FREQUENTLY ASKED QUESTIONS Below are some questions our patients have had about dentistry and oral health issues. If you have any other questions, or would like to schedule an appointment, we would love to hear from you! Q: What should I do if I have bad breath? A: Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning. There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent. Q: What may cause bad breath? A: • Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath. • Certain foods – Garlic, onions, etc. Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled. • Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth. • Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums. • Dental cavities and improperly fitted dental appliances – May also contribute to bad breath. • Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems or continuous mouth breathing. • Tobacco products – Dry the mouth, causing bad breath. • Dieting – Certain chemicals called ketones are released in the breath as the body burns fat. • Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away. • Certain medical conditions and illnesses – Chronic sinus infections, postnasal drip, chronic acid reflux (heartburn), diabetes, bronchitis, and pneumonia are several conditions that may contribute to bad breath. Keeping a record of what you eat may help identify the cause of bad breath. Also, review your current medications, recent surgeries, or illnesses with you dentist. Q: What can I do to prevent bad breath? A: • Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning. • See your dentist regularly - Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits. • Stop smoking/chewing tobacco - Ask your dentist what they recommend to help break the habit. • Drink water frequently - Water will help keep your mouth moist and wash away bacteria. • Use mouthwash/rinses - Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor. Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem. In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy, but breath is persistent, your dentist may refer you to your physician to bad determine the cause of the odor and an appropriate treatment plan. Q: How can I tell if I have gingivitis or periodontitis (gum disease)? A: Four out of five people have periodontal disease and don’t know it. Most people are not aware they have gum disease because it is typically painless in the early stages. Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without any noticeable symptoms whatsoever. Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist. Recent research indicates that periodontal disease is linked to heart disease, diabetes, and low birth weight babies. So in order to maintain overall health, it is important to see your dentist at least 2 times each year for an evaluation and thorough cleaning. Periodontal disease begins when plaque (a sticky, colorless film of bacteria) food debris, and saliva, are left on the teeth and gums. The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone. Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage. Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease: • Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth. • Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings may trap plaque and bacteria. • Many medications – Some medications have side effects that reduce saliva, making the mouth dry so it is easier for plaque to adhere to the teeth and gums. Examples include: steroids, anti-depressants, cancer therapy drugs, blood pressure medications, oral contraceptives, and ADD / ADHD medications. • Pregnancy and Puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins. • Systemic diseases - Diabetes, Heart Disease, Blood Cell Disorders, etc. • Genetics – Some patients may be predisposed to a more aggressive type of periodontitis. Patients with a family history of tooth loss should pay particular attention to their gums. Q: What are Signs and Symptoms of Periodontal Disease? A: • Red and puffy gums – Gums should never be red or swollen. • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss. • Persistent bad breath – Caused by bacteria in the mouth. • New spacing between teeth – Caused by bone loss. • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone). • Pus around the teeth and gums – Is a sign that there is an infection present in the mouth. • Receding gums – Loss of gum around a tooth. • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth. Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease. Q: How can cosmetic dentistry help improve the appearance of my smile ? A: If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile. Cosmetic dentistry is popular not only due the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health. This includes dental prevention and having a healthier,whiter, more radiant smile. There are many cosmetic dental procedures available to improve your teeth and enhance your smile. Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full smile makeover. Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry. Teeth Whitening: Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile. Whitening lightens teeth that have been stained or discolored by age, food, drink, and smoking. Teeth darkened as a result of injury or taking certain medications can also be whitened, but the effectiveness depends on the degree of staining present. Bonding / Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings. Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth. This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession. Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful smile. Made of tooth-colored materials, veneers are used to close spaces between teeth, and to treat teeth that are chipped, worn, permanently stained, poorly shaped, or slightly crooked or misaligned. Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth making them a much more conservative restoration. Porcelain Crowns (caps): A porcelain crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size. Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations. They are ideal for teeth that have large, fractured or or broken fillings and also for those that are badly decayed. Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth. Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances. Enamel Recontouring: Enamel recontouring involves modifying teeth to improve their appearance by removing or shaping enamel. The process, which often is combined with bonding, usually is quick and comfortable and the results can be seen immediately. Orthodontics and Invisalign®: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients. Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners (Invisalign®) that require no braces. Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine! Q: What can I do about stained or discolored teeth? A: Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile. Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile. Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA). As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade. The color of our teeth also comes from the inside of the tooth, which may become darker over time. Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull. Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline. Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored. It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for whitening. Occasionally, tetracycline and fluorosis stains are difficult to whiten and your dentist may offer other options, such as veneers or crowns to cover up such stains. Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before whitening begins. Once the whitening is done, your dentist can match the new restorations to the shade of the newly whitened teeth. Since teeth whitening is not permanent, a touch-up may be needed every few years to keep your smile looking bright. The most widely used professional teeth whitening systems are: Home whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth. The trays are either worn once a day for approximately 60 minutes or overnight while you sleep. It usually takes several weeks to achieve the or desired results depending on the degree of staining and the desired level of whitening. In-office whitening: This treatment is done in the dental office and you will see results immediately. It may require more than one visit, with each visit lasting 30 to 60 minutes. While your gums are protected, a whitening solution is applied to the teeth. A special light may be used to enhance the action of the agent while the teeth are whitened. Some patients may experience tooth sensitivity after having their teeth whitened. This sensation is temporary and subsides shortly after you complete the whitening process, usually within a few days to one week. Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile! Q: What are my options for replacing missing teeth? A: By age seventeen, more than seven percent of Americans are missing at least one permanent tooth, according to studies done by the U.S. Surgeon General. When you lose a tooth, it is important to have it replaced because missing teeth can cause remaining teeth to shift thereby affecting your “bite” as well as your ability to speak and chew. Tooth loss can also cause increased strain on the remaining teeth and make them more susceptible to wear, fracture, and mobility. Depending on the location of the missing tooth, your overall appearance can be negatively affected as can your self-esteem. Replacing a missing tooth usually is not an emergency situation. Typically, you have time to make an educated decision as to which replacement option is best for you. Following are the options that are available to replace one or more missing teeth: • A “Flipper” is a removable appliance made out of plastic which replaces one of several missing teeth. While it is inexpensive, it is also fragile and temporary. The Flipper must be removed on a daily basis to be cleaned. • A Partial Denture is also removable, and replaces one or more missing teeth, but lasts longer than a “flipper” because it is precision cast in metal rather than made solely of plastic. It is anchored to the existing teeth using metal clasps. Like the flipper, partial dentures must be removed on a daily basis to be cleaned. • A Fixed Bridge is a more permanent option than the flipper or partial denture. A fixed bridge literally bridges the gap created by one or more missing teeth. A bridge is made up of two crowns (for the teeth on each side of the gap) and a false tooth in between. Contrary to a flipper or partial denture, fixed bridges are permanently cemented in the mouth and cannot be removed. • Complete Dentures are the most commonly-used solutions for people who have lost all of their teeth in one or both jaws. The success of a complete denture depends upon your jaw size and shape, your oral habits, and your ability to adapt to the dentures. • Dental Implants can be used to provide support for the replacement of one or all of your teeth. They can provide artificial teeth that look natural and feel secure. Implants, however, are not a treatment option in every case. Implants are a surgical procedure; therefore, patients must be in good health, have healthy gums, have adequate bone to support the implant, and be committed to thorough oral hygiene and regular dental visits. The best way to describe a dental implant is to compare it to a real tooth. Real teeth consist of a root underneath the gum area and a crown on top. When you lose a tooth, you lose both the root and crown, causing a gap in your mouth. A dental implant is like having a new root made of titanium to replace the lost root of your natural tooth. A crown is made to fit on top of the implant perfectly, thereby creating a new “tooth” that looks and feels like a natural tooth. • Implant-Supported Denture - If you are missing all of your upper or lower teeth, implant-supported dentures are an attractive alternative to traditional dentures. Over time, traditional, removable dentures may begin to feel loose, can cause minor irritation or soreness, and can affect what you are able to eat. Because dentures often slip or shift, they can make it difficult to speak the way you used to. In contrast, implant-supported dentures can give you the stability and feeling of natural teeth and allow you to bite into foods that you would otherwise have had cut up had you been wearing traditional (non-implant-supported) dentures. Q: What are canker sores? A: Canker sores are small shallow ulcers that appear in the mouth and often make eating and speaking uncomfortable. The exact cause of most canker sores is unknown; however stress, tissue injury, and certain acidic fruits or vegetables (ex: lemons, oranges, pineapples, apples, figs, tomatoes, strawberries, etc.) can trigger or worsen a canker sore. Oftentimes, a sharp tooth surface or dental appliance, such as braces or ill-fitting dentures, might also trigger canker sores. Studies have shown that certain canker sores can be caused by underlying health conditions such as an impaired immune system, nutritional problems (ex: vitamin B-12, zinc, folic acid, or iron deficiencies), or gastrointestinal tract diseases (ex: Celiac disease and Crohn’s disease.) Canker sores typically heal within 2 weeks. You should contact your dentist if you have a sore that last longer than 2 weeks or if you have unusually large sores, sores that are spreading,or difficulty drinking enough fluids. Q: Are cold sores another name for canker sores? A: No. Although these sores are often confused for each other, they are not the same. Cold sores (also called fever blisters) are groups of painful, fluid-filled blisters. Unlike canker sores, cold sores are caused by the herpes simplex virus which is extremely contagious. Also, cold sores typically appear outside the mouth (usually around the lips) while canker sores occur inside the mouth. To prevent cold sores, people should avoid contact with infected people. Cold sores are extremely common. Fever, cold temperature, ultraviolet sunlight, sunburn, emotional stress, nerve injury, or abrasions can reactivate the herpes simplex virus to cause cold sores. There are antiviral medications that can be prescribed by your dentist to help to limit both the severity and duration of a cold sore provided it is applied early enough (i.e., at the tingle stage). These medications do not provide a cure for cold sores nor are they considered preventive in nature. Even after the use of the medication and after the cold sore has healed, the herpes virus still resides latently within the person's body therefore the person still retains their potential for future cold sore outbreaks. Q: What causes tooth sensitivity? A: Tooth sensitivity is tooth discomfort in one or more teeth that is triggered by hot, cold, sweet or sour foods and drinks, or even by breathing cold air. The pain can be sharp, sudden, and shoot deep into the nerve endings of your teeth. The sensitivity occurs when the underlying layer of your teeth (dentin) becomes exposed allowing stimuli(hot, cold, or sweet food) to travel through tiny channels (dentinal tubules) and reach the nerve in your tooth which results in the pain you feel. There are many factors that may lead to the development of tooth sensitivity including: • Recession of the gums • Clenching or Grinding of your teeth • Gum Disease • Tartar Control Toothpaste • Cracked Teeth • Whitening Toothpaste • Leaky Fillings • Brushing too hard • Abscessed Teeth • Sinus Infections Since there are many factors that can cause tooth sensitivity, see your dentist for an evaluation to determine what dental procedures or products are available to help you maintain a healthy and comfortable smile.