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Q. Can an adult have braces?

A. Yes, orthodontics work well for adults as well as children. There are advantages to beginning treatment as a child, but orthodontists are successfully treating a growing number of adults who weren’t able to afford braces as a child or stopped wearing retainers after treatment and suffered a relapse of their crowded condition.

Many orthodontists now offer Invisalign or similar systems where slight problems can be corrected with clear, removable appliances instead of traditional brackets and wires.

Besides cosmetic improvements, many adults benefit from orthodontic improvements to their bite and reduction in suffering from TMJ (jaw joint) pain related to malpositioned jaws and teeth.

Q. How can I make my teeth whiter?

A. There are several ways that teeth may be made to look lighter and the process starts with a professional examination and cleaning to remove superficial stains on the tooth surface. Then it depends on the condition of the teeth and one’s desires.

If the teeth are relatively straight and healthy, they can often be bleached to remove stains that have penetrated deeper into the teeth over the years. In our office, this is accomplished by using either prefabricated trays containing a peroxide gel or custom fitted trays which may be kept and used periodically to keep the teeth light. Both methods are used at home for about ten days to remove the acquired stain. The gel contains fluoride and a desensitizer which reduces the cold sensitivity that some people experience during the process. There is only so far an individual tooth can be lightened, but we find most people are very happy with their brighter smile. It is a safe process and is a good, conservative choice for many people.

There are some cases where bleaching will be of little or no benefit. These include cases where a person was given tetracycline as a child or grew up with well water containing too much of certain minerals such as iron. Even prolonged illness as a child can leave bands of discoloration on the teeth which won’t respond to bleaching. If the teeth have large fillings and/or crowns already, these will not be affected by the bleaching process. In these cases, it might be necessary to place crowns and/or veneers on the teeth to mask out the darkness underneath. Since their color does not depend on nature, they can also be made lighter than can be accomplished with bleaching. Crowns and veneers can also improve the shape and alignment of the teeth to a certain extent, resulting in a more symmetrical smile with braces in some cases.

Q. What is a root canal?

A. There seems to be a lot of misinformation spread about root canals, including that they are something to be avoided. While we would like for everyone to have healthy teeth that would never require a root canal, there may come a time when it is necessary. Most root canals are quite painless, are performed with local anesthetic, and actually relieve a great deal of pain. Many teeth that would otherwise require removal can be saved with root canal therapy (endodontics). Endodontics is necessary when the pulp (living tissue inside the tooth) becomes diseased or irreversibly damaged. A common cause is when a cavity is ignored and bacteria progress through the tooth and infect the pulp. Acute or long-term trauma can cause pulpal damage as well. Sometimes the pulp can die for no apparent reason, perhaps due to lack of sufficient blood flow similar to a blocked coronary artery.

The treatment involves opening the tooth to provide access to the pulp chamber and the entrances to the canal that go through the roots to the pulp. The diseased pulp tissue is removed from the pulp chamber and the root canal or canals are cleaned, shaped, and sterilized. Then a sealing material is placed into the prepared canals and a filling is placed in the access hole. The tooth may then require a crown or other type of restoration to prevent it from fracturing and to restore the proper shape of the tooth.

Q. How do I know if I have a cracked tooth?

A. Some teeth can have cracks which are superficial and don’t cause any pain. In the case of a deeper cracks, pain may arise when biting or chewing on something and then ease when you stop the biting pressure. The tooth may also experience pain when something hot, cold, or sweet is placed in the mouth and can sometimes be hard for the person to pinpoint.

The crack causes pain because the tooth is flexing and irritating the nerves going to the pulp and/or the ligaments holding the roots to the bone if the crack extends to the root. They often don’t show up on and x-ray and other tests. The nature of the symptoms is used to determine the extent of the crack and what treatment is appropriate.

Causes: Some sort of trauma is the normal cause of a cracked tooth. It can be a direct blow to a tooth or the face which causes the teeth to slam together forcibly. It can be a “chewing accident” such as biting on a cherry pit or unpopped popcorn kernel. Cracks can also be caused by long-term microtrauma. Habits such as clenching or grinding the teeth, chewing ice or other hard objects, and biting fingernails can cause problems. Teeth with large fillings are particularly susceptible, since fillings only fill holes and don’t strengthen teeth. Silver fillings actually undermine the tooth structure and often result in the fracture of weakened cusps. Teeth that have had root canals are more brittle and tend to break more than a live tooth and should often be crowned to prevent fracture.

Treatment: Some superficial cracks with no symptoms may simply be left alone and observed. Some cracks may allow the penetration of bacteria and should be treated with a filling material to seal and protect the tooth from further damage. More extensive cracks would require a crown to cover the tooth and completely surround it to prevent the painful flexing. If the crack extends down to the root below the bone level, even a crown will not be able to protect the tooth and it will have to be removed.

What to do: If you think you might have a cracked tooth, don’t wait. Get it examined right away before the problem becomes worse and fewer options are available.

Q. How do I replace my missing tooth?

A. The answer to this question depends on a number of factors including the location of the tooth, the health of the surrounding teeth, gum, and bone, if there are other missing teeth in the same arch, and financial considerations.

There are essentially three ways that a tooth or teeth can be replaced and a thorough examination and discussion of the above factors is necessary to determine which would be the best option in each situation.

An implant is really a titanium substitute for a tooth root. The technology has improved greatly and the success rate exceeds 90%. Some implants are still functioning after more than thirty years.

If a single tooth is to be replaced, the adjacent teeth are healthy, and there is good gum and bone in the site, an implant would be the best choice. A surgeon places the titanium implant at the site of the missing tooth root; it is then given time to stabilize (osseointegrate). Once it has fused solidly to the jawbone, the general dentist attaches an abutment to the implant and places a crown on top of that which replaces the structure and function of the missing tooth. One advantage is that it can never decay and can be cleaned just like a normal tooth to keep the surrounding tissues healthy. Implants can also be used to support fixed bridgework where several teeth are missing or give support to a full denture which has become loose.

Fixed Bridgework:
“Fixed” means that the bridge is cemented to other teeth and is not removable. This may be the best choice if the teeth next to the missing one have large restorations already, could benefit from crowns and still have good bone support. In this process, the adjacent (abutment) teeth are shaved down slightly and a prosthesis with the replacement tooth induced is made to fit over the abutment teeth. These can look very natural and give many years of service if properly taken care of. A floss threader must be used to help clean underneath. Sometimes a bonded bridge can be constructed that requires very little reduction of the abutment teeth, but is not as strong as the aforementioned bridge.

Removable Partial Dentures:
As the name implies, these prostheses are removable by the patient. They may be the best option where there are numerous missing teeth, where cost is a big consideration, where the other teeth are not strong enough for a fixed bridge, or as a temporary replacement before some sort of fixed prosthesis can be done.

Normally there are metal clasps which wrap partially around the existing teeth to support and stabilize it. There is a connector that runs behind the teeth to give strength and connect all the parts together. The prosthetic teeth are embedded in a pink plastic material to simulate gum tissue. There are many variations of a partial denture depending on the cost, expected longevity, and where the missing teeth are located. Their main drawback is that it does put a lot of extra material in the mouth, although most people get used to it in a short period of time. The typically do not last as long as the previous options.

Q. What can I do about my cold sensitive teeth?

A. The answer to this of course depends on the cause of the sensitivity. Some people for example have large pulp chambers in their teeth and less insulation between the nerves and the outside world. If the teeth have always been this way there is not much to do except avoiding colder drinks or using a straw to minimize tooth contact.

If the cold sensitivity began later in life, we have to ask if it involves all the teeth or just a few. There are several causes for generalized sensitivity. If it comes and goes, if may be related to medical conditions such as sinus infections, viral infections, or neuralgias that refer pain to the teeth. Some people brux (grind or clench) their teeth due to stress, especially at night, This can make teeth temperature sensitive and wear away the protective enamel on both the biting surfaces and along the gumline. The bruxing can be curbed by wearing a nightguard which prevents the teeth from contacting each other.

There are other things which can cause the roots of the teeth to be exposed. Brushing too hard, especially with something other than a soft bristled brush can scrub away the gum tissue, exposing the sensitive dentin of the roots. Gum disease or trauma can do this as well. A lot of gum chewing, breath mints, and frequent consumption of sugary and/or acidic foods and beverages may cause sensitivity as well. There are several treatments that can help once the causative behavior has been stopped. Using a toothpaste for sensitive teeth can help after about six to eight weeks. Stay away from tartar control and “whitening” toothpastes, as these can make matters worse. In isolated cases, places a gum graft over the exposed root can do the job and also improve the appearance. In other cases, a tooth colored filling material can be bonded over the root to protect the sensitive dentin. Lasers are sometimes used to seal the exposed nerve endings in the dentin.

Symptoms in an individual tooth may arise from decay, a leaking filling, or a crack in the tooth. The fix would be some sort of restoration. If the nerve has been irreversibly damaged, a root canal would be necessary to remove the diseased pulp.

The most important consideration is to find and eliminate the cause of the problem. If not, no matter what the treatment, the symptoms will come back.

Q. Are there ways to fix my crooked teeth besides braces?

A. In many cases, braces are the best way to fix crooked teeth, especially if there are bite problems as well. It is certainly the healthiest thing to do if the teeth are in good shape. There are cases, however, when the teeth have had large fillings, been badly worn or chipped, and the crowding and/or rotation is not too bad. In such instances, crowns, veneers, or some combination thereof will be able to create a beautiful smile without the need for braces.

Q. What should I do when I'm pregnant?

A. There are two main concerns now: your own oral health and the health of the baby. During pregnancy, there are hormonal changes that can result in a condition called pregnancy gingivitis if the teeth are not cleaned thoroughly and regularly. This condition is characterized by a painful swelling of the gums with increased bleeding. It is caused by normal oral bacteria and the toxins they produce getting out of control. In addition to the discomfort for you, it has been shown that these toxins increase the risk of premature delivery and lower birth weight. Morning sickness can make it harder to brush and floss without gagging, so you may have to pick times of the day when the symptoms of morning sickness are at their least. Some people avoid the dentist when pregnant, thinking there is some danger to the fetus. The opposite is true—routine cleanings, fillings, etc. can be safely performed unless there are special conditions (i.e. high-risk pregnancy) that the doctor has said would contraindicate a dental visit. It is better to take care of routine problems to keep them from turning into a major issue that might require x-rays, antibiotics, and pain medications that could have been avoided.

For the sake of the baby, keeping yourself healthy is imperative. Smoking and alcohol consumption are obviously to be avoided. Good nutrition, including lots of calcium for the baby’s teeth and bones is vital. Consuming fluoridated drinking water, both before and after delivery, is a great benefit, as it hardens the baby’s teeth against decay, reducing cavities by half.

Q. I have been told I grind my teeth in my sleep. Is this bad?

A. Grinding and/or clenching the teeth, either while asleep or awake, can have very serious consequences. Usually grinding and clenching are a reaction to life’s stresses and possibly bad dreams.

The only time that teeth are supposed to contact each other is when chewing food and briefly when swallowing. Any other contact is referred to as parafunctional behavior. Grinding the teeth can result in permanent loss of the enamel on the incisal edges of the front teeth and even progress to cracks and broken teeth if it goes on long enough. If the enamel wears completely away, the softer dentin underneath is exposed and the wear rate drastically increases. The teeth begin to look old and worn and may become sensitive without the protective layer of enamel.

Some people don’t grind back and forth but simply clench their teeth when they are stressed. This can also result in cracked and sensitive teeth. In some cases, the jaw muscles and/or joints may be affected. This can result in headaches, muscle aches, popping in the jaw joint, and difficulties opening and chewing.

What can be done to prevent these conditions? Trying to control the stress is always helpful, but can be difficult. Try to pay attention during waking hours to avoid unnecessary tooth contact. At night there are various devices that can be used to prevent tooth contact and reduce muscle contraction, since a person can’t control what they do in their sleep. Night guards which hare custom fitted provide a simple comfortable solution to protect a person’s valuable enamel, jaw joints, and musculature.


Post-Op Instructions

After Periodontal Scaling
Now that you have had periodontal scaling it is time to take care of the supporting ligaments and tissues by using great homecare to prevent a relapse. Following the procedure you want to follow these basic instructions:

  • Rinse with warm salt water (1/2 tsp salt to 8 oz glass of warm water)
  • Take Ibuprofen (anti-inflammatory), not aspirin which will cause more bleeding **unless previously directed by your physician
  • Most importantly FLOSS, FLOSS, FLOSS, and brush daily
  • Keep your follow-up appointments so that your dental health can be assessed and the frequency of your visits can be determined