Our Tutorials explains our approach to quality dental care and provides answers to many common dental questions.

DENTAL CONDITIONS:
GUM DISEASE
Gum disease, also know as periodontal disease, is the infection of the tissues surrounding and supporting your teeth. It is a major cause of tooth loss in adults. Gum disease is usually painless, and you may not know you have it. That is why it is very dangerous and requires routine check ups for prevention.

Gum disease is caused by plaque, a bacteria that creates toxins, which can damage the gums.

In the early stages of gum disease, know as gingivitis, the gums can become red, swollen and will easily bleed. At this point, the disease is still reversible and can often be eliminated by brushing and flossing.

Periodontitis, a more advanced stage of gum disease, is when the gums and bone that support the teeth become seriously damaged. Teeth can become loose, fall out or may have to be removed by a dentist.

Healthy Gums	Gingivitis	Mild Periodontitis	Moderate Periodontitis	Severe Periodontitis
Healthy gums are firm and pink.	The early stage of periodontal disease - gums become red, swell, and bleed easily.	The beginning of bone and tissue loss around the tooth.	More bone and tissue destruction.	Extensive bone and tissue loss. Teeth may become loose.

What are the signs of gum disease?

If you notice any of the following signs of gum disease, see us immediately:

• Gums that bleed when you brush your teeth
• Red, swollen or tender gums
• Gums that have pulled away from the teeth
• Bad breath that doesn't go away
• Pus between your teeth and gums
• Loose teeth
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

Periodontitis: Unremoved, plaque hardens into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums.

Advanced periodontitis: The gums recede farther, destroying more bone and the periodontal ligament. Consequently, even healthy teeth may become loose and need to be extracted.

TOOTH DECAY
What is Tooth Decay?
Tooth decay is the destruction of tooth enamel. It is caused when foods with carbohydrates (sugars and starches) like as milk, soda, raisins, cakes or candy are frequently left on the teeth. The bacteria in the mouth thrive on these foods, which produce acids when combined with these types of carbohydrates. Over time, these acids will destroy the tooth enamel, causing tooth decay.

How Do I Prevent Tooth Decay?
• Brush twice a day with a fluoride toothpaste.
• Floss in between your teeth daily.
• Maintain a healthy diet and limit snacking.
• Contact us regarding supplemental fluoride, and dental sealants which helps strengthen your teeth and prevent decay.
• Maintain regular check ups with us for professional cleanings and oral examination.

PLAQUE
What is plaque?
Many of the foods cause bacteria, which produce acids. These are foods such as candy, cookies, starches, such as bread, crackers, and cereal, also cause acids to form. These acid attacks, can cause your teeth to decay.

Plaque also produces elements that irritate the gums, which can make them red, tender or cause bleeding. After time, the gums can pull away from the teeth causing pockets to form and fill with additional bacteria and pus. If the gums are not treated, the bone around the teeth can be destroyed. This can cause the teeth to become loose or have to be removed. Gum disease is one of the leading causes of tooth loss for adults.

One method to avert tooth decay and gum disease is by maintaining a healthy diet and limiting the number of snacks. If you do snack, try to select nutritious foods such as raw vegetables, plain yogurt, cheese or fruit.

ORAL HEALTH CARE
What is daily oral health care?
The best way to remove decay-causing plaque is by brushing and flossing your teeth twice a day.

Brush your teeth twice a day, with a soft-bristled brush. The size and shape of your brush should fit your mouth, which will allow you to reach all teeth and gums effectively. Be sure to use fluoride toothpaste, which helps protect your teeth from decay. When selecting any dental product, make sure it has the American Dental Association Seal of Acceptance, certifying the dental product's safety and effectiveness.

Cleaning between the teeth once a day with floss or interdental cleaners helps remove plaque from between the teeth, which are regions the toothbrush is not as effective. This along with brushing is essential in preventing gum disease.

By regularly cleaning your teeth, maintaining a nutritious diet and scheduling regular visits to us, you can have a lifetime of healthy teeth and an attractive smile.

INLAYS AND ONLAYS
Indirect fillings are similar to composites or tooth-colored fillings, the main difference being that indirect fillings are made in a dental lab and permanently cemented by your dentist. Fillings, on the other hand, are soft to begin with and are molded to shape in the mouth. There are two types of indirect fillings - inlays and onlays. An inlay fits into the prepared space left after a cavity or old filling has been removed. An onlay sits on the tooth and builds up its shape. Inlays and onlays can be made in tooth-colored porcelain, gold or composite. Different materials are better for different parts of the mouth and teeth.

Inlays are more like fillings than onlays. As mentioned, they’re made in a dental lab after your dentist has removed the decay. Inlays are generally more durable and far out-last fillings. They can be fabricated from tooth-colored composite resin, porcelain or gold. They are also more conservative than crowns. Generally, much less tooth structure is removed in the preparation of inlays than crowns.

Onlays are essentially identical to inlays with the exception that one or more cusps have been included in the preparation. In other words, decay or trauma has affected the cusps, necessitating their replacement. Onlays may be composed of the same materials as inlays - tooth - colored composite resin, porcelain or gold. They are sometimes also referred to as partial crowns.

Procedure
Usually an anesthetic will be given to numb the area;
Inlays and onlays are applied in two visits. On the first visit, any old filling material and/or decay will be removed; An impression will be taken to record the shape of the tooth being repaired and the teeth around it. The impression will then be sent to a dental lab for fabrication of your restoration (inlay/ onlay). A temporary filling will be applied to protect the tooth while you wait for your restoration to be made; At the second appointment after your restoration has come back from the lab, your dentist will cement it in place; small adjustments may need to be made so that the tooth is comfortable to bite on.

Considerations
Depending on their size and location, fillings can reduce the strength of a tooth by up to 50%. Inlays and onlays, on the other hand, can actually increase the strength of the tooth by up to 75%. Inlays and onlays are fabricated outside of the mouth and therefore are capable of being made much stronger than typical fillings. They typically last between 10 to 30 years.

Inlays and onlays are extremely strong and usually long outlast fillings. They are especially suitable for the chewing surfaces of back teeth. We can match the color to your teeth.

CROWNS
A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Prosthetic crowns are made of metal, porcelain fused to metal substrates, or new all-white restorative materials. Crowns are necessary when a tooth is generally broken down and fillings won't solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn't get worse. Crowns are also used to support a large filling when there isn't enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth,cover badly shaped or discolored teeth or protect a root-canal filled tooth with compromised strength.

How is a crown placed?
The tooth is numbed and prepared for the crown by removing any decay or weakened areas. The remaining tooth structure is then reshaped to meet proper crown preparation design. If necessary, a restorative material, usually a composite resin, is added to the remaining tooth structure to ensure that the prosthetic crown will have a good foundation. This procedure is called a "build-up." After the tooth is prepared, an impression of teeth and gums is made and sent to the lab for the crown fabrication. On the next visit, we cements the permanent crown onto the tooth.During the second appointment,the new crown is placed on the tooth. Adjustments may be required to exact the perfect fit, so that the crown will feel comfortable in the mouth and will conform to the bite. When the crown fits seamlessly and contacts the neighboring teeth correctly, the crown is cemented on the tooth.

Will it look natural?
Yes. The dentist's main goal is to create crowns that look like natural teeth. That is why we take an impression. To achieve a certain look, a number of factors are considered, such as the color, bite, shape, and length of your natural teeth. Any one of these factors alone can affect your appearance.If you have a certain cosmetic look in mind for your crown, discuss it with us at your initial visit. When the procedure is complete, your teeth will not only be stronger, but they may be more attractive.

What is the difference between a cap and a crown?
There is no difference between a cap and a crown.

How long do crowns last?
Crowns should last approximately 5-8 years. However, with good oral hygiene and supervision most crowns will last for a much longer period of time. Some damaging habits like grinding your teeth, chewing ice, or fingernail biting may cause this period of time to decrease significantly.

How should I take care of my crowns?
To prevent damaging or fracturing the crowns, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting us and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.Regularly scheduled examinations and hygiene appointments must be adhered to, or the same bacterial assault which causes decay and makes dental care necessary may cause the restorations to fail.

BRIDGES
What is a bridge?
A bridge is a dental appliance that replaces one or more natural missing teeth, thereby "bridging" the space between two teeth. Bridges are cemented into place on the "abutment" teeth - the surrounding teeth on either side of the space or span. Unlike removable partial dentures, bridges cannot be taken out of the mouth by the patient.

A bridge is a device that typically consists of three units - a pontic (a false tooth) fused between two crowns that are cemented onto the abutment teeth.

Who should get a bridge?
A person with missing teeth and committed to maintaining good oral hygiene practices, is a good candidate for a bridge. A bridge is the most natural choice to fill the space in the mouth left by missing teeth. If left unfilled, this space can cause the surrounding teeth to drift out of position and can cause teeth and gums to become more susceptible to tooth decay and gum disease that can cause further tooth loss. Bridges not only correct an altered bite, improve the chewing ability and speech, but they also safeguard the appearance by preventing the collapse of facial features that can cause premature wrinkles and age lines.

What type of bridges are there?
Besides traditional bridges, another popular design is the resin bonded or "Maryland" bridge, primarily used for the front teeth. This is usually the most economical choice when the abutment teeth are healthy and don't contain large fillings. The pontic is fused to metal bands that can be bonded to the abutment teeth with a resin cement and hidden from view, reducing the amount of preparation on the adjacent teeth.

A cantilever bridge may be used if there are teeth on only one side of the span. This involves anchoring the pontic to one side over one or more natural, adjacent teeth. If there are no adjacent teeth to act as anchors,an implant is recommended - a metal post that is surgically embedded into the bone and capped with a crown as an abutment. In some cases where the span is large, a removable partial denture is recommended or even an implant-supported prosthesis.

What is the procedure of its fabrication?
For a traditional fixed bridge, the first appointment consists of the dentist reducing the adjacent abutment teeth that will act as anchors. Impressions are made, from which a metal framework, including the pontic, is created. By the second appointment, the final bridge is fitted over the teeth. The total treatment time is usually around one week, depending on the type of bridge. However, because it is often difficult to match the natural shade of your teeth, the treatment time may be longer.

How do I care for a bridge?
With a bridge, it is more important than ever to brush, floss and see us regularly. If buildup of food debris and plaque - the sticky film of bacteria formed from food acids - is not controlled, the teeth and gums can become infected, requiring further treatment and resulting in possible loss of the bridge.We recommend using floss threaders that help remove bacteria from hard to reach spaces between the bridge and adjacent teeth and gums. Crowns on the bridge cover most of the exposed portion of your tooth and decay does not affect a bridge since it is made of metal and /or porcelain. However, where the natural tooth meets the crown of the bridge can become decayed. If optimal oral hygiene care is maintained,a bridge can last for many years.

ROOT CANALS
A root canal, or endodontic therapy is needed to treat the tissue inside the tooth. This tissue is called the pulp, often referred to as the nerve. The pulp can become irreversibly damaged due to infection or trauma. The infection of the pulp typically results from deep decay, which is caused by bacteria. Left untreated the pulp will eventually die. This is called a necrotic pulp. This infection and necrotic tissue can work its way into the jawbone forming an abscess, a serious and sometimes painful infection.

Endodontic Procedure
A root canal can take from one to two or more appointments, depending on the individual tooth and the amount of infection present. The tooth is always numbed first so you are comfortable during the procedure. A device called a rubber dam is placed on the tooth to isolate it and to keep the inside of the tooth from saliva contamination. A small access is made to the pulp using the dental handpiece. The infected and/or dead pulpal tissue is delicately removed. Then the inside of the tooth is gently shaped, disinfected, and filled with an inert material.

After Treatment
Patients are often concerned with how painful a root canal is. Its reputation as a painful dental experience is mostly undeserved. Many patients present in pain and find the endodontic treatments bring great relief.

During the procedure you will be numb and we can always give you more anesthetic if you feel anything. Most patients have little or no pain after the procedure. Some people will have some mild post procedure discomfort which is usually manageable with over the counter pain medications. Even rarer is the patient who experiences severe pain postoperatively, and in this case we will give a prescription for a stronger pain medicine.

The root canal treats the inside of the tooth. Your tooth still needs to be restored to proper form and function. Sometimes this can be done with just a filling. However, endodontically treated teeth often are already broken down and they become brittle with time after treatment. A crown is usually needed to effectively rebuild these teeth. If the tooth is crowned, a separate procedure called a post and core is often needed to build up the tooth. A small post is cemented in the tooth and a core of filling material is built up around this post.

Success Of Root Canals
Root canals are successful about 95 percent of the time. Success is determined on follow-up examinations and x-rays. If the tooth remains pain free without any pathologic changes noted in the jawbone around the tooth on x-ray, it is a success. Problems which can develop are the formation of infection, cyst, or scarring at the root tip. Often this can happen with no symptoms so follow up x-rays are important.

If one of these rare but unfortunate problems, the tooth can usually be retreated without a problem. Sometimes a minor surgical procedure can be used to treat the tooth as well. Rarely, the tooth will not be salvageable. It is important to remember that with any medical/dental procedure there is always a risk that it may not work. Endodontic treatment has a high rate of success, but you do need to be aware of the risks involved, however unlikely.

VENEERS
Veneers can easily correct gaps in your teeth or with teeth that are stained, badly shaped or crooked. Today a veneer placed on top of your teeth can correct nature's mistake or the results of an injury and help you obtain a beautiful smile.

Veneers are thin, custom-made shells crafted of tooth-colored materials designed to cover the front side of teeth. Typically veneers are designed by a dental technician, working from a model of the patient's teeth provided by us.

Usually Veneers is an irreversible process, because it's necessary to remove a small amount of enamel from your teeth to accommodate the Veneer shell.

We may recommend that you avoid some foods and beverages that can stain or discolor your veneers such as coffee, tea or red wine. Sometimes a veneer might chip or fracture, but for many people the results are more than worth it. To find out if Veneers are right for you, schedule a free consultation.

TOOTH WHITENING
Everybody wants a bright white smile, and there are a variety of products and procedures available to help you improve the look of yours.

Many people are satisfied with the results they get from brushing twice daily with fluoride toothpaste, flossing between their teeth and regularly scheduled visits to our office. If you decide you would like to go beyond the normal routine to make your smile look brighter, you should investigate all of your options.

Several approaches to whiten your smile include:

• In-office bleaching;
• At-home bleaching;
• Whitening toothpastes

Visit us to learn more and find out which procedure is best for you.

DENTURES:
Differences between conventional dentures and immediate dentures?
Complete dentures are called "conventional" or "immediate" depending on the time they are made and when they are inserted into the mouth.

Immediate dentures are introduced immediately after the removal of the teeth. To accommodate this, we will take measurements and will make the model of the patient's jaws during a preliminary visit.
A benefit of immediate dentures is that the patient does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

What is an overdenture?
An overdenture is a removable denture, which fits over a few of the remaining natural teeth or implants. The natural teeth need to be prepared to provide stability and support for the denture. We can verify if an overdenture would be suitable for you.

What will dentures feel like?
New dentures can feel awkward for a few weeks until the patient becomes accustomed to them. Dentures may feel loose while the muscles of your cheek and tongue are 'trained' to keep them in place.

It is not unusual to experience minor irritation or soreness caused from new dentures. Patients may find that their saliva may temporarily increase as well. As the mouth becomes comfortable to the dentures, these problems should diminish. Patients should schedule follow-up appointments with us after a denture is inserted. If any problem persists, particularly irritation or soreness contact us.

DENTAL IMPLANTS
Are there alternatives to tooth replacement besides a bridge?
Dental implants are a source of artificial teeth that look natural and feel secure. Dental implants can also be used to attach full or partial dentures. However, Implants are not an option for everyone, because implants require surgery. Patients need to be in good health, have healthy gums, and have adequate bone to support the implant. The patient must also be committed to meticulous oral hygiene and regular dental visits. If you are considering implants, a thorough examination by us will help determine if you would be a good candidate.

What is involved in placing implants?
Surgery is performed to place an anchor. Surgery can take several hours, and up to six months can be required for the bone to grow around the anchor to firmly hold it in place. Some implants may require a second surgery in which a post is attached that connects the anchor to the replacement teeth. With other implants, the anchor and post are already attached and are positioned at the same time.

After the gums have had several weeks to heal, the artificial teeth are made and fitted to the post portion of the anchor. This step can take one to two months to complete, as several fittings may be required.

Implant surgery can be done either in a dental office or in a hospital, depending upon a number of factors. A local or general anesthetic can be used. Usually pain medications and, if necessary, antibiotics are prescribed. We will give you instructions on diet and oral hygiene.

TMD (TEMPOROMANDIBULAR DISORDERS)
More than fifteen percent of American adults suffer from chronic facial pain. Common symptoms include tenderness of the jaw, clicking or popping, pain in or around the ear, noises when opening the mouth, or even headaches and neck aches.

We can help identify the source of the pain with a thorough examination. Many times, it's a sinus, toothache or an early stage of periodontal disease. However, for some pains, the cause is not so easily diagnosed. It could be connected to the facial muscles, the jaw or temporomandibular joint that is located in the front of the ear. Treatments for this pain can consist of muscle relaxants, exercises, or a mouth protector preventing teeth grinding. These treatments have been successful for many patients and we can recommend the best for you.

FLUORIDE AND FLUORIDATION - FACTS ABOUT FLUORIDE
Cavities used to be very common, but over the past few decades, tooth decay has been reduced dramatically thanks to fluoride. Studies have shown that fluoride reduces cavities in both children and adults and helps repair the early stages of tooth decay even before the decay is visible. Fluoride is a nutrient, which is safe and effective when used appropriately.

Fluoride is a mineral that naturally occurs in all water sources, even the oceans. The fluoride ion comes from the element fluorine. Fluorine, which is the 17th most abundant element in the earth's crust, is never encountered in its free state in nature. It exists only in combination with other elements as a fluoride compound.

Fluoride is effective in preventing and reversing the early signs of tooth decay. Research has shown there are several ways in which fluoride achieves its decay-preventive effects. It makes the tooth structure stronger, so teeth are more resistant to acid attacks. Fluoride also acts to repair, or re-mineralize, areas that acid attacks have begun. The effect of fluoride is important because it reverses the early decay process as well as creating a tooth surface that is more resistant to decay.

Fluoride is obtained in topical and systemic forms. Topical fluorides strengthen teeth making them more decay-resistant. Topical fluorides include toothpastes, mouth rinses and professionally applied fluoride therapies.

Systemic fluorides are ingested in the body and become important in forming tooth structure. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually coats the teeth. Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.

TOPICAL FLUORIDES
Self-Applied
Self-applied topical fluoride responsible for the significant drop in the level of cavities since 1960 is fluoride toothpaste. The American Dental Association recommends that children (over two years of age) and adults use fluoride toothpaste certified by the ADA Seal of Approval. Other sources of self-applied fluoride are mouth rinses, either prescribed by us or an over-the-counter product. The ADA recommends the use of fluoride mouth rinses, but not for children under six years of age because they may swallow the rinse.

Professionally-Applied
Professionally applied fluorides come in the form of a gel, foam or rinse, and are applied by us or hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not required as frequently. The ADA recommends that dental professionals use any of the professional strength, tray-applied gels or foam products approved by the ADA. There are no ADA-accepted fluoride professional rinses for use in dental offices.

Systemic Fluorides
Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.

COMMUNITY WATER FLUORIDATION
Fluoride is present naturally in all water sources. Community water fluoridation, has been in affect for over 50 years, and is the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health. The recommended level is 0.7 - 1.2 parts of fluoride per million parts water. Water fluoridation has been proven to reduce decay in both children and adults. While water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal tooth decay prevention, not everyone lives in a community with a centralized, public or private water source that can be fluoridated. If you do not have community fluoridated water, contact us for alternative sources.

BRACES AND ORTHDONTICS
At what age can people have orthodontic treatment?
The biological process of moving teeth is the same at any age. Both children and adults can benefit from orthodontics. It is recommended that every child receive an orthodontic evaluation by age seven, as treatment can take a little longer for adults.

What causes orthodontic problems?
An orthodontic problem is called a malocclusion, which translates in common English to "bad bite." Some causes of malocclusion include: crowded teeth, extra teeth, missing teeth or jaws that are out of alignment.

Most malocclusions are inherited, although some can be acquired. Acquired malocclusions can be caused by accidents, early or late loss of baby teeth, or sucking of the thumb or fingers for a prolonged period of time.

How are orthodontic problems corrected?
First, pretreatment records are created which are important for the dentist to accurately diagnosis the patient. This includes medical/dental history, clinical examination, plaster study models of teeth, photos of your face and teeth and x-rays of your mouth and head. This information will be used to decide on the most effective treatment.

A custom treatment plan is outlined for each patient, defining the specific appliance treatment best suited to correct the patient's orthodontic problems. There are a variety of different orthodontic appliances that may be used.

When the orthodontic appliances are in place, this is considered the "active treatment" phase. Appliances are adjusted periodically to ensure the teeth are adjusted correctly and efficiently.

The length of Orthodontic treatment varies from person to person. An important determinant as to how long a patient wears braces depends on how well the patient cooperates during treatment - for example, by following instructions to wear rubber bands, head gear, etc.

After active treatment is complete, the "retention" phase begins. A patient will need to wear a retainer to ensure the teeth remain in their new positions. For severe orthodontic problems, surgery may be recommended.

Are there less noticeable braces?
Today's braces are for the most part, less noticeable than older versions. Brackets, the part of the braces that hold the wires, are bonded to the front of the teeth wires that are used for braces today are also less noticeable. These brackets can be metal, clear, or tooth-colored, making them more cosmetically appealing. In some cases, brackets may be put on the back of the teeth. Modern wires are made of sophisticated materials that exert gentle but steady, pressure on the teeth, making the tooth-moving process faster and more comfortable while being less noticeable than their predecessors.

How long will treatment take?
The normal treatment time is about 24 months, although this varies between patients. Usually, adult treatment takes a little longer than a child's treatment. Additional things to consider are the severity of the problem, the health of the teeth, gums and supporting bone and how closely the patient follows recommendations. While orthodontic treatment requires a time commitment, most people feel the benefits are well worth the time invested. Schedule a free consultation to learn more and see if braces are right for you.

ORAL CANCER
I recently noticed a white patch in my mouth that won't seem to go away. Is this a problem?
We should examine any mouth sore that persists for more than a week immediately.

Leukoplakia is a thick, whitish-color patch that can form on the cheeks, gums or tongue. It is caused by excess cell growth and is common among tobacco users although it can also be caused from irritations such as ill-filling dentures or a habit of chewing on one's cheek. The danger of leukoplakia is that it can progress to cancer. We will most likely take a biopsy if the leukoplakia appears to be threatening.

How can I help prevent oral cancer?
Eliminate risk factors such as tobacco and alcohol and schedule regular visits to us. Periodic dental exams allow early detection and treatment if cancer develops. If you become aware of any of these signs and symptoms in your mouth, contact us at once:

• Persistent sore or irritation that will not heal
• Color changes such as red and/or white lesions in the mouth
• Pain, tenderness or numbness in the mouth or lips
• A lump, thickening, rough spot, crust or small eroded area
• Having difficulty chewing, swallowing, speaking or moving the jaw or tongue
• A Change in your bite.