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What are surgical methods to treat gum disease?
Tips for healthy child's teeth
What are dentures and partial dentures?
What can I expect with my new denture?
What are the types of crowns available?
What do I do with my wisdom teeth?
What toothpaste should I use?
The most important ingredient to look for when choosing toothpaste is fluoride. Fluoride is a naturally occurring mineral. Its use has been instrumental in the dramatic drop in tooth decay and cavity occurrence that has taken place over the past 50 years. Bacteria in your mouth feed on sugars and starches that remain on your teeth after eating. Fluoride helps protect your teeth from the acid that is released when this happens. It does this in two ways. First, fluoride makes your tooth enamel stronger and less likely to suffer acid damage. Second, it can reverse the early stages of acid damage by remineralizing areas that have started to decay. Using fluoride toothpaste is an important way to ensure that your teeth are reaping the benefits of this dental-friendly mineral. Don't think you can skip fluoride if you live in an area where the water is fluoridated. Studies have shown that using fluoride toothpaste helps increase the concentration of fluoride in the teeth, even in areas with water supplies containing high levels of the mineral.
Whatever your toothpaste needs, be sure to select toothpaste that has earned an American Dental Association seal of approval. Toothpastes that have earned this distinction have been evaluated for safety and effectiveness by an independent review board of scientific experts. All toothpastes earning the ADA seal contain fluoride -- the most important ingredient in any toothpaste.
What is gum disease?
Gum disease is an infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease. The two stages of gum disease are called gingivitis and periodontitis. Gingivitis is mild gum disease that affects only the gums, the tissue that surrounds the teeth. Periodontitis is gum disease that gets worse and spreads below the gums to damage the tissues and bone that support the teeth. Gingivitis causes red, swollen gums that bleed easily when the teeth are brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need. Periodontitis develops if gum disease gets worse. The gums pull away from the teeth, leaving deep pockets where germs called bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back from the teeth. This can make the teeth look longer. Teeth may become loose, fall out, or have to be pulled out by a dentist.
Your mouth constantly makes a clear, sticky substance called plaque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the gum tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gums and damage the bone that supports the teeth. With time, the plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygienist.
What are the symptoms?
It may be hard to tell if you have a mild case of gum disease. Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. But mild cases of gum disease (gingivitis) cause:
- Gums that are red, swollen, and tender.
- Gums that bleed easily during brushing or flossing.
- As gum disease gets worse (periodontitis), the symptoms are easier to see, such as:
- Gums that pull away or shrink from the teeth.
- Bad breath that won't go away.
- Pus coming from the gums.
- A change in how your teeth fit together when you bite.
- Loose teeth.
Early-stage gum disease causes:
- Red, swollen, tender gums.
- Gums that bleed easily when brushed or flossed. Healthy gums do not bleed with regular brushing and flossing.
Because gingivitis usually isn't painful, you may not notice the symptoms and may not get the treatment you need. If you don't get treated, the disease will progress.
Advanced gum disease causes more noticeable symptoms, such as:
- Gums that pull away or recede from the teeth.
- Persistent bad breath.
- Pus coming from the gums.
- A change in how your teeth fit together when you bite, or a change in the fit of partial dentures.
- Loose teeth.
If you use tobacco you have a higher risk of gum disease. Your gums may actually bleed less, even though they are unhealthy, and you may not realize it's a problem until its too late. If you use tobacco, you will need to see your dentist more often.
How is gum disease diagnosed?
To find out if you have gum disease, your dentist will do an exam to look for:
- Bleeding gums.
- Hard buildups of plaque and tartar above and below the gums.
- Areas where your gums are pulling away or shrinking from your teeth.
- Pockets that have grown between your teeth and gums.
Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.
Your dentist or dental hygienist will examine your gums and teeth for gum disease during regular visits. Using a small mirror and a tool called a probe, your dentist will look for:
Bleeding gums. The more spots that bleed, the more likely it is that your gum disease is severe.
- Hard mineral deposits (tartar) above and below the gum line.
- Areas where your gums are pulling away from your teeth and pockets that have formed between your teeth and gums. Your dentist or dental hygienist will use the probe to measure the depth of the spaces between your teeth and gums to see how deep the pockets are.
The dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.
Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems. Your dentist or dental hygienist will examine your gums and teeth for gum disease during regular visits. Using a small mirror and a tool called a probe, your dentist will look for:
- Bleeding gums. The more spots that bleed, the more likely it is that your gum disease is severe.
- Hard mineral deposits (tartar) above and below the gum line.
- Areas where your gums are pulling away from your teeth and pockets that have formed between your teeth and gums.
If you have a mild case of gum disease, you will probably be able to take care of it by brushing and flossing your teeth every day and getting regular cleanings at your dentist's office. You may have to have teeth cleaned more than every 6 months.
If your gum disease has become worse and you have periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.
What are surgical methods to treat gum disease?
Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
Bone grafts. Involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by periodontal disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
Tips for healthy child's teeth
Be sure your child sees a dentist by his or her first birthday or 6 months after the first primary teeth appear, whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.
Parents and caregivers often share spoons, forks, and other utensils with babies. The saliva you may leave on the utensil contains bacteria that can cause tooth decay. In some instances, kissing can also transfer bacteria. You can help prevent early childhood tooth decay in your child by making sure that your family practices good dental health habits. Do not put your infant or small child to bed with a bottle of milk, formula, juice, or any other product that contains sugar. The sugar and acids in these liquids can cause tooth decay (bottle mouth). Do not prop the bottle up in your baby's mouth, and remove the bottle as soon as your baby is done feeding or is asleep. Breast-feeding your infant to sleep is safe, however. Discuss fluoride supplements with your dentist if your local water supply does not contain enough fluoride. To find out, call your local water company or health department. If you have your own well, have your water checked to determine whether your family needs fluoride supplements. You may also need to provide fluoride to your children if you use bottled water for cooking or drinking. When your child is around 6 years old, consider using a fluoride mouthwash if he or she has a lot of cavities. Be sure that your child does not swallow the mouthwash. Consider having your dentist or dental hygienist put a sealant into the grooves of the chewing surfaces of your child's back teeth to help prevent cavities. Studies show that children who have sealant applied regularly in school-linked programs have a 60% decrease in tooth decay.
Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth. The implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take from 6 to 12 weeks.
Once the implant has bonded to the jawbone, a small connector post – called an abutment – is attached to the post to securely hold the new tooth. A replacement tooth, called a crown, is then attached to the abutment. Instead of one or more individual crowns, some patients may have attachments placed on the implant that retain and support a removable denture.
Success rates vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care, implants can last a lifetime.
What are dentures and partial dentures?
Two types of dentures are available – complete and partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain. Complete dentures can be either "conventional" or "immediate." Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.
Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. Therefore a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.
A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw.
What can I expect with my new denture?
New dentures may feel a little odd or loose for a few weeks until the muscles of your cheek and tongue learn to keep them in place and you get comfortable inserting and removing them. Also, it is not unusual for minor irritation or soreness to occur and for saliva flow to increase when you first start wearing dentures, but these problems will diminish as your mouth adjusts to the new denture. Dentures are made to closely resemble your natural teeth so there should be no noticeable change to your appearance. In fact, dentures may even improve your smile and fill out your facial appearance.
Eating with new dentures will take a little practice and may be uncomfortable for some wearers for a few weeks. To get used to the new denture, start with soft foods cut into small pieces. Chew slowly using both sides of your mouth. As you get used to your new dentures, add other foods until you return to your normal diet. Be cautious with hot or hard foods and sharp-edged bones or shells. And, avoid foods that are extremely sticky or hard. You may have difficulty pronouncing certain words. If so, practice by saying the difficult words out loud. With practice and with time you will become accustomed to speaking properly with your denture.
To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material once lived. Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding). Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic and glass materials called composite resin fillings. Our office uses composite resin for filling material. Most dental insurance plans cover the cost of the composites up to the price of the silver filling, then the patient must pay the difference
Constant pressure from chewing, grinding or clenching can cause dental fillings to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up. If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscessed tooth. If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.
What are the types of crowns available?
Metals used in crowns include gold alloy, other alloys (for example, palladium) or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies.
What do I do with my wisdom teeth?
Wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them where food can become trapped and a gum infection can develop. Wisdom teeth can also come in crooked or facing the wrong direction. Or, if your jaw is not large enough to give them room, wisdom teeth may become impacted and unable to break through your gums. You may have trouble properly cleaning around wisdom teeth because they are so far in the back of your mouth and may be crowded. Most problems with wisdom teeth develop in people between the ages of 15 and 25. Few people older than 30 develop problems that require removal of their wisdom teeth.
The most common treatment for wisdom tooth problems is removal (extraction) of the tooth. Experts disagree about whether to remove a wisdom tooth that is not causing symptoms or problems. Oral surgeons generally agree that removing a wisdom tooth is easier in younger people (usually in their early 20s), when the tooth's roots and the jawbone are not completely developed. In the late 20s and older, the jawbone tends to get harder, and healing generally takes longer.
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form. "Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal. A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
Sometimes no symptoms are present; however, signs to look for include:
- Severe toothache pain upon chewing or application of pressure
- Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
- Discoloration (a darkening) of the tooth
- Swelling and tenderness in the nearby gums
- A persistent or recurring pimple on the gums
- Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
- Dislocation of the soft cushion or disc between the ball and socket
- Presence of osteoarthritis or rheumatoid arthritis in the TMJ
- Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
- Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide
- Limited ability to open the mouth very wide
- Jaws that get "stuck" or "lock" in the open- or closed-mouth position
- Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
- A tired feeling in the face
- Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
- Swelling on the side of the face
- Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
- Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
- Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, Aleve), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs or other drugs for pain such as narcotic pain relievers. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs and antidepressants are available by prescription only.
- Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper or lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn full time (24 hours a day for 7 days). Your dentist will discuss with you what type of mouth guard appliance you may need.
- Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem.
- Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
- Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
- Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
- Learning relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physical therapy or massage. Consider stress reduction therapy, including biofeedback.
Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possible causes include:
People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40. Common symptoms of TMD include:
Other common symptoms include toothaches, headaches, neckaches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitis).
Treatments range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, nonsurgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.
