Archive for the ‘Preventative Dentistry’ Category

Crowns—Dental Workhorses

Posted on: April 23rd, 2013 by Nicholas Geller, DDS No Comments

Dental Crowns and BridgesMost dentists will agree that crown restorations are at the heart of general dentistry. We’ve all studied crowns in dental school, and some of us have done our best work replacing missing teeth and saving the rest.

Research has given us the wherewithal to achieve virtually ideal restorations. They are natural looking, comfortable and stable in the moist environment of the mouth. We’re better equipped than ever to build strong, long-lasting and cosmetically superior crowns.

What is a crown?

A crown (or cap) is a restoration placed over a broken tooth that cannot sustain a conventional filling. By covering the biting surfaces and sides of the tooth, a crown strengthens the damaged tooth by binding together
the remaining structures.

There are basically three kinds of full-crown restorations, each with pros and cons, depending on your situation.

Metal crowns are made of gold or alloys—they have the longest track record for durability, but some
people object to the look of metal.

Full porcelain crowns—and their new ceramic cousins—look wonderful and fit well, but are usually best on front teeth where stress is not so great.

Porcelain-fused-to-metal crowns are our loyal work-horses for single-tooth restoration—they’re very strong.
There are elements of finesse in the creation of any crown. The fit is the thing. The teeth must be prepared with opposing teeth in mind so a good bite won’t go back after the crown is placed. The fit must accommodate adjacent teeth, too. And the “margin,” the part of the crown nearest the gum, must fit smoothly to protect the health of gum tissue.

And all this effort is to one end: to save a tooth.

When is a crown called for?

  • A tooth that has been filled more than once cracks, breaks off, or falls victim to secondary caries—a cavity under or around a filling.
  • You’ve had root canal therapy on a molar, and it’s prone to brittleness.
  • A tooth has suffered severe enamel wear.
  • The high school hockey star takes a blow in the mouth, and an other-wise sound tooth is broken.
  • You need an anchor for your new bridge.

What Your Mouth “Tells” Us…

Posted on: April 16th, 2013 by Nicholas Geller, DDS No Comments

Smiling Elderly CoupleAbout Your Overall Health

Recent studies, including the Surgeon General’s Report on Oral Health, confirm what our team has known for a long time: There are so many connections between oral health and overall health that your next dental visit can be the next best thing to a physical examination!

Your mouth is both an early warning system and a window to the health of your heart, your circulation, and your healthy well-being. A dental exam gives us the chance to recognize potentially serious conditions (certain cancers—especially oral cancer, diabetes, and more recently, AIDS)—even before they become apparent to your family physician. There’s an increasingly strong link between gum disease and the risk of heart problems and stroke.

That’s why regularly scheduled dental appointments are so critical. Dentists are trained to recognize early warning signals and alert you to seek further treatment, before the problem grows out of control.

You might just say that by looking into a mouth, we can save a life.

Treat Your Smile to a Spring Cleaning!

Posted on: March 26th, 2013 by Nicholas Geller, DDS No Comments

RDH Brushing TeethNow that the days are getting longer and the air is fresh, it’s the perfect time to burst out of those winter doldrums and create a little sparkle. Why not give your teeth a spring cleaning while you’re at it?

Regardless of how careful you are about dental hygiene on a day-to-day basis, there’s no substitute for a professional dental cleaning to insure your pearly whites stay in top shape.

This routine checkup also gives us a chance to give you plenty of free information: the best way to brush and floss, nutritional recommendations, an evaluation of gum tissue, suggestions about cosmetic enhancement of your smile, and (if you’re a smoker) suggestions about stopping this dangerous practice.

We’re not just interested in your teeth. We’re interested in your health. Call us for a spring cleaning today—and prepare to be pleasantly surprised!

Mouthwash FAQs

Posted on: March 5th, 2013 by Nicholas Geller, DDS No Comments

MouthwashWhether it’s to mask bad breath, fight cavities or prevent the buildup of plaque, the sticky material that contains germs and can lead to oral diseases, mouthwashes serve a variety of purposes. Or so we think.

Though they may leave your mouth with a clean, fresh taste, some washes can be harmful, concealing bad breath and unpleasant taste that are signs of periodontal diseases which cause inflammation and degeneration of the supporting structures of the teeth and tooth decay. Your dentist will tell you, most mouth rinses just don’t wash.

What are the differences?

Mouthwashes are generally classified by the U.S. Food and Drug Administration (FDA) as either cosmetic or therapeutic, or a combination of the two. Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth, and refresh the mouth with a pleasant taste. Therapeutic washes have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases. Therapeutic washes are regulated by the FDA and are voluntarily approved by the American Dental Association (ADA). They also can be categorized into types according to use: antiplaque, antigingivitis, and anticavity fluoride washes.

Should I use a mouthwash?

That depends upon your needs. Most are, at the very least, effective oral antiseptics that freshen the mouth and curb bad breath for up to three hours. However, their success in preventing tooth decay, gingivitis, and periodontal disease is limited.

They are not considered substitutes for regular dental examinations and proper home care. A regimen of brushing, flossing, and routine trips to the dentist should be sufficient in fighting tooth decay and periodontal disease.

Which type should I use?

Again, that depends upon your needs. Studies have shown that most over-the-counter antiplaque mouthwashes and antiseptics are only marginally effective (20-20 percent) at reducing plaque.

Anticavity mouthwash with fluoride, however, has been clinically proven to fight up to 50 percent more of the bacteria that cause cavities. But again, many dentists consider the use of fluoride toothpaste alone to be more than adequate protection against cavities.

Certain mouthwashes may be prescribed for patients with more severe oral problems such as caries, periodontal disease, gum inflammation, and dry mouth. Likewise, many therapeutic washes are strongly recommended for those who can’t brush due to physical impairments or medical reasons.

When and how often should I rinse?

If it’s an anticavity rinse, dentists suggest the following steps, practiced after every meal: brush, floss, then rinse. Teeth should be as clean as possible before applying an anticavity wash to reap the full preventive benefits of the liquid fluoride. The same steps can be followed for antiplaque rinses.

If ever in doubt, ask us in person about your specific brand or follow the instructions on the bottle. Be sure to heed all precautions listed.

Are there any side effects to mouthwashes?

Yes, and they vary depending on the type. Habitual use of antiseptic mouthwashes containing high levels of alcohol (ranging from 18 to 26 percent) may produce a burning sensation in the cheeks, teeth and gums. It can cause intoxication if swallowed, used excessively, or used by children. For a child weighing only 26 pounds, 5 to 10 ounces of many OTC rinses containing alcohol can be potentially lethal.

Many prescribed rinses with more concentrated formulas can lead to ulcers, root sensitivity, stains, soreness, numbness, or changes in taste sensation. Most anticavity rinses contain sodium fluoride, which if taken excessively or swallowed, can lead over time to fluoride toxicity. Because children tend to accidentally swallow mouthwash, they should only use rinses under adult supervision. If you experience any irritating or adverse reactions to a mouth rinse, discontinue its use immediately and consult your dentist.

Facts on Flossing

Posted on: February 26th, 2013 by Nicholas Geller, DDS No Comments

Proper FlossingFlosses and picks

Plaque is a sticky layer of material containing germs that accumulates on teeth, including places where toothbrushes can’t reach. This can lead to gum disease. The best way to get rid of plaque is to brush and floss your teeth carefully every day. The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. Some people use waterpiks, but floss is the best choice.

Should I floss?

Yes. Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces, and controls bad breath. Floss is the single most important weapon against plaque, perhaps more important than the toothbrush. Many people just don’t spend enough time flossing or brushing and many have never been taught to floss or brush properly. When you visit your dentist or hygienist, ask to be shown.

Which type of floss should I use?

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridgework. Tapes are usually recommended when the spaces between teeth are wide.

They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss often makes a squeaking sound to let you know your teeth are clean. Bonded unwaxed floss does not fray as easily as regular unwaxed floss, but does tear more than waxed floss.

How should I floss?

There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity. Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger. (Don’t cut off your finger’s circulation!) Wind the rest of the floss similarly around the same finger of the opposite hand. This finger takes up the floss as it becomes soiled or frayed. Maneuver the floss between teeth with your index fingers and thumbs. Don’t pull it down hard against your gums or you will hurt them. Don’t rub it side to side as if you’re shining shoes. Bring the floss up and down several times forming a “C” shape around the tooth being sure to go below the gum line.

The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis. Take an 18-inch piece of floss and make it into a circle. Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop. Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gumline forming a “C” on the side of the tooth.

How often should I floss?

At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

What about floss holders?

You may prefer a prethreaded flosser or floss holder, which often looks like a little hacksaw. Flossers are handy for people with limited dexterity, for those who are just beginning to floss, or for caretakers who are flossing someone else’s teeth.

Is it safe to use toothpicks?

In a pinch, toothpicks are effective at removing food between teeth, but for daily cleaning of plaque between teeth, floss is recommended. Toothpicks come round and flat, narrow and thick. When you use a toothpick, don’t press too hard as you can break off the end and lodge it in your gums.

Do I need a waterpick (irrigating device)?

Don’t use waterpicks as a substitute for toothbrushing and flossing. But they are effective around orthodontic braces that retain food in areas a toothbrush cannot reach. However, they do not remove plaque.

Waterpicks are frequently recommended for persons with gum disease when recommended by your dentist. Prescription solutions containing antibacterial agents like chlorhexidine or tetracycline  can be added to the reservoir.

Dental X-ray FAQs

Posted on: February 19th, 2013 by Nicholas Geller, DDS No Comments

Dental X-rayWhy do I need X-rays?

X-rays, or radiographic examinations, provide us with an important tool that shows the condition of your teeth, its roots, jaw placement, and the overall composition of your facial bones.

X-rays can help determine the presence or degree of periodontal disease, abscesses, and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

Do all patients have X-rays taken every six months?

No. Your X-ray schedule is based on our assessment of your individual needs, including whether you’re a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X- rays to monitor their gum condition or their chance of tooth decay.

What kind of X-rays does my dentist usually take?

Typically, most dental patients have “periapical” or “bitewing” radiographs taken. These require patients to hold or bite down on a piece of plastic with X-ray film in the center. Bitewing X-rays typically determine the presence of decay in between teeth, while periapical X-rays show root structure, bone levels, cysts and abscesses.

What are panoramic X-rays?

Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic X-ray allows us to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

Why do I need both types of X-rays?

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray provides a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray can not show. On the other hand, periapical or bitewing X- rays show a highly-detailed image of a smaller area, making it easier to see decay or cavities between your teeth. X-rays are not prescribed indiscriminately, rather,  each radiograph provides different information needed to formulate a diagnosis.

Should I be concerned about exposure to radiation?

All health care providers are sensitive to patients’ concerns about exposure to radiation. We have been trained to prescribe X-rays when they are appropriate and to tailor schedules to each patient’s individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, we will determine which techniques, procedures and X-ray films can minimize your exposure to radiation.

Bruxism – Grinding and Clenching

Posted on: February 12th, 2013 by Nicholas Geller, DDS No Comments

MouthguardWhat is Bruxism?

Bruxism is the technical term for grinding and clenching that wears down teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, they also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren’t diagnosed with bruxism until it is too late because so many people don’t realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.

Can bruxism cause harm?

People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

What are the signs?

When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ) -the jaw- which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching.

Stress and certain personality types are at the root of bruxism. For as long as humankind has existed, bruxism has affected people with nervous tension. Anger, pain and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.

What can be done about it?

During regular dental visits, we automatically checks for physical signs of bruxism. The condition may be observed over several visits to be sure of the problem before recommending and starting therapy.

The objective of therapy is to change the behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, a plastic mouth appliance, such as a night guard that’s worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient’s destructive behavior.

Fluoride & Your Health

Posted on: November 27th, 2012 by Nicholas Geller, DDS No Comments

What is fluoride, and why is it good for my teeth?

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air, and in most foods. Fluoride is absorbed easily into tooth enamel, especially in the growing teeth of children. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible.

“Systemic” fluoride is ingested when added to public and private water supplies, soft drinks and teas, and is available in dietary supplement form. It is absorbed through the gastrointestinal tract, and is distributed throughout the entire body. Most fluoride is deposited in bones and hard tissues like teeth.

What’s a “topical” fluoride, and when should I use it?

“Topical” fluoride is found in products applied directly to the teeth, including toothpastes and mouth rinses. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.

Professionally-administered topical fluorides such as gels or varnishes are applied and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of dental caries, we may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Why is most of the water we drink fluoridated?

Fluoridated water protects against cavities and root caries–a progressive erosion of adult root surfaces caused by gum recession–and helps remineralize early carious lesions. Thanks to these preventive benefits, mass water fluoridation is considered the most efficient and cost-effective dental caries prevention measure available.

What about those “theories?”

After countless studies, tests, and scientific reviews conducted since the 1930s, fluoride used in normal amounts has not been proven to be hazardous to human health.

Can I get too much fluoride?

In general, the use of fluoride is considered safe unless it’s misused or overconcentrated.

Drinking excessively fluoridated water can cause dental fluorosis, a harmless cosmetic discoloring or mottling of the enamel, visible by chalky white specks and lines or pitted and brown stained enamel on developing teeth.

Avoid swallowing toothpaste, mouth rinses or other topical supplements, and take care to only use proper dosage.

If you are concerned about the fluoride levels in your drinking water, call the local public water department. If the source is a private well, request a fluoride content analysis taken via a water sample through your local or county health department.

Open Your Mouth and Say Ahhh

Posted on: November 20th, 2012 by Nicholas Geller, DDS No Comments

There’s a lot we can learn from looking into your mouth. Not only is the oral cavity a mirror of your overall health—it’s a sort of early warning system that helps diagnose everything from malnutrition to diabetes to cancer.

If you’re not getting enough Vitamin C or B complex in your diet, there’s a clue: tiny cracks in the lips. Insufficient iron? A burning sensation in the tongue. A painful red tongue is a tip-off to lack of Vitamin B12.

It used to be part of every visit to the family doctor to “Open your mouth and say ‘Ahhh’.” Today, while physicians have highly sophisticated ways of testing for disease, the mouth remains one of your body’s most sensitive indicators.

Routine dental exams could help you get the drop on diabetes—which strikes some 600,000 new Americans every year. Early indicators are a sore tongue and tender gums. Which is why, more often than not, the dentist—not the physician—makes the earliest diagnosis.

Mouths can even signal a celebration: pregnancy evokes significant changes in the mother-to-be’s gums. So it’s possible we can confirm that a blessed event is in your future. Your mouth can tell us a lot about your health without saying a word.

Brushing Tips

Posted on: September 11th, 2012 by Nicholas Geller, DDS No Comments

What is the best technique for brushing?

There are a number of effective brushing techniques. Patients are advised to ask during an appointment to determine which is the best one for them, since tooth position and gum condition vary. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth. Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender.

Soft or hard bristles?

In general, a toothbrush head should be small (1″ by 1/2″) for easy access. It should have a long, wide handle for a firm grasp. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?

It might be a good idea to brush with the radio on, since we generally recommend brushing 3-4 minutes—the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they’re brushing longer, but most spend less than a minute brushing. To make sure you’re doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day instead of brushing quickly five or more times through the day.

Should I brush at work?

Definitely, but most Americans don’t brush during the workday. It’s a good idea to keep a toothbrush in your desk, which increases the chances that you’ll brush during the day by 65 percent, according to a survey released by Oral-B Laboratories and the Academy of General Dentistry. Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don’t even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don’t have a toothbrush with you, rinsing your mouth with water for 30 seconds after lunch also helps.

The following tips may improve your work-time brushing habits:

  • Post a sticky note on your desk or computer at work as a reminder to brush teeth after lunch.
  • Brush teeth right after lunch, before you become absorbed in work.
  • Store a toothbrush and toothpaste at work in a convenient and handy place.
  • Make brushing your teeth part of your freshening up routine at work.