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ADA Patient Education

Patient Education Library

The ADA Patient Education Library provides the most popular topics in dentistry that will help you better maintain your dental health. Select an article or video below to get started now.

Your Child’s First Dental Visit

What is the focus of your child’s beautiful SMILE? Strong, healthy teeth!Baby teeth-also called primary teeth-are important in the growth and development of a child. Baby teeth can help your child chew foods and speak. They also hold space in the jaws for adult teeth that are growing under the gums.

Babies are born without teeth. Usually baby teeth start to appear in the mouth when the child is 6 months old. By the third birthday, most children have a full set of 20 baby teeth including incisors, canines and molars.

The chart below tells the names of baby teeth, when they come in (erupt) and when they fall out (are shed). Baby teeth be will replaced by permanent (adult) teeth. However, not all children get the same teeth at the same times. Your child’s teeth may erupt earlier or later than the times shown here.

Tooth decay starts early!

Surprisingly, tooth decay can occur as soon as your child’s first tooth comes in (erupts). So it is very important to start taking care of those “pearly whites” as soon as you see them peeking through the gums. If your child gets decay, your child can suffer pain and infection. Also, if a child is in pain, he may have trouble eating, sleeping and learning.

What causes tooth decay?

The bacteria that cause decay are in everyone’s mouths. Babies get these decay-causing bacteria from their caregivers, mom and dad, just as we all are exposed to germs in our families. These bacteria then stick onto the baby teeth. Brushing the teeth to clean off the bacteria is important to keep teeth healthy. Bacteria on the teeth use the sugar in foods and drinks and turn it into acid. Each time your child eats or drinks, this acid can attack the teeth for 20 minutes or longer after eating or drinking. Over time, enamel gets damaged, tooth decay develops and cavities appear.Children are more likely to get decay if their teeth are in contact with sugar often or for long periods of time. Babies should not be put to bed with a bottle. If your baby falls asleep with the bottle in his or her mouth, the liquid in the bottle pools around the teeth. Liquids such as fruit juice, soda and even milk contain sugar. Plain water in a bottle or sippy cup at the end of the day is a better choice.

Begin Dental Visits Early

Protect your child’s teeth by starting dental checkups early. The American Dental Association and the American Academy of Pediatric Dentistry recommend that the first dental visit should occur when the baby’s first tooth appears, but no later than the child’s first birthday.

Why schedule a visit so early? A dentist can show you how to clean your child’s teeth, talk about feeding, oral habits and recommend dental care products. He or she also can help you make sure your child is getting the right amount of fluoride (FLOOR-ide), a natural mineral that protects teeth. And your dentist can answer questions about your baby’s teeth.

Having a well-baby checkup at this age also connects your child to a dental home. This is a place where you can take your child from year to year. This helps the dentist get to know your child’s and family’s needs, so your child will have the best care.

If your child is a toddler, the dentist will gently examine his or her teeth and gums, looking for decay and other problems. The dentist may also clean the child’s teeth. Your toddler can also be checked for problems related to habits such as thumb or finger sucking.

Fluoride treatments and dental sealants are two important ways your dentist can prevent cavities. Dental sealants are a coating that the dentist puts on the grooves of your child’s back teeth to protect them. Your dentist will let you know if these treatments are right for your child.

Preventive care from your dentist can save time, money and teeth. Your dentist will recommend a schedule for your child’s dental visits.

Tips for a Positive Dental Visit

  • Schedule your child’s first dental visit before his or her first birthday.
  • If possible, schedule a morning appointment when children tend to be rested and cooperative. Don’t schedule during nap time.
  • Stay positive. Don’t show any anxiety that you might feel about dental visits.
  • Never bribe your child to go to the dentist or use the visit as a punishment or threat.
  • Make your child’s dental visit an enjoyable outing. Teaching your child good oral hygiene habits early can lead to a lifetime of good dental health.

Baby Teeth: When They Come In, When They Fall Out

A healthy mouth is part of a child’s overall health.

Children need strong, healthy teeth to chew their food, speak and smile. Your child’s teeth also help give his or her face its shape and keep space in the jaw for adult teeth.

A baby’s teeth start to come in when the baby is about six months old. Baby teeth will later be lost one by one. This makes space for adult (permanent) teeth. By the time children are teenagers, they usually have all of their adult teeth. The last four teeth that come in are the wisdom teeth.

The charts below tell the names of the baby and adult teeth. The pictures show when each tooth usually comes in and is lost. But not all children get the same teeth at the same times. Your child’s teeth may erupt earlier or later than the ages in these charts.

The Transition

Adult teeth start to form under the baby teeth. After the baby teeth are lost, the adult teeth will come in through the gums.

Most children go through a stage when they have a mix of primary and permanent teeth. During this time the smile can look uneven, with some big teeth, some small teeth, some crowded teeth or maybe even some missing teeth. Try not to worry. Smiles often even out once all the permanent teeth are in place.

When your child is about age seven, the dentist will do a “bite check” to make sure your child’s adult teeth are coming in properly and that the back teeth are working together the way they should. You dentist may also take an x-ray of the teeth. If your child’s teeth or bite need treatment, it’s best to get an early start.

Why Do I Need a Bridge?

A bridge is a replacement tooth or teeth that fill the space where one or more teeth are missing. The bridge restores your bite and helps keep the natural shape of your face.

Before you get a bridge, your dentist wants you to know more about the steps involved. He or she can advise which type of bridge is best for you.

Why Do I Need a Bridge?

A missing tooth is a serious matter. Teeth are made to work together. When you lose a tooth, the nearby teeth may tilt or drift into the empty space. The teeth in the opposite jaw may also shift up or down toward the space. This can affect your bite and place more stress on your teeth and jaw joints, possibly causing pain.

Teeth that have tipped or drifted are also harder to clean. This puts them at a higher risk for tooth decay and gum disease.

When a tooth is missing, the bone may shrink. If that happens, it may change the way the jawbone supports the lips and cheeks. Over time, this can make your face look older.

How Do I Replace a Tooth?

Placing a bridge usually takes more than one dental visit. On the first visit, your dentist prepares the teeth on both sides of the gap. He or she will later attach the bridge to these teeth.

Your dentist then takes an impression or an image of your teeth and the space and sends it to a dental laboratory. Technicians at the lab make the bridge. Your dentist will place a temporary bridge to protect your prepared teeth while you are waiting for the permanent bridge.

When the permanent bridge is ready, the dentist fits, adjusts and cements the bridge to the prepared teeth. This type of bridge is permanent and cannot be taken out of your mouth without a dentist’s help.

Fixed Bridge Placement

Missing tooth
Teeth next to the space are prepared for placement of the bridge.
The custom-made bridge is placed over the prepared teeth.
The bridge is cemented into place.

Do I Need Implants?

Dental implants may be used to support a bridge when several teeth are missing. Implants are posts that are surgically placed into the jaw. Over time, the bone grows around the implants to hold them in place.

  • A key benefit of implants is that they don’t need support from the surrounding teeth.
  • Candidates for dental implants should be in good general health and have enough bone to support an implant. For some patients, implants help preserve the jawbone where teeth have been lost.
  • Implants may be placed in one day or might require multiple visits depending on your dentist’s treatment plan.

Implant-Supported Bridge

Missing teeth
A bridge is placed on implants
After the bridge is placed

What Materials Are Used in a Bridge?

Bridges are made from metal, ceramics (porcelain) or a combination of the two. Ceramics often are bonded to a metal alloy. Your dentist will talk with you about the materials that are best for you and your mouth.

Caring for Your Bridge

A bridge can fail if the support teeth or the jawbone is damaged by dental disease. Follow these tips for good oral health:

  • Brush your teeth twice a day and floss or use another between-the-teeth cleaner once a day. Brushing and cleaning between the teeth helps remove plaque, a sticky film of bacteria that is always forming on the teeth.
  • See your dentist regularly for exams and professional cleanings.
  • Eat a healthy diet.

Treating Gum Disease

Your gum disease treatment will depend on several factors, including your personal health history and the stage of your gum disease. This page covers:

  • Professional Cleaning
  • Deep Cleaning – Scaling and Root Planing
  • Periodontal Surgery
  • Bone Graft Surgery and Guided Tissue Regeneration
  • Keeping your teeth and gums healthy after treatment

Professional Cleaning

In the very early stages – when it is gingivitis – you may just need a professional cleaning from your dental team. They can also give you some great advice and tips on how you can keep your teeth and gums healthy.

Deep Cleaning – Scaling and Root Planing

If your gum disease is beyond gingivitis, the first step in treating gum disease usually involves a special deep cleaning called scaling (SCAY-ling) and root planing (PLAY-ning). This treatment may be done over more than one visit, depending on your personal needs.

Scaling:Your dentist or hygienist removes plaque and tartar down to the bottom of each periodontal pocket.

Root Planing:Then, the root surfaces of your teeth are smoothed, or “planed”, to allow the gum tissue to heal and reattach to the teeth.

Your dentist or hygienist may recommend certain medicines to help control infection and discomfort or to aid healing. You may be given pills, a mouthrinse or they may place medication directly into the periodontal pocket after the treatment.

1. Scaling removes plaque and tartar from below the gumline.
2. Root planing smoothes the tooth root and helps the gums reattach to the tooth.
3. Healed pocket after treatment.

Periodontal Surgery

Sometimes, scaling and root planing isn’t enough treatment on its own. If pockets do not heal enough after scaling and root planing, gum surgery may be needed.

Surgery allows your dentist to remove plaque and tartar from hard-to-reach areas. Afterwards, your gums will be stitched into place to tightly hug your teeth.

Surgery can also help to shrink pocket depth and make it easier for you to keep your teeth clean.

1. Probe shows pockets due to gum disease. Gums are inflamed and bone loss has occured.
2. The bone is contoured and any remaining tartar is removed.
3. Healed site after periodontal surgery.

Bone Graft Surgery and Guided Tissue Regeneration

If bone has been damaged or lost by gum disease, then you may need surgery to rebuild or reshape the bone in your mouth. This kind of surgery is called a bone graft.

First, your dentist may use splints, bite guards or other types of tools to hold loose teeth in place and help tissues heal. If too much gum or bone tissue has been lost from your gum disease, he or she may need to also do a bone graft.

Your dentist may place a membrane layer at the surgical area to help your gums stay in place while the tooth root reattaches to the supporting bone tissues. This is called guided tissue regeneration.

To help you heal after surgery, your dentist may put a protective dressing over the area and recommend or prescribe a medicated mouthrinse. You may also be given a prescription to treat infection or for pain relief.

1. Diseased tissue is removed from the pocket. In some cases, the bone may be reshaped.
2. Bone has been reshaped.
3. Grafting material is placed over the bone. A membrane covers the grafting material.
4. After the healing period

Keep your Gums Healthy After Treatment

Periodic periodontal cleanings help you stay on top of your gum disease Once your gum disease is under control, it is very important for you to get dental care on a consistent basis. The periodic cleanings recommended after these treatments are called periodontal maintenance care. These cleanings are more extensive than the standard cleaning and will help you keep your gums healthy. Your periodontal maintenance involves cleanings that are deeper than a normal cleaning in the dental office. With periodic maintenance, the amount of plaque bacteria is lowered. Then, the inflammation can get better, pockets can shrink and your gums can become healthier.

Your gum disease won’t go away on its own

Once your gum disease is brought under control, it is very important that you get dental care on a periodic basis. You have a better chance of keeping your teeth if you do. Your gum disease may get worse if you don’t!

Plan for more visits to the dentist

You will need to see your dentist more often than other people. The pockets and other issues from your gum disease will make it harder for you to clean plaque from your teeth.

Your dentist will talk to you about a treatment plan that works best for you, and he or she will recommend a maintenance care schedule that is based on your personal case. Over time, fewer appointments may be necessary. Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Medication

You may also need special medications than can help control the infection and pain or to help your gums heal. The medicine could be a pill, a special mouthrinse, or a medication that your dentist places directly into the pocket right after deep cleaning.

You may have sensitive teeth and gums after your treatment

Your teeth and gums may be sensitive after your treatment. This soreness may make you want to avoid cleaning the treated areas. But it’s important to follow your dentist’s instructions on home care! If plaque is not removed, root decay may form. Talk with your dentist or hygienist if a special toothpaste or other treatments can lower your tooth sensitivity.

Keep up your oral care at home

It is very important that you brush and floss every day – especially if you are healing from gum disease.

  • Brush two times every day for two minutes each time. Use a toothbrush with soft bristles and a toothpaste with fluoride (FLOOR-ide). Fluoride is a mineral that helps keep teeth strong.
  • Clean between your teeth every day to remove plaque and bits of food from in between your teeth.
    If your gums have pulled away from your teeth, it may be best to use special tiny brushes, picks or wider types of floss and picks to clean between your teeth.
  • Your dentist may also recommend regularly using a specific mouthrinse.
  • Look for the American Dental Association Seal of Acceptance on all of your dental care products. The ADA Seal means these products have met ADA standards for safety and effectiveness.

Don’t Use Tobacco!

Smoking, chewing, vaping and dipping puts you at a higher risk for cancer and other life-threatening diseases. Tobacco use also can make gum disease worse and make it harder to treat it. If you use tobacco, ask your dentist or physician for information about how to quit.

Tooth Decay in Baby Teeth

Did you know that tooth decay is the most common long-term childhood disease? Children of any age can get tooth decay, even babies and toddlers. And tooth decay is five times more common than asthma. The good news is that tooth decay can be prevented!

What causes tooth decay?

Bacteria in the mouth change the sugar in foods and drinks into acid that attacks the teeth. Each time you eat or drink, that acid can attack the teeth for 20 minutes or longer. Over time tooth decay can develop and a cavity can form.

How does tooth decay affect baby teeth?

Tooth decay in the primary (baby) teeth of young children is also called early childhood caries. Caries is another word for a cavity. It happens when the child’s teeth come into contact with sugary foods and drinks often and for long periods of time. These drinks include fruit juices, soda and other drinks with sugar.

Parents are often surprised to learn that tooth decay can begin as soon as a baby’s teeth come in, usually by age six months. Decay in baby teeth can cause pain, and the infection can spread. If decay is not treated, it can destroy the baby teeth.

Tooth decay can also have an effect on a child’s general health. If a child has tooth pain, she may have trouble eating. The child may not get enough vitamins and minerals to grow up healthy.

Decay in Baby Teeth

1. Healthy baby teeth
2. Moderate to severe decay
3. Moderate to severe decay
4. Severe decay

Why are baby teeth important?

Baby teeth hold space in the jaw for the adult teeth. If a baby tooth is lost too early, the teeth beside it may drift into the empty space. When it’s time for the adult teeth to come in, there may not be enough room for them. This may cause adult teeth to be crowded and crooked. Crooked teeth may be hard to keep clean.

If a baby tooth is lost too early, the teeth beside it may drift into the empty space.

If a child’s baby teeth are healthy, it is more likely his adult teeth will be healthy too.
Children who have decay in their baby teeth are more likely to have decay in their adult teeth.

Decayed and crooked teeth also can affect your child’s self-esteem.
Tooth decay is not only unhealthy, it also looks bad. If your child has tooth decay he may feel bad about his smile. On the other hand, a nice-looking smile can give your child confidence at school.

How to keep your child’s teeth healthy

Children learn healthy habits from their parents and caregivers. You can start good habits if you clean your child’s teeth every day, feed your child a healthy diet and take her to the dentist regularly.

Clean your child’s teeth at home

  • Wipe the baby’s gums with a clean, wet gauze pad or washcloth after each feeding, before sleep. This removes bits of food that can harm teeth that are starting to come in. It also helps the child get used to having his mouth cleaned.
  • As soon as the first tooth appears, start brushing your baby’s teeth twice a day (morning and night). Use a soft-bristled, child-sized toothbrush and a fluoride toothpaste. Until the child is three years old, use no more than a smear or grain-of-rice-sized amount of fluoride toothpaste. For children three to six years old, use no more than a pea-sized amount of fluoride toothpaste.
  • The American Dental Association recommends that you brush your child’s teeth until she is at least six years old. When your child is old enough to do the brushing, watch to make sure she is not “rushing the brushing.” Children should be taught to spit out toothpaste, not swallow it.

1. For children under three years old
2. For children three to six years old

Bottles, pacifiers and breastfeeding

  • Infants should finish their bedtime or naptime bottle before going to bed.
  • After your child’s first tooth comes in, he should not be allowed to breastfeed constantly or fall asleep while breastfeeding.
  • Infants should not be put to bed or allowed to fall asleep with a bottle that contains milk, formula, fruit juices, or any liquids with sugar. Even watered-down drinks can damage teeth.
  • If your child uses a pacifier, don’t dip it in sugar or honey. Also, do not put it in your mouth before giving it to the child. Decay-causing bacteria in your mouth can be passed to your baby.
  • A bottle should not be used as a pacifier. Frequent sips of sugary liquids can cause tooth decay.

Training (“sippy”) cups

  • To lower the risk of tooth decay, try to get your child to drink from a cup by her first birthday.
  • Do not let your baby constantly sip on liquids with sugar (including juice drinks). Offer these liquids only at mealtimes. Keep the cup out of reach while the child is in a car or stroller. If your child is thirsty between snacks or meals, offer water in the cup.
  • Training cups should be used for only a short time. Once your child has learned how to sip, the training cup is no longer needed and should be set aside.

A healthy diet builds strong teeth

  • Limit between-meal snacks.
  • Avoid using sweet foods and drinks to reward your child.
  • If your child eats sweets, make sure it is with a meal.
  • Infants and young children should have a healthy diet. Information can be found at www.choosemyplate.gov.

First Dental Visit

  • Talk to your dentist about planning the child’s first dental visit. It’s helpful to have the first visit after the baby’s first tooth appears but no later than the first birthday. This first visit is a “well-baby checkup” for your child’s teeth.
  • At this visit, the dentist can check for decay and other problems. He or she can show you how to properly clean your child’s teeth.
  • Also, the dentist may offer advice on your child’s diet, pacifier use, and oral care products for your family. He or she can tell you how to prevent injuries to your child’s teeth and mouth and what to do in case of a dental emergency.
  • Children should get the ideal level of fluoride to help prevent tooth decay. Ask your child’s dentist about how your child can get the right amount of fluoride.

Healthy Mouth, Healthy Body – Making the Connection

Your mouth is a window into the health of your body
Insight about your overall health can sometimes be seen in your mouth. In fact, periodontal (perry-oh-DON-tal) – or gum – disease is common in people with chronic diseases like heart disease or diabetes. This page explains the connection between your oral health and your overall health.

What you should know about gum disease

Gum disease is an infection and inflammation that affects the tissues and bone that support your teeth. The infection is caused by the bacteria in plaque, a sticky film that’s always on your teeth. Your body reacts to the infection and your gums will become inflamed – red, puffy and swollen.

If left unchecked, gum disease affects the tissues and bone that support your teeth. It is the most common reason why adults lose teeth.

Gingivitis

When your body reacts to this infection and your gums are inflamed, this condition is called gingivitis (jin-ja-VY-tis), and it can lead to more serious types of gum disease. The good news about gingivitis is that it can be reversed.

If the gum disease is caught early enough (when it is gingivitis), you may simply need a professional cleaning. Your dental team can also give you advice for improving your daily oral hygiene.

Periodontitis

If gingivitis is not treated, it can turn into periodontitis (perry-o-don-TIE-tis). Periodontitis is usually not painful, but it can lead to bone loss.

Effects of gum disease
1. Healthy gums and bone hold teeth firmly in place.
2. Periodontitis happens over time, as plaque builds up along the gum line.

Your body responds to the toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Warning signs of gum disease:

  • gums that bleed when you brush or floss
  • gums that are red, swollen, puffy or tender
  • gums that no longer tightly hug your teeth
  • bad breath that doesn’t go away
  • pus between your teeth and gums
  • feeling that your teeth are loose
  • a change in the way your teeth fit together when you bite
  • a change in the way your partial dentures fit

You may notice one or some of these warning signs, or you may not have any signs of gum disease at all. This is why it’s important to see your dentist regularly – treatment of gum disease is most successful when it’s caught early.

The Mouth-Body Connection

Certain chronic diseases are sometimes shown to raise your risk of gum disease. And, sometimes having gum disease is shown to raise your risk and severity of chronic disease. While it may not be clear whether one drives the other, some of the chronic diseases that commonly occur with gum disease are:

  • arthritis
  • diabetes
  • emphysema
  • heart disease
  • high blood pressure
  • liver diseases like the hepatitis C virus
  • obesity
  • stroke

Using tobacco raises your risk of gum disease

Keeping your teeth and gums healthy is very important.

Using tobacco products of any kind (cigarettes, dip/chew, e-cigs, hookah, etc.) is a common risk factor for many chronic diseases including gum disease. Tobacco increases the risk of getting gum disease. The disease can also get worse the longer you use tobacco.

Many of the medications used to treat other diseases can affect your mouth by causing dry mouth. These include medications used to treat blood pressure, allergies, and pain. Dry mouth can increase your risk of tooth decay and gum disease.

Get the Facts About Mouth and Throat Cancerb

Did you know that your dentist screens you for cancer at every visit? Oral cancers can be deadly diseases. Each year in the United States, roughly 45,000 new cases of mouth and throat cancer are diagnosed, and about 13% of people die within the same year they are diagnosed.

Treatment may be more successful with oral cancers that are found early. Your dentist checks for these cancers every time you visit, so this is one more reason to see your dentist regularly.

This brochure will tell you some ways to lower your risk for mouth and throat cancer. And by watching for the signs and symptoms listed here, you are more likely to find the cancer earlier if you do have it.

What Are the Signs and Symptoms?

Below is a list of mouth and throat cancer signs and symptoms. Check your mouth in the mirror each day when you brush and floss. If there are any changes in your mouth or neck, or if you notice any of these signs or symptoms, contact your dentist.

Signs and symptoms of oral (mouth) cancer:

  • A sore or irritation that doesn’t go away
  • Red or white patches
  • Pain, tenderness or numbness in mouth or lips
  • A lump, thickening, rough spot, crust or small eroded area
  • Difficulty chewing, swallowing, speaking, or moving your jaw or tongue
  • A change in the way your teeth fit together when you close your mouth

1. Cancer on the tongue
2. Cancer on the lip
3. Leukoplakia (which can turn into cancer) inside the cheek

Additional signs and symptoms of throat cancer include:

  • Lump or growth in the throat or neck area
  • Cough or sore throat that doesn’t go away
  • Ear ache
  • Trouble with swallowing
  • Hoarseness or other changes in your voice

Throat cancer affecting the base of the tongue and the tonsils.

Am I at Risk for Oral Cancer?

Anyone can get cancer. There are some factors that you may control – such as smoking cigarettes or chewing tobacco, heavy alcohol consumption, and exposure to the human papillomavirus (HPV) – which increase your risk of developing of developing oral cancer. Below is more information about factors that can affect your chance of developing mouth or throat cancer.

  • Infection with HPV is associated with increased risk of developing oral cancers. HPV is very common and many people are not even aware that they have been infected.
  • Tobacco associated risk, which includes chewing tobacco or smoking cigarettes, cigars or pipes, is affected by the amount of tobacco you use and the length of time you’ve been doing it. When you quit using tobacco, your risk of developing oral cancer continues to go down. In ten years of being tobacco free, your risk is about the same as someone who never smoked or chewed.
  • People who use tobacco products and drink alcohol have a greater chance of developing oral cancer than if they only did one or the other.
  • Spending long periods of time in the sun increases your risk of developing higher risk for lip cancer.
  • Eating too few fruits and vegetables may increase your risk for developing oral cancer.
  • The risk of mouth and throat cancer increases with age. Though not always the case, it can occur more often in people over the age of 40.

How Can I Lower My Risk for Mouth and Throat Cancer?

  • As part of your oral hygiene routine, watch for changes in the soft tissues of your mouth.
  • Avoid all tobacco products, including cigarettes and chewing tobacco
  • Avoid heavy alcohol use.
  • If sexually active, practice safe sex to prevent the spread of HPV
  • Eat a diet rich in fruits and vegetables
  • Visit your dentist for regular oral cancer screenings.

How Can My Dentist Help?

During a dental exam, your dentist will check your face, neck and mouth for lumps, red or white patches, and sore areas that do not heal. Your dentist may check you for oral cancer visually, manually, with special screening tools, or with a combination of these methods.

Be sure to tell your dentist if you notice any changes in your mouth and/or neck. If signs of cancer are found early, treatment may be more successful.

Be aware of any changes in your mouth and throat. If you have any concerns about mouth and throat cancer, talk with your dentist. It may help save your life.

TMD – Temporomandibular Disorders

Do you have frequent headaches, earaches, tender jaw muscles or a dull, aching facial pain? Does your jaw lock or stray to one side when you open your mouth? These aches and pains may be related to the jaw joint, called the temporomandibular (tem-PORO-man-DIB-u-lar) joint or “TMJ,” and the muscles that work to move the joint. When the source of these problems is this joint or its muscles, they are often referred to as “TMD” for temporomandibular disorders.

Signs and symptoms

A temporomandibular disorder is a condition, not a specific disease. TMDs can have many different signs and symptoms, from mild to severe. Some patients may have symptoms but are still able to fully function in their everyday lives. TMDs appear to be more common in women. Specific signs and symptoms include:

  • pain in or around the ear
  • tender jaw muscles
  • clicking or popping noises in the jaw
  • difficulty opening or closing the mouth
  • pain when yawning or chewing
  • jaw joints that feel as if they are “locked,” “stuck” or they “go out”
  • headaches

What causes TMD?

Several conditions may be linked with TMD. This often makes it difficult to pinpoint the cause of a particular case of TMD. These conditions include:

  • jaw or head injuries
  • diseases that affect the muscles or joints, such as arthritis
  • tooth grinding
  • anxiety and/or stress

To determine how best to treat your TMD, a complete evaluation is recommended. Your dentist may check the joints and muscles for tenderness, clicking, popping or difficulty moving. Your complete medical history may be reviewed, so it is important to keep your dental office record up-to-date about your health even though you may not think it has anything to do with your teeth. Your dentist may take X-rays of your teeth, jaw or TMJ, and may make a model of your teeth to see how your bite fits together.

How the jaw joints and muscles work

The joints and muscles on each side of your jaw work to open and close the mouth. These joints move in many different directions to give you the range of motion needed to chew, talk and swallow.

The two temporomandibular joints are among the most complex joints in the body. They work together in a delicate balance with muscles, ligaments, cartilage and your jaw bones. Pain can result when these parts don’t work together properly.

Treatment Options

For some patients, the disorders may disappear by themselves; for others, they may come and go, or may worsen over time. TMD disorders are often managed, rather than cured. Your general dentist may recommend treatment, or refer you to a physician or dental specialist.

There are a number of ways in which TMD may be managed. Success likely will require you and your dentist working together to find what the approach that relieve your symptoms.

Treatment may involve a series of steps. The step-by-step plan will allow you to try simple treatment before moving on to something that is more involved. Experts generally recommend a “less is often best” approach to treating TMJ disorders. This means that the simplest treatment that provides you with pain relief may be the best for you.

The following self-care practices may be recommended:

  • eating softer foods or avoiding foods that cause symptoms
  • minimize extreme jaw movements, such as yawning, yelling or singing
  • avoid chewing gum
  • using heat or ice packs to relieve the pain
  • practicing relaxation techniques to control jaw tension, such as meditation

If necessary, your dentist may recommend the following to relieve your symptoms:

  • exercises to strengthen jaw muscles
  • medicines to reduce pain or inflammation, or to help you relax
  • a night guard or bite plate to decrease clenching or grinding of teeth

In some cases, your dentist may recommend fixing an uneven bite by adjusting or reshaping some teeth. Orthodontic treatment may also be recommended.

Mouth Sores and Spots

Mouth sores can be painful, annoying and unsightly.

Some appear inside the mouth – on the gums, tongue, lips, cheeks or palate (roof of the mouth). Others, like cold sores, can appear outside the mouth, such as on and around the lips, under the nose and on the chin.

Mouth sores can be caused by oral cancer or bacterial, viral or fungal infections. Some other causes include:

  • Irritations, such as dentures that no longer fit properly and rub against tissues.
  • Loose orthodontic wires or the sharp edge of a broken tooth or filling.
  • Extreme sensitivity to ingredients found in some toothpastes or mouth rinses.
  • Medication, cancer treatment side effects or reaction to therapy.
  • Certain specific skin, oral or systemic diseases.

Although there are many types of mouth sores, the most common are canker sores, cold sores, leukoplakia (a thick white or gray patch) and candidiasis or thrush (a fungal infection).

Some people may experience occasional discolored, painless spots in their mouth. Most are harmless and will disappear or remain unchanged. However, some sores or spots can be serious and need the attention of your dentist or physician. For example, oral cancer may not be painful at first, but it can be deadly. That’s why regular dental checkups are important. Have your dentist examine any mouth sore or spot that fails to heal within two weeks.

Canker Sores

Canker sores appear inside the mouth. They usually are small ulcers (minor aphthous ulcers) with a white, yellow or gray center and a flat red border. Rarely, canker sores can be very large (major aphthous ulcers) with a raised border. There may be one or several ulcers and they recur at varying periods of time.A canker sore usually begins as a red spot or bump. It may produce a tingling or burning sensation before other symptoms appear. Canker sores are painful. Fortunately, most canker sores heal spontaneously in 7 to 10 days.

The exact cause of canker sores is not known. Genetics play a role. White cells (lymphocytes) in our immune system may affect the lining of the mouth causing these irritating, but harmless, sores. Fatigue, emotional stress, and certain foods can increase the possibility of a canker sore for some people. Even biting the inside of the cheek or tongue or chewing a sharp piece of food may trigger a canker sore.

Canker sores are not contagious or precancerous. There is no permanent cure for canker sores; therefore, treatment is for discomfort or pain. Over-the-counter topical medications (such as numbing agents or protective ointments) and antimicrobial (germ-fighting) mouth rinses may offer temporary relief. Avoid hot, spicy or acidic foods and beverages that can irritate the sore. Treatment for an attack involves corticosteroids, Prednisone-like medications that control troublesome lymphocytes. The medication may be in a topical form (applied to the skin), or systemic (taken as a tablet or capsule).

Cold Sores

Cold sores are groups of painful, fluid-filled blisters (often called fever blisters). These unsightly sores usually erupt on the lips, and sometimes on skin around the lips. Clusters of small blisters may also occur on the gum tissue near the teeth and/or on the bony roof of the mouth.

Cold sores – caused by herpes virus Type 1 or Type 2 – are contagious. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or the flu. The infection can cause painful lesions to erupt throughout the mouth, and some patients can be quite ill for a week. Most people who get infected with herpes do not get sick, however. Once a person is infected with herpes, the virus stays in the body, where it may remain inactive. Unfortunately, in some people, the virus becomes activated periodically, causing the cold sore to appear on the lips or other sites. A variety of irritants (wind, sun, fever, stress) can cause a flare.

Cold sores usually heal in about a week. Once the blister breaks, an unsightly scab forms. Over-the-counter topical anesthetics and protectants, anti-inflammatory agents or topical antiviral agents may provide temporary relief for the discomfort but do little to speed healing. As with the common cold, there is no cure for these viral infections. Topical or systemic antiviral drugs can be prescribed by your dentist, but they are ineffective after 3 to 4 days of blister formation and usually are not recommended in otherwise healthy patients.

Leukoplakia

Leukoplakia (loo-koh-PLAY-kee-ah) is a white or gray patch that develops anywhere on the inside of the mouth. It is caused by excess cell growth of the lining of the mouth. It is often a response to chronic irritation, such as smoking or smokeless tobacco (snuff, chewing tobacco), certain foods, cheek biting, irregular dental restorations or broken teeth. In some instances, a cause cannot be determined. Leukoplakia patches develop slowly over a period of time. The patch may eventually become rough. It typically is not sensitive or painful.

Leukoplakia generally is harmless, but there is a risk that it can become cancerous. To be certain that a spot or sore is not a threat, your dentist may do a biopsy to determine if any potentially dangerous cells are present. If the leukoplakia is sensitive, cancer must be ruled out by biopsy.

Erythroplakia

Erythroplakia (e-ryth-ro-PLAY-ki-a) is a red patch that may be found in any part of the mouth but is most common in the floor of the mouth or on the gum tissue behind the back teeth. The cause is unknown but is most likely associated with smoking or other tobacco use and alcoholic beverages. Chronic irritation and poor nutrition may also be contributing factors. Although erythroplakia is less common than leukoplakia, most of these lesions are found to be precancerous or cancerous when biopsied. Red lesions that do not heal in a week or two should be evaluated by your dentist. This applies even if you do not smoke or drink alcohol.

Lichen Planus

Lichen planus (li-ken PLAY-nus) is a disorder that involves a chronic, itchy, inflammatory rash or lesion on the skin or in the mouth. The lesions may consist of white spots or “lacelike” white changes. Lesions on the sides of the tongue, insides of the cheek and on the gums, may be tender or painful. Its cause is genetic and related to a chronic immune system reaction.

Lichen planus generally occurs during or after middle age. Lichen planus is not contagious and does not pose a high risk for becoming cancer. There is no cure, so treatment is for discomfort or pain. Rinses, ointments, or pills can be prescribed by your dentist, if needed. The diagnosis can be confirmed by biopsy and clinical characteristics.

Candidiasis

Candidiasis (can-di-DI-a-sis), also known as oral thrush or moniliasis, is a fungal infection. It produces creamy white and red patches that form on surfaces of the mouth. It can be painful and may cause bad breath and difficulty tasting and/or swallowing.

It occurs when the yeast Candida albicans reproduce in abnormally large numbers. For example, Candida may flourish after antibiotic treatment, when normal bacteria in the mouth have decreased, when the immune system is suppressed or when the mouth is dry (xerostomia). Dry mouth is a common side effect of many prescription or over-the-counter medications.

Candidiasis most often occurs in the very young, the elderly, and those debilitated by disease, such as diabetes and AIDS. It also frequently occurs among people who wear dentures.

Treatment consists of controlling conditions that cause the outbreak. Cleaning dentures to remove Candida is important in preventing denture-induced problems.

Saliva substitutes or prescription medications are also available to treat dry mouth. Antifungal medications may be used when the underlying cause cannot be treated or eliminated. Good oral hygiene is essential.

Oral Cancer

Oral or mouth cancer may appear on the lips, tongue, cheek lining, gums, palate (roof of the mouth) or floor of the mouth. Cigarettes and other tobacco products, including smokeless tobacco, are associated with 70 percent of oral cancer cases. Drinking alcoholic beverages can also increase your chances of having oral cancer.

Oral cancer may appear as a white or red lesion, lump or ulcer. It is usually small and painless at first, but can grow and spread quickly. Many oral cancers are discovered during routine dental examinations. Control of leukoplakia and erythroplakia may prevent some oral cancers from developing. Some oral cancers can resemble benign (non-dangerous) changes, so may delay early diagnosis. Early diagnosis and treatment increase the chance of a good quality of life.

What You Can Do

  • Schedule regular dental checkups. See your dentist for mouth sores that persist longer than two weeks, even if they are not painful. A biopsy (tissue sample taken for testing) can usually determine the cause or rule out cancer. Your dentist can recognize and often diagnose the type of mouth sore or spot based on its appearance and location.
  • Keep a diary of what you eat and drink.
  • Keep a list of oral hygiene products (toothpaste, mouth rinse, etc.) you have been using.
  • Avoid all tobacco products.
  • If you drink alcoholic beverages, do so in moderation.
  • See your dentist if you notice any change in your mouth, including pain or discomfort, or the presence of sores in the mouth, even if they are not painful. For oral cancer, early diagnosis and treatment can increase your chance of cure.

Gum Recession: Causes and Treatments

When your teeth are healthy, your gum tissue tightly hugs each of your teeth. But, when your gums pull away from your teeth, it is called gum recession (re-SESH-un). Gum recession can happen at any age.

Even if you take good care of your teeth, it is possible that gum recession may still happen.

Gum recession can cause problems for your teeth. Your dentist can help you understand what is causing it to happen and suggest a treatment.

Gum recession can leave the tooth root exposed. The root surface does not have a hard, protective layer covering like the top of the tooth, so it may become sensitive to hot and cold. The exposed tooth root is also more at risk for decay.

What causes gum recession?

  • gum disease
  • brushing your teeth too hard or using a toothbrush with hard bristles
  • trauma to gum tissues, such as a sports injury
  • partial dentures that don’t fit right
  • genetics–some people are born with gums that are thin or weak
  • larger-than-normal tooth roots or attachment muscles that can push gums out of place
  • smoking and using any kind of tobacco

Treatments

It is important to treat gum recession so that it doesn’t get worse and cause other problems. The type of treatment for gum recession depends on the cause.

If gum recession is caused by brushing too hard, your dentist or hygienist can show you a better way to clean your teeth. This will not repair the existing damage, but it will prevent new damage to your gums.

If gum recession is caused by periodontal (gum) disease, the first step is usually a deep cleaning treatment called scaling (SKAY-ling) and root planing (PLAY-ning). Your dentist removes plaque and tartar from your tooth and root surfaces. This helps gum tissues heal and reattach to the tooth. For many patients, this plus excellent oral care at home and regular dental visits can help control gum disease and recession.

If gum recession is caused by partial dentures that don’t fit right, your dentist can adjust or remake them for you.

If your recession is advanced, a gum graft may be needed. A thin piece of gum tissue is taken from another place in your mouth and attached where the gum tissue has receded. Once the graft heals, it covers the exposed tooth root.

Grafts may be done around one or more teeth. They protect the tooth root from sensitivity and decay. A graft can also be used to make a smile look better.

Care after your treatment

If you have a gum graft, your dentist will tell you how to care for your gums. This may include using a special mouthrinse and changing what you eat. A bandage or dressing may be placed over the graft to help it heal.

Gum grafts are a kind of surgery and the area may be tender or sore and may swell. Most people are able to go back to their normal routines the next day. However, you may need to avoid chewing for a week or two where the surgery was done. Your dentist will talk with you about your specific healing time.

To help your gums heal after surgery:

  • Avoid smoking or using any kind of tobacco.
  • Do not drink alcohol.
  • Follow all instructions from the dental team.

There are other things that can slow down healing. These include older age, grinding your teeth, not eating a healthy diet, and some medicines or health issues. Be sure to tell your dentist about all medications, drugs, or vitamins you are taking and health issues you may have.

After your gums have healed from surgery, keep your teeth and gums healthy by brushing gently twice a day with a fluoride toothpaste. Also, be sure to clean between your teeth daily with floss or another between-the-teeth cleaner. Look for products with the American Dental Association Seal of Acceptance. These products have been tested and proven to be both safe and effective in keeping your mouth healthy.

Dental Emergencies

Be Prepared Knowing how to handle a dental emergency can mean the difference between saving and losing your child’s tooth. Here are some tips to help you cope quickly and calmly with a dental emergency.

Knocked-Out Tooth

Baby tooth If something happens to any of a child’s primary (baby) teeth, you should take your child to the dentist as soon as you can. If a tooth is completely out, do not try to put it back into the tooth socket. Although it is normal for children to lose primary teeth, an accident that damages a primary tooth could also harm the permanent (adult) tooth underneath.

Adult tooth

  • Unlike a baby tooth that is knocked out, an adult tooth should be put back into the socket. After you find the tooth, hold it by the crown (top), not the root. If the tooth looks dirty, rinse the root briefly with water. Do not scrub the tooth or remove any attached bits of tissue.
  • If possible, gently insert and hold the tooth in its socket with a clean washcloth or gauze pad. If this isn’t possible, see if the child can hold the tooth under his or her tongue. If that does not work either, put the tooth in a container with milk, saliva, saline (salt) solution, or an emergency tooth preservation kit. If none of those liquids are available, put the tooth in water.
  • Take your child to the dentist as quickly as you can. It’s best to see a dentist within 30 minutes. Don’t forget to bring the tooth and any tooth pieces you can find!

Broken or Cracked Tooth

Rinse the mouth with warm water to keep the area clean. Put a cold compress (like an ice pack or a washcloth with ice wrapped inside) on the face to reduce swelling. Go to the dentist right away. If you can find the broken tooth piece, bring it with you to the dentist. Wrap it in some wet gauze or a wet towel if possible.

Bitten Tongue or Lip

Clean the area gently with a cloth and place a cold compress on the area to keep swelling down. If there is a lot of bleeding or if it doesn’t stop after a short time, take your child to a dentist or an emergency center.

Objects Caught Between Teeth

Gently try to remove the object with dental floss. If that does not work, go to the dentist. Do not try to remove the object with a sharp or pointed instrument.

Toothache or Swollen Face

Rinse the mouth with warm water to clean it out. Give your child what you would normally give him or her for pain. Do not put aspirin directly on the aching tooth or gums. Take your child to the dentist as soon as you can. If your child’s face is swollen, take your child to your dentist or physician. Swelling of the face can be a sign of serious infection.

Possible Broken Jaw

Apply a cold compress to control swelling. Take your child to the dentist or an emergency center right away.

If a Dental Emergency Happens While You Are Traveling

  • Go to www.mouthhealthy.org on the Internet and click on “ADA Find-a-Dentist” to find an ADA member dentist near you.
  • Ask the local hospital or dental society to recommend a dentist. To find a local dental society, go to www.ada.org/localorganizations.aspx.
  • Ask a hotel concierge or other hotel staff to refer you to a dentist.
  • If you are out of the country, contact the U.S. Embassy. Many embassies and consulates keep lists of local medical and dental staff, which may also be available online at www.usembassy.gov. After clicking on the country you are visiting, medical listings are usually found under the heading “U.S. Citizen Services.”

Sip and Snack All Day? Risk Decay!

  • Do you sip soft drinks or other sugary drinks (even coffee or tea with milk and sugar) all day at your desk?
  • Do you use breath mints or eat candy often?
  • Instead of eating meals, do you snack all day?
  • Do you often grab a soda, sports or energy drink when you are tired?

If you answered yes to any of these questions, you may be increasing your chances of developing cavities.

What and how often you eat can affect your teeth

1. Read food and drink labels so you can choose options that are low in sugar.

Certain eating patterns and food choices can lead to tooth erosion (ee-ROW-shun) and cavities. A steady supply of sugary foods and drinks, including sports drinks, sodas and energy drinks, can damage your teeth. Even snacking on healthy foods like oranges and dried fruit all day long can increase your risk of erosion and cavities. Here’s why:

Plaque is a sticky film of bacteria that forms on teeth. When you do not remove plaque from your teeth every day, it builds up. The bacteria in plaque create acid from eating the sugars found in what you eat and drink. This acid attacks enamel (e-NAM-uhl), the hard surface of the tooth. The acid stays on the enamel for up to 20 minutes after you are finished eating and drinking. Eventually, the enamel can wear away from these acids and cavities can start to form. Cavities do not go away on their own and must be treated by a dentist.

When you have sugary foods or drinks many times a day or over a long time, it exposes the enamel of your teeth to acid attacks throughout the day. This raises your risk of tooth erosion and getting cavities.

A healthy diet keeps your mouth healthy

Eating a well-balanced diet may improve your chances of avoiding diseases like heart disease, type II diabetes, and oral diseases, like cavities.

For teeth to be healthy, they need vitamins, protein, calcium, and phosphorous – and you can get them all from a healthy diet.

A healthy diet is one that:

  • includes a variety of whole fruits and vegetables as well as whole grains, like brown rice and oatmeal.
  • adds different protein sources such as lean meats, beans, eggs, poultry, fish, cheese and Greek yogurt.
  • is low in saturated fats, trans fats, salt (sodium), and added sugars.
  • is well-balanced and based on eating foods in amounts according to your specific height, age, weight, gender and activity level.

You cannot and should not remove all sugar from your diet. Many foods and drinks – like apples, carrots, and milk – naturally contain sugars and have key vitamins, minerals, and nutrients that your body needs. Avoiding foods that contain a lot of sugar but few other nutrients will lower your chance of developing cavities and have other health benefits, too!

Lower your risk of cavities

  • Avoid sugary drinks when possible. Many sports and energy drinks, as well as sodas and sweetened teas all, have a lot of sugar. Even fruit juices that are “100% juice” are high in sugar.
  • Limit snacks between meals. Choose foods that are low in sugar and fat, like an apple or handful of almonds. Try to follow-up with a glass of water. This can help rinse bits of food in your mouth, but it does NOT replace brushing and flossing regularly.
  • If you have sugary foods and drinks, have them with meals. Saliva increases during meals which helps weaken acid and rinse bits of food from your mouth.
  • Chew sugarless gum that has the ADA Seal of Acceptance. Chewing gum after meals have been shown to increase saliva and can help reduce cavities.
  • Drink water. Drinking tap water with fluoride (FLOOR-eyed) can help prevent cavities.
  • See your dentist regularly.

What is Periodontal Disease?

Periodontal disease is also known as gum diseasePeriodontal (perry-o-DON-tal) Disease is an infection and inflammation that affects the tissues and bone that support your teeth. It’s also called gum disease.

A surprisingly wide variety of bacteria are normally found in your mouth. When certain types of bacteria outgrow the others, this starts the process of gum disease.

When your gums are healthy, your gum tissues tightly hug each of your teeth. When you have gum disease, your gums pull away from your teeth. As the gum disease gets worse, the tissues and bones that support your teeth become damaged. Over time, your teeth may fall out or need to be removed. Treating periodontal disease in the early stages can help prevent tooth loss.

What is the connection between gum disease and other health issues? Gum disease has been linked to some other diseases. People with diabetes or heart disease are more likely to get gum disease. Strokes and high stress also may be related to gum disease. Researchers are still studying these links.

It is important to talk to your dentist if you suffer from any long-term health problem. Together, you can work out an oral care plan for your best oral and overall health.

Warning Signs of Gum Disease If you notice any of the signs below, see your dentist. However, you can have gum disease and not notice any of these warning signs. That is why regular dental checkups are very important.

  • gums that bleed when you brush or floss
  • gums that are red, swollen, puffy, or tender
  • gums that no longer hug your teeth tightly
  • bad breath that doesn’t go away
  • pus between your teeth and gums
  • feeling that your teeth are loose
  • a change in the way your teeth fit together when you bite
  • a change in the way your partial dentures fit

What Causes Gum Disease?

Plaque is a sticky film of bacteria that is always forming on your teeth. Bacteria that live in the plaque can make your gums become red, puffy and swollen. When plaque is left on your teeth and gums, it hardens. Hardened plaque is called tartar (TAR-ter) and can only be removed when your teeth are cleaned in the dental office.

When your gums are red, puffy and swollen, they can start to pull away from your teeth. Spaces called pockets start to form between your gums and teeth. These pockets give bacteria a place to collect and grow. The bacteria in your pockets will cause your gum disease to get worse. These bacteria produce toxins, which causes your body to break down the gum tissues and bone around your teeth.

Follow these healthy habits to help prevent gum disease

It generally costs much less to keep your teeth and gums healthy than to wait until you have a problem that needs to be treated. These healthy habits can help:

  • Brush your teeth twice a day with a fluoride toothpaste and for 2 minutes each time.
  • Clean between your teeth with floss or another between-the-teeth cleaner every day to remove plaque and food from areas your toothbrush can’t reach.
  • Your dentist or hygienist may recommend using a germ-killing mouthrinse or other products.
  • Eat a healthy diet and limit snacks and sugary drinks. Learn more online at www.choosemyplate.gov.
  • Visit your dentist regularly.

Tobacco Use Harms Gums

Don’t use tobacco! If you smoke, chew, or dip tobacco, then it is very important you quit. Using tobacco in any form slows down your healing and raises your chances of getting gum disease again or it getting worse if you already have it. Talk to your dentist or doctor about ways you can quit.

Are You at Risk?

Anyone can get gum disease, but there are things raise your risk of getting it. These include:

  • Not taking care of your teeth and gums.
  • Using tobacco of any kind.
  • Diseases that affect the whole body – such as diabetes and HIV infection.
  • Older Age.
  • Stress.
  • Clenching/Grinding your teeth.
  • Many medications.
  • Pregnancy, use of birth control pills, or changes in female hormone levels.
  • Family history.
  • Passing the bacteria that causes gum disease through saliva.

Stages of Gum Disease

Healthy Gums Your teeth are held in place by gums, bone and connective tissues. Your gums tightly hug your teeth and there is little or no buildup of plaque and tartar on them.

Gingivitis The bacteria in plaque make your gums red, tender and swollen. Your gums might bleed at this stage. You can also have gingivitis and not have any signs of it.

Periodontitis In time, your body responds to the toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Advanced Periodontitis Your teeth become loose or fall out or need to be removed by a dentist. Loose or missing teeth can create problems, like making it hard for you to eat the foods you like.

Checking for Periodontal Disease

Periodontal Probe Your dentist or hygienist uses an instrument called a periodontal probe to gently measure the depth of the pockets around each tooth. When your teeth are healthy, the pocket depth is 3 millimeters (mm) or less. Usually, the more severe the disease, the deeper the pocket, which give bacteria more room to grow and cause serious damage to your teeth, gums and bone.

Periodontal probe of healthy gums.

Periodontal probe showing a pocket forming between the tooth root and the gums.

Dental X-RaysDental x-rays can check on the amount of bone that is supporting your teeth. If low bone levels are spotted, it could be a sign of damage from gum disease.

Healthy gums have bone that supports the teeth.

Gum disease can create bone loss.

You don’t have to lose teeth to periodontal disease. Brush, clean between your teeth, eat a healthy diet and schedule regular dental visits for a lifetime of healthy smiles.

Advanced Periodontitis image courtesy of Dr. John C. Hall.

Sealants

Our teeth are covered with a sticky film of bacteria, called plaque (sounds like PLAK). When we eat or drink anything that contains sugar-such as cookies, candy, soda, juice, or sports drinks-bacteria turn the sugar into acids that can attack tooth enamel. Over time, these attacks may cause tooth decay, or cavities. The good news is that there is a way to protect teeth and prevent decay: dental sealants.

Why are sealants needed? Tooth decay often begins on the chewing surfaces of the back teeth. These surfaces have pits and grooves that trap plaque, bacteria, and bits of food. The pits and grooves are hard to keep clean, because toothbrush bristles cannot reach into them.

That is how decay starts in the pits and grooves and cavities form. To keep decay from starting here, the dentist may recommend dental sealants.

How are sealants applied?

Sealants are easy to apply. It takes only a few minutes to seal each tooth. First, the tooth is cleaned and the chewing surfaces are prepared to help the sealant stick to the tooth. Then the sealant is painted onto the chewing surface where it bonds to the tooth and hardens. A special light may be used to help the sealant harden. Sealants are generally clear or white and cannot be seen when you smile or talk.

How long do sealants last?

Sealants usually last several years before they need to be replaced. Over time, sealants can become loose or worn. Then they may not protect the teeth as well. Chewing on ice or hard foods can also break down sealants. During regular dental visits, your dentist will check your sealants and reapply them if needed.

How else can I protect teeth from decay? Sealants protect only the chewing surfaces of teeth. To prevent cavities, follow these Healthy Smile Tips:

  • Brush your teeth twice a day with a fluoride toothpaste.
  • Clean between your teeth once a day.
  • Eat a healthy diet and limit snacks.
  • Visit your dentist regularly.

These good habits stop decay from forming in between the teeth-spots that sealants cannot cover.

Who should get sealants?

Sealants are most often placed in children and teenagers, since tooth decay can start soon after teeth come in. But adults can sometimes benefit from sealants too, because you never outgrow the risk for developing cavities.

A sealant can be placed on a tooth that does not have a cavity in its pits and grooves. If a tooth is stained or has mild decay, your dentist may suggest you get a sealant, or another option may be necessary. If a tooth has more advanced decay, it will need a filling.

Prevention is always better than treatment. Sealants are very useful in preventing tooth decay on the back teeth and can save patients money over time. Your dentist can make sealants part of your plan for a healthy mouth.

Sealant photos courtesy of Dr. Adam A. Francois.

Scaling and Root Planing

Periodontal disease (also known as gum disease) is an infection of the gum and bone that support the teeth. If periodontal (perry-oh-DON-tal) disease is not treated, it can get worse and lead to tooth loss. Periodontal disease may not be painful. You may not be aware of a problem until your gums and supporting bone are damaged.

Fortunately, periodontal disease often can be treated with a deep cleaning called “scaling and root planing.” This brochure will tell you why treating periodontal disease is important, and how it can help you keep your teeth.

What causes periodontal disease?

Periodontal disease is caused by plaque, a sticky film of bacteria that is always forming on your teeth. If teeth are not cleaned well, plaque bacteria can cause your gums to become inflamed.

Inflamed gums can pull away from the teeth, forming spaces called “pockets.” These pockets trap more plaque that cannot be removed with toothbrushing. If the pockets are not treated, the periodontal disease can get worse.

Diseases such as diabetes and AIDS can place a person at higher risk for periodontal disease. Tobacco use also increases your risk of developing periodontal disease, and treatment may be less successful if you continue to smoke or chew.

Stages of Periodontal Disease

Healthy gums and bone hold teeth firmly in place. Gums hug the teeth tightly. There is little or no buildup of plaque and tartar (calculus).

Gingivitis (jin-ja-VY-tis) is the early stage of periodontal disease. It develops as plaque irritates the gums. The gums become red, tender, swollen and likely to bleed. Gingivitis can usually be reversed with a professional dental cleaning plus improved oral hygiene. If plaque is not removed, it can harden into tartar.

Periodontitis (perry-oh-don-TIE-tis) is a more serious condition that can develop if gingivitis is not treated. Periodontitis happens over time as plaque inflames the gums. The gums and bone that support teeth are damaged. Unless treated, the affected teeth may become loose and even require removal by a dentist.

How is periodontal disease diagnosed?

If you schedule regular dental exams, your dentist can catch periodontal disease before the gums and the bone supporting your teeth are severely damaged.

  • During a periodontal evaluation, the dentist or hygienist uses a periodontal probe to gently measure the spaces between the teeth and gums. In a healthy mouth, this space (pocket) is usually less than three millimeters deep. Very deep pockets are a sign of advanced periodontal disease.
  • He or she usually takes x-rays to check the bone supporting the teeth. Low bone levels can be a sign of damage from periodontal disease.
  • If periodontal disease is diagnosed, your dentist may provide treatment or may refer you to a periodontist (a dentist who specializes in the diagnosis, prevention and treatment of periodontal disease).

How is periodontal disease treated?

Periodontal treatments depend on the type of the disease and how severe it is. If the disease is caught early (when it is gingivitis), and no damage has been done to the supporting structures under the teeth, you may simply need a professional cleaning. The dental team can give you tips for improving your daily oral hygiene.

Even with these measures, some patients develop more severe periodontal disease. The first step in treating the disease usually involves a special deep cleaning called “scaling and root planing.” In this treatment, the dentist removes plaque and tartar down to the bottom of each periodontal pocket. This treatment may be done over several visits, depending on your needs.

The root surfaces of the teeth are then smoothed (or “planed”) to allow the gum tissue to heal and reattach to the teeth. This treatment also may take more than one visit.

Your dentist may recommend medications to help control infection and pain or to aid healing. These can include a pill, a mouthrinse or a medication that the dentist places directly into the periodontal pocket after scaling and root planing.

If you smoke or chew tobacco, it is important to quit. Ask your dentist or physician for information about ways to stop.

Another dental visit will be scheduled within a few weeks or months after your last scaling and root planing treatment. At this visit, your dentist or hygienist will look at your gums to see how they have healed. He or she will measure the periodontal pockets again. If the pockets have gotten deeper and the supporting bone is lost, more treatment may be needed.

Care After Treatment

Once your periodontal treatment is completed, your dentist may recommend more frequent checkups and cleanings. Regular dental visits and deep cleanings are important to keep periodontal disease under control. In some cases, your appointments may alternate between your general dentist and periodontist.

Oral Hygiene at Home

Good oral hygiene at home also is very important to help keep periodontal disease from becoming more serious or from coming back. Daily home cleaning helps keep plaque under control and reduces tartar buildup.

  • Brush your teeth twice a day with a fluoride toothpaste.
  • Floss your teeth (or use another between-the-teeth cleaner) once a day.

You don’t have to lose teeth to periodontal disease. Brush, clean between your teeth, eat a healthy diet and visit your dentist regularly for a lifetime of healthy smiles.

Antibiotics and Dental Treatment

Your mouth has bacteria that can get into your bloodstream. For most people, these bacteria don’t cause a problem. But there is concern that for some people, bacteria in the bloodstream can cause an infection elsewhere in the body. That’s why your physician or dentist may advise you to take an antibiotic before some dental procedures. The antibiotic can kill infection-causing bacteria.

Not everyone should take antibiotics before dental treatment. This brochure will explain who should take antibiotics in this case and who should not.

What is the dental connection?

Bacteria normally are found on and in some parts of the body, including the skin and mouth. The bacteria in the mouth can enter the bloodstream. This can happen during some dental treatments, like teeth cleanings, or even from daily activities like chewing, toothbrushing, and flossing. For most people, the body’s immune system fights any bacteria, so the risk of infection stays low.

There’s concern that for some people, bacteria in the bloodstream can cause an infection of the heart lining or valves (infective endocarditis) or an infection of an orthopedic implant (such as artificial joints or metal plates or rods).

Because of this concern, some people with certain heart conditions and orthopedic implants are told to take antibiotics before having certain dental treatments. This is done with the belief that antibiotics might help prevent infective endocarditis or an implant infection. Taking antibiotics before dental treatment is called antibiotic prophylaxis (or preventive medicine).

However, there is no scientific evidence to show that bacteria in the bloodstream cause orthopedic implant infections. There is also no scientific evidence that antibiotic prophylaxis defends against infective endocarditis or an implant infection.

Who should take preventive antibiotics?

The American Heart Association recommends antibiotics for patients who would be in the most danger if they developed a heart infection.

If you have one of these heart conditions, your dentist or physician may recommend that you take an antibiotic before dental treatment:

  • artificial heart valves
  • a history of infective endocarditis
  • certain specific, serious congenital heart conditions, including:
    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  • a cardiac transplant that develops a problem in a heart valve

The American Dental Association and American Academy of Orthopedic Surgeons also do not recommend antibiotics for all dental patients who have had orthopedic implants. However, some people with orthopedic implants may decide to take antibiotics. For example, people who have weak immune systems are at greater risk for artificial joint infection. Diabetes, rheumatioid arthritis, cancer, chemotherapy, and chronic steroid use can weaken the immune system. All patients should talk to their dentists and/or physicians before deciding whether or not to take antibiotics.

Why shouldn’t everyone with a heart condition or orthopedic implant take preventive antibiotics?In most cases, taking antibiotics is more likely to cause a problem than defend against one. Antibiotics can cause side effects from mild stomach problems to severe allergic reactions. Taking antibiotics can destroy good germs that protect against infection. Also, improper use of antibiotics can lead to the development of drug-resistant bacteria.

Talk to your dentist or physician Talk to your dentist or physician if you have any questions about antibiotics. If there are any changes in your health history or the medicines you take, let your dental office know so they can update your records.

You can maintain a healthy mouth by brushing twice a day, cleaning between your teeth daily, and visiting the dentist regularly.

Tooth Replacement Options

If you’re missing one or more teeth, you may be all too aware of their importance to your looks and dental health. Your teeth are designed to work together to help you chew, speak, and smile. When teeth are missing, it is difficult to do these things. Even the loss of a back tooth may cause your mouth to shift and your face to look older. Fortunately, missing teeth can be replaced.

The following are three options your dentist may suggest, depending on your needs. Replacement teeth should last for years at a time, so it is important to choose a treatment that’s right for you.

  1. Implants
  2. Fixed Bridges
  3. Removable Partial Dentures

1. Implants

Many patients choose implants to replace a single tooth, several teeth, or to support a full set of dentures. Implants are posts that are surgically placed in the upper or lower jaw, where they function as a sturdy anchor for replacement teeth. They are made of titanium (a strong, lightweight metal) and other materials that are accepted by the human body.

Most patients find that an implant is secure and stable—a good replacement for their own tooth. However, implants are not an option for everyone. Because implants require surgery, patients should be in good health overall. Patients either must have adequate bone to support the implant, or be able to have surgery to build up the area needing the implant. Patients also should be ready to commit to a daily oral care routine and to regular dental visits.

Chronic illnesses, such as diabetes or leukemia, may slow healing after surgery. Patients with these issues may not be good candidates for implants. Using tobacco can also slow healing. Your dentist can help you decide whether implant treatment is a good option for you.

What’s Involved?

There are many different kinds of implants. Treatment can take only one day, or it can take several months, or somewhere in between. Your dentist can outline a treatment plan that is most likely to be successful for you.

There are three general phases of implant treatment:

  1. Placement of the implant: The dentist surgically places the implant into the jawbone. There may be some swelling and/or tenderness after the surgery, so pain medication is usually prescribed to ease the discomfort. Your dentist may recommend a diet of soft foods during the healing process.
  2. The healing process: What makes an implant so strong is that the bone actually grows around it and holds it in place. This process takes time. Some patients might need to wait until the implant is completely healed, up to several months, before replacement teeth can be attached to the implant. Other patients can have the implants and replacement teeth placed all in one visit.
  3. Replacing your missing tooth or teeth (prosthesis): The dentist or a lab will custom-make a crown, bridge or dentures to fit your mouth and your implants. Once completed, the man-made teeth are attached to the implant posts.

The prosthesis usually takes some time to make. In the meantime, your dentist may give you a temporary crown, bridge or denture. This can help you eat and speak normally until the permanent replacement is ready.

Implant-Supported Bridge
1. Missing teeth
2. A bridge is placed on implants
3. After the Bridge is placed

Advantages of implants:

  • An implant is most similar to a natural tooth.
  • Nearby teeth do not have to be involved in the placement procedure.
  • Implants may last for many years, even decades.
  • Some types of implants and artificial teeth or dentures can be placed in just one or two visits.
  • Implants may help prevent shrinkage of the jawbone from tooth loss.

Disadvantages of implants:

  • Implants are not right for everyone, since they require surgery.
  • Implant placement may take longer and may require more dental visits than other options.
  • Implants may cost more than other treatments.

2. Fixed Bridges

Another tooth replacement option is a fixed bridge. This is a restoration that fills the space where one or more teeth have been lost. A fixed bridge is bonded or cemented into place — only a dentist can remove it.

How is a bridge placed? Placing a bridge usually takes more than one dental visit. On your first visit, your dentist prepares the teeth on either side of the gap. The bridge will later be attached to these teeth.

Your dentist then takes an impression of your teeth and the space and sends the impression to a dental laboratory. Technicians at the lab make the bridge out of metal, ceramics, glass-ceramics or a combination. Your dentist will place a temporary bridge to protect your exposed teeth while you are waiting for the permanent one.

When talking about bridges, your dentist may use these terms:

  • Pontic: the replacement for your missing tooth
  • Crown: a “cap” that covers the attachment tooth

During one or more follow-up visits, the bridge is fitted, adjusted and cemented in place.

Bridge Placement
1. Before the bridge, teeth are shown with the space where a tooth has been lost.
2. Teeth next to the gap are prepared for placement of the bridge.
3. The custom-made bridge is placed over the prepared teeth.
4. The bridge is cemented into place.

Advantages of fixed bridges:

3. Removable Partial Denture

As its name describes, a removable partial denture can easily be taken out of the mouth for cleaning. Partial dentures usually have replacement teeth fixed to a plastic base that matches the color of your gums. The plastic base may cover a metal framework. Partial dentures often have some form of clasp that attaches to your natural teeth.

Your dentist may also recommend crowns, or “caps,” on your natural teeth. Crowns may improve the way a removable partial denture fits your mouth.

Getting used to a removable partial denture It takes practice to put in and take out a removable partial denture. It may feel odd or tight for the first few weeks. But in time, you should get used to it. Never force it into place by biting down. This could bend or break the clasps.

Removable partial dentures should not be worn 24 hours a day. Your dentist may tell you to take out the partial denture at bedtime and put it back in when you wake up. Usually your dentist will make follow-up appointments to look for pressure points or sore spots. He or she will adjust your denture so it fits comfortably.

Once your missing teeth are replaced, eating should be a much more pleasant experience. Since missing teeth can make it difficult to speak clearly, wearing a removable partial denture can help with that, too.

Over time, as you age and your mouth changes, your removable partial denture may no longer fit well. It also could break, crack or chip, or one of the teeth could loosen. Sometimes dentists can make the repairs, often on the same day. Complex repairs may take longer.

Removable Partial Denture
1. Partial denture being placed
2. Partial denture in the mouth (showing clasps)

Advantages of removable partial dentures:

  • usually less expensive than fixed bridges or implants
  • usually easier to repair than fixed bridges

Disadvantages of removable partial dentures:

  • can be less stable than other choices
  • they can break or be lost
  • can be uncomfortable
  • some people are embarrassed to take out their teeth at night and for cleaning
  • may need more frequent replacement than other options

Explore All Your Options

How best to replace missing teeth is an important decision. Your dentist may refer you to a dental specialist for additional care. Here are some of the dental specialists who may be called upon:

  • Prosthodontist — restoration and replacement of teeth
  • Oral and maxillofacial surgeon — dental surgery and treatment of the entire oral cavity, including neck and face
  • Periodontist — treats periodontal (gum) diseases

Talk to your dentist. He or she can answer your questions and help you decide which option will work best for you: implants, a fixed bridge or removable partial denture.

Sipping, Snacking and Decay

Do you sip soft drinks or other sugary drinks all day at your desk? Do you use breath mints or eat candy often? Instead of eating meals, do you snack all day? Do you often grab a sports or energy drink when you are tired?

If you answered yes to any of these questions, you may be increasing your chances of tooth decay. Keep reading to find out why.

What and how often you eat can affect your teeth

Eating habits and food choices can lead to tooth decay, or cavities. A steady supply of sugary foods and drinks, including sports and energy drinks, can damage teeth. But snacking or “grazing” all day long can also lead to tooth decay.

Plaque (sounds like “back”) is a sticky film of bacteria that forms on teeth. When you do not remove plaque from your teeth every day, it builds up. Plaque bacteria use sugar to make acid that attacks enamel, the hard surface of the tooth. The acid can attack tooth enamel for up to 20 minutes after you consume sugary foods or drinks.

When you have sugary foods or drinks many times a day or sip the same sugary drink for a long time, acid attacks the enamel again and again. Repeated acid attacks can cause tooth decay, which must be treated by a dentist.

One way of making smarter food and drink choices is to read their labels to make sure they are low in added sugar.

A healthy diet keeps your mouth healthy

Eating a healthy diet helps keep you from feeling tired, getting sick, being overweight, and having other health problems, like tooth decay. A healthy diet is one that

  • is based on fruits, vegetables, whole grains, and fat-free or low-fat dairy products
  • includes lean meats, poultry, fish, beans, and nuts
  • is low in saturated fats, trans fats, salt (sodium), and added sugars
  • has foods in the amounts shown on the My Plate picture below

Almost all foods have some type of sugar. You cannot and should not remove all sugar from your diet. Many foods and drinks, like apples, carrots, and milk, naturally contain sugars and have vitamins, minerals, and nutrients that your body needs.

For teeth to be healthy, they need vitamins, protein, calcium, and phosphorous.

Tooth Whitening

People generally think of teeth as being white. But tooth enamel can be many different shades. Over time, tooth enamel can change color or become stained.

There are many reasons why teeth become discolored:

  • genetics—tooth color can run in the family
  • aging
  • injury to the teeth
  • illness
  • medicines, such as some antibiotics
  • tobacco use
  • contact with stain-causing food and drinks over time (such as berries, sauces, coffee, cola, black tea, and red wine)
  • getting too much fluoride while teeth are developing

If your teeth are discolored, tooth whitening may help. “Whitening” is any process that can make teeth look whiter. It may be safely done at home or in a dental office.

Options for whitening your teeth

Tooth-whitening options range from gentle surface whiteners to stronger ones that can also remove deeper stains. There are many different types of tooth whitening products. They fall into three main types:

Whitening toothpastes help remove stains on the surface of your teeth. They are the gentlest kind of whiteners. Since they work using polishing action rather than chemicals, they usually do not have side effects. However, they do not get teeth as white as chemical products. Whitening toothpastes can lighten teeth a little bit at a time, over days or weeks.

Home-use whiteners come from your dentist or are sold over the counter. They can be applied with trays, strips, a rinse, or a brush. They usually contain a chemical called peroxide, which gets below the surface to lighten tooth enamel. Home-use whiteners are meant to be used over days or weeks. It is best to consult your dentist before whitening your teeth.

Your dentist may make special whitening trays for your upper and lower teeth. You put the whitening gel in the trays and wear them for short times during the day or overnight. Your dentist will tell you how long to wear them. If you wear the trays for too long, the peroxide in the gel can irritate your teeth.

In-office whitening is done in the dental office. In-office whiteners are much stronger than whitening toothpastes and home-use whiteners, since they have more peroxide. They can change the color of your teeth faster than the other methods.

The in-office whitening is usually done in about one hour. To help protect the mouth from the peroxide, the patient’s gum tissues are covered either with a thin sheet of rubber or a protective gel. Sometimes a light or laser is used with the peroxide.

Side effects

For a few days after treatment, your teeth may be sensitive to very hot or cold temperatures. Whitening may also irritate the gums for a short time. If the side effects do not go away after a few days, see your dentist.

To avoid harming your teeth and gums, always follow the product directions and any instructions from your dentist. If your teeth become very sensitive or you get sores in your mouth, stop using in-home products and call your dentist.

There is such a thing as too much whitening. Do not use whitening products for longer than advised in the product directions or by your dentist. Overwhitening can cause severe discomfort to your teeth and gums. Too much whitening can even harm your tooth enamel.

It’s not for everyone

Tooth whitening is not a good choice for all people. If your gums have pulled away from the teeth in some places, whitening may irritate these areas. If you have tooth decay or gum disease, your dentist may recommend that these be treated before whitening. Also, the color of fillings, crowns, and some stains cannot be changed by tooth whitening.

So talk to your dentist about tooth whitening before you begin. He or she will do an oral exam to find out if tooth whitening is right for you.

Keep your teeth white

Newly whitened teeth may stain more easily. To keep your teeth white as long as possible, avoid tobacco and stain-causing food and drinks for several days after whitening. Keep in mind that teeth usually return to their original shade over time. But if you steer clear of tobacco and large amounts of stain-causing food and drinks, your teeth may stay bright for several years.

Understanding Your Insurance

Having dental coverage can make it easier to get the dental care you need. But, it’s important to understand that most dental benefit plans do not cover all dental procedures. When deciding on your treatment, dental benefits should not be the only thing you consider.

You should know what your dental plan covers and what it doesn’t. This information can help you understand why your dental benefit plan may not pay for all or even a portion of your recommended treatment. Ultimately, your treatment should be determined by you and your dentist – not by your level of dental coverage.

How dental benefit plans work

Dental benefit plans are not designed to cover all dental procedures. Plans usually cover some, but not all, of your dental costs and needs. Many plans involve a contract between your employer and a dental plan provider, but you can also buy individual plans on your own or through the Health Insurance Marketplaces.

Your dental coverage is not determined by your dentist

Your dentist’s primary goal is to help you maintain good dental health, but not every procedure your dentist recommends will be covered. To avoid surprises on your bill, it’s important to understand what and how much your plan will pay. Your employer and the plan provider agree on the amount your plan pays and what procedures are covered. Your dentist is not involved in deciding your level of coverage.

Your dental coverage is not based on what you need or what your dentist recommends. It’s based on how much your employer pays into the plan. Sometimes, you may have a dental care need that is not covered by your plan. Employers generally choose to cover some, but not all, of employees’ dental costs.

Dental plans share treatment costs with you

There are certain cost-control measures that dental benefit plans use to determine how they share treatment costs with you. Here are some key terms that are used to describe these measures:

Deductible A deductible is the amount of money that you must pay before your benefit plan will pay for any service. It can take more than one service or visit to meet your deductible. Most plans don’t require a deductible for preventive services like cleanings and exams or for diagnostic services.

Coinsurance In most cases, after you meet your deductible you will be expected to pay a percentage of the allowed benefit amount of a covered dental service. This is called coinsurance.

For example: Your plan may pay 80% and you pay the remaining 20% owed to your dentist. If your bill was $100, then your plan pays $80 and you would pay the remaining $20.

Annual Maximums This is the maximum dollar amount a dental plan will pay during the year. Your employer decides the maximum levels of payment in its contract with the dental benefit provider. You would pay for anything over that set dollar amount.

For example:

  • Your dental expenses: $3,500
  • Your annual maximum: $2,000
  • You owe: $1,500

If the annual maximum of your plan is too low to meet your specific needs, you may want to ask your employer to consider a higher annual maximum. If your plan also covers braces, there is usually a separate lifetime maximum limit

Pre-Existing Conditions

Your dental plan may not cover conditions you had before enrolling even though treatment may still be necessary. You would be responsible for paying these costs.

For example: If you had a missing tooth before the effective date of your coverage, then benefits will not be paid for replacing the tooth. Even though your plan may not cover certain conditions, you may still need treatment to keep your mouth healthy.

Coordination of Benefits (COB) or Nonduplication of Benefits

These terms apply to patients covered by more than one dental plan. The benefit payments from all plans should not add up to more than the total charges. Even though you may have two or more dental benefit plans, there is no guarantee that all of the plans will pay for your services. Sometimes, none of the plans will pay for the services you need. Each dental plan handles COB in its own way. Please check your plans for details.

Plan Frequency Limitations

A dental plan may limit the number of times it will pay for a certain treatment. But, you may need a treatment more often to maintain good oral health. Make treatment decisions based on what’s best for your health, not just what is covered by your plan.

For example: Your plan might pay for teeth cleaning only twice a year, but you need a teeth cleaning 4 times a year, so you would pay out of pocket for the extra 2 cleanings.

Not Dentally Necessary

Many dental plans state that only procedures that are medically or dentally necessary will be covered. If the claim is denied, it does not mean that the services were not necessary. Treatment decisions should be made by you and your dentist.

If your plan rejects a claim because a service was “not dentally necessary,” you can appeal. Work with your benefits manager and the plan’s customer service department or your dental office to appeal the decision in writing.

Other Cost Control Measures

  • Claims Bundling – 2 different dental procedures are combined by the dental plan into one procedure. This may reduce your benefit.
  • Downcoding – when a dental plan changes the procedure code to a less complex or lower cost procedure than was reported by the dental office.
  • Least Expensive Alternative Treatment (LEAT) – if there is more than one way to treat a condition, the plan will only pay for the least expensive treatment. However, the least expensive option is not always the best.
  • For example: your dentist may recommend an implant for you, but the plan may only cover less costly dentures. You should talk with your dentist about the best treatment option for you.

Make Your Dental Health the Top Priority!

Although you may be tempted to make decisions about your dental care based on what your dental plan will pay, remember that your health is the most important thing. Talk with your dentist to make sure you are getting the treatment that will get your mouth healthy again.

Teeth Grinding

Bruxism is a habit of grinding or clenching the teeth. Clenching means you tightly hold your top and bottom teeth together. Grinding is when you slide your teeth back and forth over each other. Bruxism can happen in children and adults of any age.

Many people with bruxism wake themselves up during the night with a loud clenching or grinding sound. Sometimes the sound is so loud that other people can hear it. For other people, bruxism may be silent.

People who suffer from bruxism may have one or more of these symptoms:

  • headache or earache
  • sore jaw
  • jaw clicking
  • frequent toothaches
  • sensitive teeth
  • facial pain
  • worn or cracked teeth or fillings
  • tongue indentations
  • insomnia (trouble sleeping)

What causes bruxism?

The causes of bruxism are not known for certain. Stress, sleep disorders and an abnormal bite are some things that may play a role.

Your dentist can diagnose bruxism by checking for unusual wear spots on your teeth and looking at any related symptoms. Regular dental checkups are important to find damage in the early stages. Your dentist can help you manage bruxism and the related symptoms, as well as repair your teeth if necessary and help prevent further damage.

How is bruxism treated?

Treatment depends on each person’s situation. Your dentist may recommend one or more treatments, such as the following:

  • stress reduction methods
  • a protective nightguard worn over the teeth while sleeping
  • medication for pain or muscle spasms
  • exercises to relax jaw muscles
  • fillings or other dental treatment to repair damaged teeth

Your dentist may recommend that you wear a nightguard during sleep. Nightguards are custom-made by your dentist from plastic or acrylic. The nightguard slips over the upper or lower teeth and prevents them from touching. It protects teeth and helps keep them from wearing down.

Since bruxism has many causes, you may need to try a few different treatments to find out what works for you. You can help manage bruxism by paying attention to the symptoms, having regular dental visits and talking with your dentist.

Why Do I Need a Crown

What is a crown? A crown is a cover or “cap” your dentist can put on a tooth. The crown restores the tooth to its normal shape, size and function. The purpose of a crown is to make the tooth stronger or improve the way it looks.

Why do I need a crown? You may need a crown if you:

  • have a cavity that is too large for a filling
  • have a missing tooth and need a bridge
  • need to cover a dental implant
  • have a tooth that is cracked, worn down or otherwise weakened
  • have had root canal treatment—the crown will protect the restored tooth
  • want to cover a discolored or badly shaped tooth and improve your smile!

What is it made from?

Crowns are made from several types of materials. Metal alloys, ceramics, porcelain, composite resin, or combinations of these materials may be used. In the process of making a crown, the material often is colored to blend in with your natural teeth.

Your dentist wants to create a crown that looks natural and fits comfortably in your mouth. To decide on the material for your crown, your dentist will consider the tooth location, the position of the gum tissue, the patient’s preference, the amount of tooth that shows when you smile, the color or shade of the tooth, and the function of the tooth.

How is a crown placed?

Several steps are involved, and two dental visits are generally needed to complete the treatment.

  1. The dentist prepares the tooth by removing its outer portion so the crown will fit. Any decay is also removed. If additional tooth structure is needed to support the crown, the dentist may build up the core of the tooth.
  2. An impression is made to provide an exact model for the crown.
  3. You will get a temporary crown while you wait for the permanent crown to be ready—usually less than two weeks. While you have the temporary crown, this tooth may be sensitive to hot and cold. Also, avoid chewing gum or sticky foods during this time.
  4. The dentist or a laboratory technician then uses the model to help make the crown.
  5. When the new crown is ready, the dentist places it in your mouth and makes the necessary adjustments. When you and your dentist are satisfied with how it looks and feels, the crown is cemented in place.

Caring for your teeth

To prevent damage to a crown, there are a few things you can do:

  • Brush twice a day and floss once a day to remove plaque, a sticky film of bacteria. Look for oral care products that have the ADA Seal of Acceptance. Products that display the Seal have met the American Dental Association’s standards for safety and effectiveness.
  • Avoid chewing hard foods, ice or other hard objects, such as pencils. This is especially important for tooth-colored crowns.
  • Be sure to see your dentist for regular exams and professional teeth cleanings.

Produced in cooperation with the American College of Prosthodontists “Crown Used to Replace a Filling” – photos courtesy of John R. Nosti, DMD, FAGD, FACE, www.cosmeticdentistryofsj.com.

Taking Care of Your Teeth and Gums

Smile Checklist

Look in the mirror.

  • Do you like the way your teeth look?
  • Do you dislike the color of any of your teeth?
  • Are there spaces between your teeth?
  • Do you have any chips or cracks on your teeth?
  • Are you missing any teeth?
  • Do you have any crooked teeth?
  • Do you feel your teeth are too long or too short?
  • Are you pleased with the shapes and position of your teeth?

If your answers show that you might want a change in your smile, talk to your dentist about Improving Your Smile.

A great smile can be the most attractive feature of your face. A smile helps you express health, success, youth and sincerity. It is a great asset in your personal, business and social contacts. So it’s important that you are happy with how your smile looks. But if you are like many people, you may not be.

Your dentist has many different techniques to shape, sculpt, and make your smile more beautiful. With a few simple steps, you can have a smile you feel great about. And treatment may be more affordable than you think.

Options for improving your smile include:

Tooth-Colored Fillings
Your dentist can use natural-colored materials to restore teeth that have cavities. Options include composite materials, such as resin, as well as lab-made porcelain inlays, inlays and crowns.

Tooth Whitening
Teeth become stained for many reasons – drinking coffee, tea or wine; smoking; and even aging can discolor teeth. Tooth whitening is a process that makes discolored teeth whiter. The bleach used for in-office (chair side) whitening is stronger than the bleach found in at-home whitening kits. Keep in mind that not everyone’s teeth can become movie-star white. Your dentist can recommend the whitening treatment that is right for you.

Veneers
Veneers are thin, tooth-colored shells that are bonded, or cemented, to the front of your teeth. They are custom-made of ceramic or composite resin, and look like natural teeth. Veneers can be used to fill spaces between teeth and to cover teeth that are stained, poorly shaped, or a bit crooked.

Braces
Braces can help correct crowded or crooked teeth or an uneven bite. Braces have become much smaller and less noticeable over the years. Brackets, the part of the braces that attach to each tooth, can sometimes be attached to the back of the tooth to make them less noticeable. Some brackets are clear or tooth coloured-which help braces blend in.

In some cases, treatment may be done without using braces at all. A series of clear, removable aligners are used to move your teeth over time. These aligners are more discreet than traditional braces.

Enamel Shaping
Your dentist can “reshape” your teeth by contouring tooth enamel, the outer layer of the tooth. When teeth are a little crowded or uneven, or when teeth appear too long, your dentist can use enamel shaping to improve how the teeth look.

Crowns
If a tooth needs more a dramatic change than veneers or enamel shaping can provide, crowns are an option. The outer part of the tooth is removed and a crown is placed over it. The crown can be made to fit in with your other teeth. It’s like a fresh start for your tooth.

First Steps to a New Smile
Once you decide to improve your smile, the first step is to visit your dentist. At this visit, you will talk about the best plan for you. If you have any signs of dental disease, your dentist may recommend treatment for this. It’s important to have a healthy mouth before starting cosmetic treatment.

These treatments and others can help you have more natural-looking and attractive teeth. What are you waiting for? Talk to your dentist today about how to make your smile the best it can be.

Before-and-after photos courtesy of Dr. John R. Nosti, SmileDesignNYC.com.

Tooth Extraction

Root Canal Treatment

Your teeth are meant to last a lifetime. Years ago, diseased or injured teeth were usually pulled. But today, a tooth can often be saved through root canal (endodontic) treatment.

Endodontics (en-do-DON-tics) is the branch of dentistry that deals with treating diseases or injuries to the dental pulp. An endodontist is a dentist who specializes in root canal and other endodontic treatments.

What happens if the dental pulp is injured?

The pulp is soft tissue inside the tooth that contains blood vessels and nerves. When the pulp becomes inflamed or infected, treatment is needed. The most common causes of pulp inflammation or infection are a cracked or chipped tooth, a deep cavity or filling, or other serious injury to the tooth. All of these can allow bacteria to enter the pulp.

Why should the pulp be removed?

If damaged or infected pulp is not removed, the tissues around the root of the tooth can become infected. Pain and swelling often result. Even if there is no pain, bacteria can damage the bone that holds the tooth in the jaw. Without treatment, the tooth may have to be removed.

Removing a tooth can create problems

When a tooth is removed and not replaced, the teeth around it may shift. This can make biting and chewing difficult and may make it harder to clean your teeth. Areas that are not cleaned well are more likely to get gum disease.

Root canal treatment can prevent these problems by saving your natural tooth. Also, root canal treatment usually is less expensive than a replacement tooth.

What does treatment involve?

Root canal treatment may involve one or more dental visits. Your dentist or endodontist will perform the necessary steps to save your tooth:

First, your tooth is numbed for your comfort. A thin sheet of latex rubber is placed over your tooth to keep it dry. An opening is made through the crown of the tooth into the pulp chamber.
The tooth’s nerve or pulp is removed from the pulp chamber and root canal (the space inside the root). Each root canal is cleaned and shaped so it can be filled.
Your dentist may place medicine in the pulp chamber and root canal to help get
rid of bacteria.
The root canals are usually filled with a rubber-like material to seal them.
A temporary filling is then placed in the tooth to prevent contamination of the root canals. You might be given antibiotics if the infection has spread beyond the end of the root(s). If your dentist prescribes medicine, use it only as directed. If you have any problems with the medicine, call your dentist.
During the next stage of treatment, the dentist removes the temporary filling and restores the tooth with a crown or a filling to strengthen it and improve the way it looks. If an endodontist performs the root canal treatment, he or she usually recommends that you return to your general dentist for this step.

How long will the restored tooth last?

When properly restored, a tooth with a root canal filling can last for many years. But, like any other tooth, it can become decayed or fractured or the tissue around it can get gum disease. Daily cleanings and regular dental exams will help keep your mouth healthy, whether you’ve had root canal treatment or not.

Improving Your Smile

Smile Checklist

Look in the mirror.

  • Do you like the way your teeth look?
  • Do you dislike the color of any of your teeth?
  • Are there spaces between your teeth?
  • Do you have any chips or cracks on your teeth?
  • Are you missing any teeth?
  • Do you have any crooked teeth?
  • Do you feel your teeth are too long or too short?
  • Are you pleased with the shapes and position of your teeth?

If your answers show that you might want a change in your smile, talk to your dentist about Improving Your Smile.

A great smile can be the most attractive feature of your face. A smile helps you express health, success, youth and sincerity. It is a great asset in your personal, business and social contacts. So it’s important that you are happy with how your smile looks. But if you are like many people, you may not be.

Your dentist has many different techniques to shape, sculpt, and make your smile more beautiful. With a few simple steps, you can have a smile you feel great about. And treatment may be more affordable than you think.

Example of an Improved Smile

Options for improving your smile include:

Tooth-Colored Fillings
Your dentist can use natural-colored materials to restore teeth that have cavities. Options include composite materials, such as resin, as well as lab-made porcelain inlays, inlays and crowns.

Tooth Whitening
Teeth become stained for many reasons – drinking coffee, tea or wine; smoking; and even aging can discolor teeth. Tooth whitening is a process that makes discolored teeth whiter. The bleach used for in-office (chair side) whitening is stronger than the bleach found in at-home whitening kits. Keep in mind that not everyone’s teeth can become movie-star white. Your dentist can recommend the whitening treatment that is right for you.

Veneers
Veneers are thin, tooth-colored shells that are bonded, or cemented, to the front of your teeth. They are custom-made of ceramic or composite resin, and look like natural teeth. Veneers can be used to fill spaces between teeth and to cover teeth that are stained, poorly shaped, or a bit crooked.

Braces
Braces can help correct crowded or crooked teeth or an uneven bite. Braces have become much smaller and less noticeable over the years. Brackets, the part of the braces that attach to each tooth, can sometimes be attached to the back of the tooth to make them less noticeable. Some brackets are clear or tooth coloured-which help braces blend in.

In some cases, treatment may be done without using braces at all. A series of clear, removable aligners are used to move your teeth over time. These aligners are more discreet than traditional braces.

Enamel Shaping
Your dentist can “reshape” your teeth by contouring tooth enamel, the outer layer of the tooth. When teeth are a little crowded or uneven, or when teeth appear too long, your dentist can use enamel shaping to improve how the teeth look.

Crowns
If a tooth needs more a dramatic change than veneers or enamel shaping can provide, crowns are an option. The outer part of the tooth is removed and a crown is placed over it. The crown can be made to fit in with your other teeth. It’s like a fresh start for your tooth.

First Steps to a New Smile
Once you decide to improve your smile, the first step is to visit your dentist. At this visit, you will talk about the best plan for you. If you have any signs of dental disease, your dentist may recommend treatment for this. It’s important to have a healthy mouth before starting cosmetic treatment.

These treatments and others can help you have more natural-looking and attractive teeth. What are you waiting for? Talk to your dentist today about how to make your smile the best it can be.

Before-and-after photos courtesy of Dr. John R. Nosti, SmileDesignNYC.com.