You may get a laugh out of jokes about snoring, but in fact snoring and “Sleep Apnea” (“a” – without; “pnea” – breath) is no laughing matter. Nights of chronically disturbed sleep results in accidents, lost productivity and even depression, as well as problems at work and with relationships. Chronic snoring as a result of sleep apnea, results in sleep deprivation and health problems such as high blood pressure, congestive heart failure, heart attacks, brain damage and strokes.

What causes snoring?
Snoring results when soft tissue structures block the airway (windpipe) in the back of the throat. These structures include tonsils, soft palate, the uvula (the little punch-bag shaped structure at the back of the throat), and fat deposits. As you relax in sleep these tissues collapse onto themselves and the tongue drops back, causing a blockage in the air passage to the lungs. These obstacles to airflow create the familiar sound that we know as snoring.

What is Sleep Apnea?
When the obstruction is severe, it can block airflow completely. Obstructive Sleep Apnea (OSA) occurs when your upper airway is so seriously obstructed that there is significant loss of airflow, or even a complete arrest of breathing for 10 seconds or more. Reduced airflow into the lungs causes low levels of oxygen in the blood reaching the brain. Your brain, saving itself from suffocation, wakes you briefly out of deep sleep, followed by a loud gasp as the flow of air starts again. This can happen more than 50 times an hour. Low oxygen levels and fragmented sleep cause most of the dangers of sleep apnea.

What can be done to combat sleep apnea?
Medical and dental treatment includes:

• Staying physically healthy: Being overweight contributes to OSA, so start by losing weight and exercising.
• Oral Appliance Therapy: Specially designed (retainer-like) appliances are designed to maintain an open, unobstructed, upper airway during sleep.
• Continuous Positive Airway Pressure (CPAP): CPAP bedside machines send pressurized air through a tube connected to a mask (covering the nose and sometimes mouth), keeping your airway open.

How can we help you combat your snoring and sleep apnea?
The first step is assessment and diagnosis. Dentists, specially trained in sleep medicine, are in a unique position to help diagnose and help treat snoring and sleep apnea as part of a medical team. Contact us today to schedule an appointment if you think you have a problem with snoring and OSA — or if your spouse thinks you do. You can learn more by reading the Dear Doctor magazine article “Snoring and Sleep Apnea.”

A consistently dry mouth is not only uncomfortable and unpleasant but also probably more serious than you think. Dry mouth, medically known as xerostomia (“xero” – dry; “stomia” – mouth) affects millions of people, but few understand why it happens or why it is important.

What Causes Dry Mouth?

It is normal to awaken with a dry mouth because saliva flow decreases at night. But if your mouth is persistently dry throughout the day, it may be a result of habits such as smoking, alcohol or too much coffee drinking or even dehydration. It is also a common side effect of some medications. Xerostomia is not a disease in itself, but it could be a symptom of salivary gland or other systemic (general body) disease.

Why is Saliva Important?

A persistently dry mouth can be a problem. Not only does it feel unpleasant and lead to bad breath, it can also significantly increase your risk for tooth decay. Saliva lubricates your mouth for chewing, eating, digestion and even speaking. Saliva also has important antibacterial activities. Most importantly normal healthy salivary flow neutralizes and buffers acids in the mouth to protect the teeth from the acids produced by bacteria on the teeth that cause decay, and by acids in sodas, sports drinks and juices that can erode tooth enamel.

Not only does saliva neutralize acids but with its high mineral content it can actually reverse de-mineralization — the process by which acids attack enamel and remove calcium from the enamel surface. Healthy saliva actually re-mineralizes the outer layers of tooth enamel, but the process can take 30-60 minutes. That's why it's important not to snack on sugars or drink sodas between meals — one an hour and your mouth is acidic all the time.

Individuals without enough saliva are especially at risk for root decay and fungal infections, and they are also more likely to lose tooth substance through abrasion and erosion.

What Can We Do for a Dry Mouth?

If your mouth is usually dry, make an appointment with us to assess the causes of the problem. However it may be more serious with medical implications. The solution may be as simple as drinking more water and using good daily oral hygiene, or it may necessitate prescription medication to promote more saliva flow.

Contact us today to schedule an appointment to discuss your dry mouth and what we can do to help. For more information read the article in Dear Doctor magazine “Tooth Decay – How To Assess Your Risk.”

If a glance in the mirror reveals stained or discolored teeth that are detracting from your self-confidence, it's time to do something about it. The first step is to make an appointment for an office visit to find out how we can help you.

External (extrinsic) stains that form on the surfaces of teeth are usually caused by beverages such as red wine, tea, coffee as well as unhealthy habits like tobacco use. Extrinsic stains generally come in shades of browns, black or grays, but may even be orange or green from color producing bacteria.

Internal (intrinsic) stains are part of the structure of the tooth and cannot be removed by polishing. Among their causes are excessive fluoride levels or tetracycline antibiotics given in childhood and during tooth formation. Teeth do become more yellow and discolored as we age. Discoloration of individual teeth may be indicative of tooth decay, or teeth that have had root canal treatment and have literally lost their vitality tend to darken over time. Internal discoloration comes in a variety of shades and hues from yellows, grays, browns, and even some reds or pink.

Five Ways to lighten, whiten and brighten stained or discolored teeth

1. Change your habits. Reduce or stop consuming or using foods, drinks or tobacco if they are staining your teeth.
2. Improve your daily oral hygiene. Make sure to brush your teeth well, twice a day. Change to a toothpaste that contains a mild abrasive. Some toothpastes also contain tooth whiteners.
3. Visit our office for a professional cleaning and polish. Routine scaling and polishing will remove most superficial external stain and discoloration. Sometimes ultrasonic cleaning (by high frequency vibration) and polishing with slightly abrasive pastes may just do the trick.
4. Treatment for internal stain and discoloration. Brown colored decaying teeth need to have the decay removed and the teeth restored. Stained old and leaking fillings may also need to be replaced.
5. Tooth whitening by bleaching. Bleaching or tooth whitening is a safe and effective way to brighten stained teeth. Internal tooth bleaching can whiten even discolored root canal treated teeth. Ask us for more information about this technique.

If your mirror tells you that your smile needs attention, there's no time like the present to get started. Get back your bright, white smile and your self-confidence as well.

Contact us today to schedule an appointment to discuss your questions about tooth staining and its treatments. You can also learn more by reading the Dear Doctor magazine article “Tooth Staining.”

Bad breath, or halitosis, is bad news in any social situation — whether you're having an intimate conversation with a date or simply saying hello as you shake someone's hand. Halitosis, from the Latin halitus (exhalation) and the Greek osis (a condition or disease causing process), can also be a warning that something's amiss healthwise — usually in your mouth (85% to 90% of the time) but sometimes elsewhere in your body.

Most Common Causes of a Malodorous Mouth
Most unpleasant odors emanating from the mouth result from the processing of food remnants by certain strains of bacteria that typically populate the oral environment. As they feed on food particles, these microbes produce nasty-smelling byproducts — mostly volatile sulfur compounds, which have a distinctive “rotten egg” odor. That's why diligent dental care is front and center when it comes to banishing bad breath. Brushing, flossing and routine professional cleanings will help ensure that traces of last night's dinner or your midday candy bar don't stick around for bacteria to dine on.

Especially important, but often overlooked, during routine home oral care is the back of the tongue. This is actually the most common location for mouth-related bad breath to develop. Unlike the front of your tongue, which is bathed in saliva, the back of the tongue is relatively dry and poorly cleansed — an ideal setting in which microbe-laden plaque can form and flourish.

Even if you're industrious when it comes to brushing and flossing, food debris can get trapped and plaque can build up in hard-to-reach places such as between teeth (interdental), under the gums (subgingival) and around faulty dental work (e.g., ill-fitting crowns or veneers) contributing to overall oral odor. Other culprits include unclean dentures and oral disease such as tooth decay, gum disease, and abscesses.

Halitosis may accompany dry mouth, or xerostomia (xero – dry, stomia – mouth), a condition in which the normal flow of saliva, which cleanses the oral environment and keeps odor-producing bacteria in check, is interrupted. Most of us wake up with a temporary case of halitosis or “morning breath” because our salivary glands are less active while we sleep, but it usually disappears after a good brushing. If dry mouth is persistent, other possible triggers include: breathing through your mouth, a medication side effect, fasting or dehydration, or even stress.

Clearly, maintaining or restoring a healthy oral environment is your greatest defense against halitosis. Take care of your teeth and there's no reason your breath should be any less attractive than your smile!

If you would like more information about halitosis and ways to prevent or treat it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bad Breath.”

If you are at all uncomfortable at the thought of getting a dental implant, you might be pleasantly surprised to learn the truth about these marvelous state-of-the-art tooth-replacement systems — and the special role of a relatively new device, the mini-implant. So, first, let's go over some basic facts.

What's a dental implant? Basically, it's just a replacement for the root part of the tooth, the part that lies beneath the gum line. It attaches to a crown, which is a replacement for the visible portion of the tooth. But instead of ceramics or metals, implants are made of titanium, which becomes fused to the surrounding bone. When complete, implants are much stronger and longer-lasting than other methods of tooth replacement, like bridgework and dentures.

Implants are presently regarded as the best way to replace missing teeth, with a success rate of over 95%. They also help prevent bone loss in the jaw, a major goal of modern dentistry. Having one put in is an office procedure that's generally accomplished with local anesthesia, and most patients experience only minor discomfort. Standard dental implants can be used to replace a single tooth, or multiple teeth. The mini-implant, which is just a miniature version of the same technology, is now playing an increasing role in many other phases of dentistry.

Why mini-implants? Because in several situations, this smaller and less expensive alternative offers a solution that's just as good — or better — than any other dental treatment. One area where mini-implants excel is in supporting lower jaw overdentures.

Many people find that lower dentures are far more troublesome than upper dentures. The movement of the tongue muscle, and the smaller area of surface contact (compared to the upper denture, which is supported by the palate) often results in a poor, loose fit, which leads to problems when eating or speaking. These problems can be solved by affixing a lower overdenture (an implant-retained denture) with just two mini-implants.

Not only do mini-implants help prevent bone loss, they also give the denture wearer increased stability, comfort, and confidence. And they do so at a price that's more economical than you might think. In some cases, the mini-implants can be placed in a single one-hour office visit, and your own denture can be modified to fit them — so you can go home and eat a steak that night!

Another area where mini-implants are finding increasing use is in orthodontics. Orthodontic appliances (commonly called braces) move teeth by exerting a light force on them, using a wire which is fixed to a solid anchor point. Traditionally, other teeth are used as anchors — but sometimes these teeth move as well! By using immovable mini-implants as the anchor points, the process is greatly simplified. Strategically placed mini-implants called TADS (temporary anchorage devices) can be used to correct both skeletal (jaw) position and dental (tooth) position problems.

Mini-implants may also be used in upper dentures and temporary bridgework.

If you would like more information about mini-implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Implant Overdentures for the Lower Jaw,” “The Great Mini-Implant,” and “What are TADS?”

Do you ever find yourself thinking, “My smile would be near perfect if only?” If your answer is yes, come and see us to discuss some of the most advanced cosmetic treatment procedures available to give you a more dazzling smile in the shortest amount of time. Almost anything is possible from simple whitening procedures to a complete smile makeover, which may include repositioning your teeth with orthodontics and changing tooth shape and color with porcelain laminate veneers, to name a few options.

Before your visit, make a list of all of the things that you would like changed or improved. Being able to effectively communicate your desires to us will help immensely as we work together on your smile makeover. Although we may have a different opinion on what may actually be possible based on your dental and oral health, simply knowing how you define “your” ideal smile can be a good starting point.

For example, have you thought about and answered the following questions:

• Do you think your teeth or gums show too much or too little when you smile?
• What do you like and dislike? Are you unhappy with the size, shape or position of your teeth?
• Do you have unsightly gaps between some or all of your teeth?
• Do you think your smile would be improved if your teeth were whiter?

Providing us with a clear picture of all the things you like or don't like about your current smile will help guide the process. Even a picture of a smile that you like of a younger you or even torn from the pages of a celebrity magazine could be helpful. During our initial consultation, we will take all the dental records necessary for a cosmetic evaluation and smile enhancement. We can then compare your actual results to your “wish list” to ascertain how close we can get to your ideal smile and even create a computer-generated image of what we can achieve.

If you think you are ready to change your smile, call us today. For further information on the importance of having a clear vision plan that both patient and dentist agree upon, read the Dear Doctor magazine article “Great Expectations: Is What You Get What You Want?”

Metal braces are often considered a rite of passage for teenagers whose teeth need straightening. While some teens have no problem with this, others are more self-conscious and would like a less noticeable and less restrictive form of orthodontic treatment (“ortho” – to straighten; “odont” – teeth). After all, traditional braces can sometimes require diet modification, regular tightenings can cause discomfort, and the hardware itself can irritate the inside of the mouth. All of these things can limit a teen's ability to function normally during an already difficult stage of life.

That's why many teens today are opting for removable clear aligners, which have been popular with adults for years. In this system of orthodontic treatment, transparent, flexible, plastic “trays” are custom-made to move an individual's teeth into better alignment in a step-by-step fashion. Each tray moves the teeth a little bit further, according to a precise plan developed with specialized computer software by an orthodontist, or a general dentist who has received special training. It's not available from every dentist, but we are happy to be able to offer it here.

It used to be that clear aligners were not recommended for teens for two main reasons. For one thing, because they are removable rather than attached to the teeth, it was assumed a teenager would not be as conscientious as an adult about wearing them nearly 24 hours a day, which is necessary to achieve the desired results. Now, however, clear aligners for teens have colored “compliance indicators” that fade over time. With this new tool, dentists and parentsâ??and teens themselves — can monitor compliance and progress.

The other main problem in prescribing clear aligners for teens had been that their second molars are still growing into position. This problem, too, has been solved. Clear aligners now have “eruption tabs” that serve as space-holders for teeth that have yet to grow in.

Finally, in recent years, improvements have been made to the whole clear aligner system that allow it to be used for more serious malocclusions (bad bites). So it's actually a viable option for more orthodontic patients in general — teens as well as adults.

If you would like to learn more about clear aligners for your teenager, please contact us or schedule an appointment for a consultation. You can also find out more in the Dear Doctor magazine article “Clear Aligners For Teenagers.”

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.”

Projecting a healthy, radiant smile can help boost self-confidence and lead to increased comfort and success in both personal and career-oriented situations. Yet, many people are unhappy with their less-than-pearly whites, causing them to avoid social interaction and even lose out on opportunities because they are too self-conscious.

Your dissatisfaction with the appearance of your teeth may also be causing you to stifle one of nature's most endearing and intrinsic impulses, simply smiling!

For example, do you:

• Avoid posing for pictures that require a smile?
• Cover your mouth when speaking or laughing in public?
• Avoid dating because you feel unattractive?
• Feel that people think less of you because your smile is flawed?
• Think your smile makes you look older than you are?

If you've answered yes to any of these questions, you are certainly not alone. A poll conducted by the American Academy of Cosmetic Dentistry found that, while a whopping 99.7% of respondents said they considered a good smile to be a highly important social asset, only 50% of those same respondents indicated that they were satisfied with their own smile. In addition, the Academy reported that people between the ages of 31 and 50 are most unhappy with their smile, are most concerned with making a good first impression through a strong smile, and most frequently seek out information on cosmetic dentistry.

The good news is that advances in cosmetic enhancement and restorative dentistry, including treatments like teeth whitening and the application of porcelain veneers to correct tooth crowding, make it possible for anyone to enhance or improve their smile and boost their self-image. And a complete “Smile Makeover” has been shown to positively impact the perception that others have with respect to attractiveness, popularity, and even wealth — all based on the quality of a person's smile.

Our office can work with you to determine just what it will take to improve your smile and self confidence from as little as a minor enhancement to a complete smile makeover — anything that would best match your idea of the perfect smile. To get started, give us a call.

To read about others who have regained their confidence after brightening and whitening their smiles through cosmetic dentistry, read the Dear Doctor magazine article “The Impact of a Smile Makeover.”

Expectant mothers expect to deal with tooth-related milestones in their child's early years, such as teething and even the eventual shedding of those baby teeth to the Tooth Fairy. But there are many facets of children's oral health that may not be as well known. For example, did you know that using sugary fluids in your baby's bottle too frequently could promote constant acid production in your child's mouth leading to early childhood decay? Did you know that parents and caregivers who have decay transmit the bacteria that cause decay to their children?

Baby or primary teeth serve as guides for permanent teeth and, therefore, their health sets the stage for the health and proper function of their permanent successors. A comprehensive examination during a child's first visit can help uncover any underlying conditions that might be indicative of future problems, like tooth decay that can start as early as the age of six months when their first teeth appear. So the “Age One Visit” is the right time for a first dental visit.

What else do you know or want to know? Take our short quiz to help your child. The answers are listed at the bottom of this article.

The Quiz

1. Mounting evidence suggests that a child's oral health is most closely tied to which relative?
1. Mother
2. Father
3. Brother
4. Sister
2. Parents should bring their children to see a pediatric dentist:
1. Once they turn two?
2. Before they start kindergarten?
3. Preferably before their first birthday?
4. When they start to lose their baby teeth?
3. Tooth decay that occurs in infants and young children is referred to as what?
1. Primary tooth decay
2. Early Childhood Caries
3. Diapers to Decay Disease
4. Pediatric Dental Caries Syndrome
4. To help diminish the likelihood that your baby/infant will develop a cavity, you should:
1. Restrict the amount of sugary fluids your child drinks to mealtimes
2. Maintain proper oral hygiene to reduce harmful bacteria
3. Use fluoride to make the teeth more resistant to acid attack
4. All of the above
5. Infants are most susceptible to tooth decay when:
1. Breast feeding
2. Drinking milk from a bottle during meal times
3. Sucking on a pacifier that has been dipped in jam
4. Sleeping on their sides

The Answers

1) a = mother 2) c = before their first birthday 3) b = early childhood caries 4) d = all of the above 5) c = sucking on a pacifier that has been dipped in jam

Your baby's first visit to the dentist will cover a lot of ground, including diagnosis, prevention, education, and treatment as we help start him or her on the path to long-lasting oral and dental health. Call our office to schedule an appointment now. You can also learn more about pediatric tooth decay by reading the Dear Doctor magazine article “Age One Dental Visit — Why It's Important For Your Baby.”

While the goal of restorative dentistry is to return all of the destroyed or lost dental tissues of the teeth to full form (shape) and function, when you blend this goal with the artistry of cosmetic dentistry, the results can be dazzling. Today's modern techniques and materials enable replacement of missing tooth structure that allows bonding directly to the tooth so that it not only is an exact color match but also actually strengthens the tooth. And tooth-colored fillings are not just for front teeth. They can dramatically improve the appearance of all teeth — even your back molars — so that it appears you've never had tooth decay at all!

All of this is accomplished through the use of either tooth-colored dental porcelain or composite resins. Porcelains are a form of ceramic material formed by the action of heat. They are available in many colors and shades made from a powder corresponding to the primary color of the natural tooth structure that is mixed with water and placed into an oven for firing (hence their ceramic nature). When built up in layers by highly trained dental ceramicists, they can be made to mimic the exact natural translucency, staining and contours of tooth enamel.

Dental composite resins are the most common materials used for tooth-colored adhesive restorations today and have properties similar to tooth structure. They consist of resin or special plastics and fillers that are made of silica, a form of glass. The fillers give the composites wear resistance and translucency (see through properties).

It is important to note that besides providing the appearance of beautiful teeth, properly restored teeth function and wear better. But most important to you, they appear indistinguishable from natural teeth! Furthermore, scientific studies and clinical experience have validated their use as both safe and predictable. In fact, these techniques are also suitable for children's teeth and can incorporate fluoride to reduce decay. Together, all of these changes have so significantly impacted the way modern dentistry is practiced that many believe we may have entered into the so-called “post-amalgam (silver metal-colored dental fillings) era.”

Contact us today to schedule an appointment to discuss your questions about tooth-colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you are unhappy with the appearance of your smile and would like to change it, we can help you determine what will work best, from a simple whitening to brighten your smile to a complete smile makeover — the possibilities are almost limitless! Consider a “Smile Design” customized just for you. One method of improving your smile is with porcelain veneers. Porcelain laminate veneer tooth restorations are thin layers of dental ceramic — a glass-like material created by dental laboratory technicians, the “artists” who exactly mimic natural teeth making them straighter, whiter, and brighter. They are used to replace worn, dull-looking stained enamel. In addition to making your teeth and smile whiter and brighter, veneers can even be used to change tooth shape and color, close small spaces, and reshape slightly crooked or mis-shapen teeth.

In order to determine if porcelain veneers are a viable solution to help you achieve the smile you have always longed for, consider the following questions:

• Do you want to permanently alter the appearance of your smile?
• Are you hoping to make improvements to your smile that don't take a very long time to complete?
• Are you looking for a way to improve your smile with minimal or even no removal of your natural tooth material?
• Would you like to have more evenly aligned teeth?
• Do you want to change the color of your teeth?
• Do you want whiter teeth and a brighter smile?

If the answer to one or more of these questions is yes and whitening or other treatments have not given you the smile you want, we can help you assess the feasibility of porcelain veneers as one of the many options to enhance and improve your smile. We can fully discuss all the benefits, risks, alternatives, and costs associated with improving your smile.

Call us to make an appointment for a Smile Design consultation and we can get started. If you would like to read more information about porcelain veneers, as well as see a few before and after photos, read the Dear Doctor magazine article “Smile Design Enhanced With Porcelain Veneers.”

Nearly every parent and caregiver has experienced that almost instantaneous sick feeling when they see that their child has been injured, especially when it is an injury to the mouth and teeth. For some, it is just a bloody lip; however, if the accident chipped a tooth, then you may have a completely different situation on your hands. If the nerve of the tooth has not been damaged, you needn't worry too much — a composite (plastic) tooth-colored restoration that is actually bonded to the tooth is an ideal material for repairing most broken or chipped teeth. See us as soon as possible to assess the extent of injury, so that proper and appropriate action can be taken.

An additional reason why bonding with composite resin may be the ideal choice for repairing a child's chipped tooth is that it can be custom created in virtually any shade so that it perfectly matches the damaged tooth and the surrounding teeth. It is also far less expensive than a crown, an important factor to consider when repairing a primary (baby) tooth that will eventually fall out to make room for a permanent tooth. If the injury is to a permanent tooth, a composite resin still may be ideal to use as a restoration until your child or teenager has stopped growing or playing contact sports. This is because your teenager may be too young for a more permanent restoration such as a crown or porcelain veneer.

An important, proactive step you can take to be prepared for the next time your child has a dental injury is to download Dear Doctor's Field-side Pocket Guide for Dental Injuries. This handy, quick reference guide is a must have for athletes, parents, caregivers, teachers, coaches or anyone who is often in an environment where a mouth injury is likely to occur. Knowing what to do and how quickly you must respond can make the critical difference between saving and losing a tooth.

Worldwide it is generally accepted that the best method for permanently replacing a missing tooth is with a dental implant. However, one fact that can affect the timing of placement of dental implants is that the person should be fully mature. In this case, it means that growth is complete, in particular the jawbones have completed growing. And while we are sensitive to teens who may beg for a dental implant to replace a missing, damaged or traumatized tooth, parents or caregivers should know that research and experience have shown that it is better to wait.

The main reason it is best to wait is because natural teeth grow and move with the jaws as they mature whereas implants don't. Natural teeth change positions and move with the jaws as the jaws grow, implants don't. They are fused to the bone in one position and as the jawbone grows, they get left behind and appear to sink as the adjacent teeth and jawbone grow in harmony.

Although it is not really possible to determine exactly when a person has finished growing, it is generally best to wait until the jaw is fully matured and developed. However, we are the most qualified, along with our orthodontic colleagues to “guesstimate” based on family history, age and genetics. Specialized radiographs (x-rays) of the skull and jaws may also be helpful in determining the timing of jaw growth completion and when implants can be placed.

Dental implants are a permanent solution to a dental problem and thus should not be used until all growth is complete. Think about it. Your young child gets a beautifully restored smile through a dental implant...and for a year or two it looks fantastic. However, as your child's jaws continue to grow, everyone begins to notice gaps between the implant and adjacent teeth. So it makes sense to avoid this eventuality; by just waiting until late teens when beautifully restored crowns on properly positioned dental implants should last for many many years.

To learn more on this subject, read the Dear Doctor article, “Teenagers & Dental Implants.” You are also welcome to contact us to discuss your questions or to schedule an appointment.

Both diabetes and gum (periodontal) disease are chronic inflammatory diseases that have negative consequences for millions of people worldwide. But before we continue, let's define these two diseases:

Periodontal disease is a condition in which biofilms of dental bacterial plaque stick to teeth near the gum lines causing the gum tissues to become inflamed and infected. If not treated properly and in an early stage, it can cause severe damage to the bone that supports the teeth, resulting in tooth loss. It occurs in the absence of good oral hygiene which includes ineffective daily brushing and flossing and neglecting to see your dentist.

Diabetes is a chronic condition in which blood glucose (sugar) levels become excessive. Glucose is the body's main source of sugar for energy. The hormone insulin, among other mechanisms, normally controls glucose. Prolonged elevated blood sugar levels are harmful and ultimately can even be life threatening if left untreated. With type 1 diabetes, insulin injections (shots) are required to maintain the proper blood sugar levels because the body no longer produces its own blood sugar. Type 2 diabetes is generally less severe and can usually be treated with a combination of diet and medication.

And while both of these diseases share the same common enemy, you, there is scientific evidence revealing links between the two. Diabetes increases the risk factor for developing periodontitis, and conversely, periodontal disease makes it more difficult for diabetics to control blood glucose levels.

Want To Learn More?

Learn more about these two diseases and their relationship by reading, “Diabetes & Periodontal Disease.” Or if you have diabetes but haven't had a dental exam and cleaning in a long time, contact us today to schedule a consultation. You can also use this consultation to discuss any questions or concerns you have about your oral health and its relationship to your diabetes.

Creating a dental crown that looks good and wears well is not an easy achievement. It is the result of good communication you, the patient, have with us, your dental professionals, and that we have with the dental lab that manufactures the crown. In addition, it reflects the quality of work done by us and by the lab technician.

What is a dental crown?
A crown is a dental restoration that surrounds the remains of a damaged tooth or is attached to a dental implant so that it resembles a natural tooth as it extends above the gum line. The choice of materials and appearance of the crown depend upon many factors. One is the location of the crown. If it is in the back part of your jaw, strength and wear will be a major factor. If it is in the front, a life-like appearance will be important.

What goes into making a good-looking and functional crown?
Options for crown materials include porcelain, gold, porcelain fused to metal (called PFM) and some newer materials such as “pressed-ceramic” restorations and computer-milled-ceramics.

You as the patient can have a say in choosing the crown's color and appearance. Before it is cemented into its final position, make sure you are happy with the feel and appearance of your new crown.

Gold is often chosen for crowns on back teeth because of its superior wear qualities. Gold crowns have been known to last more than 50 years. They also cause minimal wear to the teeth that they touch on the opposing jaw.

Crowns made of porcelain (a glass-like substance fired in an oven at a high temperature) look good but may be too brittle to stand the wear and forces given to back teeth. Like glass, they can fracture under pressure. But because of their lifelike appearance they make a good choice for visible front teeth.

PFM (porcelain-fused-to-metal crowns) are a good combination of the best of gold and porcelain, but they sometimes lose the stains applied to make them look natural, and occasionally they fracture away from the metal.

A provisional crown can help you make sure you are getting a crown with the qualities you want. With the provisional crown all the details are worked out ahead of time, and you get a chance to try them out to make sure the crown looks good and that you can eat and talk normally. After you give your approval on the provisional crown, the final crown will be made to match it, in longer-lasting and better quality components.

Contact us today to schedule an appointment to discuss your questions about crowns and other dental restorations. You can also learn more by reading the Dear Doctor magazine article “Gold or Porcelain Crowns.”

An important consideration prior to having any cosmetic dentistry is to understand both the pros and the cons of each particular dental procedure. And while porcelain laminate veneers are among the most aesthetic means of creating a beautiful, more pleasing smile, they are permanent and non-reversible and should be maintained properly.

On average, you can expect porcelain veneers to last anywhere between 7 and 20+ years. However, much of that depends whether or not you care for them properly in addition to the quality of the dental porcelain, the craftsmanship, and placement of them. How long your veneers last can also depend to some extent upon how you age. This is because the gum tissues attached to the living tooth that your veneers are cemented to may shrink or pull away from the tooth exposing its root surface. If this occurs, you should see your dentist for an evaluation, as it may require veneer replacement. Or, the issue might be resolved through some minor periodontal (gum) plastic surgery.

Porcelain veneers are a low maintenance solution for solving a multitude of cosmetic dental challenges, but they do require that you protect them during sports or vigorous activity. You should also wear an oral appliance or mouthguard (nightguard) to protect them from grinding or any other involuntary damage during sleep.

To learn more about porcelain veneers, continue reading the Dear Doctor article, “Porcelain Veneers.” If you are ready to see what cosmetic dentistry can do for you, contact us to schedule a consultation.

According to the Centers for Disease Control and Prevention (CDC), community water fluoridation has been a safe and healthy way to prevent tooth decay effectively for over 65 years now. In fact, the CDC has recognized water fluoridation as one of the 10 great public health achievements of the 20th century.

It all began back in the 1930's when it was discovered that fluoride had oral health benefits. However, community water fluoridation did not begin until January 25, 1945, when Grand Rapids, Michigan became the first city to add fluoride to its municipal water system. Before it was officially rolled out in other cities, Grand Rapids was compared to other cities or “controlled groups” that had not added fluoride to their water so that scientific research could assess the relationship between tooth decay and fluoride. Well, you can guess the results — it was proven that fluoride helped reduce tooth decay when added to ordinary tap water. On November 29, 1951, the National Academy of Sciences’ National Research Council (NRC) declared water fluoridation safe, effective, and beneficial based upon the results of their findings and the fact that there was a dramatic decline in tooth decay in the children of Grand Rapids.

Ever since, fluoride has continued to play a critical role as a simple, safe, effective way to provide improved oral health by helping reduce tooth decay in the United States. This reality is still being demonstrated with each new generation benefiting from better oral health than the previous generation.

As for identifying when the time is right to introduce fluoride to your children's oral health program, ask us. Most children get the right amount of fluoride to help prevent cavities if they drink water that contains fluoride. And if by chance you live in an area where your tap water is not fluoridated, brush your children's teeth with no more than a pea-sized amount of fluoride toothpaste twice a day and ask your dentist about fluoride supplements and treatment.

Learn more on this topic by reading the Dear Doctor article, “Fluoride And Fluoridation In Dentistry.”

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.

Yes, dental x-rays are a safe and vital tool we use for measuring and monitoring your oral health. We feel it is imperative to ensure that our patients have the facts — especially when it comes to their oral healthcare. This is why we want to respond to this important question about the safety of dental x-rays.

We want you to know what they are, how they are used, what makes them a safe and effective tool, and why they are so important to dentistry and your health. X-rays are a form of electromagnetic radiation, in fact, just like natural daylight, except they have a much shorter wavelength. And because they are a form of ionizing radiation, they can easily penetrate bodily tissues without causing any harm when used properly. The reasons we use them are obvious; they help us literally see what is unseen. For example, they enable us to see bone structure and roots of teeth among other things, and are commonly used for diagnosing tooth decay. Furthermore, today's x-ray machines and other image capturing techniques are so sophisticated and sensitive that the amount of radiation required for diagnosis is almost nothing when compared to what you get from the background radiation present in everyday living. In fact, the average single digital periapical (“peri” – around; “apical” – root end of a tooth) film is equal to 1/10 the amount of everyday natural environmental exposure. These facts make it clear that dental x-rays are completely safe and, thus, are nothing you need to be concerned about.

Learn more about this topic by reading the Dear Doctor magazine article “X-ray Frequency And Safety.” If you need to schedule an appointment, contact us today.