needed numerous veneers and dental implants to replace a lost tooth and restore her smile.

Her maintenance routine includes regular flossing and brushing, and she has her teeth cleaned every six months. She keeps up on her reading about the latest in research on dental health, and encourages her three children to floss and brush their teeth, to limit eating sweets and to do what they can to avoid injuries to their mouths and teeth.

Contact us today to schedule an appointment to discuss your questions about how to maintain your own smile. You can also learn more by reading the Dear Doctor magazine article “Kathy Ireland.”

When asked about her dazzling white smile, Cat Cora, the first female iron chef on the hit television series Iron Chef America, freely admits to maintaining the brightness of her smile with professional whitening sessions.

“With what I do, whitening your teeth is like getting your hair done, your nails done and everything else you have to do to be on television,” Cat recently told Dear Doctor magazine. However, she does have her limits. “I want my teeth to be white and healthy looking — but not stark white or looking like they could glow in the dark,” she said with a laugh.

Cat's perceptions and experiences with tooth whitening may accurately describe Hollywood, but through the power of media, celebrities and their respective fan bases, having attractive white teeth has become a goal for most people. This is because white teeth are subconsciously associated with youth and virility.

Here in the dental office, we can use professional-strength “power bleaching” to whiten teeth several shades in a single visit. To prevent irritation to the area surrounding the teeth being treated, we isolate the gums and skin of the mouth with a protective gel or a rubber barrier known as a dental dam. After the whitening solution is placed on the teeth, the process may be supplemented by heat or a light source to activate or enhance peroxide release.

For bleaching teeth at home, our office can make custom-fitted bleaching trays that you fill with a gel form of carbamide peroxide. Sometimes this whitening gel can cause a temporary tooth sensitivity to hot and cold, but this normally lasts for no more than four days after you stop bleaching your teeth.

To learn more about tooth whitening, you can continue reading the Dear Doctor magazine article “Teeth Whitening.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and discuss what treatment options will be best for you. And to read the entire interview with Cat Cora, please see the article “Cat Cora.”

Athletic activity can boost your health, but many sports also carry some risk — especially to the teeth. This is something NFL wide receiver Jerry Rice well knows.

“Football can be brutal — injuries, including those to the face and mouth, are a common risk for any player,” Rice noted in an interview with Dear Doctor magazine. In fact, Rice himself chipped a couple of teeth, which were repaired with crowns. “There wasn't a lot of focus on protecting your teeth in high school,” Rice recalled.

You don't have to be a legend of the NFL to benefit from the type of high-quality mouthguard a dentist can make for you or your child. Consider that:

• An athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard.
• Mouthguards prevent an estimated 200,000 or more injuries each year.
• Sports-related dental injuries account for more than 600,000 emergency room visits annually.
• Each knocked-out tooth that is not properly preserved or replanted can cause lifetime dental costs of $10,000 to $20,000.

You and/or your child should wear a mouthguard if you participate in sports involving a ball, stick, puck, or physical contact with another player. Mouthguards should be used for practice as well as actual games.

It's also important to be aware that all mouthguards are not created equal. To get the highest level of protection and comfort, you'll want to have one custom-fitted and professionally made. This will involve a visit to our office so that we can make a precise model of your teeth that is used to create a custom guard. A properly fitted mouthguard is protective, comfortable, resilient, tear-resistant, odorless, tasteless and not bulky. It has excellent retention, fit, and sufficient thickness in critical areas.

If you are concerned about dental injuries or interested in learning more about mouthguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Jerry Rice, please see “Jerry Rice.” Dear Doctor also has more on “Athletic Mouthguards.” and “An Introduction to Sports Injuries & Dentistry.”

Fracturing back molars is an experience no one ever wants to have. But when a helicopter crashed during a back country ski trip, supermodel Christie Brinkley soon discovered that she had fractured two molars. Fortunately for Christie, her oral health was restored with two dental implants. As she said during an interview with Dear Doctor magazine, “I am grateful for the dental implant technology that feels and looks so natural.”

While Christie's dental implants replaced back teeth, we routinely use them to replace both back and the more visible front teeth. But best of all, we have demonstrated expertise at making dental implant crowns look real. This is where we meld science and artistry.

What drives the most natural and beautiful result is how the crown (the visible, white portion of a tooth) actually emerges through the gum tissues. We also match the adjacent teeth identically in color, appearance, shape and profile. But we can't take all the credit, as it takes an entire “behind-the-scenes” team to produce dazzling results. Choice of materials, the laboratory technician (the person who actually handcrafts the tooth), the expertise we use in placing a dental implant crown and the total quality of care we provide are the ingredients necessary for success.

Another critical factor required is ensuring there is enough bone volume and gum tissue to support an implant. Both of these must also be in the right position to anchor an implant. However, if you do not have adequate bone volume, you may be a candidate for a minor surgical procedure to increase your bone volume through bone grafting or other regenerative surgical techniques.

To learn more about dental implants, continue reading the Dear Doctor magazine article “Matching Teeth & Implants.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, listen to your concerns, answer your questions and discuss treatment options. And if you want to read the entire feature article on Christie Brinkley, continue reading “The Secret Behind Christie Brinkley's Supermodel Smile.”

Perhaps you've seen Nate Berkus on The Oprah Winfrey Show or watched his television program, The Nate Berkus Show. You may even have read his best-selling book, Home Rules: Transform the Place You Live Into a Place You'll Love. Regardless of where or how you discovered Berkus, you will surely have noticed his dazzling smile.

Berkus recently opened up about the facts behind his trademark smile during an interview with Dear Doctor magazine. First off, his smile is totally natural, as he never wore braces or had any cosmetic work, including porcelain veneers. However, Berkus does give credit to his childhood dentist for the preventative healthcare he received as a young boy. “I'm grateful for having been given fluoride treatments and sealants as a child,” he said. Nate also shared the important flossing advice he learned from his dentist that he still follows today: “Floss the ones you want to keep.” Berkus went on to say that he feels, “healthy habits should start at a young age.”

And we totally agree! For this reason we have put together the following list of facts and oral hygiene tips:

• Over 50% of plaque accumulation occurs in the protected areas between teeth — a place that may be difficult or even impossible to reach with a toothbrush.
• A thorough brushing may take up to two minutes at first, and it may feel awkward as you reach some places in your mouth.
• Remember, more is NOT always better! Brushing or flossing too hard can be damaging to your teeth and gums. And never saw back and forth with your floss.

To learn more about oral hygiene, including brushing and flossing techniques, you can continue reading the Dear Doctor article “Oral Hygiene Behavior - Dental Health For Life.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, review your brushing and flossing techniques, and discuss any questions you have as well as treatment options. As needed, we will work with you to teach you the proper brushing and flossing techniques so that you feel confident before you leave our office. And to read the entire interview with Nate Berkus, please see the Dear Doctor article “Nate Berkus.”

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

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

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

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

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

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

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

In today's fast-paced society, nearly everyone is looking for reliable solutions to resolve problems almost instantly. Unfortunately, in many situations, bad breath cannot be cured that quickly. This is why we want to provide you with the following rules of thumb for treating your bad breath.

• Use a soft-bristled brush and a proper technique to clean your teeth at least twice a day, in the morning when you wake and before you go to bed.
• Floss your teeth at least once daily to remove the bacterial plaque and food particles between your teeth, as these are two known causes of bad breath and tooth decay.
• Clean your tongue, as it can often be the main culprit with too many odor-producing bacteria living on its surface. To clean your tongue, use a tongue scraper obtainable from a local drug or discount store, or brush your tongue with your toothbrush. Remember, a healthy tongue should be pink in color and not have a yellowish or brownish coating.
• Chew a sugar-free gum that contains xylitol, a natural, sugar-free sweetener that actually has been shown to help prevent caries (cavities) while improving your breath.
• Change your eating and drinking habits. Drinking plenty of tap water will not only keep your mouth hydrated (a dry mouth is another cause of bad breath), but it also can help prevent caries if you live in an area with fluoridated water. And by adding plenty of crunchy fruits and veggies such as carrots, celery and apples, you stimulate the production of saliva; thus keeping your mouth moist and rinsed out.

And last but not least, you can contact us today to schedule a consultation for an examination, cleaning and treatment plan. Or, you can learn more when you read the Dear Doctor article, “Bad Breath — More Than Just Embarrassing.”