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Dr. Carini has answered some of our most common questions.
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1.
At what age should I take my child to the dentist?
- back to top
The answer to this question varies,
depending on who you talk to. Recommended ages for the
first visit range from 6 months to 2 years. Much of the
decision depends on the parent’s expectations and
the child’s needs. I always recommend to my patients
that they bring their child in as soon as possible, if
for no other reason than to simply observe. This can be
accomplished by having mom or dad bring their child into
the room with them while they are having their teeth cleaned.
This will allow your child to familiarize themselves with
the office. They also get a chance to meet the office
staff which can help to make coming in much easier for
them.
Other factors which may influence when you bring a child
in for their first visit is if you feel your child is
having a problem, or if you are having difficulty cleaning
your child’s teeth. Some other issues you may want
to discuss with your dentist are your child’s fluoride
needs and any adverse habits that may be developing such
as thumb sucking. The bottom line is that the sooner you
can bring your child in for their first visit, the less
likely they will have a serious problem.
The most common problems that you want to avoid are tooth
decay and tooth loss. Cavities caught early are easily
restored, which will spare your child the need to experience
a toothache. Utilizing laser technology, early cavities
can usually be treated without the need for anesthesia,
that is “no shots”. Preventing tooth loss
is also very important. If baby teeth are lost too early,
the remaining baby teeth can begin to drift. This may
cause the permanent teeth to come in crooked, which usually
results in the need for braces. Bringing you child in
early can help prevent these problems from happening.
When preparing your child for their first visit, there
are some things you can do as a parent to help things
go smoothly. Tell your child ahead of time that they will
be going to the dentist. If they have any fears, you should
address them. Sometimes simply talking about what they
are afraid of can help to make it easier. Be careful about
how you express your own feelings about going to the dentist
and don’t let anyone else, such a siblings, try
and scare your child with stories about going to the dentist.
The number one fear I see in children is “getting
a shot.” Most of them probably aren’t even
sure what it means, but “it can’t be good,
whatever it is.” Never use going to the dentist
as punishment. What you can do is talk about the visit
in a positive manner. Let the child know that the dentist
is someone who helps them stay healthy, and that regular
visits help a person keep their teeth for life.
During the child’s first visit, they will get their
teeth examined and cleaned. Depending on the age and cooperative
abilities of the child, they may receive x-rays and a
fluoride treatment. They will also be taught important
home care skills so that hopefully they can begin to understand
how important their role is in keeping a healthy mouth.
A child’s first visit is the most important one.
Potentially, it is from this visit that they will form
the basis from which they will develop their opinions
and attitudes towards dentistry. It is very easy to make
that first visit a pleasant experience through a combination
of early enough first contact and positive reinforcement
from the parent. By starting a child early and developing
good home care habits, your child can have healthy teeth
for a lifetime. |
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2.
What is cosmetic whitening? - back
to top
Teeth whitening
or bleaching agents have been around since the 60’s.
It is has been, for the last two decades, that teeth whitening
has seen an increase in demand by consumers. Some of this
increase in demand can be attributed to marketing by companies
like Crest and reality based shows such as Extreme Makeover.
The end result is a consumer driven demand for whiter
teeth! In years past, dental students were instructed
by their Dental School instructors to steer older patients
away from getting teeth that were “too white”.
Now, everyone wants to jump on the “whitening bandwagon”.
There are various techniques for whitening teeth. These
include: over the counter products like Crest Whitening
Strips, take home tray systems such as those provided
by your dentist and in office whitening techniques that
are also provided by your dentist. Only those systems
provided by your dentist have received the ADA’s
seal. This ADA approval means that the whitening system
you have chosen is safe and effective. These systems are
typically 10% carbamide peroxide gels for take home systems
and much higher carbamide peroxide concentration gels
for the in office systems. There are currently no over
the counter whitening systems that I am aware of that
have received the ADA’s seal. This does not, however,
mean that these systems are unsafe. Most of these products
are hydrogen peroxide based systems and have some whitening
effect on the teeth.
The most common and cost effective procedure to use for
teeth whitening is the take home whitening tray system.
Research has shown that all of the whitening systems provided
by your dentist will achieve the same end result. The
difference between the systems are time and cost. Take
home tray systems require that you perform the procedure
at home over several days. In office whitening systems,
in many instances, require only one visit to the dentist.
These systems often utilize a special light, or in some
instances, a laser. The effects of these lights can be
dramatic, but are often temporary. Many in office whitening
systems require that you follow up with a take home system.
In office whitening systems can cost 4-5 times the fee
for the take home tray systems. There are relatively inexpensive
take home systems available that have pre-made trays.
That means that you can receive your whitening system
in a single visit at a much reduced fee.
It is important to understand that teeth whitening systems
do not actually make your teeth white. These systems actually
have a bleaching effect on the teeth. For example, if
you were to bleach a red shirt, it would end up pink,
not white. The overall effect of whitening systems is
to make the teeth 3-4 shades lighter than they started.
Not all teeth can achieve this level of whitening. Teeth
that have been discolored during their development, from
medications such as tetracycline, are sometimes difficult
to whiten and a less than desirable result is achieved.
Also, teeth that have color variations to them may not
see those colors blend into one uniform, lighter color
from the whitening process. It is always a good idea to
first consult with your dentist to see if whitening your
teeth will give you the results you are looking for. |
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3.
What’s new in laser dentistry? - back
to top
A laser is
an instrument that amplifies light energy. This amplified
light energy is used to alter gum tissue, teeth and bone.
There are various types of lasers used in dentistry. Lasers
operate at a specific wavelength of light. Certain wavelengths
of light are better absorbed by gum tissue, while others
are better absorbed by tooth and bone. Different types
of lasers have been used in dental applications since
the early 1990's for gum tissues. In 1997, the Food and
Drug Administration approved laser use in dental hard
tissues (teeth) for treatment of cavities.
A common type of laser used for treatment of dental cavities
is the erbium: yttrium-aluminum-garnet (Er:YAG) laser.
Laser technology allows tiny layers of the tooth to be
removed quietly and usually without discomfort. An injection
is usually not needed. Lasers can be used for the treatment
of small to medium sized cavities in adults and children.
It is now possible to remove decay from a tooth with virtually
no anesthetic, no vibration, and no pain.
The lasers operate by stirring up water molecules, causing
them to form microscopic explosions. When this process
is applied to gums, teeth and cavities, the explosions
vaporize the area, acting like a drill without touching
the tissue. Because this reaction occurs at the molecular
level, the process is pain-free. Many patients do experience
a sensation similar to the effects of eating ice cream
in that the tooth may feel cold. Many times the lasers
effect on the tooth is to provide a type of anesthesia.
Today, lasers are being used for treating cavities, root
canals disinfection, treating gum disease, reshaping gums
and helping to diagnose cavities. It is surprising that
despite what seems to be an obvious advantage, only a
small percentage of dentists are using laser technology.
The Academy of Laser Dentistry has a membership of only
1,100 members out of the nearly 130,000 dentists in the
country. It is apparent, however, that the future of dentistry
is laser dentistry. |
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4.
Is there anything that can be done about bad breath that
produces better long-term results?
- back to top
It is estimated that over 20 million
Americans regularly suffer from some form of bad breath.
It is also believed that the source of bad breath in almost
90% of the cases is in the oral cavity. Because of this,
over one billion dollars is spent annually on products
designed to hide the effects of bad breath. Many of these
products do provide some short-term relief to the problem
but do little to correct the problem long-term. Until
the source of one’s breath problems are discovered,
any attempt to hide the problem will be short lived. Occasionally,
bad breath can be caused by foods that we eat and the
beverages we drink. This type of problem is not considered
serious and can be solved by most over-the-counter breath
products. People who experience chronic bad breath usually
have some underlying cause of this condition that can’t
be readily corrected by these over-the-counter products.
Chronic bad breath, also referred to as chronic halitosis,
can be caused by various conditions in the oral cavity.
Gum disease is a common source of chronic bad breath.
Infected teeth and erupting teeth, such as wisdom teeth,
can also be the source of bad breath. Both of these conditions
can also produce a foul taste in the mouth. All of the
above conditions have one thing in common, and that is
an over abundance of toxin producing bacteria. The toxins
thought to be responsible for bad breath are referred
to as a volatile sulfur compound or VSCs. People who suffer
from the effects of bad breath caused by the above conditions
will typically see their breath problem resolved once
the underlying condition is corrected.
But what about those individuals who suffer from bad breath
but do not possess one of the above conditions? Some individuals
harbor great quantities of VSC producing bacteria in the
cracks and grooves on the surface of the tongue. It is
also felt that the tonsils can also become a source for
these compounds. It is imperative that these individuals
perform certain hygiene rituals, most importantly, tongue
scraping. The gentle scraping of one’s tongue will
aid in removing the bacteria that produce these compounds.
There are also products available that will help to neutralize
VSC’s rather than try to hide the odors that they
produce.
While there is a not “cure” for bad breath,
there are some steps that can be taken to help remedy
the problem. It is extremely important that the individual
who has chronic bad breath is first evaluated by his or
her dentist to determine the source of the problem. Once
the condition causing bad breath is determined, the appropriate
steps can be taken to help remedy the problem. Because
bad breath can be an indication of some underlying dental
problem, it is important to have that problem corrected
so that you can keep your teeth and gums healthy for a
lifetime. |
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5.
What is Periodontal / Gum Disease? - back
to top
Periodontal
disease, also known as gum disease, has been a frequent
topic in the media lately. This is not, however, a new
problem in oral health. In fact, gum disease is and has
been the leading cause of tooth loss over the age of 45.
It is so common that 80% of the adult population has some
form of gum disease. One of the difficulties in treating
the disease is that it is usually painless until the later
stages of its development. That is why early detection
and treatment is very important in stopping the disease
process.
Gum disease is an infection of the supporting structures
of the teeth. These structures include the soft tissues,
the periodontal ligament and the bone that helps hold
teeth in place. This infection is caused by bacteria which
can colonize in the space that exists between the teeth
and the surrounding gum tissue.
In early stages of the disease, the gums become swollen
and bleed easily; this is called gingivitis. As the disease
process begins to advance, it begins to adversely affect
the bone supporting the teeth; this is called periodontitis.
At this point the damage caused by the disease can become
irreversible. If left untreated, the supporting structures
of the teeth are destroyed, the teeth begin to loosen
and eventually they are lost. This is why gum disease
is so dangerous.
It is helpful to understand how the disease progresses.
Bacteria are in constant contact with the supporting structures
of the teeth. These bacteria release toxins as a normal
part of their metabolism. Bacterial toxins are substances
that are very harmful to the supporting structures of
the teeth. If the bacteria are left untouched, they begin
to colonize. As bacteria begin to accumulate in and around
teeth, they produce greater amounts of toxins. These substances
become very irritating and the gums become inflamed. As
the gum tissue is destroyed, deeper and deeper pockets
begin to develop around the teeth. Once this destructive
process progresses, the bone supporting the teeth can
become affected. It is the loss of bone that eventually
causes the teeth to become loose and ultimately lost.
Because gum disease is painless until its later stages,
it becomes important to know what to look for to determine
whether or not you’re developing a problem. Some
common signs that may help to alert you to a developing
problem are: gums that bleed with brushing or flossing,
bad breath, red swollen gums, receding gums, loose teeth,
teeth that are separating and pus around the teeth and
gums. If you are not sure, you should ask your dentist.
Dentists are trained to detect developing gum problems
at their earliest stages. The sooner the problem is caught,
the easier it is to treat and the greater the chance for
success. Gingivitis can often be treated with a routine
cleaning and good home care, such as proper brushing and
flossing. As the problem progresses and begins to involve
the bone supporting the teeth, many non-surgical treatments
are available to help arrest this problem. In more advanced
stages, gum surgery may be required to arrest the disease
process. We now have a type of surgical gum treatment
available to our patients that does not involve cutting
or suturing. It is called LANAP surgery. LANAP stands
for “laser assisted new attachment procedure”.
This treatment utilizes a special laser to help eliminate
the bacteria that cause periodontal disease. Whatever
treatment is prescribed, it is usually tailored to meet
the patients’ needs.
Gum disease is the major cause of tooth loss in adults.
This disease, which is generally caused by bacteria, is
painless until very advanced stages. Proper diagnosis
and treatment is a sure way to keep your teeth and gums
healthy for a lifetime. |
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6.
Is there a connection between good oral health and good
systemic health? - back
to top
For decades,
oral health has been viewed as being separate to overall
systemic health. Research over the last several years
has revealed, though, that oral health may have a significant
contributing effect on overall systemic health. Infections
in the mouth have been adversely linked to cardiovascular
disease, diabetes and complications to pregnancy. More
and more physicians are recommending that their patients
undergo comprehensive oral examinations when confronted
with the above health issues.
Infections of the mouth can come from severely decayed
teeth, but for adults, the number one source of oral infections
is the bacteria that cause gum disease. It is estimated
that 80% of all adults have some form of gum disease.
That translates to four out of every five adults. Signs
of gum disease can include receding gums, bleeding gums,
loose teeth and bad breath. Bacteria that are present
in inflamed and infected gum tissue can easily pass into
the blood stream. This process can occur all day long,
day after day. It is felt that this chronic exposure to
bacteria and the toxins they release is responsible for
or contributes to several disease processes.
Coronary artery disease occurs when the blood flow in
the arteries supplying the heart becomes restricted due
to the accumulation of plaque. Research now suggests that
the body’s response to oral bacteria helps contribute
to this build-up. Left unchecked, the restriction of blood
flow in the coronary arteries can lead to a heart attack.
People with gum disease are almost twice as likely to
suffer from coronary artery disease as those without gum
disease.
People with diabetes are more at risk for developing gum
disease than people who do not have diabetes. Diabetics
are more at risk for developing infections, which helps
to explain this relationship. Uncontrolled diabetics are
more likely to develop gum disease than are controlled
diabetics. Severe gum disease can also cause elevated
blood sugar levels, which can make controlling diabetes
much more difficult. A study done on people showed that
when individuals with severe gum disease and diabetes
had their gum disease treated, they were able to control
their diabetes much easier.
Gum disease has also been linked to low birth weight.
Pregnant women with gum disease are seven times more likely
to have a baby that is born early and too small. It is
thought that gum disease triggers the release of biological
fluids that induce labor. Research has also shown that
women whose gum disease worsens over the course of their
pregnancy are at an even higher risk of having a premature
baby.
As more and more research comes out, it is becoming increasingly
evident that good oral health is an essential ingredient
to overall good health. The harmful effects of gum disease
on disease processes such as coronary artery disease and
diabetes as well as the potential complications to pregnancy
may just be the tip of the iceberg as more research becomes
available. If you have a medical condition you should
contact a physician, but if you think you may have gum
disease contact your family dentist. |
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7.
What is a dental implant? - back
to top
A dental implant
is an artificial tooth root that is surgically placed
into your jaw to hold or support a replacement tooth or
bridge in place. Dental implants come in many shapes and
sizes and are made from titanium or titanium coated with
biologically tolerable materials. The benefit of using
implants is that they don’t rely on neighboring
teeth for support, they are permanent and stable. Implants
are a good solution to tooth loss because teeth that are
anchored to implants can look and feel like natural teeth.
People are losing fewer teeth as they age and more Americans
are choosing dental implants as a replacement option than
they did in the past. A percentage of adults who may be
implant candidates do not have implants. Extractions are
performed, bridges, partials or dentures are placed, and
the patient goes home. In many instances, dental implants
are never discussed as a viable option for tooth replacement.
By placing implants, precious jawbone that would have
been lost once the natural teeth are removed, can be saved.
Many patients are unaware that bone loss in their jaw
will always follow the loss of a tooth. Up to 30% of that
bone will be lost in the first few months following an
extraction. In time, bone loss can cause facial changes,
speech changes and diet changes. Bone surrounding the
teeth help support the lips and cheeks and when lost,
can change an individual’s appearance. Bone in the
upper palate supports the gum tissue and when used by
the tongue, helps form certain sounds when speaking. When
too many teeth and the bone that supports them are lost,
and those teeth are replaced by a partial denture or a
full denture, certain foods become very difficult to chew.
Successfully placed dental implants cause the bone to
grow around the anchor and firmly hold it in place. Dental
implants can restore normal eating and speaking abilities,
increase denture retention, and enhance facial appearance.
Strategically placed, implants can now be used to support
permanently cemented crowns and bridges, eliminating the
need for a denture. It is now possible to give someone
with no teeth, who is currently wearing a denture, a full
set of teeth anchored to implants, all in one day. The
cost is greater than that of a full denture, but the implants
and bridges more closely resemble real teeth and therefore
act like real teeth. No more worrying about teeth falling
out or what you’re going to eat when you go out
to dinner!
In order to become a candidate for implants there are
some factors to consider. Your overall health may affect
the success rate of dental implants. Individuals, for
example, with uncontrolled diabetes are not a good candidate
for implants because healing around the implants is poor.
If your diabetes is controlled with medication, then it
may be OK to proceed with implant dentistry. Oral hygiene
is another consideration when determining whether or not
to place implants. Poor oral hygiene is a big reason why
some implants fail. It is important to maintain good oral
hygiene around the implants in order to ensure their success.
We will give you customized, specific instructions on
how to care for your new implants. Additional cleanings
may be necessary to ensure that you retain healthy gums
around the implants. |
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8.
Is chronic dry mouth harmful to oral health? -
back to top
Millions of Americans suffer from chronic
dry mouth, known medically as xerostomia. The definition
of xerostomia is a dryness of the mouth due to lack of
normal secretions. Normal salivary flow is an essential
part of good oral health and there are many things that
can affect the quality of saliva produced. Medication,
uncontrolled diabetes, radiation treatment to the head
and neck and mouth breathing are but a few of the conditions
that can lead to xerostomia. A diminished salivary flow,
especially when experienced over an extended period of
time, can have a serious impact on the health of the oral
structures, especially the teeth and gums. The drying
out of these structures of the mouth can lead to an increased
incidence of decay, severely inflamed gums and bad breath.
Normal salivary flow is important because of the protection
it provides the teeth and gums. Most people are aware
of the role saliva plays in the digestive process, but
few are aware of the importance it plays in controlling
the bacteria that inhabit the oral cavity. Saliva has
the ability to help neutralize the cavity forming acids
that bacteria produce so when the flow of saliva has been
compromised, the acid produced by bacteria becomes more
effective in producing decay. Many elderly people are
on medication that reduces salivary flow as a side effect.
Many of these people also have receding gums, which has
caused the exposure of the root surfaces of the teeth.
Those surfaces are extremely prone to the development
of decay under these circumstances. This condition is
known as root decay or root caries.
Normal salivary flow also helps to control the quantity
and type of bacteria that inhabit the mouth. The normal
flow of saliva has a rising effect and helps to wash away
bacteria. This helps to control the amount of bacteria
in the mouth. When this rinsing action no longer takes
place, bacteria tend to accumulate at a much higher rate.
In addition, certain bacteria become more opportunistic
when the mouth, which is intended to be moist environment,
becomes dry. These bacteria, if not properly removed through
normal brushing and flossing, can cause an increase in
inflammation of the gums. This usually presents itself
as swelling and bleeding of the gum tissue. An increase
in bacteria can also lead to an increase in the toxins
that they produce, which in turn can lead to bad breath.
What can be done to combat the effects of xerostomia?
First, it is extremely important to practice meticulous
home care. That means brushing at least twice a day and
flossing at least once a day. This will help to eliminate
the accumulation of bacteria and should include not only
the teeth but also the soft structures of the mouth such
as the tongue, gums and palate. Secondly, it may be prudent
to employ the use of an antimicrobial rinse In some cases,
it may be necessary to use a fluoride rinse to help reduce
the increased susceptibility someone with xerostomia would
have to the development of decay. For milder cases, sucking
on sugar-free lemon drops can help generate some added
salivary production. If necessary, there are products
available that help generate some salivary flow. There
are also artificial saliva products available to those
people who have completely lost the ability to produce
saliva.
If you have xerostomia, there are some steps you can take
to help minimize the damage it can cause. It is very important
to see your dentist regularly in order to help maintain
good oral health so that you can keep your teeth and gums
healthy for a lifetime. |
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9.
What is cracked tooth syndrome? - back
to top
You’re
enjoying a meal when you bite down and feel a sharp pain.
The tooth stops hurting so you continue to eat. Moments
later, as you continue to chew, you again feel the same
pain. You realize that you can no longer chew comfortably
on one side of your mouth and proceed to do all of your
chewing on the other side of your mouth. If this scenario
sounds familiar, you could have “cracked tooth syndrome”.
Teeth can develop cracks for many different reasons. One
of the most common causes of cracks developing in teeth
is the loss of too much coronal tooth structure. Coronal
tooth structure is that portion of the tooth that is visible
in the mouth. As a tooth loses coronal tooth structure
to decay and previous fillings, it weakens that portion
of the tooth that is still present. A filling does not
add strength to a tooth; it merely replaces what has been
lost. As a tooth’s structural integrity becomes
more and more compromised, the remaining tooth structure
becomes susceptible to forming cracks due to the stress
of normal chewing.
Another cause of cracks forming in teeth is the habit
of grinding or clenching. Most individuals that clench
or grind do so in a manner that creates lateral or shearing
forces on a tooth. When these habits are chronic, that
is, they are done on a regular basis, the tooth becomes
fatigued and cracks begin to develop. This is especially
prevalent in individuals that also have a history of dental
work.
Chewing on hard substances can also cause cracks to develop
in teeth. Many individuals enjoy chewing ice or eating
hard substances such as nuts or un-popped popcorn kernels.
When this occurs, all of the forces of chewing are directed
to one or two teeth. This excessive force, in combination
with the hardness of the material being chewed, can cause
cracks to develop.
Most cracks that develop in teeth cause discomfort through
mechanical irritation. When forces of chewing are placed
onto a tooth at the right angle, the cracked area moves
slightly, causing discomfort. This mechanical irritation
accounts for the discomfort in approximately 90% of cracked
teeth. When this occurs, a type of restorative procedure,
such as a crown or bonded onlay, is necessary to eliminate
the tooth’s symptoms. Occasionally, a crack in a
tooth will involve the pulp chamber of a tooth. The pulp
chamber of a tooth contains the nerves, blood vessels
and various cells which make a tooth living tissue. If
this has occurred, a root canal may be necessary in addition
to the crown or onlay, in order to eliminate the symptoms
the tooth has. If the crack in a tooth is vertical in
nature and travels down onto the root area of a tooth,
the tooth may need to be removed.
Cracks usually appear as hairline fractures, which may
not be visible to the naked eye. Cracks typically do not
show up on an x-ray. It usually takes a thorough evaluation
of all the teeth on an affected side of the mouth to determine
which tooth is the culprit. It is also important to note
that cracks in teeth typically get worse, not better,
so it is important to have your teeth evaluated at the
first sign of trouble, in order to try and avoid additional
procedures or possibly the loss of the tooth. |
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