Nasveschuk Implant and General Dentistry

Tooth Decay and Fluoride

What is community water fluoridation?

Community water fluoridation is the adjustment of the fluoride concentration in the community water supply to a level beneficial to reduce tooth decay and promote good oral health. The mineral fluoride is essential for strong healthy teeth that resist decay. Almost all waters contain some quantity of naturally occurring fluoride, but usually at levels insufficient to prevent decay. The optimum concentration of fluoride in water has been determined to be between 0.7 to 1.2 milligrams per liter (mg/L) depending on the air temperature in a given region. Given the dramatic decline in tooth decay during the past 60 years, the Centers for Disease Control and Prevention (CDC) named water fluoridation one of Ten Great Public Health Interventions of the 20th Century. Community water fluoridation has been recommended by the past five United States Surgeon General’s. More information can be found on our Benefits page.

How does fluoride work?

Tooth decay is caused by bacteria in the mouth. When a person eats sugar, or other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth, a process known as demineralization. If demineralization goes on long enough, a cavity is formed. Fluoride can promote the remineralization of enamel, thereby preventing the cavity from continuing to form. In addition, fluoride reduces the ability of the oral bacteria to produce acid. More information can be found in a fact sheet on Background Information.

Is tooth decay still a serious problem?

Yes. More than two-thirds of U.S. children and adolescents aged 19 years or younger, 91% of U.S. adults, and 93% of Americans aged 60 years and older have experienced tooth decay.

Will community water fluoridation benefit my family?

Fluoride’s action in preventing tooth decay benefits both children and adults throughout their lives. The health benefits of fluoridation are:

• Fewer cavities and less severe cavities.

• Less need for fillings and tooth extractions.

• Less pain and suffering associated with tooth decay.

• Better self-esteem from teeth that work well and look good.

• See the The Benefits of Fluoride statement from the Office of the Surgeon General

Have Americans had less tooth decay since water fluoridation began?

Yes. Independent studies initiated in 1945 and 1946 followed four communities and assessed the value of water fluoridation. By 1960, tooth decay rates in these communities declined, on average, 56% more than in demographically similar communities whose water supplies were not fluoridated. Now that there are additional ways of obtaining fluoride benefits such as in toothpaste, rinses, and professional treatments, as well as in many foods and beverages produced in fluoridated areas; more recent studies show that water fluoridation reduces tooth decay in permanent teeth by approximately 18%—40%. Although this reduction in decay is not as dramatic as it was in the 1950s and 1960s, it continues to be significant when compared with tooth decay in many nonfluoridated communities.

Is community water fluoridation a cost-effective method for disease prevention?

Yes. In 2004, an estimated $78 billion was spent on dental services, representing about 5% of all expenditures for personal health care in the United States. A CDC study estimated that every $1 invested in community water fluoridation saved $38 in avoided costs for dental treatment. The national average cost to fill one cavity with dental amalgam is approximately $65—the approximate cost of providing fluoridation to an individual for a lifetime.

Safety and Fluoridation

Is community water fluoridation safe?

Yes. Extensive research conducted over the past 60 years has shown that fluoridation of public water supplies is a safe and effective for all community residents. More recent reviews of the safety of water fluoridation include a comprehensive review of the scientific literature by the U.S. Public Health Service in 1991 and by the University of York in 2000. Additional information on safety can be viewed.

The overall value and safety of community water fluoridation has been endorsed by:

• CDC.

• U.S. Surgeons General (Oral Health in America and other reports).

• U.S. Task Force on Community Preventive Services.

• American Dental Association.

• American Medical Association.

• American Association of Public Health.

• U.S. Public Health Service.

• World Health Organization.

Can I use fluoridated water for preparing infant formula?

Yes. You can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there is the increased potential for mild dental fluorosis, which is a white spotting on teeth. Additional information can be found in a fact sheet on Infant Formula.

Fluoride in Drinking Water

How can I find out the fluoride concentration of my drinking water?

All public water systems are required by the U.S. Environmental Protection Agency (EPA) to publish an annual Consumer Confidence Report with information about their drinking water, including the fluoride level.

If you are on a public water system, you can call the water utility company and request a copy of the utility’s most recent Consumer Confidence Report.

If you live in a state that participates in CDC’s My Water’s Fluoride you can go online and find information on your water system’s fluoridation status.

My home gets it water from a private well. What do I need to know about fluoride and groundwater from a well?

Although most U.S. households are connected to a public water system, the U.S. Geological Survey estimates that approximately 14% of U.S. residents rely on private wells that are not regulated by the EPA Safe Drinking Water Act. Fluoride is present in virtually all waters at some level, and it is important to know the fluoride content of your water since too little may not protect against tooth decay and too much may be a health concern. It is recommended that you have a sample of your well water analyzed by a laboratory. If you have water fluoride levels under 0.6 ppm, your child’s dentist or pediatrician should evaluate whether your child can benefit from daily fluoride supplements. Their recommendation will depend on your child’s risk of developing tooth decay and as well as exposure to other sources of fluoride (e.g., drinking water at school or daycare, toothpaste). If the natural fluoride level of your well or community drinking water is greater than 2 ppm, you should consider an alternate source of drinking water for any child 8 years and younger. Their teeth are still developing and will be at risk for enamel fluorosis. If you have an infant which is predominately consuming infant formula reconstituted with water with fluoride greater than 0.7 mg/L, you may wish to review the fact sheet on Infant Formula and the Risk for Enamel Fluorosis. If you have additional questions on your well and fluoride levels, please see the Fact Sheet on Private Well Water and Fluoride FAQs.

How much does it cost the community to fluoridate the water?

The per person cost of fluoridation varies by the size of the community population. The average cost of providing fluoridated water to communities with more than 20,000 residents is about 50 cents per year. For communities of 10,000–20,000 residents, the cost is about $1, and for those living in communities of less than 5,000, the cost is about $3 per year.

Will using a home water filtration system take the fluoride out of my home’s water?

Removal of fluoride from water is difficult. Most home treatment systems are installed at single faucets and use activated carbon filtration, which does not remove fluoride.

If your fluoride level is above 2 ppm and you are trying to reduce the amount of fluoride in your water a home device must meet National Sanitation Foundation (NSF) Standard 58 criteria for fluoride removal. The Standard 58 requirements are for a device to achieve a 1.5 milligrams per liter (mg/L) concentration in the product water if the original concentration was 8.0 mg/L, or approximately an 80 percent removal. This percentage removal may not be consistent at lower concentrations of fluoride. Check with the manufacturer of the individual product for specific product information. If you are concerned about the fluoride level in your home water (above the level of 2 mg/L), you may consider using water from a commercial bottler whose water has the level of fluoride you desire as an alternative to removing the fluoride.

Fluoride is not released from water when it is boiled or frozen. One exception would be a water distillation system. These systems heat water to the boiling point and then collect water vapor as it evaporates. Water distillation systems are typically used in laboratories. For home use, these systems can be expensive and may present safety and maintenance concerns.

Does bottled water have fluoride?

Some bottled waters contain fluoride but most do not. The U.S. Food and Drug Administration (FDA) does not require bottlers to list the fluoride content of water, and only requires that if fluoride is added, the additive used be listed. Most bottlers will use National Sanitation Foundation certified additives for quality control. If you are interested in the fluoride content of a specific water brand, you should ask the bottler. In 2006, the FDA announced that bottled water with greater than 0.6 and up to 1.0 mg/L could be labeled with the statement “Drinking fluoridated water may reduce the risk of tooth decay.” Additional information is available in our Fact Sheet on Bottled Water and Fluoride.

Does water fluoridation result in pipe corrosion or increased lead in drinking water?

Water fluoridation does not increase corrosion of pipes or cause lead to leach (dissolve) from pipes and household plumbing fixtures. Although lead in public drinking water is typically found to be very low or is below laboratory detection, there are locations where old lead pipes, solder, or plumbing fixtures in old homes may leach lead into water. This is principally a problem in some older homes because newer homes have been constructed in accordance with new plumbing standards that prohibit the use of lead in plumbing pipes and fixtures.

Ask your local water utility system if there have been problems with higher lead levels in water from older homes in your community. Claims that fluoride might result in increased lead leaching from pipes and fixtures have not been substantiated in the peer-reviewed literature.

Regulations, Standards

What standards does the U.S. Environmental Protection Agency (EPA) set for levels of fluoride in water?

The EPA establishes criteria for safe drinking water under the Safe Drinking Water Act and its amendments (1974, 1986, and 1996). These standards include the maximum contaminant level goal (MCLG), the maximum contaminant level (MCL), and the secondary maximum contaminant level (SMCL).

The MCLG is a health goal set at a concentration to minimize adverse health effects. This goal is not enforceable and serves as an advisory to the states. The MCL is an enforceable regulatory standard that is set as close to the MCLG as practical, taking into consideration factors such as treatment technology and costs. The SMCL is a nonenforceable secondary standard that, in the case of fluoride, provides guidance on cosmetic or aesthetic considerations related to tooth enamel fluorosis.

In 1986, the EPA established an MCLG and MCL for fluoride at a concentration of 4 milligrams per liter (mg/L) and an SMCL of 2 mg/L. The Safe Drinking Water Act requires periodic reassessment of regulations for drinking water contaminants.

Does the U.S. Food and Drug Administration (FDA) or U.S. Environmental Protection Agency (EPA) regulate fluoride added to drinking water?

The EPA and FDA established in a 1979 Memorandum of Agreement that the EPA would regulate drinking water for public water systems and the FDA would regulate consumer beverages, including commercial bottled water. The EPA has issued maximum drinking water contaminant standard for fluoride of 4 mg/L, based on health considerations, and has entered into an agreement with National Sanitation Foundation (NSF) International to formulate program standards for drinking water additives. Those standards are known as NSF/ANSI (American National Standards Institute) Standard 60. The FDA requires bottlers to list the chemical used to adjust the fluoride concentration, and permits manufacturers to claim the benefits for improved oral health when fluoride is adjusted to a range of 0.6 to 1.0 mg/L.

How does the release of the 2006 National Research Council (NRC) report affect the standards set by the EPA?

On March 22, 2006, the NRC issued the committee’s report, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The report addresses the safety of high levels of fluoride in water that occur naturally at levels of 2 mg/L and higher, and does not question the use of lower levels of fluoride to prevent tooth decay. The findings are consistent with CDC’s assessment that water fluoridation at optimal levels (0.7 mg/L–1.2 mg/L) is beneficial for good oral health. For more information on this report and other publications by the National Academy of Sciences referencing fluoride in drinking water, see the findings on National Academy of Sciences on Fluoride in Drinking Water.

The recommendations from CDC remain the same—that community water fluoridation is safe and effective for preventing tooth decay. CDC continues to recommend steps to prevent moderate and severe enamel fluorosis; these recommendations were made in the August 17, 2001, MMWR report, “Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States” . These steps include using an alternate water source for children aged 8 years and younger if the primary drinking water source has naturally occurring fluoride above 2 mg/L, and supervising the use of toothpaste by children younger than 6 years to prevent swallowing excess toothpaste. Fluorosis can only occur when the teeth are developing (ages 0 to approximately 8) Other steps to prevent fluorosis include: Parents should place only a pea-sized amount of toothpaste on the child’s brush. Children under age 6 should not use fluoride rinses as they are prone to swallow them. Check with your child’s medical doctor or dentist about the use of dietary fluoride supplements if you live in an area with low levels of fluoride in your water.

Fluoride Additives for Water

What additives are used to fluoridate water?

Fluorosilicic acid is the most commonly used additive for water fluoridation, followed by two dry additives—sodium fluorosilicate and sodium fluoride. Fluorosilicic acid is derived from production of phosphate fertilizers. Phosphate rock which is comprised of calcium phosphate, calcium fluoride, apatite ore, and limestone, is mixed and heated with sulfuric acid to form a phosphoric acid-gypsum slurry, the starting point to make pelletized phosphate fertilizers. The hydrogen fluoride and silicon tetrafluoride that would otherwise be left in the gypsum slurry is deliberately recovered from the slurry by evaporators and condensed to a high purity fluorosilicic acid that can be used for water fluoridation. Both sodium fluorosilicate and sodium fluoride are created by neutralizing fluorosilicic acid with either sodium chloride (table salt) or caustic soda. See Water Fluoridation Additives for a more detailed explanation.

Do these additives have to meet standards for quality and purity?

The American Water Works Association (AWWA) prepares standards for the manufacturing, quality, and verification of the fluoride additives. NSF/ANSI (National Sanitation Foundation/American National Standards Institute) prepares standards that cover impurities of drinking water treatment additives from their production and distribution to user, and documents the purity of additives. Verification testing by independent certification entities including NSF and Underwriters Laboratories documents that the actual purity exceeds the NSF Standard 60 requirements.* A key concept is that an additive should not add more than 10% of the EPA-established MCL (Maximum Contaminant Level) of any regulated drinking water substance in order to ensure the protection of the public. The NSF/ANSI standard 60 was developed by a consortium of associations, including NSF International, AWWA, ANSI, the Association of State Drinking Water Administrators, and the Conference of State Health and Environmental Managers.

Is fluorosilicic acid the residue of the production of pesticides, rodenticides, or the nuclear industry?

No. It is a valuable coproduct derived from the production of fertilizer. It is not derived from pesticide, rodenticide, or nuclear power production.

Date last modified: February 2, 2010

Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion

From cdc.gov 4-16-2010

Q: I don’t like my teeth or my smile – what can I do?

A: A wide variety of options are available to improve how your teeth work and the way your smile looks.

Q : How much does it cost to get a great smile?

A : Like most services, cost will vary based on the time required and the difficulty of the procedures.  Generally, improving a smile will require a combination of treatment options such as bleaching, reshaping gums and using bonded materials (resin or porcelain) to improve the appearance of teeth.  A great way to start is having a consultation to determine the ways that you can reach your goals.  Improving your smile is an investment in you.

Q: What are some of the benefits of cosmetic dentistry?

A : A great smile should improve your self-confidence, which can have a positive impact on the social and professional aspects of your life.  Cosmetic dentistry is not just about pretty smiles though.  New techniques and materials are available for back teeth as well as the ones you see when you smile.  Now your mouth can look great, get healthy and function better at the same time.

Q: Why should I go to an AACD dentist?

A: Our member dentists have shown a special interest in new technologies and procedures, specifically to help them achieve better results for you.  The AACD provides a wide variety of educational and interactive opportunities that assist member dentists in attaining the best possible clinical skills.  That helps promote excellent to care for their patients.

Q : Will a dentist I select be able to provide all of the treatment I need?

A : Some dentists choose to provide a variety of procedures, while others focus on specific areas of treatment.  Many times, cosmetic and restorative dentistry requires a team approach to achieve the best results.  A consultation is a way to determine your needs, and plan with your dentist how to achieve your goals. Subsequently the dentist will work to give you the smile you want and deserve.

Q: How many office visits will it take to fix my teeth and improve my smile?

A: That will vary for each person, depending on his or her needs.  Sometimes, you can dramatically improve your oral health and appearance in just a couple of visits.  It makes sense to make your treatment as convenient as possible, perhaps choosing slightly longer visits instead of more trips to the office.  Talk to your dentist about your goals and concerns so the best plan can be developed for your individual situation.  If you start today, a new smile can be yours sooner than you think.

Q: What will my new smile look like?

A : Your dentist with work with you to choose the look that’s right for you.  A smile enhancement can be made to look dramatic and natural at the same time.  Your dentist can use photographs and models to show you what to expect.  Sometimes, trial materials can be placed directly on your teeth to help visualize the change.  Ask your dentist what can be done to give you the smile you desire.

Q : If my teeth are reshaped for veneers or crowns, what will they look like?  Will they be sensitive?

A: Generally, cemented restorations like crowns or veneers (see our procedure section) will require two visits – one to shape the teeth, and one to cement the restorations to the teeth.  In between, your dentist can place attractive temporary restorations to help prevent sensitivity, allow function and provide a nice smile.  These temporaries are designed to be in your mouth for a limited time, but should be comfortable and natural looking until you can get your new smile completed.

Q: Is my new smile permanent?

A : With good home care and regular visits to your dentist, modern materials can last for many years and possibly decades.  Like most things, excellent maintenance will extend the life of your dental restorations.

Q : I have dental insurance.  Will it pay for my new smile?

A : Most dental insurances have very low total benefits per year, which may offset the cost of regular hygiene visits, and may not pay toward purely cosmetic services.  Insurance is a business, and as such, your carrier will often contract to pay for the least expensive “payout” option instead of the best solution for your particular needs or desires.  A caring dental office will work to maximize your benefits, and may have suggestions for alternative methods of financing so you can obtain the treatment of your choice.

Q : How do I choose the right dentist for me?

A : The AACD is a great place to start, having members all across the US and in countries around the world.  Continuing education is important, which is why the AACD offers courses in techniques and materials at our annual meeting, and has relationships with over 60 Universities and teaching institutions.   Ask your dentist about experience and expertise.  Exceptional cosmetic dentistry is not an accident.  Talk to your dentist, develop a plan and work together toward your goal.

Q : Is teeth whitening bad for patient’s enamel?

A : There is no permanent damage caused to the enamel or any other tooth structures by tooth whitening.

Q : Does teeth whitening cause permanent teeth sensitivity?

A : Sensitivity from teeth whitening is always transient.  That means if there is any sensitivity caused by the whitening, it goes away within one to two days after the cessation of bleaching, and the patient returns to the state of sensitivity that they had before they started the whitening process.

Most information from the American Academy of Cosmetic Dentistry March 2010

WHAT IS ORAL HEALTH? 

Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene. 

WHAT ARE COMMON CAUSES OF ORAL DISEASE? 

Oral diseases share common risk factors with the four leading chronic diseases — cardiovascular diseases, cancer, chronic respiratory diseases and diabetes — including unhealthy diet, tobacco use, and harmful alcohol use. Poor oral hygiene is also a risk factor. 

ORAL HEALTH FACTS 

• The most common oral diseases are dental cavities and periodontal (gum) disease.
• 60-90% of school children worldwide have dental cavities.
• Severe periodontal (gum) disease, which may result in tooth loss, is found in 5-20% of middle-aged adults; the rate varies across geographical regions.
• Incidence of oral cancer ranges from one to 10 cases per 100 000 population in most countries.
• Birth defects such as cleft lip and palate occur in around one per 500-700 of all births; the birth prevalence rate varies substantially across ethnic groups and geographical areas.
• 40-50% of people who are HIV-positive have oral fungal, bacterial or viral infections, which often occur early in the course of HIV infection.
• Traditional curative dental care is a significant economic burden for many high-income countries, where 5-10% of public health expenditure relates to oral health.

HOW CAN THE BURDEN OF ORAL DISEASES BE REDUCED? 

The burden of oral diseases and other chronic diseases can be decreased simultaneously by addressing common risk factors such as tobacco use and unhealthy diet: 

• Decreased intake of sugars and well-balanced nutrition prevent tooth decay and premature tooth loss.
• Tobacco cessation and decreased alcohol consumption reduce risk for oral cancers, periodontal disease, and tooth loss.
• Fruit and vegetable consumption is protective against oral cancer.
• Effective use of protective sports and motor vehicle equipment reduces facial injuries.

Dental cavities can be prevented by a low level of fluoride constantly maintained in the oral cavity. Fluoride can be obtained from fluoridated drinking water, salt, milk, mouth rinse or toothpaste, as well as from professionally-applied fluorides. Long-term exposure to an optimal level of fluoride results in fewer cavities in both children and adults. 

By using these prevention strategies, the high cost of dental treatments can be avoided. 

WHO ACTIVITES FOR INTEGRATED PREVENTION OF ORAL DISEASE AND HEALTH PROMOTION 

The public health solutions for oral diseases are most effective when they are integrated with other chronic diseases and with national public health programmes. The activities of the World Health Organization (WHO) span advocacy, prevention and treatment: 

• Advocacy for a common risk factor approach to prevent oral and other chronic diseases simultaneously;
• Fluoridation programmes to improve fluoride access in low-income countries;
• Technical support for countries that are integrating oral health into their public health systems.

WHO Recognizes Fluoride Benefits- Click Pic

WHO STRATEGY FOR PREVENTION AND CONTROL OF CHRONIC DISEASE 

WHO’s oral health activities are integrated into the overall WHO chronic disease prevention and control framework of the Department of Chronic Diseases and Health Promotion. The strategic objectives of the Department are to raise awareness about the global epidemic of chronic diseases; create healthy environments, especially for poor and disadvantaged populations; slow and reverse trends in common chronic disease risk factors such as unhealthy diet and physical inactivity; and prevent premature deaths and avoidable disability due to major chronic diseases. 

From World Health Organization 3-14-2010

Sherri’s Story

When I was pregnant, I began to have some bleeding around my gums when I brushed my teeth. My gums also looked swollen, and I started to get worried. I knew many pregnant women have some gum bleeding when brushing their teeth, but I decided to have my dentist check them out anyway. I am glad I did! She said that my problem was worse than what usually happens during pregnancy—I was starting to get gum disease. I didn’t even know that I was at risk for serious gum disease while pregnant! My dentist said that having my teeth and gums cleaned, and brushing and flossing regularly can help me prevent gum disease in the future. With her help, we’re all smiling now!

What is oral health?

Good oral health does not just mean you have pretty teeth. Your whole mouth needs care to be in good health. The word “oral” refers to the mouth, which includes your teeth, gums, jawbone, and supporting tissues. Taking good care of your oral health can prevent disease in your mouth. Oral health can also affect the health of your body. It is easy to take your oral health for granted. But good oral health is key to your overall health.

How might problems in your mouth be linked to health problems in other parts of your body?

The health of your mouth can be a sign of your body’s health. Mouth problems are not just cavities, toothaches, and crooked or stained teeth. Many diseases, such as diabetes, HIV, cancer, and some eating disorders, can cause oral health problems. For instance, people with diabetes can develop tooth and gum problems if their blood sugar stays high. Regular dental exams help you maintain good oral health and avoid related health problems.

What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Dental cavities

We are all at risk of tooth decay, or cavities. Bacteria (germs) that naturally live in our mouths use sugar in food to make acids. Over time, the acids destroy the outside layer of your teeth. Then holes and other tooth damage occur.

Gum diseases

Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do. Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist’s office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected “pockets.” You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed.

Your risk of gum disease is higher if you:

• smoke
• have a disease such as diabetes or HIV/AID

What are some other problems I might have with my mouth?

Burning mouth. People with this condition describe a burning feeling in the mouth or tongue. It is most common in postmenopausal women. The cause is unknown, but might be linked to:

• hormones
• dry mouth
• taste problems
• nutritional deficiencies
• use of ACE inhibitors (blood pressure medicines)

Talk to your doctor or dentist if you have burning mouth. Treatment depends on the cause—if it can be determined—and might include menopausal hormone therapy, vitamin supplements, or pain or other medicines.

Cold sores. These small, painful sores are caused by herpes simplex virus type 1. Once you are exposed to the virus, it can hide in your body for years. Things that trigger the virus and lead to cold sores include:

• getting too much sun
• having a cold or infection
• having your period
• feeling stressed

Cold sores can spread from person to person. They most often form on the lips and sometimes under the nose or chin. The sores heal in about 7 to 10 days without scarring. You can buy over-the-counter drugs to put on cold sores to help relieve pain. If you get cold sores a lot, talk with your doctor or dentist about a prescription for an antiviral drug. These drugs can help reduce healing time and the number of new sores.

Canker sores. These sores are small ulcers inside the mouth. They have a white or gray base and a red border. Women are more likely than men to have canker sores that recur. The cause of canker sores is unknown. Risk factors include:

• fatigue
• stress
• your period
• a cut on the inside of your cheek or on your tongue
• allergies
• celiac disease
• Crohn’s disease

Canker sores most often heal on their own in 1 to 3 weeks. See your dentist if you get a large sore (larger than a half inch). You may need medicine to treat it.

To help with pain:

• avoid hot, spicy foods
• use mild mouthwashes or salt water
• try over-the-counter coatings or pain medicines

No proven way exists to prevent canker sores. If you get them often, talk with your dentist.

Thrush, called oral candidiasis (kan-dih-DEYE-uh-suhss). These fungal infections appear as red or white lesions, flat or slightly raised, in the mouth or throat. They can be caused by overgrowth of the fungus Candida. This fungus lives naturally in your mouth. Your risk of getting thrush increases if:

• you have a weak immune system
• you don’t make enough saliva
• you take antibiotics

Treatment includes antifungal mouthwash or lozenges. If the infection spreads or your immune system is weak, you may need antifungal medicine.

Thrush is common among:

• denture wearers
• people who are very young or elderly
• people with dry mouth

If you wear dentures, clean and remove them at bedtime. Talk with your dentist about medicines that may be helpful if you have thrush.

Dry mouth, called xerostomia (ZEER-oh-STOM-mee-uh). This problem happens when you don’t have enough saliva in your mouth. Some reasons why people get dry mouth include:

• side effect of medicines or medical treatment
• health problems, such as saliva and salivary gland disorders and rheumatoid arthritis
• blockage of a salivary gland

Dry mouth may make it hard to eat, swallow, taste, and speak. If left untreated, it can lead to cavities. This is because saliva helps rid your mouth of bits of food and helps stop acid from forming plaque on your teeth. Treatment of dry mouth depends on the cause and can range from medicines to diet changes. To lessen the dryness, use artificial saliva, suck on sugarless candy, and use a humidifier.

Bad breath, called halitosis (hal-lih-TOH-suhss). Bad-smelling breath can be caused by several things, including:

• poor oral hygiene
• some foods
• dentures
• gum disease
• dry mouth
• tobacco use
• respiratory, digestive, or other health problems
• some medicines

Practicing good oral hygiene and avoiding tobacco and some foods often helps people with bad-smelling breath. But if doing so doesn’t seem to help or if you always need mouthwash to hide bad breath, talk to your dentist.

Oral cancer. This cancer can affect any part of the mouth. If you smoke or chew tobacco, you are at higher risk. Alcohol use along with smoking raises your risk even more. Yet more than 25 percent of oral cancer affects nonsmokers.

Oral cancer most often occurs after age 40. It isn’t always painful. So it may go undetected until the late stages. Ask your doctor to check for signs of oral cancer during your regular checkup. Oral cancer often starts as a tiny white or red spot or sore anywhere in the mouth. Other signs include:

• a sore that bleeds easily or does not heal
• a color change in the mouth
• a lump, rough spot, or other change
• pain, tenderness, or numbness anywhere in the mouth or on the lips
• problems chewing, swallowing, speaking, or moving the jaw or tongue
• a change in the way the teeth fit together

Oral problems from cancer therapies. Treatments such as chemotherapy or radiation to the head and neck can cause dry mouth, tooth decay, painful mouth sores, and cracked, peeling lips. Get a complete dental exam before starting cancer treatment.

As a woman, why do I have to worry about oral health?

Everyone needs to take care of their oral health. But female hormones can lead to an increase in some problems, such as:

• cold sores and canker sores
• dry mouth
• changes in taste
• higher risk of gum disease

Taking good care of your teeth and gums can help you avoid or lessen oral health problems.

I’m pregnant. Do I need to take special care of my mouth?

Yes! If you are pregnant, you have special oral health needs.

Before you become pregnant, it is best to have dental checkups every 6 months. You want to keep your mouth in good health before your pregnancy.

If you are pregnant and have not had regular checkups:

• Have a complete oral exam early in your pregnancy. Because you are pregnant, your dentist might not take routine x-rays. But if you need x-rays, the health risk to your unborn baby is small.
• Remember dental work during pregnancy is safe. The best time for treatment is between the 14th and 20th weeks. In the last months, you might be uncomfortable sitting in a dental chair.
• Have all needed dental treatments. If you avoid treatment, you may risk your and your baby’s health.
• Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Both poor oral hygiene and higher hormone levels can cause pregnancy gingivitis. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby. Researchers have not been able to confirm this link, but studies are still under way to learn more.

I’m a new mother. What can I do for my baby’s oral health?

You can do a lot! Below are some things you need to know about your baby’s oral health.

• The same germs that cause tooth decay in your mouth can be passed to your baby. Do not put your baby’s items, such as toys, spoons, bottles, or pacifiers in your mouth.
• Wipe your baby’s teeth and gums with a clean gauze pad or baby toothbrush after each nursing and feeding. This can help remove sugars found in milk that can cause tooth decay.
• If you bottle-feed your baby, try to finish bottle weaning by age 1. Avoid giving your baby bottles or pacifiers at naps and bedtime. Sucking on a bottle when lying down can harm your baby’s teeth.
• All babies should visit a dentist by age 1. The dentist will screen for problems in your baby’s mouth. You will also be shown how to care for your child’s teeth and mouth.
• Talk with your doctor about the best water choices for infants. Fluoride is good for teeth. But too much fluoride can harm development of tooth enamel in infants.

I’m confused! What type of toothpaste or mouthwash should I use?

Many types of toothpastes line the store shelves. Some say they’re made for whitening, others for reducing gingivitis and plaque, and others for sensitive teeth. Before choosing toothpaste for your family, know the basics.

• As long as toothpaste contains fluoride and its box has the American Dental Association’s (ADA) seal of acceptance, it is good for your oral health. Beyond that, choosing toothpastes is a personal choice.
• Mouthwashes claim to freshen your breath. But they really only mask breath odor for a few hours. If you always need to use a mouthwash to hide bad breath, see your dentist.

I’m not happy with the stains on my teeth. How can I safely whiten them?

Safe whitening options vary in price and how well they work:

• Chairside bleaching or “power bleaching.” In your dentist’s office, he or she applies a gel or rubber shield to protect your gums and oral tissues. Then bleach is put on your teeth. Ask if the bleaching agents have the ADA seal. A special light or a laser may be used to help the bleach work better. But no products that use lasers are accepted right now by the ADA. With this method you may have to go for more than one visit. You will see results right away (about five shades brighter). It works well on a range of stains.

• Dentist-dispensed and over-the-counter bleaching products. These products are for home use. They contain peroxide(s), which bleach the tooth enamel. Most come in a gel and are placed in a mouth guard or tray that fits inside your mouth. How long you use them depends on the results you’re looking for and if you are sensitive to the bleach. Some products are used twice a day for 2 weeks, and others are used overnight for 1 to 2 weeks. They help many types of staining. Your teeth turn about six shades brighter with long-lasting results. But only the dentist-dispensed solutions have the ADA seal.

• Over-the-counter whitening products. These products are for home use and include whitening strips, paint-on products, gels, and trays. They have a low amount of peroxide. You wear some during the day and apply some at night before bedtime. They can help staining due to age and certain foods. Your teeth turn about two shades brighter for up to 6 months. For better results, have a cleaning at the dentist before you use these products. These gels and trays do not have the ADA seal.

• Whitening toothpastes. All toothpastes help remove surface stain through mild abrasives. “Whitening” toothpastes that have the ADA seal have special polishing agents that remove even more stains. Unlike bleaches, these products do not change the actual color of teeth. They help surface stains only. You might see short-term results that are one to two shades brighter.

Products used to whiten teeth can make teeth more sensitive. They can also bother your gums. These side effects most often go away after you stop using the product.

Before using whitening products, talk with your dentist. He or she can help you decide which method is best for the type of stains on your teeth. Not all products work on all people. Options offered by your dentist can be expensive, so ask your dentist to fully explain the results you can really expect. Keep in mind that whitening your teeth does not make your mouth any healthier.

What small, easy steps can I take to have a healthy smile?

1. Brush your teeth at least twice each day with fluoride toothpaste. Aim for first thing in the morning and before going to bed. Once a day, use floss or an interdental cleaner to clean food your toothbrush missed.

Make sure you:

• Drink water that contains added fluoride if you can. Fluoride protects against dental decay. Most public water systems in the United States have added fluoride. Check with your community’s water or health department to find out if there is fluoride in your water. You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
• Gently brush all sides of your teeth with a soft-bristled brush. Round and short back-and-forth strokes work best.
• Take time to brush along the gum line, and lightly brush your tongue to help remove plaque and food.
• Ask your dentist or dental hygienist to show you the best way to floss your teeth.
• Change your toothbrush every 3 months, or earlier if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.
• If you wear dentures, be sure to remove them at night and clean them before putting them back in the next morning.

2. Have a healthy lifestyle.

• Eat healthy meals. Cut down on tooth decay by brushing after meals. Avoid snacking on sugary or starchy foods between meals.
• Don’t smoke. It raises your risk of gum disease, oral and throat cancers, and oral fungal infections. It also affects the color of your teeth and the smell of your breath.
• Limit alcohol use to one drink per day for women. Heavy alcohol use raises your risk of oral and throat cancers. Using alcohol and tobacco together raises your risk of oral cancers more than using one alone.
• Limit how much of soda you drink. Even diet soda contains acids that can erode tooth enamel.

3. Get regular checkups.

• Have an oral exam once or twice a year. Your dentist may recommend more or fewer visits depending on your oral health. At most routine visits, the dentist and a dental hygienist will treat you. During regular checkups, dentists look for signs of diseases, infections, problems, injuries, and oral cancer.
• See your dentist right away
  -your gums bleed often
  -you see any red or white patches on the gums, tongue, or floor of the mouth
  -you have mouth or jaw pain that won’t go away
  -you have sores that do not heal within 2 weeks
  -you have problems swallowing or chewing
• Besides your dentist, other types of dental providers include:
  -Dental hygienists: Members of the dental staff who clean gums and teeth and teach patients how to maintain   good oral health.
  -Periodontists: Dentists who treat gum disease and place dental implants.
  -Oral surgeons: Dentists who operate on your mouth and supporting tissues.
  -Orthodontists: Dentists who straighten teeth and align jaws.
  -Endodontists: Dentists who perform root canals.
  -Prosthodontists: Dentists trained in restoring and replacing teeth.

4. Follow your dentist’s advice.

Your dentist may suggest ways to keep your mouth healthy. He or she can teach you how to properly floss or brush. Follow any recommended steps or treatments to keep your mouth healthy.

5. If you have another health problem, think about how it may affect your oral health.

For instance, if you take medicines that give you a dry mouth, ask your doctor or nurse if there are other drugs you can use. Have an oral exam before starting cancer treatment. And if you have diabetes, practice good oral hygiene to prevent gum disease.

From womenshealth .gov- The Federal Government Source for Women’s Health September 23, 2008.

What is a laser and how does it work?
A laser is an instrument that produces a very narrow, intense beam of light energy. When laser light comes in contact with tissue, it causes a reaction. The light produced by the laser can remove, vaporize, or shape tissue.

Are lasers used in dentistry?
Yes, lasers have been used in dentistry since 1990. The U.S. Food and Drug Administration has determined that lasers can be used as a safe and effective treatment for a wide range of dental procedures. Lasers are often used in conjunction with other dental instruments.

How are lasers used in dentistry?
Dental lasers can be used to:
•    correct speech problems caused by a tongue-tie, which prevents normal tongue movement.
•    uncover partially erupted wisdom teeth.
•    remove decay from a cavity and prepare the tooth for a new filling.
•    remove muscle pulls, as seen in orthodontic patients.
•    manage gum tissue during impressions for crowns.
•    remove swollen tissues caused by medications.
•    perform biopsy procedures.
•    remove inflamed gum tissues and reduce the amount of bacteria within a periodontal pocket.
•    remove or reshape excess gum and bone tissues during crown lengthening procedures.
•    treat abscessed gums and infections in root canals.
•    reduce the discomfort of canker and cold sores.
•    activate whitening chemicals that are used to lighten teeth.
What are the benefits of using dental lasers?
There are several advantages. Dentists may not need to use a drill or administer anesthesia,  allowing the patient to enjoy a more relaxed dental experience. Laser procedures can be more precise. Also, lasers can reduce symptoms and healing times associated with traditional therapies; reduce the amount of bacteria in both diseased gum tissue and in tooth cavities; and control bleeding during surgery.

Are dental lasers safe?
If the dental laser is used according to accepted practices by a trained practitioner, then it is at least as safe as other dental instruments. However, just as you wear sunglasses to protect your eyes from prolonged exposure to the sun, when your dentist performs a laser procedure, youwill be asked to wear special eyeglasses to protect your eyes from the laser.

How can I be sure my dentist is properly trained to use a laser?
Ask your dentist questions about the extent of his or her laser education and training. Make sure that your dentist has participated in educational courses and received training by the manufacturer. Many dental schools, dental associations, and the Academy of Laser Dentistry (ALD) offer dental laser education. The ALD is the profession’s independent source for current dental laser education and credentialing.

How will I know if treatment with a dental laser is an option for me?
Ask your dentist. Although the laser is a very useful dental instrument, it is not appropriate for every dental procedure.

Sleep apnea is a serious, potentially life-threatening sleep disorder. It affects approximately 18 million Americans. It owes its name to the Greek word apnea, meaning “want of breath” and refers to episodes in which a person stops breathing for 10 seconds or more during sleep. With each episode, the sleeper’s brain briefly wakes up in order to resume breathing, resulting in extremely fragmented and poor-quality sleep.

What are the different types of sleep apnea?

There are two major types of sleep apnea, both of which can severely disrupt the regular sleep cycle:

•    Obstructive apnea: A s you sleep the muscles in the walls of your throat relax to the point where the airway collapses and prevents air from flowing into your nose and mouth, but efforts to breathe continue. This is the most common type of apnea.
•    Central apnea: Breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
What are the symptoms of sleep apnea?

People with sleep apnea usually do not remember waking up during the night. Indications of the problem may include the following:

•    Morning headaches
•    Excessive daytime sleepiness
•    Irritability and impaired mental or emotional functioning
•    Excessive snoring, choking or gasping during sleep
•    Insomnia
•    Awakening with a dry mouth or sore throat
What is the difference between snoring and sleep apnea?

Unlike mild snoring, individuals with sleep apnea stop breathing completely for 10 seconds or more, typically between 10 and 60 times in a single night. A person with severe sleep apnea may have more than 100 waking episodes. If your partner hears loud snoring, punctuated by silences and then a snort or choking sound as you resume breathing, this pattern could signal sleep apnea. While snoring and sleep apnea are related disorders, not all snorers will develop sleep apnea, and not all sleep apnea patients snore.

Why is sleep apnea a concern?

Studies have shown that patients with this potentially life-threatening disorder are so fatigued during the day that when driving, their performance is similar to that of a drunk driver. If left untreated, sleep apnea can lead to impaired daytime functioning, high blood pressure, heart attack and possibly stroke. If you already have a weakened heart, apnea can aggravate your condition by placing stress on your heart during sleep.

Who is at risk for developing sleep apnea?

It is estimated that as many as 18 million Americans have sleep apnea. It is more common in men, although it may be underdiagnosed in women and young African-Americans. Sleep apnea tends to run in some families, although no genetic link has been proven. Risk factors associated with sleep apnea include the following:

•    Physical abnormality in the nose, throat or other parts of the upper airway
•    Obesity
•    High blood pressure
•    Smoking, which can cause inflammation, swelling and narrowing of the upper airway
•    Use of alcohol or sedatives and sleep medications
How can my dentist help?

If your dentist suspects you suffer from sleep apnea, he or she may refer you to a physician or a sleep specialist. For a proper diagnosis, you may have to undergo an overnight sleep study, called a polysomnography, which measures heart rate and how many times breathing is interrupted. If you have been diagnosed with sleep apnea, your dentist can work closely with your physician to implement and manage the prescribed therapy.

What are my treatment options?

Treatment is based on your medical history, physical examination and the results of polysomnography. If you have mild obstructive sleep apnea, initial treatment may include avoiding sleeping on your back, losing weight or cessation of smoking. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or those who snore but do not have apnea.

If you have severe sleep apnea, continuous positive airway pressure (CPAP) systems – resembling something a jet pilot might wear –is a commonly prescribed therapy. CPAP delivers air through a small mask that covers the nose, and the constant pressure keeps the airway open, which prevents both snoring and episodes of apnea. If a patient has trouble tolerating CPAP, surgery also can eliminate sleep apnea symptoms; but medications are generally ineffective.

Tooth sensitivity is caused by the movement of fluid within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp), which results in nerve irritation. When the hard enamel is worn down or gums have receded, causing the tiny tube surfaces to be exposed, pain can be caused by eating or drinking foods or hot or cold beverages, touching your teeth, or exposing them to cold air.

Exposed areas of the tooth can cause pain and even affect or change your eating, drinking, and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth. The excessive consumption of acid-containing foods and beverages, such as citrus juices and fruits and soft drinks, can also put you at risk for tooth sensitivity. Bulimia and acid reflux can also result in erosion of the hard enamel and sensitivity due to acid in the mouth.

Is tooth sensitivity a common condition?

Tooth sensitivity is one of the most common complaints among dental patients. At least 40 million adults in the United States suffer at some time from sensitive teeth.

How can I avoid sensitivity?

Some toothpastes contain abrasive ingredients that may be too harsh for people who have sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel and sodium pyrophosphate, the key ingredient in tartar-control toothpaste, may increase tooth sensitivity.

What can I do about sensitive teeth?

Tooth sensitivity can be reduced by using a desensitizing toothpaste; having your dentist apply sealants and other desensitizing and filling materials, including fluoride; and decreasing the intake of acid-containing foods. Using tartar-control toothpaste will sometimes cause teeth to be sensitive as well as drinking soft drinks throughout the day, so these habits should be avoided.

Avoid using hard-bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth’s surface and expose sensitive spots. The way to find out if you’re brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you’re brushing too hard.

How do I know when it’s time to see a dentist?

If a tooth is highly sensitive for more than three or four days and reacts to hot and cold temperatures, it’s best to get a diagnostic evaluation from your dentist to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that’s not yet visible.

How do I describe my symptoms to my dentist?

Sensitivity may be defined as a short, sharp pain that is usually initiated by eating hot or cold foods or exposure to cold air. Aching often follows. Because sensitivity may mean different things to a patient and dental professional, be sure to clarify exactly what you feel when you discuss the condition with your dentist. Be sure to tell the dentist when the pain started and if there is anything, such as the application of a warm compress, that helps eliminate the pain.

Do some products help decrease sensitivity?

Toothpaste for sensitive teeth usually contains a desensitizing agent that protects the exposed dentin by blocking the tubes in the teeth that are connected to nerves. In most cases, these products must be used on a regular basis for at least a month before any therapeutic benefits may be noticed.

What can the dentist do for my sensitive teeth?

Dentists have a variety of regimens to manage tooth hypersensitivity, including both in-office treatments and patient-applied products for home use. If you are diagnosed with dentin hypersensitivity, your dentist may apply a desensitizing agent or a protective coating. You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride. These ingredients help block the transmission of sensation from the tooth to the nerve. It also might help to massage the special paste onto your gums with your finger after brushing.

What should I do after the dentist has applied a desensitizing agent?

Listen closely to your dentist’s instructions. He or she may advise you not to eat or drink for a short period of time to eliminate all sources of irritation, such as acidic foods, medication, or flavored toothpastes. You may also be instructed to change oral hygiene habits that are likely to cause abrasion or use a daily fluoride application (a rinse or brush-on gel).

Men are less likely than women to take care of their physical health and, according to surveys and studies, their oral health is equally ignored. Good oral health recently has been linked with longevity. Yet, one of the most common factors associated with infrequent dental checkups is just being male. Men are less likely than women to seek preventive dental care and often neglect their oral health for years, visiting a dentist only when a problem arises. When it comes to oral health, statistics show that the average man brushes his teeth 1.9 times a day and will lose 5.4 teeth by age 72. If he smokes, he can plan on losing 12 teeth by age 72. Men are also more likely to develop oral and throat cancer and periodontal (gum) disease.

Why is periodontal disease a problem?

Periodontal disease is a result of plaque, which hardens into a rough, porous substance called tartar. The acids produced and released by bacteria found in tartar irritate gums. These acids cause the breakdown of fibers that anchor the gums tightly to the teeth, creating periodontal pockets that fill with even more bacteria. Researchers have found a connection between gum disease and cardiovascular disease, which can place people at risk for heart attacks and strokes. See your dentist if you have any of these symptoms:

•    Bleeding gums during brushing
•    Red, swollen or tender gums
•    Persistent bad breath
•    Loose or separating teeth
Do you take medications?

Since men are more likely to suffer from heart attacks, they also are more likely to be on medications that can cause dry mouth. If you take medication for the heart or blood pressure, or if you take antidepressants, your salivary flow could be inhibited, increasing the risk for cavities. Saliva helps to reduce the cavity-causing bacteria found in your mouth.

Do you use tobacco?

If you smoke or chew, you have a greater risk for gum disease and oral cancer. Men are affected twice as often as women, and 95 percent of oral cancers occur in those over 40 years of age.

The most frequent oral cancer sites are the tongue, the floor of the mouth, soft palate tissues in back of the tongue, lips and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery and even death. More than 8,000 people die each year from oral and pharyngeal diseases. If you use tobacco, it is important to see a dentist frequently for cleanings and to ensure your mouth remains healthy. Your general dentist can perform a thorough screening for oral cancer.

Do you play sports?

If you participate in sports, you have a greater potential for trauma to your mouth and teeth. If you play contact sports, such as football, soccer, basketball and even baseball, it is important to use a mouthguard, which is a flexible appliance made of plastic that protects teeth from trauma. If you ride bicycles or motorcycles, wear a helmet.

Taking care of your teeth

To take better care of your oral health, it is important to floss daily, brush your teeth with fluoride toothpaste twice daily and visit your dentist at least twice a year for cleanings. Here are some tips to better dental health:

•    Use a soft-bristled toothbrush to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one.
•    Replace your toothbrush every three months or after you’ve been sick.
•    Choose a toothpaste with fluoride. This can reduce tooth decay by as much as 40 percent.
•    Brush properly. To clean the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion using short, gentle strokes. To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle strokes over each tooth and its surrounding gum tissue. Spend at least three minutes brushing.
•    Floss properly. Gently insert floss between teeth using a back-and-forth motion. Do not force the floss or snap it into place. Curve the floss into a C-shape against one tooth and then the other.

Gum disease, or periodontal disease is a chronic inflammation and infection of the gums and surrounding tissue. It is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life. Periodontal diseases include gingivitis and periodontitis.

What causes gum disease?

Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets that fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper, and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body’s ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body’s immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control. Pregnant women experience elevated levels of hormones that cause the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as “pregnancy gingivitis.”

What are the warning signs of gum disease?

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, pus between the gum and tooth, persistent bad breath, a change in the way teeth fit together when the patient bites and a change in the fit of dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That’s why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages of gum disease, most treatment involves a special cleaning called scaling and root planning, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums – sometimes with the assistance of a laser – and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

How can I maintain treatment at home?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit the dentist every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don’t reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners are the best way to clean between the recesses in the teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist.

A dental implant is an artificial tooth root that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don’t rely on neighboring teeth for support and they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth.

Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

How do they work?

Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

Can anyone receive dental implants?

Talk with your dentist about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

What can I expect during this procedure?

The dentist must perform surgery to anchor the “artificial root” into or on your jaw bone. The procedure is done in the dental office with local anesthesia. The gum is then secured over the implant, which will remain covered until it fuses with the bone. The dentist then uncovers the implant and attaches an extension, or post, to the implant. With some implants, the implant and post are a single unit placed in the mouth during the initial surgery. Finally, the dentist makes an artificial tooth, or crown, that is attached to the implant post.

How long does the process take?

The process can take up to nine months to complete. Each patient heals differently, so times will vary. After the implant and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months. Sometimes, if a patient has good bone quality, posts can be placed and replacement teeth fitted in one appointment.

What is the success rate of implants?

The success rate for implants depends on the tooth’s purpose and location in the mouth, as well as a patient’s overall health.

How do I care for implants?

Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

What is the cost of implants?

Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. Your dentist can help you with this process.

From subtle changes to major repairs, your dentist can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discolored, chipped, misshapen or missing. Your dentist can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include bleaching, bonding, crowns, veneers and reshaping and contouring.

These improvements are not always just cosmetic. Many of these treatments can improve oral problems, such as your bite.

Bleaching

Bleaching is a common and popular chemical process used to whiten teeth. Some people get their teeth bleached to make stains disappear, while other just want a whiter shade.

Discoloration occurs in the enamel and can be caused by medication, coffee, tea and cigarettes. Discoloration also can be hereditary or due simply to getting older.

Bleaching can be performed by your dentist in the office or, under dental supervision, at home. Many patients enjoy bleaching at home because it is more convenient. Treatment begins when your dentist creates a custom mouthpiece to ensure the correct amount of whitening solution is used and that your teeth are properly exposed. Typically, whitening at home takes two to four weeks, depending on the desired shade you wish to achieve. Whitening in the office may call for one or more 45-minute to one-hour visits to your dentist’s office.

Bonding

Bonding is tooth-colored material used to fill in gaps or change the color of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape.

Crowns

Crowns, also known as caps, cover a tooth to restore it to its normal shape and appearance. Due to their cost, they are used in cases where other procedures will not be effective. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time-consuming.

Veneers

Veneers are thin pieces of porcelain or plastic placed over the front teeth to change the color or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Little or no anesthesia is needed. Veneers are used to treat some of the same problems as bonding.

This treatment is an alternative to crowns, which are more expensive. The procedure requires your dentist to take an impression of your tooth. Before the custom-made veneer is cemented directly onto the tooth, your dentist will lightly buff the tooth to compensate for the added thickness of the veneer. Once the cement is between the veneer and your tooth, a light beam is used to harden it. Porcelain veneers require more than one visit because they are fabricated in a laboratory. Veneers have a longer life expectancy and color stability than bonding.

Contouring and reshaping

Tooth reshaping and contouring, is a procedure to correct crooked teeth, chipped or irregularly shaped teeth or even overlapping teeth in a single session. Tooth reshaping and contouring, is commonly used to alter the length, shape or position of your teeth. Contouring teeth may also help correct small problems with bite. It is common for bonding to be combined with tooth reshaping.

This procedure is ideal for candidates with normal, healthy teeth but who want subtle changes to their smile. Your dentist will take X-rays to evaluate the size and location of the pulp of each tooth to ensure that there’s enough bone between the teeth to support them.

Which procedure is right for me?

Your dentist can answer any questions you may have about techniques used to improve your smile. The condition of your teeth and desired result you want often dictates the best procedure. If you are considering a treatment, there are a few questions you can ask your dentist before deciding if a particular procedure is right for you.

• What will the changes look like?
• What should I expect through the course of treatment?
• What type of maintenance will be required?

What should I look for in a cosmetic dentist?

In order to make sure your dentist is skilled in cosmetic dentistry, the American Academy of Cosmetic Dentistry (AACD) recommends that you ask your dentist for the following items before undergoing treatment:

• Before and after photos. These photos will allow you to examine the results of other patients being treated by the dentist to make sure his or her work fits your dental needs.
• References. References allow you to get a sense of the quality of care the dentist provides.
• Proof of continuing education. Be certain that your dentist has taken continuing education courses to keep him or her up-to-date with the latest techniques in clinical cosmetic dentistry.

Your dentist can answer the questions you have about the techniques used to improve your smile. The condition of your teeth and your desired result often indicate the best procedure for you.