Diagnosis, treatment planning, treatment, and prevention of disease
The overwhelming fear of dental appointments can be a common cause of anxiety. Many people visualize a drill-wielding man in a white coat just waiting to cause pain and remove teeth. The reality, however, is very different. The comfort, relaxation, and happiness of the patient are the primary focus of any good dental practice. The staff at the practice will do whatever they can to reduce anxiety, allay fears, and provide painless, quick treatments.
Recent technological advancements have meant that in many cases, dentists are able to replace noisy drills with painless laser beams. There are also a wide variety of safe anesthetics available to eliminate pain and reduce anxiety during routine appointments.
Here is a list of some of the most common dental fears:
- Fear of embarrassment about the condition of teeth.
- Fear of gagging.
- Fear of injections.
- Fear of loss of control.
- Fear of not becoming numb when injected with Novocain.
- Fear of pain.
- Fear of the dentist as a person.
- Fear of the hand piece (or the drill).
How can one overcome dental anxiety?
Dental anxiety and fear can become completely overwhelming. It is estimated that as many as 35 million people do not visit the dental office at all because they are too afraid. Receiving regular dental check-ups and cleanings is incredibly important. Having regular routine check-ups is the easiest way to maintain excellent oral hygiene and reduce the need for more complex treatments.
Here are some tips to help reduce dental fear and anxiety:
Talk to us – We can't read minds. Though it can be hard to talk about irrational fears with a stranger, we can take extra precautions during visits if fears and anxiety are communicated.
Bring a portable music player – Music acts as a relaxant and also drowns out any fear-producing noises. Listening to calming music throughout the appointment will help to reduce anxiety.
Agree on a signal – Many people are afraid that the dentist will not know they are in significant pain during the appointment and will continue with the procedure regardless. The best way to solve this problem is to agree on a "stop" hand signal. Both parties can easily understand signals like raising the hand or tapping on the chair.
Spray the throat – Throat sprays (for example, Vicks® Chloraseptic® Throat Spray) can actually control the gag reflex. Two or three sprays will usually keep the reflex under control for about an hour.
Take a mirror – Not being able to see what is happening can increase anxiety and make the imagination run wild. Watching the procedure can help keep reality at the forefront of the mind.
Sedation – If there is no other way to cope, sedation offers an excellent option for many people. There are several types of sedation, but the general premise behind them is the same: the patient regains their faculties after treatment is complete.
Ask about alternatives – Advances in technology mean that dental microsurgery is now an option. Lasers can be used to prepare teeth for fillings, whiten teeth, and remove staining. Discuss all the options with us and decide on one that is effective and produces minimal anxiety.
If you have questions or concerns about how we can help you overcome anxiety and fear, please contact our office.
Dental emergencies are quite frightening and often painful. Prompt treatment is almost always required to alleviate pain and to ensure the teeth have the best possible chance of survival.
Sometimes, teeth become fractured by trauma, grinding, or biting on hard objects. In other cases, fillings, crowns, and other restorative devices can be damaged or fall out of the mouth completely. If there is severe pain, it is essential to contact our office immediately. The pain caused by dental emergencies almost always gets worse without treatment, and dental issues can seriously jeopardize physical health.
Types of dental emergency and how to deal with them
Avulsed tooth (tooth knocked out)
If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately. When a tooth exits the mouth, tissues, nerves, and blood vessels become damaged. If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.
Here are some steps to take:
- Call our office.
- Pick up the tooth by the crown and rinse it under warm water. DO NOT touch the root.
- If possible, place it back into its socket - if not tuck it into the cheek pouch.
- If the tooth cannot be placed in the mouth, put the tooth into a cup of milk, saliva, or water as a last resort. It is important to keep the tooth from drying out.
- Get to our office, quickly and safely.
We will try to replace the tooth in its natural socket. In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy might be necessary.
Lost filling or crown
Usually, a crown or filling comes loose while eating. Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes and pressure. Crowns generally become loose because the tooth beneath is decaying. The decay causes shape changes in the teeth - meaning that the crown no longer fits.
If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Keep the crown in a cool, safe place because there is a possibility that we can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.
When we are not immediately accessible, here are the steps to take:
- Apply clove oil to the tooth to alleviate pain.
- Clean the crown, and affix it onto the tooth with dental cement. This can be purchased at a local pharmacy.
- If the crown is lost, smear the top of the tooth with dental cement to alleviate discomfort.
- DO NOT use any kind of glue to affix the crown.
We will check the crown to see if it still fits. If it does, it will be reattached to the tooth. Where decay is noted, this will be treated and a new crown will be made.
Cracked or broken teeth
The teeth are strong, but they are still prone to fractures, cracks, and breaks. Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme. Fractures, cracks, and breaks can take several different forms, but are generally caused by trauma, grinding, and biting. If a tooth has been fractured or cracked, there is no alternative but to schedule an appointment as quickly as possible.
Where a segment of tooth has been broken off, here are some steps that can be taken at home:
- Call our office.
- Rinse the tooth fragment and the mouth with lukewarm water.
- Apply gauze to the area for ten minutes if there is bleeding.
- Place a cold, damp dishtowel on the cheek to minimize swelling and pain.
- Cover the affected area with over-the-counter dental cement if you cannot see us immediately.
- Take a topical pain reliever.
The nature of the break or fracture will limit what we are able to do. If a fracture or crack extends into the root, root canal therapy is often the most effective way to retain the tooth. In the case of a complete break, your dentist will usually affix the fragment back onto the tooth as a temporary measure.
When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it. If the tooth remains in the mouth still attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.
It is important to call our office immediately to make an appointment. In the meantime, use a cold compress and over-the-counter medications to relieve pain. Your dentist will reposition the tooth and add splints to stabilize it. If the tooth fails to heal, root canal therapy might be required.
If you have questions or concerns about dental emergencies, please contact our office.
Digital radiography (digital X-ray) is the latest technology used to take dental X-rays. This technique uses an electronic sensor (instead of X-ray film) that captures and stores the digital image on a computer. This image can be instantly viewed and enlarged, helping the dentist and dental hygienist detect problems more easily. Digital X-rays reduce radiation 80-90% compared to the already low exposure of traditional dental X-rays.
Dental X-rays are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam. Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan. Without X-rays, problem areas can go undetected.
Dental X-rays may reveal:
- Abscesses or cysts.
- Bone loss.
- Cancerous and non-cancerous tumors.
- Decay between the teeth.
- Developmental abnormalities.
- Poor tooth and root positions.
- Problems inside a tooth or below the gum line.
Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!
Are dental X-rays safe?
We are all exposed to natural radiation in our environment. Digital X-rays produce a significantly lower level of radiation compared to traditional dental x-rays. Not only are digital X-rays better for the health and safety of the patient, they are faster and more comfortable to take, which reduces your time in the dental office. Also, since the digital image is captured electronically, there is no need to develop the X-rays, thus eliminating the disposal of harmful waste and chemicals into the environment.
Even though digital X-rays produce a low level of radiation and are considered very safe, dentists still take necessary precautions to limit the patient’s exposure to radiation. These precautions include only taking those X-rays that are necessary, and using lead apron shields to protect the body.
How often should dental X-rays be taken?
The need for dental X-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary X-rays based upon the review of your medical and dental history, a dental exam, signs and symptoms, your age, and risk of disease.
A full mouth series of dental X-rays is recommended for new patients. A full series is usually good for three to five years. Bite-wing X-rays (X-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.
Fluoride is the most effective agent available to help prevent tooth decay. It is a mineral that is naturally present in varying amounts in almost all foods and water supplies. The benefits of fluoride have been well known for over 50 years and are supported by many health and professional organizations.
Fluoride works in two ways:
Topical fluoride strengthens the teeth once they have erupted by seeping into the outer surface of the tooth enamel, making the teeth more resistant to decay. We gain topical fluoride by using fluoride containing dental products such as toothpaste, mouth rinses, and gels. Dentists and dental hygienists generally recommend that children have a professional application of fluoride twice a year during dental check-ups.
Systemic fluoride strengthens the teeth that have erupted as well as those that are developing under the gums. We gain systemic fluoride from most foods and our community water supplies. It is also available as a supplement in drop or gel form and can be prescribed by your dentist or physician. Generally, fluoride drops are recommended for infants, and tablets are best suited for children up through the teen years. It is very important to monitor the amounts of fluoride a child ingests. If too much fluoride is consumed while the teeth are developing, a condition called fluorosis (white spots on the teeth) may result.
Although most people receive fluoride from food and water, sometimes it is not enough to help prevent decay. Your dentist or dental hygienist may recommend the use of home and/or professional fluoride treatments for the following reasons:
- Deep pits and fissures on the chewing surfaces of teeth.
- Exposed and sensitive root surfaces.
- Fair to poor oral hygiene habits.
- Frequent sugar and carbohydrate intake.
- Inadequate exposure to fluorides.
- Inadequate saliva flow due to medical conditions, medical treatments or medications.
- Recent history of dental decay.
Remember, fluoride alone will not prevent tooth decay! It is important to brush at least twice a day, floss regularly, eat balanced meals, reduce sugary snacks, and visit your dentist on a regular basis.
A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients. Your personal home care plays an important role in achieving that goal. Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.
Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.
- Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
- Brush the outer, inner, and biting surfaces of each tooth.
- Use the tip of the brush to clean the inside of the front teeth.
- Brush your tongue to remove bacteria and freshen your breath.
Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.
Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.
- Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
- Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
- Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
Floss holders are recommended if you have difficulty using conventional floss.
Rinsing – It is important to rinse your mouth with water after brushing and after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.
Use other dental aids as recommended by your dentist or dental hygienist: interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.
Brushing and flossing are of paramount importance to oral hygiene. Though bi-annual professional dental cleanings remove plaque, tartar, and debris, excellent homecare methods are equally valuable. Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle, and prevent serious diseases.
Reasons why proper brushing and flossing are essential:
Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures. Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth. This phenomenon can easily be prevented by using proper home hygiene methods.
Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession, and jawbone recession. Periodontal disease is caused by the toxins found in plaque and can lead to serious health problems in other parts of the body. Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.
Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth. These food particles can be removed with regular brushing and flossing, leaving the mouth healthier, and breath smelling fresher.
Prevention of staining – Staining, or yellowing, of teeth can be caused by a wide variety of factors such as smoking, coffee, and tea. The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.
The Proper Way to Brush
The teeth should be brushed at least twice a day, ideally in the morning and before bed. The perfect toothbrush is small in size with soft, rounded-end bristles, and is no more than three months old. The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue. The American Dental Association (ADA) has given electric toothbrushes their seal of approval, stating that those with rotating or oscillating heads are more effective than other toothbrushes.
Here is a basic guide to proper brushing:
- Place the toothbrush at a 45-degree angle where the gums and teeth meet.
- Use small circular motions to gently brush the gumline and teeth.
- Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
- Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
- Use back and forth strokes to brush the chewing surfaces.
- Brush the tongue to remove fungi, food, and debris.
The Proper Way to Floss
Flossing is a great way to remove plaque from the interdental regions (between the teeth). Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets. The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis. The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.
Here is a basic guide to proper flossing:
- Cut a piece of floss to around 18 inches long.
- Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
- Work the floss gently between the teeth toward the gum line.
- Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
- Carefully move the floss up and down several times to remove interdental plaque and debris.
- Do not pop the floss in and out between the teeth as this will inflame and cut the gums.
If you have any questions about the correct way to brush or floss, please contact our office.
Regular dental check ups are essential for maintaining excellent oral hygiene and diagnosing potential problems, but they are not a “fix-all” solution. Thorough oral homecare routines should be practiced on a daily basis to avoid future dental problems.
Periodontal disease (also called gum disease and periodontitis) is the leading cause of tooth loss in the developed world, and is completely preventable in the vast majority of cases. Professional cleanings twice a year combined with daily self-cleaning can remove a high percentage of disease-causing bacteria and plaque. In addition, teeth that are well cared for make for a sparkling white smile.
There are numerous types of oral hygiene aids on the supermarket shelves, and it can be difficult to determine which will provide the best benefit to your teeth.
Here are some of the most common oral hygiene aids for homecare:
Dental floss is the most common interdental and subgingival (below the gum) cleaner and comes in a variety of types and flavors. The floss itself is made from either thin nylon filaments or polyethylene ribbons, and can help remove food particles and plaque from between the teeth. Vigorous flossing with a floss holder can cause soft tissue damage and bleeding, so great care should be taken. Floss should normally be used twice daily after brushing.
Many hygienists and periodontists recommend interdental brushes in addition to dental floss. These tiny brushes are gentle on the gums and very effective in cleaning the contours of teeth in between the gums. Interdental brushes come in various shapes and sizes.
There are two basic types of mouth rinse available: cosmetic rinses which are sold over the counter and temporarily suppress bad breath, and therapeutic rinses which may or may not require a prescription. Most dentists are skeptical about the benefits of cosmetic rinses because several studies have shown that their effectiveness against plaque is minimal. Therapeutic rinses however, are regulated by the FDA and contain active ingredients that can help reduce bad breath, plaque, and cavities. Mouth rinses should generally be used after brushing.
Oral irrigators, like Water Jets and Waterpiks have been created to clean debris from below the gum line. Water is continuously sprayed from tiny jets into the gum pockets which can help remove harmful bacteria and food particles. Overall, oral irrigators have proven effective in lowering the risk of gum disease and should not be used instead of brushing and flossing. Professional cleanings are recommended at least twice annually to remove deeper debris.
Rubber Tip Stimulators
The rubber tip stimulator is an excellent tool for removing plaque from around the gum line and also for stimulating blood flow to the gums. The rubber tip stimulator should be traced gently along the outer and inner gum line at least once each day. Any plaque on the tip can be rinsed off with tap water. It is important to replace the tip as soon as it starts to appear worn, and to store the stimulator in a cool, dry place.
Tongue cleaners are special devices which have been designed to remove the buildup of bacteria, fungi and food debris from the tongue surface. The fungi and bacteria that colonize on the tongue have been related to halitosis (bad breath) and a great many systemic diseases like diabetes, heart disease, respiratory disease and stroke. Tongue cleaners can be made from metal, wood or plastic and shaped in accordance with the contours of the tongue. Tongue cleaning should be done prior to brushing to prevent the ingestion of fungi and bacteria.
There are a great many toothbrush types available. Electric toothbrushes are generally recommended by dentists because electric brushes are much more effective than manual brushes. The vibrating or rotary motion helps to easily dislodge plaque and remove food particles from around the gums and teeth. The same results can be obtained using a manual brush, but much more effort is needed to do so.
Manual toothbrushes should be replaced every three months because worn bristles become ineffective over time. Soft bristle toothbrushes are far less damaging to gum tissue than the medium and hard bristle varieties. In addition, an appropriate sized ADA approved toothbrush should be chosen to allow proper cleaning to all the teeth. Teeth should ideally be brushed after each meal, or minimally twice each day.
If you have any questions about oral hygiene aids, please contact our practice.
Panoramic X-rays (also known as Panorex® or orthopantomograms) are wraparound photographs of the face and teeth. They offer a view that would otherwise be invisible to the naked eye. X-rays in general, expose hidden structures, such as wisdom teeth, reveal preliminary signs of cavities, and also show fractures and bone loss.
Panoramic X-rays are extraoral and simple to perform. Usually, dental X-rays involve the film being placed inside the mouth, but panoramic film is hidden inside a mechanism that rotates around the outside of the head.
Unlike bitewing X-rays that need to be taken every few years, panoramic X-rays are generally only taken on an as-needed basis. A panoramic X-ray is not conducted to give a detailed view of each tooth, but rather to provide a better view of the sinus areas, nasal areas and mandibular nerve. Panoramic X-rays are preferable to bitewing X-rays when a patient is in extreme pain, and when a sinus problem is suspected to have caused dental problems.
Panoramic X-rays are extremely versatile in dentistry, and are used to:
- Assess patients with an extreme gag reflex.
- Evaluate the progression of TMJ.
- Expose cysts and abnormalities.
- Expose impacted teeth.
- Expose jawbone fractures.
- Plan treatment (full and partial dentures, braces and implants).
- Reveal gum disease and cavities.
How are panoramic X-rays taken?
The panoramic X-ray provides the dentist with an ear-to-ear two-dimensional view of both the upper and lower jaw. The most common uses for panoramic X-rays are to reveal the positioning of wisdom teeth and to check whether dental implants will affect the mandibular nerve (the nerve extending toward the lower lip).
The Panorex equipment consists of a rotating arm that holds the X-ray generator, and a moving film attachment that holds the pictures. The head is positioned between these two devices. The X-ray generator moves around the head taking pictures as orthogonally as possible. The positioning of the head and body is what determines how sharp, clear and useful the X-rays will be to the dentist. The pictures are magnified by as much as 30% to ensure that even the minutest detail will be noted.
Panoramic X-rays are an important diagnostic tool and are also valuable for planning future treatment. They are safer than other types of X-rays because less radiation enters the body.
If you have questions or concerns about panoramic X-rays, please contact our practice.
A sealant is a thin, plastic coating applied to the chewing surface of molars, premolars and any deep grooves (called pits and fissures) of teeth. More than 75% of dental decay begins in these deep grooves. Teeth with these conditions are hard to clean and are very susceptible to decay. A sealant protects the tooth by sealing deep grooves, creating a smooth, easy to clean surface.
Sealants can protect teeth from decay for many years, but need to be checked for wear and chipping at regular dental visits.
Reasons for sealants:
- Children and teenagers – As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.
- Adults – Tooth surfaces without decay that have deep grooves or depressions.
- Baby teeth – Occasionally done if teeth have deep grooves or depressions and child is cavity prone.
What do sealants involve?
Sealants are easily applied by your dentist or dental hygienist and the process takes only a couple of minutes per tooth.
The teeth to be sealed are thoroughly cleaned and then surrounded with cotton to keep the area dry. A special solution is applied to the enamel surface to help the sealant bond to the teeth. The teeth are then rinsed and dried. Sealant material is carefully painted onto the enamel surface to cover the deep grooves or depressions. Depending on the type of sealant used, the material will either harden automatically or with a special curing light.
Proper home care, a balanced diet, and regular dental visits will aid in the life of your new sealants.
If you are experiencing extreme sensitivity or are suffering from advanced periodontal disease, you may be required to have a tooth extracted. With a simple extraction, the dentist can safely remove the affected tooth without the need for major surgery.
Reasons for a tooth extraction
There are numerous situations in which a simple extraction can help alleviate pain or prepare you for another cosmetic or restorative procedure. Some common reasons for extraction include:
- Advanced periodontal disease that has loosened the tooth roots
- Extra teeth or baby teeth that impede adult teeth
- Preparing a patient for orthodontic treatment
- Removing a fractured or malformed tooth
- Severe tooth decay which cannot be remedied with root canal therapy
How is a tooth extracted?
As a precaution, the dentist will first take X-rays of the tooth or teeth in question, to help plan the procedure. After preparing a method of extraction, you will be given a local anesthetic that will prevent you from feeling pain during the procedure. Next, the dentist will use a tool called an elevator to lift the tooth and loosen ligaments and gum tissue around the base of the tooth. Finally, the dentist will use a pair of forceps, to gently rock the tooth back and forth until it breaks free of the ligaments holding it in the gum tissue. Occasionally, a stubborn tooth will resist the dentist’s soft tug, refusing to come out. In these and more complex cases, the tooth may need to be broken up into smaller pieces for removal.
Once removed, we will pack gauze into the socket and have you place pressure on the area by biting down. If necessary, the dentist will place stitches to close the socket.
If you are sick the week prior to your scheduled extraction or on the day of, please contact our office, as alternative arrangements may need to be made. Please contact us if you have any questions or concerns.