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How often should one see the Dentist?
The American Dental Association (ADA) recommends a routine check-up once every six months (exam & cleaning). X-rays should be taken as needed.

What X-rays should be taken and why?
Bitewings are recommended every 12-18 months and are taken to radiographically diagnose the presence of interproximal caries (i.e. cavities between teeth). A full mouth or Panoramic x-ray should be taken every 36 – 60 months. This x-ray is diagnostic, in that it shows the entire mouth, and any anomalies / pathology of the hard tissues that may exist. Once identified, appropriate treatment can be rendered. It also provides the clinician a means to evaluate the level of bone, any abscesses or abnormalities which should ordinarily not be present.

Am I getting too much radiation from Dental X-rays?
No. The equipment that is used these days is so efficient, and the film speed so fast, that excessive radiation exposure is no longer of any significance. This by no means indicates or suggests that x-rays should be randomly taken without indication or merit.

When should my child get his/her first cleaning and check up?
The ADA recommends that a child’s first check up be at age 3.

Should my child be taking supplemental fluoride?
Fluoride seems almost ubiquitous in today’s environment. If however, you live in an area where the water is non-fluoridated (well-water), then supplemental fluoride should be prescribed for the child. Consult your dentist or physician for a prescription and appropriate dosage. If your water supply is fluoridated, then you do not require supplemental fluoride for your child.

Is taking too much fluoride bad for me or my teeth?
Yes. Fluoride if consumed in concentrations greater than 1 PPM (part per million) for extended periods of time can result in a dental condition known as Fluorosis. Fluorosis, in severe cases can result in the deformation of the tooth enamel, making it appear "mottled" with brown pits.

What kinds of foods should I not be eating?
Foods and drinks that are high in sugar content, sticky foods such as caramels, dates and graham crackers should be kept to a minimum. Foods that stick to teeth cause more dental disease than similar amounts of sugar in less sticky forms or in liquids. Frequent consumption of sugar rich foods without adequate brushing is a sure request for dental disease.

Is chewing gum good for me?
Sugar-free gum has been shown to clinically reduce the incidence of caries, when chewed immediately following meals.

How often should I brush/floss my teeth? What is a good hygiene regimen?
The regimen I recommend to my patients is the following – for Morning and Night:

- Pre-rinse with Plax
- Brush with a fluoride toothpaste (your choice) for at least 2 minutes
- Rinse (water)
- Brush your tongue
- Rinse (water)
- Flossing (night time only)
- Rinse (mouthwash or water – patient preference)

Using an electric rotary toothbrush is far more efficient and effective in overall plaque removal and massaging of the gums. The one we recommend and dispense to patients (at a substantial discount) is the Braun Oral B Ultra 4-head with built-in timer.

What are Sealants? What teeth should be sealed? Am I too old for Sealants?
Sealants are basically resins which are flowed into the grooves of teeth (back teeth) to help reduce the likelihood of cavities. They can be placed on primary and / or permanent teeth (molars and premolars). The new generation of Sealants are themselves fluoride releasing for yet added benefit. Any posterior tooth that has grooves which are deep and has no evidence of caries or an existing filling, is a candidate for a sealant. There is no age limit at which a person can have sealants placed. Many insurance companies however, will only pay for Sealants through age 14.

How should I select a Dentist?
Do not choose a dentist solely on fees, or because my insurance company says I have to see Dr. X, Y or Z. Find out something about the dentist; ask for a tour of the facility; ask to speak with the dentist: ask other patients who see the dentist about the quality of care they are receiving.

Patients seeking low dental fees can usually find them, but the fees are usually low for a reason – cheap materials, old equipment, inadequate sterilization techniques, antiquated clinical techniques – often low quality, less complete service. This can invariably lead to irreparable situations, premature tooth loss and expensive future treatment or re-treatment. Similarly, high fees do not necessarily mean quality care either. Therefore, don’t select a dentist based solely on fees.

How do I know if my tooth is dead and when do I need a Root Canal? Are they guaranteed to work? What if they fail? Are they very painful?
Invariably one doesn't know that a problem even exists, because the patient is asymptomatic – no complaints of any pain. Upon clinical examination, a discolored tooth is generally a pretty good indication that the tooth is non-vital (dead). Upon vitality testing of suspicious tooth, an electric current is passed through the tooth. A tooth which is alive will respond immediately. One which is almost dead, might barely respond, and one which is dead will be non-responsive. A tooth which has a large carious lesion (decay) that is approximating the pulpal chamber (nerve) might also be a candidate for a root canal. These are all indications for a root canal.

Root Canals, if performed properly, enjoy a very high success rate. There is no guarantee that every root canal will succeed. Sometimes they fail – even the best, text-book root canal fails sometimes for no apparent reason. Treatment options then can include re-treatment of the root canal, a microsurgical procedure known as an "Apicoectomy", or the patient might elect to have the tooth extracted. In terms of pain, root canals cover a very broad spectrum of pain -- from absolutely painless to outrageously painful. We always tell our patients not to wait for the pain, despite all the horror stories they have heard. If it’s present, it will hopefully be very short-lived and the pain-medications will help lessen the pain.

Does a tooth which has had a root-canal always need a crown?
Always – No. In instances when a large amount of tooth structure is lost due to decay, then yes the tooth should be protected with an onlay or a crown (generically referred to as a "cap"). If the tooth has an excessively large filling with evidence of fracture lines in the remaining natural tooth structure, and is in a stress bearing area of the mouth, that too is an indication for a crown or onlay. Invariably, teeth in the front of the mouth do not need crowns even after root canals. If they radically discolor, other options such as bleaching or veneering might be treatment possibilities.

What causes discolored teeth?
Many conditions may cause the teeth to be discolored (brown, gray, yellow, orange, black, etc.) Some of the causes include foods, chemicals ingested during the early years of life (ex: Tetracycline), injury to the primary teeth affecting the permanent developing tooth follicle, excessive fluoride ingestion during the first few years of life, genetic conditions, childhood diseases, external stains due to foods, smoking, etc.

What can I do about the spaces between my front teeth? Fractured front teeth? Irregularly shaped front teeth? Worn down front teeth?
Cosmetic procedures ranging from inexpensive (Bondings) to expensive (Veneers) are all treatment options to correct the cosmetic appearance of these commonly occurring conditions, and give you the smile you deserve.

What are Implants? When can they be used? Are they permanent?
Implants are basically root forms that are placed inside your jaw bone by an oral surgeon or periodontist. The patient must first be evaluated radiographically and clinically by both the general dentist and the surgeon to see if he/she is a candidate for implants. The determining factors are the patients pre-existing medical conditions, the amount of bone present (both quality and quantity), the patients oral hygiene status, etc. If all these criteria are satisfied, then success of the implant now and long-term can be realistically appreciated. Once placed, they generally stay undisturbed for a period of six months to a year to achieve osseointegration, the inter-weaving of the bone matrix within and surrounding the implant to secure it. Once sufficient osseointegration is achieved, the restorative phase can be undertaken. Implants can be for single tooth replacement, for bridges, and for partial or complete dentures. Each of the following applications, requires a specific type of implant.

What is TMJ and TMD?
TMJ stands for Temporomandibular Joint and TMD stands for Temporomandibular Dysfunction. The causes for TMD are numerous and patients suffering from TMD or chronic facial pain should consult with a dentist immediately for treatment.

What is the treatment for grinding and clenching?
Grinding and clenching these days is unfortunately, all too common. It appears to be a stress induced response, and one which is invariably treatable by utilization of a simple splint. Grinding is referred to as bruxism and is more a "nocturnal" habit (night-time).

Clenching, on the other hand, is a "diurnal" habit (day-time). Once, the cause has been established, a splint is custom made for the patient to wear (day or night) to help reduce the deleterious effects that this parafunctional habit causes. Two of the best splints available these days for this condition are the "Brux-eze" and the "Reme-deze". Usually this modality of treatment is sufficient in obtaining a favorable result. If unsuccessful, then other regimens can be utilized.

What are the different types of Dental Specialists?

Endodontist - deals with Root Canals
Orthodontist - deals with Braces & TMJ correction
Periodontist - deals with the Gums and gum surgery and Implants
Oral Surgeon - deals with Extractions, surgeries, Implants & TMJ correction
Pedodontist - Pediatric dentist
Prosthodontist - deals with Crowns, Bridges and Dentures

What is Gingivitis and Periodontitis?
Gingivitis is basically inflammation of the gums in response to an irritant. It can be mild, moderate or severe. All forms of gingivitis are generally reversible with improved oral hygiene and some interceptive treatment. The more advanced cases might require a gingivectomy, which is the surgical excision of the redundant tissue. Causes of gingivitis include lack of good oral hygiene, drug induced (side-effects), hormonal to name a few.

Periodontitis, on the other hand, involves bone loss. It too can be mild, moderate or severe. The worse the condition, generally the worse the prognosis. Bone-loss is non-reversible, at least not naturally. Surgical placement of synthetic bone to correct periodontal defects can be performed for moderate to severe cases.

Words of Wisdom: "Be True to your Teeth, or your Teeth will be False to You!!" (Anon).

What is a Deep Cleaning and why do I need it?
A Deep Cleaning is properly termed "Periodontal Scaling and Root Planing". It is a cleaning which, instead of cleaning from the gumline up onto the tooth, is a cleaning done under anesthesia, starting at the gumline and extending beneath the gum onto the surface of the root. It is a procedure which is recommended when the calcified deposits present in the mouth are heavy supra and subgingivally; the gums appear irritated and bleeding in response to the presence of these accretions; is radiographically evident; and is more than a routine cleaning can accomplish. Typically there is also "pocketing" the extent of which is measured using a "Periodontal Probe." After the deep cleaning is performed, with patient compliance and improved oral hygiene, the patient should experience a significant difference in his/her oral health

My teeth are becoming increasingly sensitive -- what can I do to help reduce the sensitivity?
When the gums start to recede, either due to periodontal disease or physiologically as one grows older, nerve endings which are housed in the "cementum" the covering of the root become exposed, and when stimulated, illicit a response. They are generally sensitive to cold, sweet, acidic foods. There are a number of treatment modalities that can be used to help reduce or eliminate the discomfort. The simplest method would be to use a desensitizing toothpaste like Sensodyne, Crest Sensitive, Aquafresh Sensitive, or any other sensitive formulation. Regular usage twice a day for 8-12 weeks should show signs of improvement. If that doesn’t work, then desensitizing medicaments (prescription) can be topically applied in the office and a prescription given for home use. They are generally quite effective and offer immediate results. If the area of cervical erosion is too deep (at the gumline), then a tooth colored restoration can be bonded to eliminate both the sensitivity as well as the tooth defect.

What are some of the causes of Bad Breath? What can I do about it?
Unpleasant mouth odor is scientifically referred to as "Halitosis". It can be the result of many conditions, such as periodontal breakdown, ill-fitting restorations (fillings or crowns), digestive system problems, sinus infections, nose disorders, certain foods, especially those high in sulfur content, to name a few. Food which is trapped under defective crowns or bridges, or in-between teeth with ill-fitting broken restorations, decompose and ferment, sometimes also in the presence of pus, and illicit a very foul taste and smell. Treatment measures should include improved oral hygiene, a comprehensive oral examination with x-rays, evaluation of existing restorations, and replacement of defective restorations. Effective mouthrinses (TriOral) are available at the office for purchase that eliminate the volatile sulfur compounds that cause halitosis.

Why is a bone graft sometimes recommended when I am having an extraction?
As of recent, bone replacement therapy, is becoming increasingly popular in extraction situations. Two of the best systems and the ones we use at our practice are "Perio Glass" (Block Drug Company) and Bioplant HTR Polymer (Septodont). What this bone replacement therapy does is prevents bone loss which naturally occurs whenever a tooth is extracted, thus preventing future problems. By replacing the bone immediately at the time of extraction, one eliminates having to undergo a future surgery for bone augmentation, and accomplishes a strong and secure foundation for future dental implants, crowns, bridges, dentures. When a tooth is extracted and the site is not appropriately addressed, bone loss occurs and can be in excess of 60%. When this bone resorption occurs over the years, bridges start to have food collecting under them, dentures become loose, and this situation which could have been prevented or lessened, is now a reality. Placing bone in an empty socket (especially in lower wisdom teeth situations) can often significantly reduce an exceedingly painful post-operative condition referred to as a "Dry Socket" (Acute Alveolar Osteitis). For what it costs and what it offers in return, it is truly one of the biggest bargains that dentistry has to offer.

Why do I need to replace some teeth that are missing in the back? Nobody sees them?
That may be true, but that is not the way that teeth were made to function. Teeth like to have adjacent and opposing teeth to keep them in sync. When a tooth is prematurely lost, some sort of replacement should be considered by the patient to be inserted four to six months post extraction. This limits the amount of drifting, tilting, rotation, extrusion, etc., which will result the longer that space exists. The replacement can be as simple as a space maintainer to as elaborate as an implant; removable as in a denture or fixed as in a bridge.

Dentures are ugly – I don’t want everyone to know that I have dentures? I don’t want to be eating dinner and have my dentures fall into my soup?
These are some of the most common concerns patients have. Dentures, if well made are very retentive and do not present any of these problems. A whole new generation of thermoplastic dentures are now available, and are what we almost exclusively utilize. They are the most esthetic, most comfortable and natural looking dentures available – no visible metal whatsoever, so you can smile away and nobody knows you have any dentures. These are a group of what we call specialty dentures, and are not the dentures that insurance companies allocate benefits for. Dentures of this classification include -- Valplast, Virginia Partials, Flexite, Valplast to Vitallium.

I see this gray band around my crown on my front tooth – what can I do about it?
The most common crowns, even today, are the porcelain fused to metal crowns. The substructure is metal, onto which is baked an "opaquer" and onto that the porcelain. The gum tissue being thin at the margin allows the collar of the crown to be visible and hence that gray outline. There are also numerous specialty crowns that are available today, which are almost every bit as strong as conventional porcelain-metal crowns, but exceedingly esthetic. There is no comparison in the esthetic component of these specialty crowns, but again these are not crowns that insurance companies allocate benefits for. Crowns of this classification include -- Occlusal Glass, IPS Empress, Wolceram, Captek, Procera, Occlusal Gold, to name some.

What different Sensitivities mean dentally –

Sensitive to Sweet - generally denotes decay which might be deep, and requires prompt attention.
Sensitive to Cold - also denotes presence of decay, usually alleviated by the placement of a filling.
Sensitive to Heat - usually denotes nerve involvement, and treatment is usually in the form of a root canal.
Sensitive to Pressure - also indicates nerve involvement, and treatment is also in the form of a root canal.
Pain on Chewing - usually denotes a condition known as "Cracked Tooth Syndrome". Treatment is usually in the form of an onlay or a crown.
Pain on Percussion - generally indicates trauma from occlusion and a widened Periodontal ligament. An occlusal equilibration will usually help limit the discomfort.

My mouth is always dry – what causes Dry Mouth?
Xerostomia (dry mouth) can be a result of aging, salivary gland problems, certain pre-existing medical conditions (ex: Sjogrens), numerous medications, to name a few. This condition can influence speech and can cause an increase in the incidence of caries (decay). Saliva substitutes (prescription and OTC) should be used frequently and treatment to reduce or eliminate the causative agent should be sought.