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Frequently Asked Questions


Endodontics


Q I had a toothache and my dentist told me I need a root canal. He put me on antibiotics and it stopped hurting. Do I still need the root canal?
A Yes. Even though your tooth feels better since your dentist prescribed antibiotics, the underlying disease process did not change. Patients sometimes believe that antibiotics will "cure" a dental infection in the same way they can cure a medical infection such as strep throat. However, this is not the case. Once the inside (pulp) of a tooth becomes diseased, a root canal (or extraction) is necessary even if you are not experiencing pain or swelling.

Q Why do I have to have that rubber thing on my mouth when I have a root canal?
A That 'rubber thing' is called a Dental dam, or rubber dam and it is an absolute requirement for root canal treatment. The dental dam is important for many reasons. First, the dam protects the patient from swallowing or aspirating instruments or materials. It also keeps the operating field aseptic and improves visualization for the dentist. During root canal treatment, one of the main objectives is to eliminate bacteria in or around the root canal system. Having rubber dam isolation greatly improves disinfection because it prevents bacteria from the oral cavity from entering the tooth during treatment.

Q I was told by my dentist that I needed a root canal. What is root canal treatment?
A Root canal treatment is a very successful procedure and permits the patient to keep a tooth that otherwise would require extraction. Treatment is necessary when the pulp tissue inside the tooth (nerve) becomes diseased and is irreversibly damaged. Frequent causes for injury include bacteria from dental caries (decay), trauma, and coronal cracks. During treatment the dentist makes an opening in the top of the tooth and cleans the diseased or necrotic (dead) nerve tissue and bacteria from inside the root. The resulting space is sealed with an inert filling material to prevent future leakage of bacteria from saliva. Following the root canal treatment, a new filling or crown is required.

For additional information see: Endodontics Department

 


General Dentistry


Q Are athletic mouthguards necessary?
A In order to protect your smile during athletic activities a mouthguard is crucial. A properly fitted mouthguard will help cushion an impact to the mouth. Mouthguards can protect you from broken teeth, jaw injuries, or cuts to the lip or tongue. Dental health professionals can fabricate a mouthguard for you or your child which will offer a custom fit. If a custom mouthguard is not feasible, discuss other types of mouthguards with your dentist.

Q Do you think extra fluoride would help prevent cavities, or is there enough fluoride in toothpastes?
A Fluoride has reduced the rate of cavities more than any other method of decay prevention. However, too much ingested fluoride can cause unesthetic spotting on teeth. Most community water supplies in our area are optimally fluoridated, so between using fluoridated toothpastes and using community water supplies, additional fluoride might not be needed for most people. However, for added cavity protection for teens and adults, daily rinsing with fluoride mouthrinses also can be beneficial. If you see a dentist who determines that you are at high risk for development of cavities, he/she might prescribe some prescription dispensed fluoride that is even more concentrated, so consult your dentist to determine how much fluoride is best for you.

Q Is it true that the teeth that have been broken due to an accident can be reattached?
A A frequent trauma related dental injury is a fractured tooth. To increase success with this emergency situation, your dentist should be contacted immediately. If possible the tooth fragments should be found, rinsed with water and kept moist. In some situations, the fragments may be reattached to the tooth. If this is not possible, the tooth often can be restored with resin composite with excellent esthetic results and minimal removal of the tooth structure. If the fracture is severe, root canal treatment and eventual crowning may be necessary. Remember that most sports related dental injuries may be prevented by using a mouthguard.

Q Can I help prevent oral cancer?
A Your dentist should look for signs of oral cancer in your mouth at every routine checkup. You can help your dentist by advising him/her of any unusual color changes in the tissues in your mouth (red or white areas), abnormal growths, ulcerated areas that don't heal, areas of numbness or pain, or any problems with chewing or swallowing. Oral cancers often are found on the sides of the tongue, under the tongue, and on the soft palate, though they can occur on any soft tissues throughout the mouth. People who drink alcohol or smoke are more likely to get oral cancer, but anyone can get it, which is why early detection is so important.

Q I thought cavities were a problem for kids but not adults. As an adult, can I still get cavities?
A As long as you have teeth, you can get cavities. Cavities result from bacteria in your mouth that feed on carbohydrates in your diet. As the bacteria feed on the carbohydrates, they release acid that dissolves away tooth structure. As people age, they tend to get cavities around old fillings or crowns, or on root surfaces that have become exposed due to receding gums. People with dry mouth tend to have more problems with cavities than other people who have normal salivary flow. Everybody has bacteria in their mouth, so if you still have teeth and still eat carbohydrates, you can still get cavities.

Q How can I close spaces between my front teeth without braces or crowns?
A One of the best ways to close spaces between front teeth is by bonding composite resin to natural tooth structure to change the width of the teeth. This technique requires minimal or no removal of tooth structure, therefore does not affect the strength and vitality of the natural tooth. The dentist can select composite resin from a variety of shades, making sure the restorations blend perfectly with the rest of the dentition. The composite resin becomes an extension of the natural tooth and the distinction between the two is imperceptible. This treatment option provides excellent esthetic results while being very conservative, entirely reversible, fast and economical in comparison to braces or crowns.

Q What does an implant examination and diagnostic work up involve?
A In order to achieve optimal results, treatment with dental implants requires planning. At your initial visit we will assess your suitability for implant treatment by evaluating the volume of your available bone with X-rays; checking your bite; taking impressions of your teeth; and discussing your expectations. Sometimes, more sophisticated imaging procedures such as a cone beam CT may be required to provide more information. We have all equipment and expertise for the necessary imaging procedures located right in our clinics. The information gathered is used to visualize the final result in order to allow for ideal placement of your implant(s).

Q I haven’t been to the dentist in 10 years because nothing hurts. Wouldn’t my teeth hurt if they had a problem?
A Most often, cavities don’t start to hurt until they are very large; most people who have had fillings had them before they knew there was a problem. Also, most often gum disease doesn’t hurt at all, so you would only know there was a problem when a tooth became loose, and by then sometimes it’s too late to deal with. Oral cancer sometimes can hurt but many times it doesn’t. If it’s been a long time since you’ve seen a dentist, it’s a good idea to have a comprehensive oral examination and dental radiographs (x-rays) made, just to be sure you haven’t developed any problems that you don’t know about.

Q I would like to improve my smile. What options do I have?
A Many options are available nowadays to improve people's smiles, such as braces, whitening or bleaching, crowns and porcelain veneers. Every smile change needs to start with a proper diagnosis to evaluate individual considerations and desires, your bite and your smile. We believe in minimal and conservative intervention to improve your smile. We have all the diagnostic knowledge, experience, and state-of-the-art tools to provide you with an understanding and with realistic treatment options so that we can help you select the best way to achieve the smile you seek.

Q I have heard that soda pop can affect my teeth. What problems does it cause and is diet pop OK?
A High frequency consumption of soda pop is one of the major risk factors that cause dental decay. A twelve ounce can of soda such as Mountain Dew has eleven teaspoons of sugar and is very acidic. The acid can dissolve enamel and when combined with sugar provides the perfect environment for bacteria which cause decay. Diet soda does not have the sugar, but has the same acidity and therefore can create erosion. If drinking pop, minimize its use, choose diet over regular, and drink it quickly with a meal or snack. It is preferable to select water or other sugar-free non-acidic beverages.

Q Should I have the silver fillings in the back of my mouth replaced with tooth colored ones?
A There are excellent options for placing tooth colored fillings in the teeth in the back of the mouth. These include restoration with directly placed composite resin, porcelain inlays, or crowns. Tooth colored fillings cannot be placed in all situations, however, and may have limitations such as reduced longevity or increased cost. Silver fillings can provide excellent long term service in the mouth. Research studies have not shown silver fillings containing mercury to cause health related problems. Their replacement should be for reasons due to restoration failure, decay or esthetic improvement purposes.

Q I do not like the spaces between my front teeth. What can I do?
A Before we can present you with appropriate options, we first need to determine why you have those spaces. Depending on your individual circumstances, the options may range from braces to bonding. Bonding a tooth colored material to your existing tooth, to close those spaces, is quite often the most conservative and reversible option. In most cases this “Bonding” option does not require removal of any part of your tooth. New materials are capable of imitating natural tooth structure very realistically, so nobody can tell you have had anything done!

Q My teeth are sensitive when I drink something cold. What can I do about it?
A Tooth sensitivity can be due to a variety of causes. These can include decay, faulty fillings, and exposed root structure. It is best to visit your dentist to determine the cause. If it is decay or defective fillings, the problem should be fixed by the dentist. If it is exposed root structure, there are a variety of options including varnishes or solutions that the dentist can apply in the office. There are also other at home options such as fluoride gels and desensitizing pastes. Some sensitive situations will resolve and not return, but others may have to be retreated periodically.

Q May I receive dental treatments during pregnancy?
A Recent research has shown that the oral health of pregnant mothers can affect the health of their babies. This two-page document informs pregnant women, physicians, and dentists about dental care for the pregnant patient: Oral Health and Your Baby.

 


Oral Pathology, Radiology and Medicine


Q I have heard that there is such a thing as a cone beam CT x-ray machine designed for dentistry. What is this and should my dentist have one?
A Cone beam CTs (CBCTs) are a family of units, each slightly different based on the manufacturer, like cars, but each basically similar. These units produce images that are 2D and 3D, and can be used for dental implant planning, to localize impacted teeth and look at some other disease processes involving the jaws and TMJs. The radiation dose for CBCTs is considerably lower than for standard CTs (1/10 to 1/100), but they do not show most soft tissue (non bone) very well. Also, these are expensive units, and to diagnose from them requires specialized training and knowledge. Your dentist can refer you to such a person, if there is a need.

Q I have been bothered with canker sores for a number of years. What are canker sores and can anything be done to treat them?
A Canker sores are also called aphthous ulcers. They appear within a day or two, usually heal in 7-14 days, and can be painful and annoying. We do not completely understand what causes canker sores, but they are not an infection and are completely different from fever blisters which occur on the outside of the lips and are caused by a virus. The discomfort caused by canker sores can be controlled by using topical steroid mouth rinses and ointments. Your local dentist should be able to prescribe these medicines for you.

For additional information see: Oral Pathology, Radiology & Medicine

 


Oral Surgery


Q At a recent dental exam, my general dentist noticed an area on my gums which concerned him. He has recommended that I see an oral and maxillofacial surgeon for evaluation and possible treatment. Why?
A Oral and maxillofacial surgeons are well trained in the identification and treatment of pathologies of the oral and perioral hard and soft tissues. After taking your history and a careful clinical exam, they can advise you on the need for further tests or observation or the need for a biopsy to determine the exact diagnosis and need for treatment of the lesion. Their training and expertise can provide evaluation, management and possible surgical care for all the pathologies which present in the oral cavity and perioral tissues.

Q Does the oral surgeon always use sutures when removing impacted wisdom teeth (3rd molars)?
A The use of sutures depends on the type of tooth impaction. Sutures are used to hold the tissue in place until initial healing occurs (usually around 7 days). Most impacted teeth require some suturing. These sutures are commonly resorbable(dissolve in the mouth) and do not need removal in the office. Your oral surgeon will explain if sutures were used in the surgery, and how to manage them in the healing period.

Q I have osteoporosis and I take a bisphosphonate drug to help strengthen my bone structure. Recently I heard these drugs can interfere with bone healing in some people. Is that true?
A Bisphosphonate drugs have been used intravenously to help cancer patients and orally for patients with osteoporosis. These drugs have improved the quality of life forpatients with metastatic cancer that involves the skeletal system. They have also been extremely effective in the prevention of bone fractures in patients with osteoporosis. Unfortunately,there have been reports of an increasing number of cases of osteonecrosis of the jaw. This condition is characterized by an area of nonhealing, exposed jaw bone which can lead to severe loss or destruction of the jaw bone. The majority of these cases have been related to the injectable form of bisphosphonate however there has been a small percentage related to the oral form. Most cases of osteonecrosis have been diagnosed after dental procedures such as tooth extraction however the condition can occur spontaneously. Patients who have been taking bisphosphonates and are considering elective dental surgery should speak with their prescribing physician, family dentist, or oral and maxillofacial surgeon about the risks and benefits of continuing treatment.

Q My dentist recommended that I have my wisdom teeth extracted. Will I have to stay home from school?
A Usually the postoperative course is influenced by the complexity of the extractions. In most situations the patient is advised to stay home for a couple of days following the removal of the wisdom teeth. This is due to the occurrence of post op discomfort and swelling which often tends to reach its peak within forty-eight to seventy-two hours after surgery. Ultimately the recuperative period will depend on the individual's ability to heal.

Q I lost a tooth sometime ago and now worry that I do not have enough bone to allow dental implant placement. Do I have options if bone is missing?
A Your Oral Surgeon can advise you if there is sufficient bone to allow dental implant placement by examining you and reviewing your x-rays. Bone grafting is an option to make you an implant candidate. Various bone grafting materials can be used including your bone, bank bone, bovine bone mineral or other bioactive substance that promotes bone growth. Bone grafting for dental implants has become common and quite successful, enabling you to move ahead with dental implants versus conventional restorations such as a bridge.

Q I have been told that my jaws do not “match” one another affecting my bite and profile. What are my options for treatment?
A Discrepancies between the upper and lower jaws can be significant and may require surgery in conjunction with orthodontic care. Such surgery is termed “orthognathic” and can be used to correct many skeletal(bony) abnormalities of the jaws. It is usually covered by medical insurance. A few examples include: retrusive or small lower jaw; protrusive or large lower jaw; gummy smile or long upper jaw. Crooked or asymmetric aws can also be fixed. See your oral surgeon and orthodontist to discuss proper diagnosis and treatment.

Q My child has a bump on their lower lip. It periodically swells, then "pops" and decreases in size. What is this?
A A bump on the lips or within the oral cavity should be evaluated by your dentist. An area that swells periodically and then decreases in size is most typically a mucocele. It forms due to blockage of minor salivary glands. This creates a swelling filled with mucous from the gland. Treatment of a mucocele requires removal of the soft tissue enlargement and underlying minor salivary gland tissue. An oral and maxillofacial surgeon would evaluate the area and perform removal in their clinic.

Q My child was seen by his orthodontist and he recommended having teeth removed to facilitate his growth and dental development. Our general dentist referred us to an oral and maxillofacial surgeon for their removal because my child is extremely fearful and apprehensive. Why?
A You were referred to an oral and maxillofacial surgeon because of their training and expertise in anesthesia and their ability to safely and comfortably manage the surgical experience for your child. As part of their residency, they have full training in anesthesia and can provide care from local anesthesia to conscious sedation and outpatient general anesthesia. All of these anesthesia modalities are provided in an office setting and will allow your child to have a safe and comfortable surgical experience without the need and cost of hospital care. There are many anesthesia options which you and your surgeon can discuss to provide an optimal experience for your child.

Q My child has a baby tooth that has been loose for some time but it hasn't come out yet. I can see the permanent tooth coming in behind it. Do I need to do anything?
A You should see your dentist or pediatric dentist to evaluate your child's teeth if a loose tooth does not come out on its own or if the permanent teeth proceed to erupt when the primary teeth is still in place. They will examine the area and make radiographs. They may recommend removal of the primary tooth to facilitate the eruption of the permanent tooth in a timely fashion.

Q My seventeen year old daughter told me that she wants to get her tongue pierced. I don't feel comfortable with this. What do you suggest?
A Common symptoms after oral piercing include pain, swelling, and occasionally infection. It may also induce a slight change in speech and periodically contribute to chipped or cracked teeth. The oral cavity is very vascular, especially the tongue. If a blood vessel is penetrated during the piercing severe bleeding can occur which may be difficult to control. As mentioned earlier, swelling of the tongue can be a common side effect. In extreme cases the swelling can become so severe that it can compromise the airway and prevent breathing. I would advise against it. She may think it's fashionable now but many young people are not aware of the potential complications that can occur.

Q I need to have a tooth removed and my dentist suggested a dental implant. What is a dental implant?
A Dental implants are a titanium implant that is placed into the bone of the upper or lower jaw. It replaces the root of the missing tooth. The bone integrates, or heals directly to the surface of the implant, which gives it longevity. Once this healing has occurred, your dentist makes a crown, or tooth, to go on top of the implant.

Q What is an oral and maxillofacial surgeon?
A An oral and maxillofacial surgeon has received extensive training and experience in the diagnosis and management of impacted teeth, misaligned jaws, and dental related infections of the head and neck. They also treat accident victims suffering facial injuries, perform jaw reconstruction with bone grafts, care for patients with tumors and cysts of the jaws, and provide dental implant surgery for patients who are missing teeth.
Another significant aspect of their training is the acquisition of knowledge and skill in advanced and complex pain control methods, including intravenous sedation and ambulatory general anesthesia. Thus, the oral and maxillofacial surgeon is able to provide quality care with maximum patient comfort and safety in the office setting.

Q Should my wisdom teeth be removed if they haven’t caused any problems yet?
A Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. Third molars however frequently become impacted due to a lack of space in the dental arch and their growth and eruption may be prevented by overlying gum, bone, or another tooth. Impacted third molars can be painful and lead to infection. However, not all problems related to third molars are painful or visible. These teeth may eventually crowd or damage adjacent teeth or roots. Sometimes they may even be associated with the growth of certain cysts or tumors. As wisdom teeth grow, their roots become longer and therefore more difficult to remove. This is why it is often recommended to remove impacted third molars when the roots are one-third to twothirds formed, usually between the ages of seventeen and twenty.

For additional information see: Oral & Maxillofacial Surgery

 


Orthodontics


Q There has been a lot of media attention recently about extreme makeovers. How can orthodontic treatment help achieve an ideal smile makeover?
A Orthodontic treatment can be extremely helpful to achieve a smile makeover. For example, orthodontic treatment can place the teeth in better positions to correct the bite and eliminate crowding so that it is easier for the restorative dentist to improve the appearance of the teeth. A smile makeover without orthodontic correction may require reshaping and removal of tooth structure to adjust for crowding or faulty positions of the teeth. Often, an extensive makeover can be eliminated with orthodontic treatment and patients may only desire whitening or relatively small corrections of blemished or worn teeth.

Q I know orthodontic treatment provides cosmetic benefit, but what are some of the other reasons for having braces?
A Adults and children benefit from orthodontic treatment to correct the bite, alleviate crowding and improve alignment, thus improving function, facilitating proper oral hygiene, and preventing possible future dental problems such as increased wear of teeth. For children, orthodontics is not only important for alignment of teeth, but treatment may help correct jaw discrepancies through some modification of jaw growth in combination with tooth movement and bite correction. Children also benefit through correction of problems when teeth do not erupt normally and reduction of overjet (“buck teeth”) to minimize trauma and fracture of front teeth.

Q My dentist has recommended my daughter see an orthodontist because her canine teeth are not coming in correctly. How will this be corrected?
A Depending on the exact position of the canines and if the patient is seen early enough, the orthodontist may be able to help redirect the eruption path of the canines so that they will erupt normally. However, if the patient is already past the age of the normal canine ruption time or the positions of the teeth are significantly abnormal, the orthodontist may need to assist in the eruption of the teeth by employing surgical uncovering of the tooth and orthodontic tooth movement.

Q Can I select my orthodontist myself?
A Yes. A good starting point is for your family dentist to make a recommendation. If this is not an option, a good source of information is the American Association of Orthodontists (www.braces.org or 1-800-787-2444). There will be a directory of orthodontists in your area who have graduated from an accredited orthodontic program.

Q What is Invisalign?
A Invisalign is a form of orthodontic treatment that utilizes a series of custom made clear retainers to move teeth. Each retainer moves select teeth a tiny amount and then the patient progresses to the next retainer. It is usually more expensive than fixed orthodontics and is more limited in the scope of what can be accomplished compared to traditional fixed braces. It is not recommended for children and is designed for the adult who does not want to wear traditional braces.

Q Do I still need to see my dentist while I am in braces?
A Absolutely yes! I recommend that all of my patients see their dentist at least every 6 months or as recommend by their dentist; in some situations, a patient may need to have professional exams and cleanings more frequently.

Q Is it necessary to have teeth removed for braces?
A Your orthodontist may or may not recommend removal of teeth as part of your treatment. The most obvious reason is for severe crowding or protrusion of teeth. However, there may be many other reasons for the removal of teeth. For example, in young patients, extraction of baby teeth may be necessary to help the eruption of the permanent teeth and to prevent a tooth from being “impacted” or unerupted. In adult and adolescent patients, extraction of teeth may be necessary to correct a bite problem.

Q What is an underbite and what problem does it cause?
A The word “underbite” is used to describe a bite characterized by the lower front teeth biting ahead of the upper front teeth. This situation can be seen in all ages. It may be a sign of an abnormality in the position of the jaws but it can also be caused by just a few teeth that are poorly positioned. In the latter case, the patient may have excellent jaw positions but actually has to position his jaw forward in order to bite because of the faulty tooth positions. Early detection and correction of this situation can help a child greatly.

Q What is meant by a jaw discrepancy?
A I use the term “jaw discrepancy” to describe, in general, situations where jaws do not line up properly in one or more dimensions. For example, most people recognize when someone has a lower jaw that is too far back. Many other scenarios exist such as a lower jaw that is too far to one side, or too far forward causing an “underbite”, or an upper jaw that is too far forward. These situations are skeletal in their cause and are not just due to faulty tooth positions. They result from unfavorable patterns of facial growth.

Q What is surgical orthodontics?
A Surgical orthodontics involves a course of treatment during which a patient who has a major discrepancy between the positions of the jaws has orthodontics in combination with a surgical repositioning of one or both jaws. The surgery is often called orthognathic surgery. Typically, the patient undergoes orthodontic treatment first to carefully position the teeth in each jaw so that when the jaw positions are corrected, the teeth fit nicely together. The patient's braces stay on during the surgery, and after the surgery, the orthodontist then “fine-tunes” the position of the teeth and bite prior to removal of the braces.

Q At what age is a patient too old for orthodontics?
A Fortunately, age does not disqualify someone from orthodontic treatment. As long as a person has healthy teeth and healthy supporting bone and gum tissues, they may be a candidate for orthodontics. Even if someone has had some bone loss around the teeth, they may be able to have orthodontics with careful treatment and monitoring of the gum tissues. One factor that may prevent someone from having orthodontic treatment is the chronic use of a bone density medication called a bisphosphonate; Boniva, Fosamax, and Actonel are examples of such drugs. A specific consultation with an orthodontist is recommended in such situations.

Q At what age do most children begin orthodontic treatment?
A Most children do not need to start treatment until preadolescence when they are starting to loose the last few baby teeth. A relatively small percentage of children will have specific conditions that warrant early intervention including problems such as correction of anterior or posterior cross bites which cause a child to “shift their jaw”, guidance of eruption when there are problems with teeth erupting in the wrong position, and a few very specific jaw position problems. In these cases, the early limited treatment is intended to prevent or minimize future problems and to facilitate comprehensive treatment when all of the permanent teeth are erupted.

Q At what age should I have my children seen by an orthodontist?
A Depending on the recommendation of your child’s general dentist or pediatric dentist, every child should have an initial examination by an orthodontist no later than age 8 or 9. However, your child’s dentist may recommend an earlier or later evaluation based on specific situations. The initial evaluation usually involves a screening radiograph to check for missing teeth or teeth that are erupting in an unfavorable position and a clinical exam to check the bite, jaw positions, and amount of crowding. Then the orthodontist can advise you if there are immediate needs or establish a time for a future follow-up examination.

 


Pediatrics


Q What is Baby Bottle Tooth Decay?
A “Baby bottle tooth decay” refers to cavities caused by drinking liquids containing sugar from a baby bottle. The teeth most likely to be damaged by this are the upper front teeth, but other teeth can also be affected. To avoid baby bottle tooth decay, don't put your child to bed with a bottle containing anything other than water. Other liquids contain varying amounts of sugar ranging from very high amounts (Kool-Aid and juice drinks) to lower amounts (cow's milk). Children are also at risk of developing “Baby bottle tooth decay” if they use a bottle or sippy cup for prolonged periods during the day.

Q Are dental x-rays really necessary for my child?
A X-rays (radiographs) are a vital and necessary part of your child's dental visit. Without them certain dental conditions can and will be missed. They detect much more than cavities. X-rays may be needed to learn more about erupting teeth, diagnose bone disease, evaluate an injury or plan orthodontic treatment. Missing or extra teeth are commonly found on X-rays. Many times if dental problems are found and treated early, dental care can be more comfortable for your child and more affordable for you.

Q My teenaged son drinks too much pop. Is sugar free pop safe for teeth?
A It is not only the sugar in pop that contributes to cavities, but just the acidity (even in diet pop) eats away enamel. We know that sugar + acidity + frequency + plaque bacteria = tooth decay. Drinking diet pop only addresses one factor. High acidity can be found in many canned and bottled beverages including water or tea with fruit flavoring and many energy drinks. Brushing your teeth immediately after drinking pop will not help. Brushing after acid exposure will erode even more enamel. The safest and healthiest beverage is water.

Q Should I be flossing my 4 year old son's teeth?
A Yes, flossing once a day before brushing removes plaque and food particles that can't be removed by brushing alone. The dental floss cleans between the teeth and below the gumline. To floss properly, wrap an 18-inch strand of floss around your middle fingers leaving a 1 or 2 inch section of floss to work with. Holding the floss tightly between your thumb and index finger, gently ease the floss between the teeth. Curve the floss around the tooth, making sure you go beneath the gumline. Slide the floss up and down several times to clean the tooth. Always remember to floss behind the last tooth.

Q How do dental sealants work?
A Dental Sealants are a plastic coating placed on the biting surface of the teeth. They are very effective in preventing tooth decay. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years.

Q My 10 year old daughter wants to bleach her teeth. At what age is it safe to bleach?
A Enamel discoloration can lead to negative self-image and is a valid reason for bleaching, but you are right to be concerned with safety and the appropriate age to bleach. There are a wide variety of over- the counter or professionally applied products. It is wise to have professional advice before using these in children. There are many reasons for discoloration such as stain, trauma, enamel defects, or tooth complexion.’ The dentist can determine the best method for each situation or possibly spot bleach single teeth. Full arch bleaching is not recommended until after eruption of all permanent teeth and is best done after orthodontics.

Q How much radiation does my child get from dental x-rays?
A Pediatric dentists are particularly careful to minimize the radiation exposure that their young patients receive during dental examinations that involve x-rays. With contemporary safeguards, the amount of radiation received in dental x-rays is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead aprons and shields will help protect your child. Modern equipment and the newest technology like digital x-rays, high speed films, and filters are designed to help in minimizing even the small amount of radiation that your child will receive.

Q My children need to go to the dentist but we can't afford it. Can you help?
A Routine dental care is important for all children, but many families cannot easily afford dental care for their children. Depending on your income, you may be eligible for state programs that include dental care as a benefit. Have you applied for Medicaid (Title XIX) or “Healthy and Well Kids in Iowa (hawk-i)? You can apply for these programs through your county's Department of Human Services office. There are other programs available state-wide for specific circumstances (for example, if your child has a disability). Also, if your children are treated in the student clinics at the College of Dentistry, the cost is generally about half of what you would pay in private practice.

Q I heard somewhere that if my child has a tooth knocked out in an accident I should put it in milk. Is that true?
A When a child has a permanent tooth knocked out, the most important thing is to put the tooth back in the socket as soon as possible. This should be done immediately if possible by someone at the scene of the accident. The tooth should be picked up by the crown (don't touch the root) and if dirty it should be quickly rinsed off. Then the tooth should be placed back in the socket and the child should be transported to a dentist who will splint the tooth in place. If it is impossible to get the tooth back into the socket, it is important to store the tooth in a liquid that will keep the cells on the root surface alive. Cold milk is one of the best storage media for this.

Q My child is 10 months old and still doesn't have any baby teeth. Should I be concerned?
A Children's teeth begin forming before birth, and begin appearing in the mouth around six months of age. There is a lot of variation in this timing however, with some children getting teeth as early as four months of age, and others not getting their first tooth until after their first birthday. This wide variation is normal. The American Academy of Pediatric Dentistry recommends that your child's first visit to the dentist be at age one or within six months of the first tooth coming in. At this visit, you can discuss any concerns you have about your child's teeth, including the delayed emergence.

Q Can you recommend some healthy snacks for my children that won't cause tooth decay?
A One of the healthiest snacks for your child's teeth is cheese. Research has shown that Cheddar, Swiss, Mozzarella and Monterey Jack stimulate saliva production which protects teeth from acids. Because of this, cheese actually disrupts the development of cavities especially when eaten between meals or immediately following a meal. Other “teeth healthy” snacks include fresh vegetables, fresh fruit, and yogurt. For beverages, water and low-fat milk are the healthiest for teeth. Snacks to avoid include sticky candy and sugar-containing drinks such as soda pop and Kool-Aid. If your child is going to eat sweets, it is best to have them eat them with a meal rather than between meals.

Q What are things I should know about teething?
A “Teething” refers to the process when new teeth break through a child’s gums. Many children do not experience difficulties with teething, but some children experience discomfort, irritability, and increased drooling. Home remedies that can help with discomfort include giving your child something to chew, such as a teething ring or a cool damp washcloth, and massaging your child’s gums with your finger. Over-the-counter teething gels can be helpful but they should not be over-used. Follow package instructions carefully. Pain relievers such as tylenol or ibuprofen can be used for children experiencing significant discomfort. It is important to understand that high fevers and diarrhea are not normally associated with teething and could be an indication of a systemic problem or an era infection. You should contact your doctor if your child exhibits these symptoms.

Q When will my child start losing her baby teeth?
A Children usually lose their first baby tooth around age 5 or 6 years, although the timing can vary widely from one child to the next. As baby teeth get ready to fall out, the developing permanent teeth cause the roots of the baby teeth to dissolve. Children usually wiggle the baby teeth loose with their tongues and fingers. By the time the permanent tooth is ready to come in, there is often little holding the baby tooth in place besides a small amount of tissue. If your child wants you to pull out a loose baby tooth, grasp it firmly with a clean tissue or gauze and remove it with a quick twist. Apply gentle pressure to the site with a clean washcloth or gauze to stop any bleeding.

Q When should my child first visit a dentist?
A The American Academy of Pediatric Dentistry recommends that a child have an oral exam within 6 months of the eruption of their first tooth but no later than 1 year of age. Although this may seem too early, many children already have dental decay by age 3.

For additional information see: Pediatric Dentistry

 


Periodontics


Q What happens at your first visit with a periodontist?
A At your first visit, your periodontist will review your medical history and dental history, as well as any medications or drug allergies. Your periodontist will examine your gums and their attachment to each tooth by using small measuring instruments to check the space between the teeth and gums, paying attention to any sites that bleed. He or she will also look for any recession of gum tissue and check if any teeth are loose. Radiographs (x-rays) will be taken, to see if there is any bone missing from around the teeth. Your periodontist will discuss the findings with you and then make treatment recommendations.

Q Am I a candidate for dental implants?
A The ideal candidate for dental implants is in good general health and has healthy gum tissues with adequate bone in their jaws to support the implant. If insufficient support is not present, soft and/or hard tissue grafting may be needed. Dental implants are one of the options to replace missing teeth. Your dentist and periodontist can work with you to establish if you are a candidate for dental implants and help you decide what your best option to replace missing teeth is.

Q I have gum recession around a tooth. Can anything be done to fix this problem?
A There are various causes of loss of gum tissue resulting in root exposure. The most common causes are aggressive tooth brushing or gum disease. The first step in treatment of recession is to correct the cause. For patients who have healthy gums and normal support for their teeth, it may be possible to cover exposed root surfaces with gum grafts. For individuals with a history of gum disease, root coverage will be less predictable. Gum grafting involves the use of either your own tissue from another spot in your mouth or the use of commercially available tissue materials. For these procedures, the gum graft is stitched in place at the site of recession. With current techniques, post treatment discomfort is usually minimal, and the healed tissues usually provide a good match with the adjacent tissues.

Q show a lot of gums when I smile. What can I do about this?
A There are several potential causes for excess gum tissue or “gummy smile.” This situation can be caused by certain medications, genetics, tooth wear, the position of the teeth in the jaw, or the growth pattern of the jaw bones. The situation can be worsened by poor oral hygiene. It is important that your periodontist determine the cause to select the proper treatment, which may include removing small areas of excess gum tissue and reshaping of the smile line. Because the results are immediately visible, patients are often surprised at how much their smile has improved.

Q Is there a relationship between tobacco use and periodontal disease?
A Yes, tobacco users are more likely to get periodontal diseases and suffer from the more severe forms. Healing following the various forms of periodontal therapy may take more time. Tobacco use is associated with a number of detrimental effects to the mouth and the body as a whole. There can be a decrease in a patient's immune response (their ability to fight off infections), constrictions of blood vessels in the gum tissue around the teeth, an increased risk of certain types of mouth cancers and bad breath. On average smokers are four times as likely to exhibit signs of periodontal disease as were those persons who had never smoked. The good news is that research suggests that those persons who quit can reverse many of the adverse risks caused by the use of tobacco products.

Q What are the warning signs of Periodontal Disease?
A There are various causes of loss of gum tissue resulting in root exposure. The most common causes are aggressive tooth brushing or gum disease. The first step in treatment of recession is to correct the cause. For patients who have healthy gums and normal support for their teeth, it may be possible to cover exposed root surfaces with gum grafts. For individuals with a history of gum disease, root coverage will be less predictable. Gum grafting involves the use of either your own tissue from another spot in your mouth or the use of commercially available tissue materials. For these procedures, the gum graft is stitched in place at the site of recession. With current techniques, post treatment discomfort is usually minimal, and the healed tissues usually provide a good match with the adjacent tissues.

For additional information see: Periodontics

 


Prosthodontics


Q If I have all my teeth pulled and dentures made will I ever have to see my Prosthodontist again?
A The answer is yes. When teeth are pulled the bone that once supported those teeth resorbs, or shrinks as it heals. The denture you have made will fit for awhile, but as time goes on will loosen. This can be problematic as the dentures can rub and irritate the soft tissues that the denture rests on. Overgrowth of the tissue, inflammation, and sore spots can follow because of poor fit. So it is advised that you continue to see your Prosthodontist every 3-6 months during the first year and then yearly for recall after that. They will check the bite and fit to determine if a reline is needed. So even if you wear dentures you should routinely visit your Prosthdontist for check ups.

Q What is a crown?
A A crown is a restoration that covers the entire visible part (crown) of a tooth. Crowns can be cemented onto a natural tooth or onto an implant. The color of a crown depends on the material that is used to make it. A gold crown is yellow in color, although in can be silver in color if less gold is used and if more platinum or palladium is used. A porcelain crown is white and is characterized to match the shade of your natural teeth. The longevity of crowns can vary from patient to patient. Crowns usually fail due to fracture or cavities forming at the margin where the crown joins the tooth. With proper diet, brushing, and flossing crowns can last 8-12 years or longer.

Q What is a Prosthodontist?
A A prosthodontist is a dentist who specializes in esthetic restorations and replacement of your broken or missing teeth. They are specialists who have received 2-3 years of additional training after dental school to learn how to manage complex treatment as it relates to restoring your teeth with crowns, bridges, dentures, removable partials, veneers, and implants. They do this to reestablish both the function of your teeth and to create a pleasing esthetic smile. A prosthodontist is a dentist who specializes in prosthodontics, the specialty of implant, esthetic and reconstructive dentistry.

For additional information see: Prosthodontics