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April 2016

dental inspection

The dental exam is critical to your ongoing oral health—and only your dentist can perform this.

The exam consists, in part, of the dentist looking inside your mouth. In the past, you may not have ever realized an exam was taking place. Perhaps you thought the dentist was checking the work the hygienist had just completed.

Not so. The dentist actually looks in your mouth for things that can affect your oral—and your overall—health. Many of these are things you can’t see on your own, but that a dentist is trained to detect. Here is some of what your dentist is looking for during a dental exam:

  • damaged, missing or decayed teeth
  • early signs of cavities
  • condition of your gums, such as periodontal pockets, inflammation or other signs of gum disease (which can lead to tooth and bone loss)
  • to see how previous dental work such as root canals, fillings and crowns are holding up
  • early signs of mouth or throat cancer, such as white lesions or blocked salivary glands
  • other suspicious growths or cysts
  • position of your teeth (e.g., spacing, bite)
  • signs that you clench or grind your teeth (a treatable problem that can cause headache or sore jaw and can, if serious, lead to hearing loss and tooth loss)
  • signs of bleeding or inflammation on your tongue and on the roof or floor of your mouth
  • the overall health and function of your temporomandibular joint (which joins the jaw to skull), checking for signs of disorders that can cause pain or tenderness
  • the general condition of the bones in your face, jaw and around your mouth

The dental exam can catch problems early—before you see or feel them—when they are much easier and less expensive to treat.

As well as the visual inspection of your mouth, the exam includes:

  • a complete medical history so the dentist knows about any health conditions that may affect the success of dental treatments or procedures or that may be associated with oral health problems.

It may also include:

  • an examination of your neck area, with the dentist feeling the glands and lymph nodes for possible signs of inflammation that could indicate general health problems; and
  • dental x-rays, if necessary. These can show such problems as cavities under existing fillings, fractures, impacted wisdom teeth, decay under your gum line and bone loss caused by gum disease.

Your dentist may explain what’s happening during the exam and give you a summary of the findings. If not, be sure to ask. As patient, you are a full partner in your oral health care.

Checklist

Be Sure to Tell Your Dentist

The more your dentist knows about your overall health, the more effective they can be in addressing your oral health care needs. Be sure to mention:

  • any new medical conditions you’ve been diagnosed with since your last visit, such as diabetes or AIDS, even if they don’t seem pertinent. Your dentist needs to know to properly manage your treatment and prevention program.
  • any new medications you’re taking (side effects can often include dry mouth and overgrown gums)
  • if you’re pregnant
  • if you have any allergies
  • any changes you’ve noticed in your teeth, such as changes in colour, looseness or position
  • any changes you’ve noticed in your gums, such as bleeding when you brush or floss, or changes in appearance
  • any increased sensitivity to heat, cold or sweets
  • whether your floss catches on rough edges, causing it to shred
  • any colour changes in the skin on the inside of your mouth
  • if you smoke or chew tobacco (which increases the likelihood of oral cancer)
  • if your neck or jaw muscles are tight or if you’re aware of clenching or grinding your teeth
  • if you’re nervous about going to the dentist—new ways of doing things have made modern dentistry more comfortable for patients, and talking to your dentist may reassure you and help you feel more relaxed

tooth-decay-and-cavities-image

What are Cavities?
“Cavities” is another way of saying tooth decay. Tooth decay is heavily influenced by lifestyle, what we eat, how well we take care of our teeth, the presence of fluoride in our water and toothpaste. Heredity also plays a role in how susceptible your teeth may be to decay.

While cavities are generally more common among children, adults are also at risk. The types of cavities include:

  • Coronal cavities—the most common type occurring in both children and adults, coronal cavities usually are located on chewing surfaces or between the teeth
  • Root cavities—as we age, our gums recede, leaving parts of the tooth root exposed. Since there is no enamel covering tooth roots, these exposed areas easily decay
  • Recurrent decay—decay can form around existing fillings and crowns. This is because these areas may have a tendency to accumulate plaque, which can ultimately lead to decay

Adults are especially at risk for cavities if they suffer from dry mouth, a condition due to a lack of saliva. Dry mouth may be caused by illness, medications, radiation therapy and chemotherapy, and may be either temporary (days to months) or permanent, depending on its cause.

Cavities are very serious. Left untreated, a cavity can destroy your tooth and kill the delicate nerves at its center, which may result in an abscess, an area of infection at the root tip. Once an abscess forms, it can only be treated with a root canal, surgery or by extracting the tooth.

How Do I Know if I Have a Cavity?
Only your dentist can tell for sure whether you have a cavity. That’s because cavities develop below the tooth’s surface, where you can’t see them. When you eat foods that contain carbohydrates (sugars and starches), these carbohydrates are eaten by the bacteria in plaque, producing acids that eat into the tooth. Over time, the tooth enamel begins to break down beneath the surface while the surface remains intact. When enough of the sub-surface enamel is eaten away, the surface collapses, forming a cavity.

Cavities are most likely to develop in pits on the chewing surfaces of the back teeth, in between teeth, and near the gumline. But regardless of where they occur, the best way to spot them and treat them before they become serious is by visiting your dentist regularly for checkups.

How Can I Help Prevent Cavities?

  • Brush at least twice a day and floss daily to remove plaque from between teeth and below the gumline
  • Have regular dental checkups. Preventive care can help stop problems from occurring and keep minor problems from becoming major ones
  • Eat a well-balanced diet that limits starchy or sugary foods. When you do eat these foods, try to eat them with your meal instead of as a snack to minimize the number of times that your teeth are exposed to acid
  • Use dental products that contain fluoride, including toothpaste
  • Make sure that your children’s drinking water is fluoridated. If your water supply does not contain fluoride, your dentist or pediatrician may prescribe daily fluoride supplements

wisdom_teeth

There are many misconceptions about what exactly Wisdom Teeth are, and why and when they may need to be extracted or worked on. In this blog post, we will explain exactly what Wisdom Teeth are, and what in what situations they would need attention from your dentist.

What Are Wisdom Teeth?

Wisdom teeth are the third and last molars on each side of the upper and lower jaws. They are also the final teeth to erupt; they usually come in when a person is in their late teens or early twenties.

When should your Wisdom Teeth be looked at by your Dentist?

Wisdom teeth that only partially emerge or come in crooked can also lead to painful crowding and disease. As teeth removed before age 20 have less developed roots and fewer complications, the American Dental Association recommends that people between 16 and 19 have their wisdom teeth evaluated to see if they need to be removed.

What is the cause of the most common issue with Wisdom Teeth?

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Dental bridges can last for decades, but eventually they need repairing or replacing. A dental bridge is a fixed appliance that is placed in the mouth when one or more teeth are missing. Usually, the pontic (or false) teeth are anchored to the healthy teeth on either side of the gap, which are called the abutment teeth. You might need dental bridge repair because your bridge has broken, or your dentist identified a problem during a routine checkup.

Causes of Dental Bridge Failure

Most dental bridges are made of ceramics or porcelain fused to an underlying metal frame, and lacking oral care can cause these products to fail. Bacteria can enter under the bridge through the crowns and manage to produce decay in the abutment teeth, according to the Windsor Centre for Advanced Dentistry. Abutment teeth can also fracture.

Problems in the bridge itself include breakage of the underlying metal and a fracture of the coating or pontic. Sometimes there aren’t any structural problems with the bridge, but it doesn’t fit well in the mouth or the color doesn’t match the surrounding teeth.

When They Need Fixing

Dental bridges are an effective treatment for missing teeth, but they aren’t a permanent solution. The Cleveland Clinic states that dental bridges should last five to seven years or longer – up to 35 years according to the Creighton University School of Dentistry. But because the abutment teeth are covered, signs of decay aren’t visible, and sensitivity in the teeth or gums around a dental bridge could be a sign that it needs repair. You might also notice or feel a crack in the tooth, or pieces of the porcelain may come off. If you notice chips or cracks in your dental bridge, or feel pain or sensitivity when chewing on it or brushing it, you should see your dentist.

Dental Bridge Repair

Treatment to repair a dental bridge depends on the cause of the failure. If the issue is with an abutment tooth, the dentist must remove the bridge. Fixed bridges are typically cemented to the abutment teeth, so this often requires breaking the original bridge. Once the supporting teeth have been treated, and if they’re still healthy, a replacement bridge can be made. If the dentist can’t restore the abutment teeth, they can be replaced with implants that support a new bridge. The abutment teeth and the missing teeth can also be replaced with implants, which are placed surgically into the jaw bone.

If the porcelain coating on the bridge is chipped or fractured, but the bridge is otherwise sound, it may be possible for the dentist to repair the coating. Dentists can sometimes repair a fractured pontic as well, as detailed in The Journal of the American Dental Association.

Caring for a New Bridge

Good oral care habits increase the longevity of a bridge. Twice-daily brushing can help prevent decay of the abutment teeth, and dentists often recommend a special flossing tool that cleans the gap between the gum and the pontic. A regular professional cleaning schedule and a diet that is high in fruits and vegetables also helps to maintain good mouth health.

Failing bridges don’t repair themselves and only get worse over time, so if your bridge is giving you problems, book an appointment at your dentist’s right away. He can offer a range of options to restore your confident smile.

Content courtesy colgate.com

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Why are dental implants often the first choice and a standard of care compared to other options to restore missing or damaged teeth?

  • Next best thing to healthy, natural teeth.  Strong and stable, a dental implant restores a lost tooth so that it looks, feels, fits and functions like a natural tooth. Other options can lead to bone deterioration, and may interfere with eating, smiling, speaking and other activities of everyday life.
  • Built to last. Dental implants are a long-term solution. Traditional, tooth-supported dental bridges only last five to seven years, and with proper care often more than 10 years, but at some point they may need to be replaced. While dental implants may need periodic adjustments, they can last a lifetime when properly placed and cared for over time.
  • Enjoy life without worrying about your teeth!  No need to stay home or feel uncomfortable in public, embarrassed because your smile looks different, or worrying that missing teeth will limit your ability to join in the fun or that removable dentures or tooth-supported replacement teeth will loosen or fall out when you talk, eat or laugh. Teeth restored with dental implants are teeth that let you, not your teeth, lead your life.
  • Retain your natural face shape, and smile.  A face without teeth can sag and appear sunken and sad. Dental implants allow you to maintain the natural shape of your face and smile.
  • Protect healthy bone. Leaving empty spaces in your mouth after losing one or more teeth can lead to additional health issues, such as the loss and deterioration of some of your jawbone. When it is not being used to support a natural tooth, the jawbone deteriorates, losing its strength and firmness. Dental implants are the only dental restoration option that preserves and stimulates natural bone, actually helping to stimulate bone growth and prevent bone loss.
  • Keep your teeth in your mouth – not in a cup. Dental implants allow you to keep your teeth where they belong – in your mouth. And no more worrying that your dentures might slip or fall out. Brush, floss and care for teeth that have been replaced using dental implants exactly the way you would natural teeth – in your mouth.
  • Speak easy.  Adjusting to removable dentures can mean struggling to pronounce everyday words. Not so with dental implants, which function like natural teeth.
  • Eat your favorite foods! Taste and enjoy the foods you love without hesitation. You can bite naturally, eat virtually anything you want and, unlike removable dentures that can feel uncomfortable, you can experience the full taste of the food you eat with dental implants, too.
  • Look Mom, no cavities! Cavities can’t occur in an implant-restored crown, or replacement tooth; however, you will need to visit your dentist as scheduled and clean and care for it and your gums and mouth every day, the same as you would if it were a natural tooth.
  • Keep teeth in place – silently. Dentures may slip when you eat, talk, smile, laugh, kiss, yawn or cough, so that you have to “reposition” them back into place in the mouth. Dental implants are fixed in place and fuse naturally with your jawbone, meaning your replacement teeth won’t move, click or shift.
  • Protect your healthy teeth. Placing a tooth-supported bridge requires grinding away the teeth on one or both sides of the missing tooth or teeth – thereby damaging healthy teeth to restore those that are missing. The modified healthy teeth are attached to, and support, the bridge. Dental implants go in the jawbone, in the spot where your missing tooth root was, without impacting healthy teeth. They also help prevent healthy, adjacent teeth from shifting as they would if an empty space were left for an extended period of time.
  • More predictable than other repair and restoration methods. Dental implant treatment has a track record of reliable, long-term successful outcomes and is often considered “more predictable” than other treatments to repair or replace missing teeth, including bridgework, removable appliances and retreatment of failing root canal (endodontic) therapy.

Content courtesy of: aaid-implant.org

dental-bridge-diag

What are Dental Crowns and Tooth Bridges?
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.

How do Crowns Work?
A crown is used to entirely cover or “cap” a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.

Your dentist may recommend a crown to:

  • Replace a large filling when there isn’t enough tooth remaining
  • Protect a weak tooth from fracturing
  • Restore a fractured tooth
  • Attach a bridge
  • Cover a dental implant
  • Cover a discolored or poorly shaped tooth
  • Cover a tooth that has had root canal treatment

How do Bridges Work?
A bridge may be recommended if you’re missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.

Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.

How are Crowns and Bridges Made?
Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth/teeth, your dentist will take an impression to provide an exact mold for the crown or bridge. If porcelain is to be used, your dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.

Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.

How Long do Crowns and Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by Brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.

To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.

Crowns
Porcelain
Gold
Full porcelain fused to metal.Full cast gold crown.
Bridges
SpaceBridgeCemented
Teeth around the space are prepared.The bridge is mounted and adjusted for fit and comfort.The bridge is cemented into position.

Content courtesy colgate.com

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You’ve probably seen the warning on cigarette packages: “Quitting smoking now greatly reduces serious risks to your health.” What smoking-related diseases come to mind? Lung cancer, probably. Emphysema, maybe.

But did you know that half of periodontal (gum) disease in smokers is caused by smoking? Chronic (long-term) gum disease can lead to the loss of your teeth.

“Studies have found that tobacco use may be one of the biggest risk factors in the development of periodontal disease,” says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor at the Columbia University College of Dental Medicine.

Periodontal (gum) disease is a bacterial infection. It destroys soft tissue and bone that anchor your teeth to your jawbones. Bacteria grow in the dental plaque that forms in the pockets around your teeth. Your body’s reaction to the plaque leads to the breakdown of soft tissue and bone.

In early stages of the disease, you may notice that your gums bleed when you brush or floss. As the infection worsens, your gums begin to break down. They pull away from your teeth, forming pockets. Later, the pockets between your teeth and gums deepen as more of the supporting structures are destroyed. Ultimately, your teeth may become loose and painful. They may even fall out.

Studies have shown that smokers have more calculus (tartar) than nonsmokers. This may be the result of a decreased flow of saliva. Calculus is the hardened form of plaque.

Smoking tobacco products can make gum disease get worse faster. Smokers have more severe bone loss and more deep pockets between their teeth and gums than nonsmokers. In studies, smokers were three to six times more likely to have gum destruction than nonsmokers. Severe bone loss was five times greater among current or former heavy smokers than among people who never smoked.

“Smokers have much less gum bleeding and redness than other people even though their mouths are not healthy,” Dr. Albert says. “This can lead to the false impression that the gums are healthy. It is therefore very important that tobacco smokers have regular dental exams to evaluate their gum health.”

Not only does smoking increase the chance that you will develop gum disease, it makes treatment much more difficult. And the treatment is less likely to succeed. That’s because smoking hinders healing in your mouth.

One study found that smokers were twice as likely as nonsmokers to lose teeth in the five years after completing periodontal treatment. In most studies of nonsurgical gum treatment (deep scaling), smokers improved less than nonsmokers. Smokers also don’t respond as well to oral surgery treatments. Dental implants are much more likely to fail in people who smoke, because of poor bone healing.

Crowns and bridges look great when first placed in the mouth. In smokers they often lose this beautiful appearance, especially as the gums recede and bone is lost. Popular cosmetic procedures, such as porcelain laminates, will not look good for a long time in a person who smokes.

Researchers still are studying just what smoke does to mouth tissue. It appears to interfere with basic functions that fight disease and promote healing. Researchers have found that smoking affects the way gum tissue responds to all types of treatment.

“It is believed that the chemicals contained in tobacco interfere with the flow of blood to the gums,” Dr. Albert says. “This leads to a slowdown in the healing process. It makes the treatment results less predictable and often unfavorable.”

It is not just cigarette smoke that contributes to periodontal disease, Dr. Albert says. All tobacco products can affect gum health. This includes pipe tobacco, smokeless tobacco and cigars. Labels on smokeless products such as chewing tobacco or snus include warnings that the products can cause oral cancer, gum disease or tooth loss.

A study conducted at Temple University showed this risk. Researchers reported that 18% of former cigar or pipe smokers had moderate to severe gum disease. “This is three times the amount found in non-smokers,” Dr. Albert says. The study was published in the Journal of Periodontology in 2000.

Experts say pipe smokers have rates of tooth loss similar to those of cigarette smokers. Smokeless tobacco can cause the gums to recede. This increases the chance of losing the bone and fibers that hold teeth in place.

The only good news about smoking and oral health is that the Surgeon General’s warning holds true. Quitting now does greatly reduce serious risks to your health. A recent study reported that people who had quit smoking 11 years before had about the same rate of periodontal disease as people who never smoked.

Even reducing the amount you smoke seems to help. One study found that people who smoked more than a pack and a half per day were six times more likely to have periodontal disease than nonsmokers. Those who smoked less than a half pack per day had only three times the risk.

“The dental office is a good place to visit for help with quitting,” Dr. Albert says. “Your dentist can show you the effect of smoking on your mouth and teeth. She or he can help you set a quit date and provide you with advice on which medicines can help you quit, such as nicotine patches or gum.”

Oral Cancer

Tobacco’s greatest threat to your health may be its link to oral cancer. The American Cancer Society reports that:

About 90% of people with mouth cancer and some types of throat cancer have used tobacco. The risk of developing these cancers increases as people smoke or chew more often or for a longer time.

Smokers are six times more likely than nonsmokers to develop these cancers.

About 37% of patients who continue to smoke after cancer treatment will develop second cancers of the mouth, throat or larynx. This compares with only 6% of those who stop smoking.

Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the mouth or the part of the throat just behind the mouth. It also can cause cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Pipe smoking also can cause cancer in the area of the lips that contacts the pipe stem.

Smokeless tobacco has been linked to cancers of the cheek, gums and inner surface of the lips. Smokeless tobacco increases the risk of these cancers by nearly 50 times.

Implant Failure

Dental implants can replace lost teeth in people who smoke. However, smokers should know they have an increased risk that the procedure will fail.

“Studies have consistently found that patients who smoke have more implant failures,” Dr. Albert says. Smokers who are considering getting a dental implant need to realize this risk, he says.

“Before getting implants, it is very important to quit smoking. I advise that you consider seeking counseling and support to help you quit,” he says.

Content courtesy colgate.com

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