A dental bridge is a device used to fill the space where a tooth has fallen out or been removed. A typical dental bridge consists of a pontic (a filler tooth) that is attached to two surrounding dental crowns (abutments). Once complete, this bridge structure is bonded into the mouth. Without the use of a bridge, spaces in the mouth from missing teeth can cause multiple teeth to shift, lead to occlusion (biting) and/or jaw problems, and may spur periodontal disease. Dental bridges safeguard the integrity of existing teeth and help maintain a healthy, vibrant smile.

The Process
Dental bridges usually require two trips to the dentist's office. During the initial visit, the surrounding teeth are numbed with a local anesthetic. The dentist prepares the surrounding teeth by cleaning any plaque or decay that remains and reducing them so that the dental crowns can be fitted. The dentist makes a mold of the teeth and sends it off to a dental lab where the customized impression is prepared. The customized mold takes one to two weeks to return to the office. In the interim, patients are fitted with a temporary bridge constructed of acrylic resin. When the patient returns to the dental office, the dentist removes the temporary bridge and replaces it with the permanent one. The dentist then adjusts the dental bridge for the proper bite and fit, and the bridge is permanently bonded into the mouth.

Types of Dental Bridges
There are several different types of dental bridges. The first is a fixed bridge, which consists of a filler tooth (referred to as a pontic) that is attached to two dental crowns. The crowns fit over the existing teeth to hold the bridge in place. The fixed bridge is the most popular bridge.
Another bridge design is a composite bond, known as a "Maryland" bridge. This type of bridge is commonly used to replace the front teeth. The pontic is attached to metal bands that are bonded to the abutment teeth and the metal bands are hidden with a white-colored composite resin.
A cantilever bridge is often used when there are teeth on only one side of the span. A typical 3-unit cantilever bridge consists of two abutment crowns that are positioned side by side on the same side of the missing tooth space. The pontic is then connected to the two dental crowns, which extend into the missing tooth space.
If the missing tooth space has no surrounding teeth, the dentist may decide a dental implant is the most appropriate choice. Please refer to Dental Implants in the Patient Education Library for more information. When a series of teeth are missing, the dentist may suggest a partial denture as the most effective way to maintain the structure of the jawbone and teeth.

Proper Maintenance of Dental Bridges
Special care must be given to insure that the gumline and area surrounding the new structure is kept clean. This is especially true because the pontic and crowns are constructed as a single piece. Special floss is often necessary to clean underneath the teeth and maintain strong, healthy gums. With proper dental care, bridges can last upwards of 10 years.

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The ideal time as recommended by the American Academy of Pediatric Dentistry, the American Dental Association and the Academy of General Dentistry is at approximately one year of age. This is an ideal time for the dentist to carefully examine the development of your child's mouth. Because dental problems often start early, the sooner the visit, the better. To safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.

How Do I Prepare?
Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit- cooperative or non-cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child's complete medical history.

What Will Happen?
Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem.
Appointments for children should always be scheduled earlier in the day, when your child is alert and fresh. For children under 2 years of age the parent may have to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.
If the child is compliant, the first session often lasts between 15-30 minutes and may include the following, depending on age:

• A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas.
• If indicated, a gently cleaning which includes polishing teeth and removing any plaque, tartar build-up and stains; X-rays; a demonstration of proper home cleaning; assessment of the need for fluoride.
• The dentist should be able to answer any questions you have and try to make you and your child fee comfortable throughout the visit. The entire dental team and the office should provide a relaxed, non-threatening environment for your child.

When Should the Next Visit Be?
Children, like adults should see the dentist every six months. Some dentists may schedule interim visits for every three months when the child is very young to build up a comfort and confidence level, or to treat a developing problem.

How Do I Find a Good Dentist?
Many general dentists treat children. If yours does not, ask for a referral to a good dentist in your area. A word-of-mouth recommendation from a friend or family member can also yield the name of a quality dentist.

5 Ways to Protect Your Child's Oral Health At Home

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The dental profession refers to the dental cleaning appointment as a dental prophylaxis, or prophy. It's most significant functions are prevention of dental disease and patient education. It is likely the most important and valuable visit a patient may ever make to the dentist.
The routine dental cleaning is anything but routine, and should include:

• Personal oral hygiene evaluation, home care review and recommendations.
• Toothbrushing and flossing instructions.
• Supra gingival (above the gum) scaling to remove plaque and tartar from all visible tooth surfaces.
• Debridement of tartar beneath the gum, as conditions warrant.
• Topical fluoride treatment to the age of thirteen.
• Polishing the teeth.
• Nutrition assessment, if needed.
• Periodontal charting, and scheduling of additional periodontal care as indicated.

The dental prophylaxis is the cornerstone for a lifetime of dental health.

Ultrasonic and Hand Scaling
Plaque is the colonization of natural oral bacteria on food debris that remains on the surface and in the crevices of the teeth and gums. Combing with minerals in the saliva, it ultimately forms hard, rough sediment known as dental tartar or calculus, which attracts further plaque buildup. Calculus must be removed by a dental professional for the prevention of periodontal disease.
Removal of calculus may be performed by a licensed dental hygienist or dentist, either by manual scaling of the teeth, or with an ultrasonic device. The choice of technique is a personal preference by the hygienist or wishes of the patient. Most states permit trained dental hygienists to administer local anesthetic and nitrous oxide (laughing gas), often necessary for deep periodontal scaling and root planning.
Light or moderate tartar buildup is commonly removed by manual scaling instruments of various shapes and sizes. The skills of the hygienist are especially important for this procedure.
The ultrasonic scaler, commonly called by the brand name, Cavitron, is often indicated for the efficient removal of heavy, tenacious tartar and stain The hygienists may follow its use with hand scaling for a more finite smoothing of tooth and root surfaces.
Caution is warranted for people who wear pacemakers, as the ultrasonic sounds may interfere with the function of the pacemaker.

Root Planing
Accumulation of plaque causes inflammation of the gums and an ensuing breakdown of the periodontal attachment (the fibrous connection of the teeth to the supporting structures). Pockets between the teeth and soft tissue become deeper, and the underlying bone recedes Increased pocket depth encourages the formation of more calculus, plaque and further tissue breakdown The ongoing bacterial colonization byproducts perpetuate the disease process.
Root planing is a procedure to treat periodontal conditions (moderate to advanced gum disease) by thoroughly scaling the roots of teeth to establish a smooth, calculus free surface The process may be performed by a dental hygienist, dentist or periodontist (gum specialist), and usually requires local anesthesia to prevent pain Thorough periodontal scaling customarily involves several dental visits.
More advanced conditions may necessitate periodontal surgery for complete debridement of the roots and recontouring of the hard and soft tissue to arrest the disease process or to restore, in select situations, lost bone.

Polishing
The dental prophylaxis is refined by a final polishing of the teeth to remove stain and create a sensation of fresh breath and a clean mouth It may be accomplished by spraying high pressured water mixed with baking soda paste onto the surface of the teeth (prophy jet polishing), or a rubber cup and polishing paste. Many states permit a certified dental assistant to polish teeth with a rubber cup and to apply fluoride for children.

The Dental Recall Appointment
Patients should schedule their recall appointments on a regular basis for the early diagnoses of dental disease The hygienist or dentist may recommend a prophylaxis visit every two to six months Even if your dental insurance plan only covers the procedure twice a year, its money well spent. Recall frequency depends on many factors and should be determined on an individual basis. Some people tend to have more buildup of calculus than others and some may be more prone to periodontal inflammation or the development of tooth decay. Patients with inadequate oral hygiene practices will require more frequent cleanings.

Dental Cleaning for Children
The dental prophylaxis is especially important for children to establish good oral hygiene practice and to appreciate the importance of dental health. Easy dental prophy appointments help create self-esteem and will lessen anxiety should dental restorative care become necessary in the future.
The regular application of topical fluoride, early detection of orthodontic (bite) problems, and an evaluation for pit and fissure sealants are part of preventive dental health.
See also, "Child Dentistry".

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Composite bonding, also known as dental bonding or tooth bonding, is a technique used to improve the appearance of your teeth. The term composite bonding refers to any composite material, either a plastic or resin, which is bonded to an existing tooth. Dental bonding is ideal for fixing chipped or cracked teeth, hiding discoloration on the tooth's surface, or reducing the gaps in between teeth. Whatever the specific intent, tooth bonding creates more aesthetically pleasing teeth and a more vibrant smile. Unlike veneers or crowns, composite bonding removes little if any of the original tooth.

The Advantages of Dental Bonding
Composite bonding is a quick process, typically lasting less than an hour. Compared to veneers or crowns popular choice because it does not reduce the tooth's original structure. As well, tooth bonding is relatively inexpensive. And finally, composite resins are available in many different shades. The shade can be chosen to match the natural color of the original tooth.

Dental Bonding Process
The dentist begins by examining and cleaning the tooth to be bonded. Once the tooth is properly prepped, the dentist rubs the tooth with a mild solution that facilitates the bonding of the composite resin to the tooth. The composite resin is then applied in several coats. Each coat is hardened (or set) using a specially designed dentist's light. Once the dentist has placed an adequate amount of resin on the tooth, the bond is sculpted for the desired shape and texture. Bonding is performed in the dentist's chair and usually does not require any anesthesia.

After Your Dental Bonds are Placed
Proper care of the bonded tooth insures the longest possible duration of the bonding. The bonded teeth, just like the rest of your teeth, should be brushed and flossed daily. This is especially important if you drink coffee, tea, or smoke tobacco; all of which stain composite bonds. Bonds typically do not last as long as veneers or crowns, and may need to be retouched or replaced every five to ten years.

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Until recently, dentists filled and sealed cavities exclusively using a silver and mercury amalgam. Unfortunately, these dental fillings (or restorations) often weaken teeth due to the large amount of the original tooth that has to be removed. Modern dentistry has increasingly turned to composite fillings as a strong, safe and more natural looking alternative. Composite fillings utilize a soft white plastic substance that includes a hardening agent.

Pros and Cons of Composite Fillings
The major advantage of these dental fillings is that they come in a range of shades that closely match the color of an individual's tooth. Due to the increased strength of modern composite material, they can now also be used in the back teeth. Unfortunately, composite fillings are 1 1/2 to 2 times more expensive than traditional restorations. Dental insurance typically covers the cost of composite fillings up to the price of the silver/mercury fillings.

The Dental Filling Procedure
During your initial visit to the dentist, he or she begins by anesthetizing the tooth and removing any remaining decay. Once the tooth has been prepared, the dentist places the composite into the tooth where it binds to the original surface. The process is typically performed in several layers wherein each layer is cured or hardened with the use of a hardening light. Composite restorations (fillings) for the back teeth are referred to as inlays. If the inlays need to be custom-made at an off-site dental lab, two visits to the dentist may be required. Once the dental office receives the custom inlays, the patient returns to the dentist's office, where the inlays will be bonded into place.

After the Fillings Have Been Placed
Patients may have increased sensitivity in the tooth for several weeks following the procedure. Unlike porcelain veneers, composite fillings are porous. Over time, they may become stained from coffee, tea, tobacco, etc. Many dentists place a clear covering over the filling to avoid any future staining. Composite fillings typically last three to twelve years, depending on the location of the restoration, an individual's occlusion (or bite), and several other factors.

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When a tooth is cracked, decayed, or damaged, a dental crown may need to be fitted onto the tooth. A dental crown is a permanent covering that fits over the original tooth. Dental crowns can be made of porcelain, gold and other metals, acrylic resin, or an amalgam (a mix) of these materials. Porcelain crowns typically have the most realistic appearance, although they tend to be less durable than other materials. Crowns can whiten, reshape, and realign existing teeth, adding to a healthy and vibrant smile.

Preparing the Tooth and Crown
During your first visit, the dentist will numb the tooth to be crowned and remove the decay in or around it. The tooth is then resculpted to provide an easy fit for the dental crown. This is a painless process that is performed in the dentist's chair. An impression of your teeth is then taken and sent to the dental lab where permanent, custom-made dental crowns are created (this usually takes one to two weeks). During this interim period, temporary crowns made of an acrylic resin are fitted onto the teeth.

Applying the Dental Crown
On your next visit, the dentist removes the temporary crown and fits the permanent crown onto the teeth. He or she makes sure the crown has the proper look and fit, and then cements the crown into place.

Maintaining Your New Dental Crown
The proper dental hygiene for normal teeth should be applied to your new dental crown. Daily brushing and flossing will help to keep the teeth, gums, and new crown free from the bacteria that can cause gum disease. Avoid chewing on hard foods such as ice or pistachios, which, over time, can cause crowns to crack or break. Given proper care, crowns can last several decades, and may last a lifetime.

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Over time, people's teeth tend to naturally deteriorate. When a tooth has deteriorated substantially, it often needs to be extracted. And when multiple teeth are extracted, dentures may be the most appropriate solution. Dentures can create a natural and healthy looking set of teeth. As well, a properly fitting set of dentures can greatly enhance your smile and sense of self-esteem.

Complete and Partial Dentures
Many types of dentures exist, including complete and partial dentures. Complete dentures are used when few of the original teeth remain. The dentist begins by removing any remaining teeth so the dentures can be fitted. He or she then makes a mold of the gums and sends it to a dental lab where customized dentures are constructed. Patients are typically fitted with temporary dentures until the permanent set of dentures have returned from the laboratory. Partial dentures are prepared in much the same way as a complete set, and are utilized when only a few teeth are missing.

Over Dentures
If the roots of a patient's remaining teeth (the tissue and gums) are strong, the dentist may suggest over dentures. Over dentures fit on top of the remainder of teeth in the mouth. With over dentures, the remaining teeth are resculpted and covered with metal caps to help to stop future decay. The advantage of over dentures is that they do not have to be relined as frequently as a complete set of dentures because the jawbone and gums recede less. In addition, over dentures create less occlusion (bite) problems than complete dentures.

Once Your Dentures Have Been Placed
At first, your dentures will feel uncomfortable because the gums and tissue are not accustomed to contact with man-made relining material. Once placed, patients should wear their dentures continually for the first few days to reduce the amount of swelling that may occur in the mouth. This swelling typically recedes in two to three days. Until patients become accustomed to their new set of teeth, the dentures may feel loose and awkward while chewing food. Eating soft food may also be necessary for the first few days. Reading aloud helps to overcome any speech impediments that may occur from the new dentures. Typically, lower dentures take longer to get used to than upper dentures. The underlying jawbone may take several months to completely heal and become accustomed to the dentures. Once this occurs, the dentist removes the dentures and creates a permanent lining for your teeth (a denture lining is the soft material that cushions the contact between the denture and the gum tissues).

The Life of Your Dentures
Proper care and cleaning will increase the life of your dentures. Although they typically last five years, proper care and minimal jaw recession can extend the life of dentures up to 25 years. Dentures should be cleaned daily with a normal or specially-made denture toothpaste. Once the swelling has reduced, it is advisable to leave one or both dentures out at night to allow the gum tissues to breathe. In order to prevent dentures from warping, they should be left in water overnight. Over time, the lining of the dentures may change, owing to the wear and tear of daily use. In the case of tissue/bone shrinkage, worn down teeth, or breakage, dentures may come loose and need to be remade.

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Wisdom teeth derive their name from the fact that they form in the late teen years, making them "older and wiser." In today's world, the softer diet and shorter jaw of modern humans have rendered wisdom teeth unnecessary. In fact, the onset of wisdom teeth can be a painful and potentially dangerous development. In most cases, a relatively simple and straightforward surgery can extract the wisdom teeth before they cause permanent damage to the teeth and mouth.

Growth of Wisdom Teeth
Wisdom teeth are located at the back of the mouth, the "third" molar at both ends of the top and bottom row of teeth. As the wisdom teeth begin to grow, they can become impacted, or trapped in the jawbone and/or gums. As they continue to grow beneath the gum line in an angled or horizontal direction, displacement of the original line of teeth and wearing into the back molars can occur. Wisdom teeth that are unable to "erupt" above the gum line can lead to inflammation and infection. In the case of a partial eruption, a pocket often forms under the gumline, which can lead to the formation of a cyst or tumor. If left untreated, wisdom teeth cause permanent damage, including cavities, nerve damage, gum infection, bone infection, and a weakening of the jaw. Unfortunately, wisdom teeth often grow unnoticed until they cause problems in the mouth or outlying areas, such as the face. These problems can cause headaches, pain in the ears, neck, upper or lower jaw.

Wisdom Tooth Surgery
As a rule of thumb, wisdom teeth should be extracted when the oral surgeon first concludes that the teeth are impacted and pose a risk to the patient. In certain cases, surgery may require an incision into the gums, partial bone removal, and/or sectioning of the tooth before removal. The procedure is almost always performed in the dentist's office, on an outpatient basis. The surgery is usually performed in less than an hour, depending on the depth of the impacted teeth and their angle of growth. The surgeon will recommend using a local anesthesia, a mild sedative, or a general anesthesia.

After Surgery
Following the surgery, one can expect to experience minor pain, bleeding of the gums, and swelling of the mouth. The surgeon will prescribe medication to alleviate much of this discomfort. Unfortunately, it is impossible to know how much swelling will occur because the amount of swelling does not always correspond to the severity of the impacted teeth. However, swelling typically begins the day of the surgery and peaks within two to three days, gradually subsiding in five to seven days. Applying ice packs to the jaw helps reduce any swelling you may experience. Your surgeon may prescribe antibiotics to prevent infection and to aid the healing process. Most patients are fully recovered and back to work in one to two weeks.

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For individuals who wish to replace missing teeth, dental implants may be an effective long-term solution. Implants provide greater structural support and last longer than either bridges or dentures. Dental implants serve as the artificial root to which new teeth are bonded. They are typically constructed of titanium, a strong and safe material that effectively attaches to bone. The procedure to insert dental implants typically involve three steps: the implant insertion stage, osseointegration (the period of healing for the jawbone), and the attachment of the restoration or new tooth.

Types of Dental Implants
The most popular form of dental implant is the Root Implant. This type of implant is very effective and mirrors the size and the shape of a patient's natural tooth. Many times, this dental implant will be as strong structurally as the original tooth's root. Once the dentist applies the local anesthesia, he or she makes an incision in the gum in order to gain access to the jawbone. The bone is then prepared and the implant inserted into the jawbone with care and precision. Finally, the dentist stitches the gums and, if necessary, prescribes the appropriate medication. During the osseointegration step, which lasts anywhere from 3 to 8 months, the jawbone firmly attaches itself to the dental implant. Once osseointegration is completed, the patient returns to the dental office where the implant is fitted with the new tooth. Another form of dental implant is the Plate Form Implant. This implant is ideal in situations where the jaw bone is not wide enough to properly support a Root Implant. The Plate form implant is long and thin, unlike the Root Implant, and anchors into thin jawbones. Once the dentist applies the local anesthesia, he or she makes an incision in the gumline in order to gain access to the jawbone. The bone is then prepared and the implant is inserted into the jawbone with care and precision. The dentist then sutures the gums and prescribes the appropriate medication. In certain cases, Plate Implants are immediately fitted with the restoration without waiting for the osseointegration period. The last type of dental implant is the Subperiosteal Implant. These implants are utilized when the jawbone has receded to the point where it no longer supports a permanent implant. These dental implants are placed on top of the bone and imbedded in the gums, but not in the jawbone as with the other types of implants. The dentist applies a local anesthesia, and makes a mold of the mouth and jawbone. From this impression, a dental lab constructs implants to custom fit the patient's jaw. On the second visit to the dentist, the dentist exposes the jawbone and inserts the implant on top of it. Over the next month the gums grow up and around the implant. This same type of implant can sometimes be performed in a single procedure with the use of an initial CAT scan of the gumline and jawbone.

Dental Implant Side Effects
As with any oral surgery, complications are rare, but can include infection, slight damage to nerves, and mild discomfort. Although very unlikely, infection of the gums or jawbone is a possibility and is treated through medication and/or antibiotics. Surgery to the upper or lower jawbone can result in mild nerve damage. Nerve damage typically subsides in several weeks, but can persist for longer periods of time. As the jawbone heals, patients may experience some discomfort, which can be tempered through medication. Discomfort subsides within 7 to 10 days.

Proper Maintenance of Dental Implants
Although patients should always practice proper dental hygiene, this is especially true once a dental implant has been put into place. When teeth and gums are not properly cleaned, bacteria can attack sensitive areas, causing the gums to swell and the jawbone to gradually recede. Enough recession of the jawbone can weaken dental implants and eventually necessitate their removal. Patients should visit their dentist's office at least twice a year in order to insure the health of your teeth and your implant. Following an implant operation, smoking should be avoided, as it impairs the gum and jawbone's ability to heal. Given the proper care, dental implants should last 25 years or longer.

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For Americans in their 30's and beyond, the threat of gum disease (periodontal disease) is a very real and potentially dangerous condition. By the age of 40, over 70% of the Nation's population has some stage of the disease. Although genetics may play a small role in its development, doctors agree that gum disease is directly related to how well one cares for their teeth and gums. Gum disease is particularly dangerous because the progression of the disease is often painless and undetected until it creates serious problems.

The Stages of Gum Disease
Periodontal disease is a gradual infection of the gums and, eventually, the underlying bones of the mouth. Periodontal disease is caused by the build up of plaque on and around the teeth that eventually calcifies into tartar. This tartar releases bacteria, which contains toxins and a sulfur compound that slowly decay the teeth and gums. In the first stage of gum disease (known as gingivitis), the bacteria begin to weaken the fibers that hold the gums to the teeth. Gingivitis is characterized by a swelling, inflammation, and bleeding of the gums. In the advanced stage of gum disease (referred to as periodontitis), the gum tissues have decayed significantly and have pulled away from teeth. The bones below the teeth have usually become infected and begun to dissolve.

Gum Disease Treatment
Treatments to alleviate the effects of gum disease depend on the severity of the tooth and gum erosion. The periodontist begins by removing the diseased tissue, scraping the tartar and plaque from the tooth's surface and from below the gumline. The root of the tooth may need to be planed and smoothed in order to allow gum tissue to properly heal. If periodontal pockets (deep spaces between the teeth and gums) have formed, the doctor places antibiotic fibers to fill in these spaces. The surgeon may prescribe antibiotics to stem the growth of the toxin producing bacteria while the gums heal. Once the periodontal pocket (s) is adequately rebuilt, the surgeon sutures the gums. In the case of bone decay, the surgeon may need to rebuild and shape the bone below the teeth.

Gum Disease Prevention
The ravages of gum disease are best prevented by early detection and proper dental hygiene. Brushing your teeth twice a day helps to remove the thin layer of bacteria that release the dangerous toxins into your mouth. Flossing or other interdental cleansing is also important to keep your mouth free from residual food and bacteria. Finally, maintaining a balanced diet and taking regular trips to the dentist helps stem the advance of gum disease and keeps you healthy and smiling.

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Porcelain veneers are thin shells that are laid onto the teeth and bonded to the surface. Although they can be made of different materials, porcelain is frequently used because of its durability and very realistic appearance. Porcelain veneers are a more conservative alternative to crowns since they require less removal of the tooth's original surface. With porcelain veneers in place, patients can expect straighter, whiter, and more even looking teeth.

Porcelain Veneers Placement
During the initial visit, the patient and dentist discuss the process of placing porcelain veneers and the options available (e.g. types and shades of veneers). On your next visit, a very small layer of each tooth's outer enamel is removed. A local anesthesia may be used, but is usually not necessary. The dentist makes a mold of the teeth and then sends it to a dental lab where they create customized porcelain veneers for the teeth. The lab prepares the veneers in roughly seven to ten days. During this time, the teeth have a slightly different appearance because of the removal of the outer layer of enamel. Some patients choose to have temporary restorations placed on their teeth, but this step is usually not necessary. Once the porcelain veneers have returned from the lab, the patient makes their final dental visit. The dentist applies the veneer to the tooth using a bonding material. When exposed to light, this bonding material dries and hardens.

What to Expect
Patients may experience some sensitivity in the teeth, especially with contact to hot or cold foods and drinks. This sensitivity should lessen within two weeks. If you grind or clench your teeth while you sleep, your dentist can fit you with a mouthguard to protect the teeth. Porcelain veneers are quite strong and can withstand considerable force when a patient bites down, but they may fracture or break if twisted. Patients should therefore avoid hard or sharp foods such as ice or peanuts that may cause undue stress. Porcelain veneers should be cared for in much the same way as normal teeth, this includes daily brushing, flossing, and periodic checkups with a dentist. Given the proper care, veneers can keep you smiling for decades to come.

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Prior to recent advances in medicine, damage to the core of a tooth usually meant its quick removal. The modern solution is a root canal, known in the medical community as endodontic treatment. This procedure usually involves several trips to the dentist and is performed in the dentist's chair. A root canal procedure cleans, disinfects, and refills the interior of the tooth, thereby preventing serious pain and permanent damage to decayed teeth.

Why It Happens
A root canal is usually performed on a cracked tooth or a tooth with a deep interior cavity. If a root canal is not performed, bacteria is able to enter the core of the tooth (the pulp) and cause decay of the nerve, tissue, and blood vessels in the tooth's canal(s). If left untreated, the diseased tooth may become extremely sensitive to heat and cold, may throb, or even cause infection in the jawbone (an abscess).

Root Canal Surgery
During the surgical portion of a root canal, the decayed tooth is first anesthetized. A hole is made through the crown of the tooth, down into the pulp. The surgeon uses tiny metal instruments to extract the remaining pulp from the tooth, and thoroughly cleans and disinfects the canal(s). If the tooth canal is twisted, the surgeon may have to enter the tooth through the gums to remove the difficult-to-reach pulp. Once cleaned out, the canal(s) is reshaped to allow the surgeon to easily and completely fill the interior of the tooth. The canal(s) is filled with a rubberized inert material that helps prevent future infection. A temporary seal protects the tooth until the patient can return to the dentist's office. A permanent metal pin may be attached to the root of the tooth to provide long term structural support. On your follow-up visit, the temporary sealing is removed and a permanent crown or veneer is fitted on the tooth to permanently seal it.

Health Risks
Although a root canal is an often-performed procedure, complications may occur. These include bleeding, soreness in the jaw, infection, and a reaction to the anesthesia. Occasionally, the tiny metal instruments used to clean the canal break off inside the tooth. Although the surgeon can usually recover them, they may have to be permanently sealed up within the tooth, where they pose a very small chance of future infection. If the tooth is unable to be properly cleaned, or if bacteria has damaged the tooth beyond repair, the surgeon may have to extract the tooth. In order to maximize surgical success, always follow your dentist's specific pre and postoperative instructions.

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A sealant is a plastic material that is usually applied to the chewing surfaces of the back teeth - premolars and molars. This plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque and acids.
Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But toothbrush bristles cannot reach all the way into the depressions and grooves to extract food and plaque. Sealants protect these vulnerable areas by "sealing out" plaque and food.

A Complicated Procedure?
Sealants are easy for your dentist to apply, and it takes only a few minutes to seal each tooth. The teeth that will be sealed are cleaned. Then the chewing surfaces are roughened with an acid solution to help the sealant adhere to the tooth. The sealant is then 'painted' onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.
As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed. During your regular dental visits, your dentist will check the condition of the sealants and reapply them when necessary.

Just For Kids?
The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well.
Key ingredients in preventing tooth decay and maintaining a healthy mouth are twice-daily brushing with an ADA-accepted fluoride toothpaste; cleaning between the teeth daily with floss or interdental cleaners; eating a balanced diet and limiting snacks; and visiting your dentist regularly. Ask your dentist about whether sealants can put extra power behind your prevention program.

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A mouthguard is a flexible appliance made out of plastic that is worn in athletic and recreational activities to protect teeth from trauma.

Should I Wear a Mouthguard?
To protect your mouth from injuries, the dental profession unanimously supports the use of mouthguards in a variety of sports activities. More than 200,000 injuries to the mouth and jaw occur each year.
A mouthguard can prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by helping to avoid situations where the lower jaw gets jammed into the upper jaw.
Mouthguards are effective in moving soft issue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks, especially for those who wear orthodontic appliances.

Sports and Kids
Anytime there is a strong chance for contact with other participants or hard surfaces, it is advisable to wear a mouthguard. Players who participate in basketball, softball, wrestling, soccer, lacrosse, rugby, in-line skating, and martial arts as, well as recreational sports such as skateboarding, and bicycling should wear mouthguards while competing.
Currently, five sports at the amateur level require mouthguards during practice and competition: boxing, football, ice hockey, men's lacrosse and women's field hockey.
Parents are sometimes uninformed about the level of contact and potential for serious dental injuries involved with sports in which the child participates. Some, though not all schools, reinforce the health advantage of mouthguards for their contact sports. Cost may be another consideration, although mouthguards come in a variety of price ranges.

Types of Mouthguards
Stock mouthguard: The lowest cost option is a stock item, which offers the least protection because the fit adjustment is limited. It may interfere with speech and breathing because this mouthguard requires that the jaw be closed to hold it in place. A stock mouthguard is not considered acceptable as a facial protective device.

Mouth-formed protectors: These mouthguards come as a shell-liner and "boil-and-bite" product. The shell is lined with acrylic or rubber. When placed in an athlete's mouth, the protector's lining material molds to the teeth and is allowed to set. The lining of the "boil-and- bite" mouthguard is immersed in boiling water for 10-45 seconds, transferred to cold water and then adapted to the teeth. The "boil-and-bite" mouthguard is used by more than 90 percent of athletes who use mouthguards. While they are less expensive than custom-made guards, the fit is not as good and they do not last as long.

Custom-made mouth protectors: The best choice is a mouthguard custom-made by your dentist. It offers the best protection; fit and comfort level because it is made from a cast to fit your teeth.

Mouthguard Care

• Clean your mouthguard by washing it with soap and warm (not hot) water. Before storing, soak your mouthguard in mouthwash.
• Keep your mouthguard in a well-ventilated plastic storage box when not in use. Make sure the box has several holes so the mouthguard will dry.
• Heat is bad for mouthguards; so don't leave it in direct sunlight or in a closed automobile.
• Don't bend your mouthguard when storing.
• Don't handle or wear someone else's mouthguard.
• Call your dentist who made the mouthguard if there are any problems.

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Regardless of how well you care for your teeth, it is inevitable that, over time, some yellowing or discoloration will occur. This gradual change can be caused by aging, substances that stain your teeth (such as coffee and tobacco), excessive fluoride, or the deterioration of a tooth's nerve. A teeth whitening treatment can be performed either as an at-home, dentist-supervised process or in the dentist's chair. Teeth whitening can have dramatic results, lightening teeth by multiple shades and brightening your entire appearance.

At-Home Whitening
One method of whitening teeth is the at-home, dentist-supervised option. During your visit to the dentist, a mold of your teeth and creates a comfortable, customized tray. The tray holds a mild solution whose main ingredient is carbamide peroxide, a substance that reacts with water to release a non-toxic bleaching element (hydrogen peroxide). The tray is placed inside the mouth, and sits only against the teeth, thereby avoiding contact with the gums. Patients can choose either to wear the tray throughout the night or for stretches that last from two to four hours. When the tray is worn throughout the night, the treatment lasts one to two weeks. Patients with more sensitive teeth may opt for the latter approach, which lasts three to five weeks.

In-Office Whitening with White Speed
The fastest way to whiter teeth is in-office whitening. Dr. DeVor uses the White Speed whitening system in his office. White Speed is a simple procedure. Special trays are used to hold the White Speed material and then is placed into the mouth for a mere thirty minutes. During this time, you are educated on the use of the at home materials, proper care and storage of your whitening material, and have the opportunity to ask any questions that you may have. For many people, this "kick-start" to their whitening is just what they need!

Patient Concerns
When using the at-home treatment, your teeth may temporarily feel a heightened sensitivity. The gums may also feel more sensitive or burn slightly. Most White Speed patients do not report discomfort. For those who do experience sensitivity or mild aching, the duration is usually short. It should be noted that teeth whitening does not prevent future stains. Proper cleanings are necessary to maintain results. For people who drink large amounts of coffee, tea, or dark sodas, treatment may be repeated in the future. Teeth whitening does not lighten veneers, crowns, or bonding material.

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Dental problems often go undetected because they remain hidden within the teeth and bones of the mouth. Dental X-rays identify these unseen developments. In addition to visually identifying cavities, X-rays can detect trauma to the teeth and bones, show impacted teeth, and illuminate signs of periodontal or bone disease. Dental X-rays are an inexpensive and relatively harmless way to detect dental problems before they result in serious and potentially costly problems down the road.

How Dental X-rays Work
When a patient needs an X-ray, the dentist inserts a photographic film card into the mouth at the location where the X-ray is taken. When the dental X-ray is filmed, a majority of the rays are absorbed by the hard parts of the mouth, namely the teeth and jawbone. These show up on a radiograph (an X-ray film which shows the X-ray results) and display any areas of concern that need to be addressed.

Types of Dental X-rays
There are three main types of dental X-rays: bitewing, periapical, and panoramic. Bitewing X-rays can detect any decay that is occurring in between teeth. Periapical X-rays identify the structure of the jaw, the roots of a particular tooth, and the formation of abscesses. Panoramic X-rays, on the other hand, provide a full shot of a patient's mouth. This type of X-ray allows the dentist to get an overall sense of the tooth and bone structure of a patient's mouth. Panoramic X-rays are ill suited for pinpointing minute conditions of individual teeth. Every 3-5 years, a dentist takes a complete set of X-rays in order to get a detailed visual picture of a patient's mouth. This usually consists of approximately 18 films.

Health Concerns
Because dental X-rays do contain a small amount of radioactive material, patients often worry about this exposure. Fortunately, X-rays are taken with high-speed film that minimizes a patient's exposure to this radiation. Combine this with a lead apron and the high tech equipment used by today's dentists, and patients have little cause for worry. In fact, normal dental X-rays are safer than allowing existing problems in the mouth (cavities or impacted teeth) to persist. Children typically need more X-rays because of the growth and changes occurring in their mouths. Although there is little or no risk, parents should monitor how often their children have dental X-rays taken.

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