Frequently Asked Questions
Please review the following frequently asked questions.
 

Bleaching

Dental bleaching is a safe, effective and cost-efficient means to achieve a winning smile.

Countless people may now have white teeth and brilliant smiles, previously thought only available to celebrities. While unlikely to land you a lead role on television, whiter teeth may well improve your appearance and even brighten your outlook on life! Although generally successful in whitening teeth, dental bleaching is not for everyone.

Naturally, prior to any treatment, a thorough examination and diagnosis should be performed, evaluating the potential benefits the technique may offer you. Teeth that have become stained from age, coffee, tea or smoking are ideal candidates. Patients with healthy, natural, and unrestored teeth often achieve dazzling results. Teeth darkened with extrinsic, or surface stains, respond better to bleaching than deep, intrinsic discoloration caused by fluorosis or tetracycline. These types of stain are less likely to produce dramatic results. Bleaching is generally not indicated for sensitive or worn teeth; those with large fillings or crowns; and teeth affected by periodontal disease.

If your dentist determines that you are a candidate for tooth bleaching, an impression of your teeth is made to prepare a custom-fitted tray. Within a day or two, you will receive the appliance, bleaching materials, and instructions on use for home bleaching. This approach requires wearing the tray about one hour a night, for 10 to 14 days.

If you simply can't wait, or choose to have more effective results, you may decide to have your teeth lightened immediately. Your dentist may recommend an in-office bleaching system using a higher concentration of the bleaching agent while you sit in the dental chair. Due to possible damage to soft tissue, the gums need special protection under careful dental supervision. This approach is customarily used in conjunction with dentist-supervised at-home bleaching.

Depending on your personal habits -- such as smoking and drinking coffee or tea -- bleaching may produce many years without reversal. Of course, under the dentist's supervision, you may choose to touch up the teeth with periodic (once a month, perhaps) use of the bleaching tray.
The active ingredient in most of the whitening agents is 10 percent carbamide peroxide (CH4N2O2), also known as urea peroxide; when water contacts this white crystal, the release of hydrogen peroxide lightens the teeth. There are many brands on the market, many of which are approved by the American Dental Association.
Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends. Many years of study have confirmed that bleaching is safe, effective and long-lasting.
No one can really predict how much lighter your teeth will become, since every case is different. Typically, there is a noticeable improvement in whitening, sometimes quite dramatic. The success rate depends upon the type of stain involved and your compliance. Bleaching does not lighten artificial materials such as resins, silicants or porcelains.

Crowns

Permanent crowns can be made from all metal, porcelain-fused-to-metal, all resin, or all ceramic.
  • 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, metal crowns 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-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.
  • 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. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
  • Temporary versus permanent. Temporary crowns can be made in your dentist's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.
Preparing a tooth for a crown usually requires two visits to the dentist -- the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.

First Visit: Examining and preparing the tooth.

At the first visit in preparation for a crown, your dentist may take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.

Before the process of making your crown is begun, your dentist will anesthetize (numb) your tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used (for instance, all-metal crowns are thinner, requiring less tooth structure removal than all-porcelain or porcelain-fused-to-metal ones). If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to "build up" the tooth to support the crown.

After reshaping the tooth, your dentist will use impression paste or putty to make an impression of the tooth to receive the crown. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions are sent to a dental laboratory where the crown will be manufactured. The crown is usually returned to your dentist's office in 2 to 3 weeks. If your crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using a temporary cement.

Second Visit: Receiving the permanent dental crown.

At your second visit, your dentist will remove your temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.
How Should I Care for My Temporary Dental Crown?

Because temporary dental crowns are just that -- a temporary fix until a permanent crown is ready, most dentists suggest that a few precautions be taken with your temporary crown. These include:
  • Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
  • Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of your mouth.
  • Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
  • Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.
  • Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush your teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix this problem.
  • Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.
  • Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact your dentist's office.
  • Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit or a lack of cement. If this happens, clean the crown and the front of your tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for your tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement your crown in place; if not, a new crown will need to be made.
  • Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.
  • Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.
On average, dental crowns last between 5 and 15 years. The life span of a crown depends on the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting your fingernails, and using your teeth to open packaging).

Dentures

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you're talking, speak more slowly.

You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.
A removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture. Your dentist can determine if an overdenture would be suitable for you.
New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place.

It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should diminish. One or more follow-up appointments with the dentist are generally needed after a denture is inserted. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.
Dentures can be made to closely resemble your natural teeth so that little change in appearance will be noticeable. Dentures may even improve the look of your smile and help fill out the appearance of your face and profile.
Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.
Your dentist will provide instructions about how long dentures should be kept in place. During the first few days, you may be advised to wear them most of the time, including while you sleep. After the initial adjustment period, you may be instructed to remove the dentures before going to bed. This allows gum tissues to rest and promotes oral health. Generally, it is not desirable that the tissues be constantly covered by denture material.
Denture adhesive can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.
Dentures are very delicate and may break if dropped even a few inches. Stand over a folded towel or a basin of water when handling dentures. When you are not wearing them, store your dentures away from children and pets.

Like natural teeth, dentures must be brushed daily to remove food deposits and plaque. Brushing helps prevent dentures from becoming permanently stained and helps your mouth stay healthy. It's best to use a brush designed for cleaning dentures. A toothbrush with soft bristles can also be used. Avoid using hard-bristled brushes that can damage dentures.

Some denture wearers use hand soap or mild dishwashing liquid, which are both acceptable for cleaning dentures. Avoid using other powdered household cleansers, which may be too abrasive. Also, avoid using bleach, as this may whiten the pink portion of the denture.

Your dentist can recommend a denture cleanser. Look for denture cleansers with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.

The first step in cleaning dentures is to rinse away loose food particles thoroughly. Moisten the brush and apply denture cleanser. Brush every surface, scrubbing gently to avoid damage.

Dentures may lose their shape if they are allowed to dry out. When they are not worn, dentures should be placed in a denture cleanser soaking solution or in water. Your dentist can recommend the best method. Never place dentures in hot water, which could cause them to warp.

Ultrasonic cleaners are also used to care for dentures. However, using an ultrasonic cleaner does not replace a thorough daily brushing.
You can seriously damage your dentures and harm your health by trying to adjust or repair your dentures. A denture that is not made to fit properly can cause irritation and sores.

See your dentist if your dentures break, crack, chip, or if one of the teeth becomes loose. A dentist can often make the necessary adjustments or repairs on the same day. A person who lacks the proper training will not be able to reconstruct the denture. This can cause greater damage to the denture and may cause problems in your mouth. Glue sold over-the-counter often contains harmful chemicals and should not be used on dentures.
Over time, dentures will need to be relined, rebased, or remade due to normal wear. To reline or rebase a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear. Dentures become loose because a mouth naturally changes with age. Bone and gum ridges can recede or shrink, causing jaws to align differently. Shrinking ridges can cause dentures to fit less securely. Loose dentures can cause health problems, including sores and infections. A loose denture also makes chewing more difficult and may change your facial features. It's important to replace worn or poorly-fitting dentures before they cause problems.
Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.
Your dentist will advise you about how often to visit. Regular dental check-ups are important. The dentist will examine your mouth to see if your dentures continue to fit properly. The dentist also examines your mouth for signs of oral diseases including cancer

With regular professional care, a positive attitude and persistence, you can become one of the millions of people who wear their dentures with a smile.

Sealants

Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay. Most tooth decay in children and teens occurs on these surfaces. Sealants protect the chewing surfaces from tooth decay by keeping germs and food particles out of these grooves.
Which teeth are suitable for sealants?

Permanent molars are the most likely to benefit from sealants. The first molars usually come into the mouth when a child is about 6 years old. Second molars appear at about age 12. It is best if the sealant is applied soon after the teeth have erupted, before they have a chance to decay.
Sealants can only be seen up close. Sealants can be clear, white, or slightly tinted, and usually are not seen when a child talks or smiles.
A sealant can last for as long as 5 to 10 years. Sealants should be checked at your regular dental appointment and reapplied if they are no longer in place.
No. Fluorides, such as those used in toothpaste, mouth rinse, and community water supplies also help to prevent decay, but in a different way. Sealants keep germs and food particles out of the grooves by covering them with a safe plastic coating. Sealants and fluorides work together to prevent tooth decay.
Sealants are one part of a child's total preventive dental care. A complete preventive dental program also includes fluoride, twice-daily brushing (see the Brush Up on Healthy Teeth tip sheet), wise food choices, and regular dental care.
Decay damages teeth permanently. Sealants protect them. Sealants can save time, money, and the discomfort sometimes associated with dental fillings. Fillings are not permanent. Each time a tooth is filled, more drilling is done and the tooth becomes a little weaker.
Applying sealants does not require drilling or removing tooth structure. The process is short and easy. After the tooth is cleaned, a special gel is placed on the chewing surface for a few seconds. The tooth is then washed off and dried. Then, the sealant is painted on the tooth. The dentist or dental hygienist also may shine a light on the tooth to help harden the sealant. It takes about a minute for the sealant to form a protective shield.

Root Canal

Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.
When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.
Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it's always best to keep your original teeth.
Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an endodontist (a pulp specialist). Treatment usually involves one to three appointments.

First, you will probably be given a local anesthetic to numb the area. Next, a gap is drilled from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp and reshaped. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or the dentist may go right ahead and fill the canals. If you're given a temporary filling, usually on the next visit it's removed and the pulp chamber and canal(s) are filled with rubberlike gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.

Bonding

Preparation. Little advance preparation is needed for dental bonding. Anesthesia is often not necessary unless the bonding is being used to fill a decayed tooth. Your dentist will use a shade guide to select a composite resin color that will closely match the color of your tooth.
The bonding process. Next, the surface of the tooth will be roughened and a conditioning liquid applied. These procedures help the bonding material adhere to the tooth. The tooth-colored, putty-like resin is then applied, molded, and smoothed to the desired shape. An ultraviolet light or laser is then used to harden the material. After the material is hardened, your dentist will further trim and shape it, and polish it to match the sheen of the rest of the tooth surface.
Time-to-completion. Dental bonding takes about 30 to 60 minutes per tooth to complete.
  • Advantages: Dental bonding is among the easiest and least expensive of cosmetic dental procedures. Unlike veneers and crowns, which are customized tooth coverings that must be manufactured in a laboratory, bonding usually can be done in one office visit unless several teeth are involved. Another advantage, compared with veneers and crowns, is that the least amount of tooth enamel is removed. Also, unless dental bonding is being performed to fill a cavity, anesthesia is usually not required.
  • Disadvantages: Although the material used in dental bonding is somewhat stain resistant, it does not resist stains as well as crowns. Another disadvantage is that the bonding materials do not last as long nor are as strong as other restorative procedures, such as crowns, veneers, or fillings. Additionally, bonding materials can chip and break off the tooth.
Because of some of the limitations of dental bonding, some dentists view it as best suited for small cosmetic changes, for temporary correction of cosmetic defects, and for correction of teeth in areas of very low bite pressure (for example, front teeth). Consult with your dentist about the best cosmetic approach for your particular problem.

Periodontal Disease

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque.  Plaque that is not removed can harden and form "tartar" that brushing doesn't clean.  Only a professional cleaning by a dentist or dental hygienist can remove tartar.
People usually don't show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.

Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.

Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.

Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medications can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep gums clean.

Illnesses. Diseases like cancer or AIDS and their treatments can also negatively affect the health of gums.

Genetic susceptibility. Some people are more prone to severe gum disease than others.

 

Symptoms of gum disease include:

  • Bad breath that won't go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth

Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. At your dental visit the dentist or hygienist should:

  • Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
  • Examine your gums and note any signs of inflammation.
  • Use a tiny ruler called a 'probe' to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
  • The dentist or hygienist may also take an x-ray to see whether there is any bone loss.
  • Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

Here are some things you can do to prevent periodontal diseases:

  • Brush your teeth twice a day (with a fluoride toothpaste)
  • Floss every day
  • Visit the dentist routinely for a check-up and professional cleaning
  • Eat a well balanced diet
  • Don't smoke
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.

In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it is not been determined whether gum disease is the cause of these conditions

There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and other conditions, or it could be coincidence that gum disease and other health problems are present together.

More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.

In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.