Frequently Asked Questions

You should ideally brush your teeth after you eat or drink anything other than water. As this is not an ideal world, brushing during the following times is acceptable: 1) when you get out of bed in the morning, 2) after breakfast, lunch and dinner, 3) just before bed. This will keep your mouth clean and the level of plaque very low. If you counted, that’s five (5) times a day minimum.

Flossing once a day is sufficient if it’s done properly.  The recommended time is after brushing your teeth just prior to going to bed.  This is followed by vigorously rinsing your mouth to wash away the newly loosened plaque.  After you fall to sleep, the amount of saliva that your body produces goes way down.  You don’t have a natural mechanism to dilute the plaque and help wash it away.  This is the reason it is recommended that you floss just before bedtime, so the least amount of bacteria is left in your mouth when you are most susceptible, while you sleep.

Plaque is a large colony of bacteria.  These “bugs” occur naturally in the mouth. Their population is kept low by brushing four to five times a day and flossing at least once a day.  Your natural saliva (spit) helps keep these numbers lower by helping wash them away. If your mouth is dry due to disease, radiation therapy or medications that you take, be sure to let us know so we can make recommendations that may help keep your mouth moist. Cavities occur MUCH more quickly and spread rapidly in a dry mouth.

A cavity is a space. In dentistry it is commonly used interchangeably with the term caries (decay). In reality, a cavity is caused after decay has advanced and weakened the tooth structure. A cavity forms like a volcano. At the top (outside) is a little hole, but underneath is a large area of decay that is not strong enough to support the tooth. This is why the tooth breaks under pressure. Often a patient will call in and say, “My filling fell out.” This almost always is due to decay around an old filling. There is no longer sound tooth structure to retain the restoration, and it can crumble (actually, the filling rarely falls out. It’s usually the remaining tooth that actually fractures!) You can have a cavity without any visible signs. Usually it doesn’t even bother you . . . until it’s too late. This is why we take necessary x-rays, to catch things while they’re small and much less costly to correct. Regular dental visits are the key to preventing such situations.

Your teeth should be cleaned by a dentist or a dental hygienist at least every six months. If (plaque and tartar) deposits build up on your teeth more readily than normal or if you have gum disease, you should be seen professionally every three or four months. The reasoning is to keep disease away or at bay, and so the dentist can examine your mouth periodically for gum and tooth problems and screen for oral cancer.

For some reason (trauma, decay, etc.), the nerve in your tooth is dead or dying. As this occurs, it rots (necrosis). Bacteria are always present in the oral cavity, which provides for them an ideal environment (moist, warmth and food). They are fruitful and  multiply. This leads to an abscess, a localized pus pocket, which can become extremely painful. The remnants of the nerve and the bacteria must be removed. This is the first part of a root canal.

Why do it? 1.) To relieve the pain. 2.) Because infections of the head and neck are very serious and can be deadly! 3.) It saves the tooth, which can then maintain proper spacing and keep the jaw in harmony.

There are numerous reasons. One might be that the tooth is broken or fractured. A large cavity sometimes doesn’t leave enough tooth structure to properly hold a filling. Sometimes crowns are used strictly for cosmetic purposes. A tooth which has had a root canal will generally require a crown. Why? The teeth mentioned above are severely compromised. If they are not adequately protected by fully covering them, all too often they will fracture—sometimes unfavorably—and require extraction. Of course, Murphy’s Law applies: If a tooth is going to break, it does so on the first bite of a really good steak at your favorite restaurant…dinner’s ruined!

Gold crowns have been around for many years. Gold is an excellent material to use in the mouth (I use gold under my porcelain crowns!). Over the past few decades, people, especially here in the U.S., have found it unacceptable to have metals showing in their smiles. Porcelain has become the more popular choice, particularly in the front of the mouth. Here are some characteristics about each type:

Gold

+ solid metal, it will not break
+ more conservative, there is less tooth reduced
– it is gold colored

Porcelain

+ very natural looking
+ the technology, techniques and materials are getting better every day
– requires more tooth reduction
– glass – it can break, though it rarely does

A veneer is a thin covering. It is generally used cosmetically, like Formica on a counter top. Veneering teeth can be done to cover unsightly stains (tetracycline). These restorations can also change the shape of the tooth, making the smile more appealing. Veneers of different thickness can be used to straighten slightly crooked or crowded teeth. However, if there is too much crowding or crookedness, orthodontics might be indicated first.

Implants are usually cylinders that replace the roots of missing teeth. They are surgically placed into the jawbone and covered with the gum tissue to heal for a number of months before they can be restored. The waiting period is for healing and to allow the implant to osseointegrate (the bone will grow and fill any voids around the implant created at the time of surgery). The maxilla (upper jawbone) usually requires around six months for integration while the mandible (lower jawbone) takes only about three or four months. The difference is due to bone density and blood supply. Following the healing period, the implant can be restored in nearly the same way as a tooth having a crown placed.

The temporo-mandibular joint is the most complicated joint in the body. It allows the mandible (lower jaw) to move in relationships to the rest of the head. It’s located just in front of the ear. If you can place your fingers there and open your mouth, you can feel the joint in action. As the joint is so complex, it is frequently dysfunctional. Some things that cause problems are an irregular bite, missing teeth, night time grinding (bruxism), trauma and stress.

Over the years, we’ve alleviated hundreds of patients’ headaches that usually were misdiagnosed as migraine headaches. Correcting a patient’s bite cannot help true migraine headaches, BUT muscle tension headaches are often a different story. One way to help tell the difference is by rubbing the muscles in the area of your temples (temporalis muscles).  If it makes the headache feel better, it may well be a muscle tension headache.

I explain it to patients in the following way.  Suppose you have a pebble in your shoe under your heel. You walk around all day on your toes, so it doesn’t hurt, right?  After about a week of this, the muscles in your lower and upper leg hurt. Your knee and maybe even your hip hurts. Do you need to have your hip worked on, or your knee? Very likely NOT! Why wouldn’t we try to remove the pebble? Why wouldn’t we let you walk normally again and see if your body, moving as it was designed to, makes the problem go away? It has worked over and over again for my patients.

Don’t say, “I have TMJ.”  It’s the same as saying, “I have knee.”

The TMJ problem could be treated in a number of different ways. An occlusal splint may be utilized. Orthodontics can reposition crooked teeth if they are the cause. Equilibration (selective reshaping) of involved teeth can sometimes help.  If the above methods are of little assistance, surgery may be indicated.

Bonding is a process that mechanically and/or chemically adheres the restoration (crown, veneer or filling) to the tooth. These materials get better every day and are very strong.

Gum disease, periodontitis, periodontal disease or pyorrhea all mean the same thing. It occurs when plaque has been left on the teeth and gums for a long time. The plaque gives off acid which chronically irritates the gum tissues. These swollen gum tissues form “pockets,” which are places where the plaque lives. The accumulations can demineralize the teeth and surrounding bone. When teeth are demineralized, you have cavities. When the gum and bone are involved, gum disease is present. You may also notice much tarter on the teeth. It is usually brown to black but can be other colors, due to eating habits. If the gums look purple/red rather than pink, there is probably tarter present below the gums. Some warning signs are red, swollen gums. The teeth may have deposits on them. Bad breath, gums that bleed during brushing or flossing, pain, pus and bad taste are other indicators of gum disease. Gum disease has been linked to cardiovascular problems, stroke and diabetes. This is not a game! Be aware of your health and take control.

The treatment usually depends on the severity of the problem. If the infection below the gumline is caught early, generally the problem can be controlled by scaling and root planing (a deep cleaning usually accomplished while you’re numb). If the disease has progressed, surgery may be required. This involves pushing the gums back, removing affected tooth structure, calculus, plaque, gum tissue and remodeling the bone. Sometimes skin and/or bone grafting are necessary. If gum disease is left untreated, it will progress, leading to loose teeth and tooth loss.

Wisdom teeth are the third molar teeth. They generally erupt into the mouth between ages of 17 and 21. They’re not much different than the first (6-year) or second (12-year) molar teeth. They’re called wisdom teeth because of the years of when they erupt. Four wisdom teeth are the rule; however, some folks don’t get any, and I’ve seen patients with eight—two in each corner!

No. Some people have adequate space for their third molar teeth (wisdom teeth).  As long as the teeth have erupted properly and space is available, wisdom teeth are like the other molars. My mom still has all of hers!

Children should see a dentist when their first birthday rolls around. Not all the baby teeth will have erupted by this time, but the ones that have require care. Just before bed time, brush teeth (only a little dab of toothpaste), and do not put the child to bed with anything other than water—no juice, no milk, no cola!  These lead to baby bottle cavities.

When a child is consistently put to bed with a bottle containing fluids and sugar (i.e. cola, milk, juice or just about anything but water), the sugars in these remain in contact with the teeth because the salivary flow at night dramatically decreases. The sugar remains in the mouth throughout the night. These sugars feed the naturally occurring bacteria which give off acid. The acid attacks the teeth and, over time, causes large cavities. This is preventable!! Once a tooth has erupted into the child’s mouth, use a toothbrush or gauze pad to clean it. Afterwards give nothing but water until morning. The child is unhappy for a few days, but this is nothing in comparison to the pain for your child and money it will cost you to repair the damaged teeth.