Bonding:

Bonding is a “catch all” term that dentists and patients use to refer to the ability to make a tooth colored material “stick” to a tooth. A tooth consists of two basic layers; enamel and dentin. Tooth restorations such as crowns, veneers, inlays, onlays, bridges, and composite filling materials are made to stay in place by first placing a “bonding agent” on the tooth. These materials are very, very strong and long lasting. We pride ourselves on taking continuing education classes to be able to provide you with the latest choice of materials and “bonding agents” for long term success.

Crowns

Crowns are used in dentistry to cover the entire tooth. They provide strength and beauty to your smile. The choice of “what kind of crown” should I have placed will always be discussed with you. We do leucite reinforced glass ceramics (both pressed or CAD/CAM), feldspathic fired ceramics, lithium disilicate, zirconium oxide (pressed or layered to core), aluminum oxide and metal-ceramic and all metal crowns.

The consumer choices are overwhelming. Let us help you chose which material to use based upon your history, the level of esthetics your desire, the level of translucency, occlusal trauma history, strength, and parafunctional habits.

Dentures:

Dentures are not a replacement for missing teeth. They are a prosthesis to help you smile confidently and aid you in chewing. Complete dentures are one of the most complex prosthesis to make in dentistry. We will be happy to discuss the kind of denture that would be best for you. We do conventional dentures, dentures made to attach to mini implants, dentures made to attach to conventional implants and bar over dentures.

Partial Dentures:

Partial dentures are an economical means of replacing missing teeth in which some natural teeth remain to help support the prosthesis. They improve your esthetics, aid your ability to eat, and stabilize your remaining teeth from moving. We offer several different kinds of partial dentures, conventional partial dentures, Equipoise partial dentures, and Thermoplastic partials which are very cosmetic. The advantages and disadvantages of each will be discussed with you.

Fillings:

I do not think that there is a dentist who does not do fillings. However, there is a difference as to “how” the filling is placed. Once your filling is placed, we will always give your our post treatment assessment of your treatment.
We do the following kinds of fillings:

• Amalgams – Silver Fillings. Very limited use.
• Composite Resins – Very cosmetic, and very strong. Our material of choice in nearly all areas.
• Inlays and Onlays – Usually custom fabricated using porcelain. Very strong and cosmetic. Limited insurance coverage.
• Cast Gold – Very strong and long lasting. Not cosmetic. Limited to back teeth use

Veneers:

Veneers produce a beautiful cosmetic result with minimal tooth alteration. Your most visible teeth can undergo a natural and lasting change. Veneers may or may not require tooth shape alteration. Let us help your chose the kind of veneer that works best for you.

Lumineers:

Due to the heavy marketing by the DenMat Corporation, the general public has become very much aware of “Lumineers”. Lumineers are a brand of veneer porcelain that do an excellent job of masking unwanted colors and change the cosmetic look of your front teeth and best of all are not invasive. The treatment is reversible with no damage to your natural teeth. We are proud to be able to offer this service to you.

Whitening:

Teeth discolor for many reasons, including age, minerals, tobacco, antibiotics, foods and beverages, such as red wine and coffee and tea.
. One Hour/In-Office - Our updated bleaching system, Sapphire Whitening, removes stains and discolorations to whiten and brighten your smile. The process takes about an hour, and the results are immediate and dramatic--up to eight shades whiter! Very convenient for the busy individual!
. Take Home - Rembrandt, whitening requires the fabrication of trays that you place in your mouth at your convenience at home. Best of all, it is easy to maintain your whitening with one of our inexpensive touch up kits!

Bridges:

A bridge is designed to replace a missing tooth. When a space exists between two teeth it is necessary to fill the gap so that the teeth on either side don’t start to shift, tip out of alignment, or alter biting pressure. When a bridge is selected for treating a missing tooth, the two teeth next to the space are prepared under local anesthetic. An impression is taken prior to modifying the teeth; this is used to create a temporary bridge. The teeth are reduced and any decay is removed. Once the tooth is prepared a temporary bridge is made. Impressions are sent to our dental lab and a bridge (essentially 3 crowns in one unit) is made. The materials used are gold, porcelain or porcelain fused to metal. Two weeks following the appointment the permanent bridge is cemented in place. Special cleaning instructions will be given in order to access under the replacement tooth.

Inlays and Onlays:

Onlays and inlays are an alternative to placing a large filling or may be used as a conservative approach to treating a tooth that almost needs a crown. To prepare a tooth for an onlay a technique similar to a crown preparation is used. The area will be numbed to make the procedure comfortable. Any existing decay or failing restorative material will be removed. Impressions are taken to fabricate a temporary onlay and to send to our dental laboratory so that a permanent onlay can be made. Onlays may be made out of porcelain or gold.

Enamel Reshaping and Microabrasion Occasionally a minor enamel defect may distract from your smile. With a minimally invasive reshaping, the edge or your tooth can be recontoured or the enamel surface of your tooth can be changed to create a more cosmetic smile.

Gums and Supporting Bone

Of all of the dental problems we see in dentistry, diseases of the gums and the supporting bone are the most challenging because it requires the complete cooperation and behavior modification of the patient as well as bacteria and an individual’s response to that bacteria. We offer the following gum and bone services:

Crown Lengthening is required when it is necessary to place a finished crown and the margin of that crown is within 3 mm of the supporting bone. Teeth are often badly decayed or fractured requiring this treatment.

Frenectomy

A frenum is the soft tissue “flap” usually seen between your two upper front teeth. It is a muscle attachment attaching your lips to your face. Sometimes this attachment comes too close to the two front teeth. This acts as a “rubber band” between the two front teeth allowing them to separate. A frenectomy is done to remove these rubber band like forces.

Debridement

Some folks form a great deal of debris on their teeth either from poor oral hygiene or from failing to seek the care of a dentist or a hygienist for a long period of time. A “debridement” is a “super cleaning” designed to help get your gums healthy again!

Root Scaling

Your gum tissue sits around your teeth like a turtle neck sweater may sit around your neck. Your dentist and hygienist sometimes need to remove debris under the turtle neck where plaque and calculus allow gram negative bacteria to harbor. Your immune system knows the bacteria is there and reacts by creating a complex immune response that can cause you to lose bone around your teeth. Root Scaling removes this debris and helps to decrease your immune response and save the bone around your teeth.

Gum Tissue Grafting

Our gum tissue that sits directly around the tops of our teeth is referred to as epithelial tissue. It is made to act as a sort of “leather” guard around our teeth. It is tough tissue made to take abrasion. However, due to aggressive brushing, or very thin bone around the top of a tooth, this tissue may be inadequate. If this is the case, we will recommend this tissue be “autografted” (from yourself) to thicken the tissue to protect the bone around your teeth.

Root Surface Covering

Again, from habits such as aggressive brushing, an area around the surface of a tooth may expose the root of a tooth and make it look too long. Canines are especially prone to this.

Perio Protect

Many people who have a history of gum disease may not desire to have their condition treated with periodontal surgery. We offer a ‘non-surgical” solution to help treat periodontal problems without surgery using carbimide peroxide and Vibramycin antibiotics. More information may be found at http://www.perioprotect.com/index.asp.

Tooth Grinding

Tooth clenching and grinding can play an important role in your periodontal health. Long term grinding and clenching may cause your teeth to loosen, crack and make your teeth and muscles sore. We can help relieve the stress you place on your teeth and bone with several different kinds of mouth protectors.

Uneven Gums

An important factor in a “cosmetic” look is for your gum tissue of your front teeth to have an even appearance. If you have concerns about the cosmetic appearance of your gums, we can help!

Chronic Redness

A crown margin that is placed too close to the bone around a tooth, can cause “chronic redness” around a tooth. No amount of brushing and flossing or rinsing will remove it. If you have concerns, we can you solve this problem.

Tooth Removal

Try as we may, not every tooth can or should be saved. We have many years of experience to make this therapy as comfortable as possible. We are able to treat nearly all extractions in the office.
Oral Cancer Exams Signs of Early Stage Oral Cancer:
• A sore/lesion that doesn't heal in two weeks
• A lump or thickening in the cheek
• A white/red patch on gums, tongue, tonsils, mouth lining
• When something feels caught in the throat/sore throat
Facts:
• 30,000 new U.S. cases of oral cancer each year
• Oral cancer is the sixth most common type of cancer
• Fastest growing population: non-smoking females<40
• The mortality rate has been unchanged for 50 years
IT IS VERY CURABLE WITH EARLY DETECTION

Biopsies

It is always safe to send an unusual tissue sample to a pathology service “just to be safe” and to help make a definitive diagnosis. A “biopsy” does not insinuate that you have a malignant lesion. It is a tool that dentists and physicians use to aid in diagnosis.

Pericorinitis

Pericorinitis is soft tissue inflammation around your wisdom teeth. It is nearly always caused by bacteria that have established themselves because an area around a wisdom tooth cannot be kept clean. We can help you wish short term treatment to help get your comfortable and advise you how to make it go away forever.

Wisdom Teeth
There are many indications and contraindications for wisdom teeth removal. Remember, it is easier to remove them in your younger years. The older you get, the more difficult they are to remove!

Implants

An implant is quite simply an artificial root. Once placed into bone, your natural bone “grows” around the implant. How long this takes depends upon where the implant is placed in your mouth. There is no finer means of replacing a missing natural tooth than using an implant. We would love to spend time teaching you all about this great service!

Sinus Lifts

Often your maxillary sinus position prevents the proper placement of an implant in your upper arch back teeth areas. Fortunately, the sinus is made much like a balloon, and can be “lifted” and bone grafted into this space to create room to get the implants your desire!

Bulimia Nervosa

Bulimia is characterized by compulsive overeating or binging followed by self-induced vomiting, and produces signs and symptoms that can be detected in the mouth during a routine oral exam. The anorexic patient achieves extreme weight loss by severely limiting calorie intake, but the oral signs in both patients may consist of dry mouth, reddening of the palate and dry, chapped lips.

The repeated vomiting, in addition to these symptoms, which is a common characteristic of both disorders, exposes teeth to gastric acids which erode tooth enamel, the hard protective tooth covering. Teeth may become rounded and soft or fillings may protrude above the tooth's surface.Eating disorders often can be successfully treated when detected early.

Canker Sores

Canker sores, also known as aphthous stomatitis, are among the most common causes of painful sores in the mouth. From 20%-40% of the U.S. population have them at some point in their lives. The peak incidence occurs among people in adolescence and young adulthood. They become less frequent as we get older. They are not contagious. Canker sores are not the same thing as cold sores. Cold sores ("fever blisters") occur on the outer lip, whereas canker sores are found inside the mouth. These lesions can be painful and are easily treated.

Cold Sores

Cold sores are small, painful, fluid-filled blisters or sores that appear on the lips, mouth, or nose that are caused by a virus. The sores can be painful and usually last a few days. Unlike most viral infections, the cold sore virus is not completely eliminated by the body defenses. For this reason, cold sores often recur. Ask us if you need help treating this contagious and sometimes painful condition.

Facial Pain and TMJ

Nearly 80% of facial pain and migraine headaches are caused due to facial muscle imbalances. We can help you relieve these symptoms with dental appliance therapy.

Cuts and Lacerations

Accidents happen! When they do, please call us at 724-869-0446 or 724-935-8236 and allow us to help you with your emergency!

Infections

Dental infections are still one of the most common infections. The diagnosis can sometimes be very difficult as well as the treatment. The kind of bacteria that causes the infection as well as the “length of time” the infection has been present all determines how the infection should be treated. We can help!

Diabetes

Diabetes causes changes to the blood supply to the tissues in the oral cavity. It causes the mouth to be dry and response to infections will be altered. If you have Diabetes, we would like to help you with your oral care!

If you, a loved one, or your child has a fear of dentists, including dental anxiety or severe dental phobia, it is best to contact a dentist or pediatric dentist in your area to discuss your treatment alternatives. Sedation dentistry now enables fearful patients to attend their appointments and receive the treatment they need.

Walkmans

Bring your Walkman, favorite CD player, iPod, MP3 player and listen to your favorite music while we work! It helps your relax and is the simplest means of getting you to relax.

Ibuprofen Use

Although there are generic forms of Ibuprofen, we prefer ADVIL, 400mg taken one hour prior to your dental appointment. It helps to reduce your feelings to any discomfort.

Anxiety Control

It is estimated that approximately 30 to 40 million Americans avoid seeing the dentist because of dental anxiety or dental phobia (fear of dentists). People with dental anxiety have fears that are often greatly exaggerated and overwhelming. Severe dental phobia is a more serious condition, causing those affected to cancel or avoid their dental appointments altogether. Various sedation dentistry techniques can be used to treat those who suffer from dental anxiety or dental phobia.

Oral sedative medications such as diazepam or triazolam can be given to a patient the night before a dentistry procedure or 30 minutes to an hour before the dental appointment, depending on the severity of the anxiety. Oral sedatives do not provide pain relief, so an injection of local anesthetic will also be administered.

Midlevel Sedation (Also referred to as Conscious Sedation)

Moderate dental sedation can refer to either nitrous oxide, sedation utilizing greater doses of anxiolytic medications such as triazolam or IV sedation. These sedatives can induce conscious sedation, where the patient will be awake and able to respond to commands, but will be in a state of extreme relaxation.

Nitrous Oxide

In one form of conscious inhalation sedation, nitrous oxide gas (also known as laughing gas) is used to induce a state of relaxation. A local anesthetic will be administered in combination with nitrous oxide sedation to eliminate pain.

Clear Correct
Is a licensed orthodontic treatment for adults. It utilizes a series of thin clear plastic trays to direct the teeth into their most perfect position. The average treatment time is about 12 months.

Inquiries regarding this technique can be directed to any TEAM member or to Dr. Feduska @ mybestsmile.net. Also, you can click onto www.clearcorrect.com for more info.

PowerProx Six Month Braces

Is a licensed orthodontic treatment that offers adults the opportunity to correct crooked “front teeth”, both top and bottom. It utilizes new technology braces and nickel-titanium wires that offer a constant force to move the front teeth into their most perfect position. The average treatment time is just 6 months! You can access more information at www.sixmonthbraces.com.

Phase I Straight Wire Orthodontics

Patient age range is 6 - 12 years. This is an interceptive orthodontic technique that is used to correct dental (tooth) and/or skeletal (bone) problems that can be diagnosed as early as 3 years old. It includes misaligned upper and lower jaws, and crowded crooked teeth.

The treatment utilizes interceptive orthodontic techniques. This requires wearing appliances (a common one is an expander) to develop and direct growth where it is deficient. Once the skeletal corrections are made, the dental corrections are addressed. This involves wearing braces on the permanent teeth to align these teeth into their most perfect position. Retainers are then worn until the remaining permanent teeth erupt. Then the patient is evaluated for Phase II orthodontics.

This technique usually provides enough correction that when the remaining permanent teeth erupt, there is enough room and the extraction of permanent teeth is avoided.

Phase II Straight Wire Orthodontics

This is a comprehensive treatment of the permanent teeth. It can begin as early as 11 yrs. old and there is no age limit. It is a full braces technique that may require some Phase I, interceptive appliances (expanders) prior and others during the treatment in order to
develop the the arches and align the teeth into their most perfect, stable position. We utilize the new Carrie X bracket that eliminates the need for elastics, and is proven to shorten the treatment time and the number of office visits.

Teething

FIVE SIGNS YOUR BABY IS TEETHING

• Bulging gums – you can actually see the outline of the teeth as they are bulging inside the gums. The middle bottom teeth are usually the first place this happens.
• Drooling – it will seem like someone left a "drool faucet" on inside your baby's mouth.
• Fussing – baby often will become cranky and more difficult to console.
• Night waking – most babies sleep fairly well between one and four months of age, but now the honeymoon is over! Beginning around four months of age, baby may start waking up much more frequently at night.
• Biting – baby will start chewing on everything he can get his hands, or gums, on – his fingers, your fingers, toys, and especially the breast.

REMEDIES FOR TEETHING

• Anything cold – here are a variety of cool favorites:
• Frozen teething rings
• Ice – rub an ice cube along baby's gums.
• Frozen juice slushy or popsicle
• Cold spoons
• Frozen bagel or banana
• Frozen washcloth

Medications

• Acetaminophen or Ibuprofen – these are both safe and effective pain relievers to help your baby, and you, get some sleep. Click on these for dosing.
• Teething gels– there are various over-the-counter gels, pastes, or liquids that numb the gums. Pat the gums dry with a washcloth, then apply a small amount only on the area of the gums that is bulging. There are several drawbacks to these, so we suggest you only use them as a last resort:

1. They taste terrible
2. They travel throughout the mouth in the saliva and can numb the tongue and lips
3. It is easy to use too much
4. Baby may swallow too much

FOUR TEETHING SYMPTOMS THAT ARE HARMLESS
There are several symptoms most babies exhibit during teething. DON'T WORRY. These are only temporary.

• Drool rash – your baby may get a red, raised rash on the face, lips, chin, neck, and chest. Gently wash with warm water and pat dry. A lanolin ointment is a good treatment.
• Diarrhea – this is generally mild and does not require any special treatment.
• Cough – the abundance of saliva often drips down baby's throat and can cause coughing or gagging.
• Fever – baby may experience low-grade fevers less than 101. If your baby has a fever higher than this, click on fever for more info.

Behavior Management Many children are calm, comfortable and confident in a dental office. The office is designed for families and children. Our staff understands that we chose to treat children Sometimes, however, a child feels anxious during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective technique to calm a child's fear of the dental visit. Our office offers several agents used in midlevel sedation. During your new patient visit, we will explore sedation options based on your child's age, level of anxiety, amount of dental work, and length of the appointment.

• Nitrous Oxide
• Midlevel (Conscious) Sedation
• Calming the Anxious Child

Infants Teeth

Childhood caries (cavity formation ) is still one of the most common childhood diseases. Primary teeth not only serve to help your child chew, they also serve to “hold space” for the future development of their permanent dentition. We pride our services we can provide utilizing both preventive and restorative options to make your child’s dental development a pleasant one.
Often parents don't think primary (baby) teeth are important since they are lost anyway. But primary teeth need the same care as permanent teeth for chewing, good speech, habits for appearance, and to preserve space for the permanent teeth.

A Child’s First Dental Visit

The child's first visit is important for several reasons. In many instances, it is the child's first experience with dentistry; in some cases, the child has had a previous unpleasant experience. Emergency problems will be dealt with first, and if your child is in pain, we will do our best to alleviate it. If there are no emergency problems, we will examine your child's mouth ( lips, cheeks, tongue, floor of the mouth, tonsil area, hard and soft palate), check the growth and development of the head, and check the teeth and gums. The child will receive a thorough cleaning and topical fluoride treatment, and we will take such x-ray films as necessary. We will evaluate any tongue lip, cheek, or thumb habit that may influence the development of attractive teeth. We will also examine your child to see how active his or her organized bacteria are at producing dental disease. After this has been completed, there will be a consultation during which we will present our findings and recommendations. Because this first visit is easy and enjoyable, it helps to overcome many of the fears that the child has acquired, and the child becomes acquainted with dentistry in a pleasant manner.

Fluoride

The tooth is made more resistant to decay by the use of fluoride. Fluoride is a mineral like calcium or sodium. When used on a tooth makes the enamel more decay resistant. The best way to do this is by fluoridating the drinking water.

X-Rays

We feel it is our obligation to give the child patient the very best in dental care. To accomplish this goal we must have at our command all diagnostic aids, including x-rays. Looking at the teeth alone without x-rays misses over 60% of dental decay. A tooth may even be abscessed without evidence of pain or swelling. Only an x-ray can show this to us. As far as safety, we utilize minimum radiation dosage, protective lead aprons, and the most modern equipment available.

Importance of Primary Teeth

Because primary teeth, also called baby teeth, are eventually replaced by permanent teeth, many people don't realize that they are, in fact, very important for a child's long-term dental health.

Normally, some of the primary teeth remain in the mouth until a child is eleven or twelve. During this time, they serve as space maintainers and ensure that the permanent teeth are properly aligned as they grow into the mouth. Early loss of primary teeth often causes misalignment of the permanent teeth and may even alter normal facial development. Expensive orthodontic solutions may be necessary to correct these problems.

Children need strong, healthy teeth to chew their food. Cavities and tooth loss can make it impossible for a child to eat properly, which affects her overall level of health. Speech development can also be affected by premature tooth loss. In combination, these problems may lower a child's self-esteem during her important formative years.

As you can see, primary teeth are critically important for a child's health and development. It's important to keep them in the mouth as long as possible by practicing excellent oral hygiene and treating problems early.

Eruption of Teeth Permanent teeth which consist of 32 teeth completely erupt by the age of 18-25, the first in the sequence to erupt being the 1st Molar(6-7 yrs) and the last to erupt is the 3rd Molar(18-21 yrs).

The anterior teeth or the incisors mainly the mandibular erupt lingually to that of the deciduous, and the posteriors which are the Premolars erupt from below the deciduous molars which are the predecessors of the Permanent premolars.

The Permanent teeth dissolve the roots of the Deciduous teeth with the help of cells called osteoclasts which dissolve the dentin and the pulp of the root and as the Permanent teeth erupt push the Deciduous teeth out of the alveolar bone sockets.

The sequence of eruption of the permanent teeth is different in the mandible and the maxilla, the change seen due to the canine.

Importance of Good Diet

To prevent cavities and maintain good oral health, your diet - what you eat and how often you eat - are important factors. Changes in your mouth start the minute you eat certain foods. Bacteria in the mouth convert sugars from the foods you eat to acids, and it's the acids that begin to attack the enamel on teeth, starting the decay process. The more often you eat and snack, the more frequently you are exposing your teeth to the cycle of decay.

Mouth-Healthy Foods and Drinks

The best food choices include cheeses, chicken or other meats, nuts, and milk. These foods are thought to protect tooth enamel by providing the calcium and phosphorus needed to remineralize teeth (a natural process by which minerals are redeposited in tooth enamel after being removed from enamel by acids).

Other food choices include firm/crunchy fruits (for example, apples and pears) and vegetables. These foods have a high water content, which dilutes the effects of the sugars they contain, and stimulate the flow of saliva (which helps protect against decay by washing away food particles and buffering acid). Acidic foods, such as citrus fruits, tomatoes and lemons, should be eaten as part of a larger meal to minimize the acidic environment to which your teeth and mouth must be exposed.

Poor food choices include candy - such as lollipops, hard candies, and mints -- cookies, cakes, pies, breads, muffins, potato chips, pretzels, french fries, bananas, raisins and other dried fruits. These foods contain large amounts of sugar and/or can stick to teeth, providing a fuel source for bacteria. In addition, cough drops should be used only when necessary as they, like sugary candy, contribute to tooth decay because they continuously coat the teeth with sugar.

The best beverage choices include water (especially fluoridated water), milk, and unsweetened tea. Limit your consumption of sugar-containing drinks, including soft drinks, lemonade, and coffee or tea with added sugar. Also, avoid day-long sipping of sugar-containing drinks - day-long sipping exposes your teeth to constant sugar and, in turn, constant decay-causing acids.

Sugar Substitutes and Sugar-Free Products

Sugar substitutes are available that look and taste like sugar; however, they are not digested the same way as sugar, so they don't "feed" the bacteria in the mouth and therefore don't produce decay-causing acids. They include: erythritol, isomalt, sorbitol and mannitol. Other sugar substitutes that are available in the U.S. include saccharin, aspartame (marketed as Equal), acesulfame potassium (marketed as Sunett), and sucralose (marketed as Splenda).

Sugarless or sugar-free food sometimes simply means that no sugar was added to the foods during processing. However, this does not mean that the foods do not contain other natural sweeteners, such as honey, molasses, evaporated cane sugar, fructose, barley malt or rice syrup. These natural sweeteners contain the same number of calories as sugar and can be just as harmful to teeth.

To determine if the sugarless or sugar-free foods you buy contain natural sweeteners, examine the ingredients label. Words that end in '-ose' (like sucrose and fructose) indicate the presence of a natural sweetener. On the label, look under sugars or carbohydrates.

Is Chewing Gum OK?

Chewing sugarless gum is actually beneficial to your teeth as chewing helps dislodge food that becomes stuck to your teeth and also increases saliva flow to buffer (neutralize) mouth acids. Gums that contain the sugar substitute xylitol even reduce cavities

Baby Bottle Cavities

Decay in infants and children is called baby bottle tooth decay. It can destroy the teeth and most often occurs in the upper front teeth. But other teeth may also be affected.

What causes baby bottle tooth decay?

Decay occurs when sweetened liquids are given and are left clinging to an infant's teeth for long periods. Many sweet liquids cause problems, including milk, formula and fruit juice. Bacteria in the mouth use these sugars as food. They then produce acids that attack the teeth. Each time your child drinks these liquids, acids attack for 20 minutes or longer. After many attacks, the teeth can decay.
It's not just what you put in your child's bottle that causes decay, but how often — and for how long a time. Giving your child a bottle of sweetened liquid many times a day isn't a good idea. Allowing your child to fall asleep with a bottle during naps or at night can also harm the child's teeth.

How can baby bottle tooth decay be prevented?

Sometimes parents do not realize that a baby's teeth can decay soon after they appear in the mouth. By the time decay is noticed, it may be too late to save the teeth. You can help prevent this from happening to your child by following the tips below:

1. After each feeding, wipe the baby's gums with a clean gauze pad. Begin brushing your child's teeth when the first tooth erupts. Clean and massage gums in areas that remain toothless, and begin flossing when all the baby teeth have erupted, usually by age 2 or 2½.
2. Never allow your child to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquids.
3. If your child needs a comforter between regular feedings, at night, or during naps, give the child a clean pacifier recommended by your dentist or physician. Never give your child a pacifier dipped in any sweet liquid.
4. Avoid filling your child's bottle with liquids such as sugar water and soft drinks.
5. If your local water supply does not contain fluoride (a substance that helps prevent tooth decay), ask your dentist how your child should get it.
6. Start dental visits by the child's first birthday. Make visits regularly. If you think your child has dental problems, take the child to the dentist as soon as possible.

Initial Exam

Your initial exam includes a visual examination, charting, periodontal probing, diagnosis and treatment recommendations. We may also recommend X-rays. The kind of X-rays we will recommend depends upon our initial examination.

What is Dental Plaque?

Dental plaque is a complex mix of many kinds of bacteria that form biofilm on your teeth. The kinds and quantity of bacteria vary from person to person. Leaving plaque on your teeth can lead to cavity formation as well as loss of bone around your teeth.

Brushing

Our hygienists will help teach you the best means to clean your teeth. The right kind of brush as well as toothpaste are important to help you keep your smile at its best!

Chosing the right Toothbrush With so many shapes, sizes and styles of toothbrushes on the market, deciding which kind to buy can be confusing. Our hygienists will recommend the type of brush best suited for you . Here are some simple tips:

• Always chose a soft bristle brush
• Hard to reach back teeth are reached better with a smaller head on the brush
• The best brush is the one that fits your mouth the best
• A hygienist should recommend the bristle shape best for you

Mechanical Toothbrushes

A battery powered toothbrush is a good alternative. It can do a better job of cleaning teeth, particularly for those who have difficulty brushing or who have limited manual dexterity. Before investing in a battery brush, talk to our hygienists first.

Water Piks

We recommend Water Piks only to remove large gross debris for patients who have may have areas that trap food easily such as an orthodontic patient in treatment. A Water Pik is never a substitute for good brushing and flossing habits. We do recommend it to clean difficult spaces between teeth also.

Toothpaste Choices

Wow! Talk about confusing! Have you been to the grocery isle recently? There are a million choices!!! Simplify your life. Talk to our hygienists and dentists about your dental history. We will recommend a specific choice for you!

Fluoride Treatments Fluoride alters the surface of a tooth to make it more resistant to decay. Fluoride treatments are not just for young patients anymore. We recommend fluoride for:

• Patients with developing dentitions
• Patients who are prone to cavity formation
• Patients whose teeth are sensitive
• Patients whose medications make their mouth dry
• Senior citizens
• Patients with exposed root surfaces

Home Fluoride Use

Many over the counter fluoride rinses are available. They all contain fluoride as 1000 parts per million. The brand does not matter. Supplemental fluoride rinses are effective to help young children who are cavity prone fight decay as well as for senior citizens and patients suffering from dry mouth.

Other forms of home fluoride are available by prescription only. These will be recommended for you based upon your dental history and needs.

Flossing is the most effective means of removing plaque between your teeth. Brushing alone only removes about 85% of your plaque in your mouth. Let our hygienists recommend the proper floss technique, the right kind of floss for you, and any flossing aids that will make the job easier! Failure to floss leads to gum disease and cavities between your teeth. Flossing not only removes plaque, it introduces oxygen to your gums that also kills bacteria that cause gum disease.

What kind of floss to use can be just about as confusing as what kind of toothpaste to brush with. It is best to work with your hygienist to determine what floss is best for you. Here are some tips:

• Waxed floss does not break as easy.
• Unwaxed floss tends to shread easier.
• If your floss gets stuck, pull it straight through your teeth, not upwards.
• If your floss shreds between your teeth, you may have decay of an ill-fitting filling
• Many floss aids are available
• Glide floss is very strong

Mouth Rinses

Like purchasing toothpaste, the choice as to what kind of mouthrinse to use is just as confusing. Generally, alcohol based mouthrinses “burn” or sting when you use them. We recommend rinses that help kill bacteria not just “perfume” your breath. A mouth rinse should be used as a supplement to your oral care, not a substitute for good brushing and flossing. Let our hygienist recommend a rinse that is best for your needs.

Sealants

Placement of sealants..... typically produce a 60% reduction in decay onthe chewing surfaces of posterior teeth of children.
A dental sealant is a safe plastic like material that is painted on to the chewing surfaces of the back teeth (molars and premolars) and acts like a physical barrier to help "seal out" germs and food that cause tooth decay and destroy tooth structure.

18% of 2-4 year olds have tooth decay... by age 17, 78% of children will have experienced dental disease with 7% losing at least one permanent tooth. 88% of children cavities are pits and fissure cavities...fluoride is not as effective in this area as on the smooth tooth surfaces. Tooth susceptibility to cavities remains the highest in molars.

Tooth structure is lost every time a tooth is filled or a filling is replaced, which occurs every 6-8 years. Eight-four percent of cavities in 5 to 17 year olds are on tooth surfaces.

As long as the sealant remains intact, food particles and bacteria cannot penetrate through a sealant to cause decay.
Sealants are 100% effective in reducing tooth decay as long as the sealants remain intact and will last for 15 years or longer with a good follow-up program. Sealants need to be repaired and restored to continue to be beneficial, however only 2-4% of all sealants placed need some form of repair over the lifetime of the tooth. This repair usually occurs during the first year.
Sealants are a painless, effective, safe, easy to apply, long-lasting and cost effective treatment.
Children and teens ages 5 to 15 benefit most from dental sealants because molars erupt during this period. However, less than 20% of children l5-17 have dental sealants.

Sealants act as a barrier, protecting enamel from plaque and acids. They should be applied to newly erupted, permanent teeth in order to receive the greatest benefit for cavity prevention.

Denture and Partial Denture Care An effective way to keep your denture clean, fresh and odor-free is to both brush AND soak daily. A range of products exists, so it is best to discuss your needs with our hygienist to help choose the cleaning and freshening routine that’s best for you. These include effervescent tablets for soaking in as little as three minutes or overnight and foams for a totally new brushing experience and feeling of lasting freshness.

• Always rinse your denture/partial in water first to remove loose food particles.
• Rinse over a water-filled sink to prevent breakage if dropped.
• When you brush, use a toothbrush with soft bristles to avoid scratching and damaging denture material.
• Dentures and partials should be cleaned daily to help keep your breath feeling fresh and your smile as sparkling clean as possible.
• After soaking, rinse your dentures with running water. Do not place tablets or tablet solution in mouth.

Some additional tips:

• In addition to brushing any remaining natural teeth, also brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.
• The easiest way to get effective cleaning power is to add a denture tablet to the water you soak your dentures in every night.

Daily use of a denture cleanser helps:

• Clean food particles from crevices and between dentures
• Remove plaque and odor-causing film
• Eliminate bacteria that can cause denture odor
• Provide added confidence around others

Whether you prefer a quick soak (in as little as three minutes) or soaking overnight, you'll find a product that's right for you.
Denture Adhesives No matter how well your dentures are made or how ideal their initial fit, the fit may change over time. Weight loss or gain, or an overly thin ridge of supporting bone, or a change in medications that may dry your mouth, may also affect denture fit.

A denture adhesive can help maintain denture stability and confidence.

Use denture adhesive strips for strong, all-day hold without the messy ooze.

An adhesive will also help to keep out food particles between the denture and the gum to prevent gum irritation. New denture wearers may benefit from using an adhesive during the period of adapting to wearing a denture if your gums are tender and sensitive. If the denture is loose as your mouth adapts to the fit of the new denture, an adhesive can provide added security.
In summary, a denture adhesive can offer many advantages:

• Increases the amount of "biting force" you can exert by up to 38%*. This means you can enjoy more of your favorite foods like apples, steak and corn on the cob
• Holds securely all day, up to 16 hours
• Improves denture fit
• Provides added comfort and helps to make dentures feel more natural in the mouth
• Help seal out annoying food particles and alleviate gum irritation they cause
• Helps control denture odor**

When you're not wearing your dentures:

• Store them in a water-filled container to prevent them from drying out.
• Never use hot water as it can warp your dentures.
  

Athletic Mouthguards It is estimated by the American Dental Association that mouthguards prevent approximately 200,000 injuries each year in high school and collegiate football alone.

A properly fitted mouthguard must be protective, comfortable, resilient, tear resistant, odorless, tasteless, not bulky, cause minimal interference to speaking and breathing, and (possibly the most important criteria) have excellent retention, fit, and sufficient thickness in critical areas.

Unfortunately, the word "mouthguard" is universal and generic, and includes a large range and variety of products, from "over the counter" models bought at the sporting goods stores to professionally manufactured and dentist prescribed custom made mouthguards.

Presently, over 90% of the mouthguards worn are of the variety bought at sporting good stores. The other 10% are of the custom made variety diagnosed and designed by a health professional (dentist and/or athletic trainer).

There are four types of mouthguards presently available, listed from least to most effective

• Stock Mouth guards
• Boil and Bite Mouth Guards
• Vacuum Formed Custom Made by a dentist
• Pressure Laminated made by a dentist

Dry Mouth….Or Xerostomia.

Xerostomia is not a disease but can be a symptom of certain diseases. It can produce serious negative effects on the patients quality of life, affecting dietary habits, nutritional status, speech, taste, tolerance to dental prosthesis and increases susceptibility to dental caries. The increase in dental caries can be devastating in many patients and therefore special care must be made to control this condition.

Causes for Xerostomia include:

• Medications - Several hundred current medications can cause xerostomia. These include antihypertensives, antidepressants, analgesics, tranquilizers, diuretics and antihistamines c.
• Cancer Therapy - Chemotherapeutic drugs can change the flow and composition of the saliva. Radiation treatment that is focused on or near the salivary gland can temporarily or permanently damage the salivary glands.
• Sjogren's syndrome - An autoimmune disease, causes xerostomia and dry eyes.
• Other conditions -such as bone marrow transplants, endocrine disorders, stress, anxiety, depression, and nutritional deficiencies may cause xerostomia.
• Nerve Damage - Trauma to the head and neck area from surgery or wounds can damage the nerves that supply sensation to the mouth. While the salivary glands may be left intact, they cannot function normally without the nerves that signal them to produce saliva.

Treatment:

1. Identify the xerostomic condition and the cause. Some of the causes may be ameliorated and this will aid therapy. But in many situations, it will be difficult to eliminate the causes. Thus, it will be necessary for the Dentist to control the results of xerostomia. This is especially true about the increase in dental caries.
2. Palliative treatment can be used but does not cure the condition:

• pilocarpine (Salagen) 5mg, qid, prescription required.
• special food preparation - blended and moist foods are easier to swallow artificial saliva (available over-the-counter).
• sipping plain water is usually preferred over artificial saliva by most patients.
• Biotene brand, over-the-counter, dry mouth products (toothpaste, alcohol- free mouth rinse and Oralbalance lubricating gel).
• avoidance of alcohol-based mouth rinses
• use of water and glycerin mixed in a small aerosol spray bottle.
  

Bad Breath……also known as Halitosis There are a number of possible causes of bad breath. Below are listed some possible causes of a bad breath conditions.

Medical Causes of Bad Breath

1. Sinus infections & abnormal sinus anatomies, post nasal drainage (drips)
2. Tonsilar infections or tonsiloliths
3. Lung diseases
4. Kidney diseases
5. Liver diseases
6. Blood disorders
7. Diabetes
8. Gallbladder dysfunction
9. Menstruation
10. Carcinomas
11. Certain foods

Dental Causes of Bad Breath

1. Extensive dental decay
2. Periodontal (gum) disease
3. Oral infections or abscesses
4. Oral cancers
5. Xerostomia (dry mouth condition). Many medications can contribute to a condition of xerostomia.
6. Oral conditions resulting from post-nasal drips or discharges
7. Allergy conditions
8. A proliferation of specific types of gram (-) anaerobic bacteria.

Tobacco Cessation As healthcare professionals we do not approve of the use of tobacco in any form. There are a number of medications available to help you as well as a number of websites loaded with advice and information. We are willing to help you with any tobacco use concerns you may have.

Oral Piercing If you are considering piercing your tongue, lip or check consider these facts first:

This procedure can present considerable dental and medical risks. The dental dangers may be directly related to size of the piercing and the length of time worn.

Please consider the following risks:

• Infection of the tongue due to an oral wound. The mouth is teeming with bacteria.
• Prolonged bleeding from hitting one of the tongue’s blood vessesls
• Swelling and Possible nerve damage.
• Transmission of Hepatitis B, C, D and G as well as syphilis, tetanus and tuberculosis.
• Blood poisoning, septicemia, AIDS, and staph infections.
• Endocarditis, a serious inflammation of the heart valves or tissues.

This is especially prevalent in people with heart abnormalities.

Infection Control Because all infected patients cannot be identified by history, physical examination, or readily available laboratory tests, the following recommendations should be used routinely in the care of all patients in dental practices. This protects not only the practitioner, but also the patient.

• Medical History
• Use of Protective Attire and Barriers
• Proper Hand Washing
• Use and Care of Sharp Instruments
• Use of high-level disinfection of surfaces and instruments
• Use of sterilization of instruments
• Disinfection of Surfaces
• Decontamination of laboratory supplies
• Proper disposal of biohazard waste
• Use of ultrasonic instrumentation
• Use of water retraction valves on water supplies

Recommended practices may be viewed at http://www.cdc.gov/mmwr/preview/mmwrhtml/00033634.htm

Latex Allergy This website is designed to provide educational materials, publications and product information to assist you with your understanding of natural rubber latex allergy. http://www.latexallergyresources.org/

Soft Drinks/Sports Drinks Did you know that consuming some everyday foods and drinks can lead to a condition where your tooth enamel can be more easily worn away, resulting in some undesirable effects on your teeth?

Many of the foods and drinks that we associate with a modern diet, including wine, many fruits, fruit tea and balsamic vinegar contain acids that temporarily soften tooth enamel and can lead to a condition called acid erosion. Soda Pop, including diet sodas, and sports drinks may make your teeth sensitive and more prone to cavity formation.

Pregnancy and Your Teeth About half of women experience pregnancy gingivitis. This condition can be uncomfortable and cause swelling, bleeding, redness or tenderness in the gum tissue. Conversely, a more advanced oral health condition called periodontal disease (a serious gum infection that destroys attachment fibers and supporting bone that hold teeth in the mouth) may affect the health of your baby.

Periodontal disease linked to preterm low birthweight babies?
Studies have shown a relationship between periodontal disease and preterm, low birthweight babies. In fact, pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small. The likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin. Very high levels of prostaglandin are found in women with severe cases of periodontal disease.

What if I'm diagnosed with periodontal disease during pregnancy?

If you're diagnosed with periodontal disease, your periodontist might recommend a common non-surgical procedure called scaling and root planing. During this procedure, your tooth-root surfaces are cleaned to remove plaque and tartar from deep periodontal pockets and smooth the root to remove bacterial toxins. Research suggests that scaling and root planing may reduce the risk of preterm births in pregnant women with periodontal disease. The added bonus is that the procedure should alleviate many of the uncomfortable symptoms associated with pregnancy gingivitis, such as swelling and tenderness of the gums.

As you make your way through the “to-dos,” remember to check off a visit to the dentist or periodontist. This baby step benefits you and your unborn baby.

Premature births: the answers can't come soon enough
According to the March of Dimes, premature births have soared to become the number one obstetric problem in the United States. Many premature babies come into the world with serious health problems. Those who survive may suffer life-long consequences, from cerebral palsy and mental retardation to blindness.

The March of Dimes has launched a $75 million, five-year campaign to raise public awareness and reduce rates of preterm birth and increase research to find the cause. Until all of the answers are in, the March of Dimes recommends the following to reduce the risk and/or effects of a premature birth:

• Consume a multivitamin containing 400 micrograms of the B vitamin folic acid before and in the early months of pregnancy.
• Stop smoking.
• Stop drinking and/or using illicit drugs, or prescription or over-the-counter drugs (including herbal preparations) not prescribed by a doctor aware of the pregnancy.
• Once pregnant, get early regular prenatal care, eat a balanced diet with enough calories (usually about 300 more than a woman normally eats), and gain enough weight (25 to 35 pounds is usually recommended).
• Talk to your doctor about signs of premature labor, and what to do if you show any of the warning signs.

Senior Citizen Dental Care As we age, many of our normal functions slow, including our salivary flow. In addition, many medications can cause dry mouth.

During our lifetimes, many senior citizens may have had a history of gum disease that exposes root surfaces. The combination of a dry mouth and exposed root surfaces makes senior citizens much more prone to decay and tooth loss. During our senior years, it is extremely important that our senior citizens receive regular dental care.

X-rays Our practice uses digital dental x-rays. This type of x-ray vastly reduces the amount of radiation necessary to expose an image. Digital x-rays also provide instant feedback for patients. X-rays are extremely safe. You would need to literally take nearly 5000 dental x-rays to cause any concern. If you have concern over the safety of x-rays we will be happy to discuss your concerns with you. We take only the x-rays necessary to provide a proper diagnosis, and only take them based upon your dental history.

Sensitive Teeth This is quite literally the most common complaint that we hear in our practice. Diagnosing the cause of sensitive teeth can be difficult. Sensitive teeth can become quite annoying and make enjoying many foods and drinks difficult. Tooth sensitivity is caused by a number of problems. The following describes causes, gives diagnosis tips, and presents possible solutions. Should the problem persist, you should see us for help.

Receded gum tissue is one of the most common causes of tooth sensitivity. Exposed root surfaces have no enamel and are much more sensitive to temperature.
Causes include periodontal disease (gum disease), toothbrush abrasion, malocclusion (bad bite), teeth grinding, frenum pull, poor oral hygiene, cracked tooth syndrome, and consumption of acid foods such as soda pop and sports drinks.

Sensodyne or other sensitivity toothpastes work well after about two weeks of use in most cases. However once treatment is stopped the sensitivity often returns. Dentists have a host of desensitizing medicaments that have improved recently and are quite effective. If the tooth is notched or worn a filling is often indicated as well. Severe recession may need a gingival graft procedure to help replace lost gum tissue.

It is important that your dentist treat tooth decay, tooth grinding (bruxing), and gum disease that may expose your tooth dentin to the environment.

Nutrition and Your Teeth The foods that you eat come in contact with the germs and bacteria that live in the mouth. If you don’t brush, plaque will accumulate on the teeth. Plague thrives on the starches and sugars that are found in a great deal of foods. When plaque combines with the sugars and starches, an acid is produced that attacks enamel on the teeth, and eventually causes decay. According to the American Dental Association, the acid attacks the teeth for 20 minutes or more.
Choosing a healthy diet may sound easy, however, fruits, milk, cereals, bread and some vegetables contain sugars and / or starches. Carbonated sodas, sweet fruit drinks and sugary snack foods should be limited.

You don’t have to avoid these foods, just keep in mind that you should eat a balanced diet, brush your teeth twice a day and floss daily.

Eating Tips

• Drink plenty of water, avoid sodas and sport drinks
• Eat a variety of healthy foods from the five major food groups
• Cut down on snacking in between meals
• Limit snacks and drinks that are high in sugar
• Brush twice a day
• Floss Daily
• Visit your dentist for regular exams

While eating healthy foods and avoiding snacks and drinks that are high in sugar are good ways to prevent cavities, a good dental regime is essential in maintaining healthy teeth and gums. Plaque can be removed by brushing and flossing thoroughly and your dentist can detect any signs of early decay. If you have a severe sweet tooth, try starting out by replacing one snack a day with healthy choices.

Knocked out Teeth

First Aid for Knocked Out Tooth Step #1: Save the Tooth

Save the tooth that was knocked out. Hopefully you didn't swallow it!

First Aid for Knocked Out Tooth Step #2: Clean the Tooth Without Damaging It

Only hold the tooth by the crown and not the roots. You don't want to damage the tooth roots.

Do not scrape or rub dirt off of the tooth. You can severely damage a tooth by scraping the blood and dirt off of it.
Dip the tooth in a bowl of warm tap water. NEVER rinse a tooth under running water or you will damage it.

First Aid for Knocked Out Tooth Step #3: Place Tooth Back in the Mouth

The not so fun part comes now. You have the tooth dirt free and now you need to gather up some gauze. Place the tooth back in the socket. Place gauze on top of the tooth and bite down to hold the tooth into the socket. Some people bite down on cool tea bags.

First Aid for Knocked Out Tooth Step #4: Get Emergency Medical Treatment

Go directly to the emergency dentist or emergency room for professional healthcare medical attention. If you did not put the tooth back in the socket, don't lose it on the way to the ER. Remember to only hold the tooth by the crown and avoid wrapping it in a paper towel or sticking in the coin compartment of your handbag.

Resources:
Staff at Mayo Clinic. Tooth Loss First Aid. Mayoclinic.com: Tools for healthier lives. 4 January, 2006.

Root End Therapy (Apicoectomies)

An Apicoectomy, or Root-End Resection, is the removal of the root tip and the surrounding infected tissue of an abscessed tooth. This procedure may be necessary when inflammation and infection persists in the area around the root tip after root canal therapy or root canal retreatment.

After the tooth is "numbed", thegum is reflected (lifted) to uncover the underlying bone and the root end of the tooth. The root-end is resected (removed) with all the surrounding infected tissue.

A root-end filling is placed to seal the end of the root canal, the gum is repositioned, and a few dissolvable sutures (stitches) are placed to hold the gum tissue back in its place until healing occurs.

After a few months, the bone around the root-end has healed, and all symptoms are gone.

Traumatic Injuries

Most traumatic dental injuries occur in children, but people of all ages can be affected. Whether the injury is a result of an automobile accident, a sports mishap, an altercation or a bad fall, the severity and type of injury will determine the treatment necessary.

There are a number of common injuries that occur to teeth. Many of them affect the inner soft tissues of the tooth, known as the dental pulp. When the pulp becomes injured or inflamed, root canal treatment may be needed.

Mouthguards

Types of Athletic Mouthguards

Properly diagnosed, designed, and custom fabricated mouthguards are essential in the prevention of athletic oral/facial injuries.

In Dr. Raymond Flander's 1995 study, he reported on the high incidence of injuries in sports other than football, in both male and female sporting activities. In football where mouthguards are worn, .07% of the injuries were orofacial. In basketball where mouthguards are not routinely worn, 34% of the injuries were orofacial. Various degrees of injury, from simple contusions and lacerations to avulsions and fractured jaws are being reported.

The National Youth Sports Foundation for the Prevention of Athletic Injuries, Inc. reports several interesting statistics. Dental injuries are the most common type or orofacial injury sustained during participation in sports. Victims of total tooth avulsions who do not have teeth properly preserved or replanted may face lifetime dental costs of $10,000 - $15,000 per tooth, hours in the dentist's chair, and the possible development of other dental problems such as periodontal disease.

It is estimated by the American Dental Association that mouthguards prevent approximately 200,000 injuries each year in high school and collegiate football alone.

A properly fitted mouthguard must be protective, comfortable, resilient, tear resistant, odorless, tasteless, not bulky, cause minimal interference to speaking and breathing, and (possibly the most important criteria) have excellent retention, fit, and sufficient thickness in critical areas.

Unfortunately, the word "mouthguard" is universal and generic, and includes a large range and variety of products, from "over the counter" models bought at the sporting goods stores to professionally manufactured and dentist prescribed custom made mouthguards.
Presently, over 90% of the mouthguards worn are of the variety bought at sporting good stores. The other 10% are of the custom made variety diagnosed and designed by a health professional (dentist and/or athletic trainer).

There are four types of mouthguards presently available. Each type will be discussed.

Stock Mouthguard:
The stock mouthguard, available at most sporting good stores, come in limited sizes (usually small, medium, and large) and are the least expensive and least protective. The prices range approximately from, $3 to $25. These protectors are ready to be used without any further preparation; simply remove from the package and immediately place in the mouth. They are bulky and lack any retention, and therefore must be held in place by constantly biting down. This interferes with speech and breathing, making the stock mouthguard the least acceptable and least protective. This type of mouthguard is often altered and cut by the athlete in an attempt to make it more comfortable, further reducing the protective properties of the mouthguard. It has been suggested and advised in the medical/dental literature that these types of mouthguards not be worn due to their lack of retention and protective properties.

As sports dentists and health professionals interested in injury prevention, we do not recommend this type of mouthguard to our patients and athletic teams. See photo of Stock Mouthguard after use for several weeks.

Mouth formed or Boil and Bite Mouthguard: Presently, this is the most commonly used mouthguard on the market. Most marketing and advertising in the past has been for this type mouthguard. Made from thermoplastic material, they are immersed in boiling water and formed in the mouth by using finger, tongue, and biting pressure. Available in limited sizes, these mouthguards often lack proper extensions and repeatedly do not cover all the posterior teeth. Dental mouth arch length studies have shown that most boil and bite mouthguards do not cover all posterior teeth in a majority of high school and collegiate athletes. Athletes also cut and alter these bulky and ill fitting boil and bite mouthguards due to their poor fit, poor retention, and gagging effects. This in turn further reduces the protective properties of these mouthguards. When the athlete cuts the posterior borders or bites through the mouthguard during forming, the athlete increases their chance of injury, especially concussion, from a blow to the chin. Some of these injuries, such as concussion, can cause life long effects. (See concussion section of Sports Dentistry On Line). Certain thicknesses and extensions are necessary for proper mouthguard protection.

Dr. Keith Hunter, Australian sports dentist, reported that mouthguards should be of certain thickness, without being bulky. He suggests labial thickness of 3mm, palatal thickness of 2mm, and occlusal thickness of 3mm. The mouthguard material should be biocompatible and have good physical properties. These are recommended thicknesses. It should be noted that each athlete should be evaluated individually for thickness and design as to promote comfort and sufficient protection.

Joon Park, PhD et al, at the First International Symposium on Biomaterials in August of 1993 reported that boil & bite mouthguards provide a false sense of protection due to the dramatic decrease in thickness occlusally during the molding and fabrication process. Dr. Park further stated that "Unless dramatic improvements are made, they (boil and bite mouthguards) should NOT be promoted to patients as they are now." He reported that boil and bite mouthguards decrease in occlusal thickness 70%-99% during molding thus taking away the protective properties of the mouthguard.

Care should be taken by the public when bombarded with clever marketing schemes, claims, and promotions by stock and boil and bite mouthguard companies. The bottom line is that Stock and Boil and Bite Mouthguards do not provide the expected care and injury prevention that a properly diagnosed and fabricated custom made mouthguard does. Why is there a general belief that mouthguards are uncomfortable, do not fit, are bulky, and interfere with breathing and speaking? Could it be because 90% of today's mouthguards worn are of the stock or boil and bite variety, and it is the perception by the public and coaches that these are the only available mouthguards? Indeed, most mouthguards today do not fit, are bulky, and do interfere with speaking and breathing because they are wearing stock or boil and bite mouthguards! The majority of athletes are not wearing properly made dentally diagnosed and designed custom made mouthguards provided by your sports dentist.

As sports dentists and health professionals interested in injury prevention, we do not recommend store bought boil and bite mouthguards to our patients and athletic teams. The public deserves the best quality of care in injury prevention and boil and bite mouthguards DO NOT provide this quality. See photo of Boil and Bite Mouthguard after use for several weeks.

Custom-made Mouthguards:
Custom made mouthguards are supplied by your dentist. Custom mouthguards provide the dentist with the critical ability to address several important issues in the fitting of the mouthguard. Several questions must be answered before the custom mouthguard can be fabricated. These questions include those addressed at the preseason screening or dental examination. Is the mouthguard designed for the particular sport being played? Is the age of the athlete and the possibility of providing space for erupting teeth in mixed dentition (age 6-12) going to affect the mouthguard? Will the design of the mouthguard be appropriate for the level of competition being played? Does the patient have any history of previous dental injury or concussion, thus needing additional protection in any specific area? Is the athlete undergoing orthodontic treatment? Does the patient present with cavities and/or missing teeth? Is the athlete being helped by a dentist and/or athletic trainer or by a sporting good retailer not trained in medical/dental issues? These are important questions that the sporting good store retailer and the boil & bite mouthguard CANNOT begin to address.

The custom made mouthguards are designed by your dentist and are the most satisfactory of all types of mouth protectors. They fulfill all the criteria for adaptation, retention, comfort, and stability of material. They interfere the least with speaking and studies have shown that the custom made mouthguard has virtually no effect on breathing. There are two categories of custom mouthguards, the Vacuum Mouthguard and the Pressure Laminated Mouthguard.

The Vacuum Mouthguard is made from a stone cast of the mouth, usually of the maxillary (upper) arch, using an impression (mold) fabricated by your dentist. A thermoplastic mouthguard material is adapted over the cast with a special vacuum machine (See photo).

Vacuum machine
The most common material for this use is a poly (ethylene vinyl acetate-EVA) copolymer.The vacuum mouthguard is then trimmed and polished to allow for proper tooth and gum adaptation. All posterior teeth should be covered and muscle attachments unimpinged. Vacuum machines are adequate for single layer mouthguards. However, it is now being shown in the dental literature that multiple layer mouthguards (laboratory pressure laminated) may be preferred to the single layer vacuum mouthguards.

It should be noted that these vacuum custom mouthguards are still superior to the store bought stock and boil and bite mouthguards because they have a much better fit, made from a mold of your mouth, and are designed by your dentist.
Strap attachments to helmets may be requested and are easily adapted to the custom made mouthguard, although not needed because of the good fit. Custom made mouthguards can be fabricated through the dental office or commercial laboratory for a nominal fee.

A custom made multiple layered mouthguard,Laboratory Pressure Laminated Mouthguard can be modified for full contact sports by laminating two or three layers of EVA material to achieve the necessary thickness. Lamination in defined as the layering of mouthguard material to achieve a defined end result and thickness under a high heat and pressure environment. Efficient and complete lamination cannot be achieved under low heat and vacuum. The layers will not properly fuse together with the vacuum machine, but will chemically fuse under high heat and pressure with machines such as the Drufomat, the Erkopress 2004, or the Biostar. See Photo

Drufomat machine
Protective thickness is important because as the thickness of the mouthguard material increases logarithmically, the transmitted impact force decreases logarithmically. Also, the mouthguard does not fully adapt to the model with so little pressure and vacuum. Until recently, vacuum fabricated mouthguards have been the standard of care for protective mouthguards.

Dr. Keith Hunter reported that mouthguards should be of certain thickness, without being bulky. He suggests labial thickness of 3mm, palatal thickness of 2mm, and occlusal thickness of 3mm. The mouthguard material should be biocompatible and have good physical properties and last for at least 2 years. These are recommended thicknesses. It should be noted that each athlete should be evaluated individually for thickness and design as to promote comfort and sufficient protection.

Dr. Hunter further states the advantages of pressure formed lamination to be:

1. Precise adaptation
2. Negligible deformation when worn for a period of time. The combination of the relatively high heat and pressure used in construction of laminated mouthguard means that the mouthguard material has virtually no elastic memory.
3. The ability to thicken any area as required as well as place any inserts that may be needed for additional wearer protection.

Therefore, mouthguards must maintain minimal and consistent thicknesses in critical areas. These thicknesses may have to vary according to the athletes individual needs for optimal protection. The thicker materials (3-4mm) are more effective in absorbing impact energy and the thinner materials show marked deformation at the site of impact. These mouthguards are not bulky and uncomfortable.

The clinician cannot expect that a 3mm thick material will remain 3 mm thick after fabrication. This is a physical impossibility due to shrinkage during fabrication adaptation. Vacuuming a commercially laminated 3mm sheet of EVA will give the same unsatisfactory results. Therefore, laboratory pressure lamination procedures must be used incorporating two or more EVA materials to achieve our end result of 3mm - 4mm thickness occlusally. This will allow the clinician to monitor and measure these results before delivery of these mouthguards.

There are presently two ways of obtaining a Pressure Laminated Mouthguard; dentist fabrication with either the Drufomat, Erkopress-2004 or Biostar in the dental office; or referral to a qualified commercial laboratory presently using the pressure lamination technique.
In cases where the dentist does not wish to construct the pressure laminated mouthguard in their office, there are laboratories in the United States that fabricate the pressure laminated mouthguards.

As sports dentists and health professionals, we highly recommend the custom made mouthguard, especially those of the laboratory lamination type for the very best in oral/facial protection as well as concussion deterrence.

This section has presented a discussion of the various issues relating to injury prevention and mouthguards. By acknowledging these significant differences in mouthguards, the public will be better informed and educated to seek their dentistry from dental health professionals and not from sporting good retailers.
Source: http://www.sportsdentistry.com/index.html

Intentional Reimplantation of a Tooth

Preservation of natural dentition is the primary goal of any conservative treatment modality. Although not the primary therapy of choice, extraction and reimplantation of the same tooth are indicated in situations when the patient (and/or the existing clinical conditions) will not accept alternative solutions such as root canal treatment, apicoectomy, or implants. This therapy is only provided if a tooth might otherwise be certainly lost without applying this therapy.

Our office is proud to offer the following technologies

Dexis Digital X-Rays

Patient Benefits
· Environmentally friendly
· No more film, chemicals, or disposal fees
· Instant images allow significant time savings to the patient
· Increased clarity of images
· More chairside time to spend with you!
· Reduced exposure to radiation
· Less waiting time
· Shorter appointments
· Involved in co-diagnosis
· Better understanding of treatment

Intraoral Camera

Intra-oral cameras can produce accurate images of your teeth and the supporting structure. This allows you, your dentist and a dental technician that might be involved in your treatment, to see tooth defects. Intra-oral cameras also help you to learn more about dental hygiene practices, including where to focus on brushing your teeth.

Dental Lasers

Lasers offer reduced discomfort and in some cases, a suture free option for the treatment of benign tumors, cold sores, crown lengthening, decay removal, gummy smile changes, filings, tongue tie and speech impediment improvements, nerve regeneration for damaged nerves and blood vessels and scars. Lasers may also be applied in the treatment of select dental conditions such as sleep apnea, certain cases of temporomandibular disorders and tooth sensitivity. This is a very exciting area of development in dental technologies. Lasers use light energy as their method of operation, resulting in a shortened and almost painless healing period.

Internet

Today, dental appointments can be made through a practice website. Dentists can send dental technicians emails with your intra-oral photos in real time so that they can discuss the case in real time with you in the chair. The Internet also serves as an informational tool through which you can receive updates as they relate to the field of dentistry.

Cephalometric X-rays

Lateral Cephalometric x-rays are used to determine the bone and teeth position from front to back and also growth forecasting. A frontal Cephalometric x-ray is used to determine the bone and teeth position from side to side in the skull. These x-rays are important when choosing an orthodontic adjustment appropriate to the situation. This x-ray is taken a few times through orthodontic treatment to view outcome.

Loupes

Dental loupes are worn by your dentist or your dental hygienist to simply help them see better! The loupes provide magnification to benefit you with better patient care!

Dental Water Safety

We make sure all the water used during your examination is as clean as possible.

The water in our office comes from the municipal water supply — the same water you drink at home, in restaurants and at school. This water naturally contains microscopic germs that form thin layers on virtually all surfaces, including waterlines in the dentist office.

There are absolutely no documented cases of any illness related to the water coming from dental waterlines. But just to be on the safe side, we use the following guidelines from the American Dental Association and the Centers for Disease Control and Prevention to make the water as hygienic as possible:
· Flush the waterlines with clean water between patients.
· Sterilize dental instruments.
· To be extra safe, we also choose to disinfect the waterlines with bleach or even use a completely separate water source.

Sapphire Power Tooth Whitening

Recent Study Participants are WOWed by the sensitivity free whitening that comes with Sapphire Professional Chairside Whitening!

Zero sensitivity

With Sapphire Professional Whitening, you can bid farewell to sensitivity - the most common patient complaint about whitening. Not even a pre-treatment Aspirin is needed when you use this breakthrough chairside formula. Offer your patients the more gentle way to whiten.
Easy maintenance for lasting results

Not only can you create bright, white smiles with Sapphire Professional Whitening, but also included in the kit is everything you need to maintain that radiance. Sapphire After Care is a complete maintenance kit with Sapphire Take Home Whitening and Sapphire Brilliance Toothpaste. Sapphire combines the speed of in office whitening with the longevity available with home whitening.

Unbelievable brilliance and health

Sapphire Professional Whitening allows you to achieve dramatic results quickly. When used with the Sapphire Supreme Light1, the system is proven to whiten smiles up to 7 shades in only 30 minutes. Sapphire Professional Whitening also allows you the flexibility to whitened smiles without light activation. Beyond beautifying smiles you can also protect them from demineralization and caries, thanks to the integrated fluoride.

Panorex X-rays

A type of dental x-ray machine has been developed that simplifies the dental X-ray process as a diagnostic tool.

This X-ray along with bite-wing X-rays give the dentist much needed information about the health of your teeth and gums. A Panoramic X-ray is very commonly taken on a first visit or emergency visit.

As the name suggests a Panoramic X-ray makes a complete half circle from ear to ear to produce a complete two dimensional representation of all your teeth to give an overall picture of your teeth and jaw bones.

Where the bitewing or periapical X-ray film allow us to see small areas of your mouth; the Panoramic X-ray film allows us to see a “panoramic” single picture view of your entire oral cavity, all at one time.

This “panoramic” view of your oral cavity is accomplished by rotating the X-ray film around your head for about 12 seconds. It is important that you remain as still as possible during these 12 seconds to obtain a total angle view for a high quality picture.

You will be positioned erect between the x-ray source and the film. Correct position of the head is very important for a good picture.

Panoramic radiographs (PMX)s may provide information about systemic health conditions .
This Panoramic X-ray is especially effective in the following areas:
1. Fractures of the teeth and/or jaws can be seen when it is difficult to open your mouth
2. Viewing development, position, and eruption of baby teeth so we can see all your child’s baby teeth and permanent teeth at one time
3. For individuals who have difficulty holding x-ray films in their mouth
4. Diagnosing temporomandiblar (Jaw hinge) dysfunction
5. Viewing impacted wisdom teeth (third molars)
6. Detecting presence of bone or gum disease
7. Diagnosing early signs of oral cancer
8. Discovering nonmalignant tumors
9. Surveying the sinus region
10. Discovering stones in the salivary glands
11. Examining trauma
12.Screening for stroke, osteitis deformans, hyperparathyroidism and other systemic diseases.
13.Obtaining baseline data for long term dental health
14. Diagnostic data for referring dentist to use
15. Critical for setting broken facial bones
16. Identification in case of an accident
17. Provide valuable information about signs of carotid calcification. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.
18. Evaluation for full or partial removable dentures, dental implants, or braces.
19. Alternative for those who can not tolerate other types of films, gaggers.
20. New patients to help screen for diseases beyond just the teeth.
21. Screening for osteoporosispostmenopausal women may lose as much as 20% of their bone mass within
5-7 years postmenopause. 1 in 4 men have osteoporosis after the age of 50. 55% of people over 50 have osteoporosis.
22. Metastases to jaws. Carcinomas of the brest, lung, prostate, thyroid glad, kidney, and colon may produce cyst-like growth.
23. Genetic abnormalities.
24. Developmental abnormalities-cleft palate.
25 Asymmetry of the Oral and Maxillofacial area which could be caused by swelling on one side of the face such as seen in eating disorders.
26. Altered nerve sensation-paresthesia in lip, or hypersensitivity which could be caused by infectious osteomyelitis or a malignancy compressing a nerve.
27. Pain-find cause and location of pain.
28. Ill fitting dentures- due to alveolar bone loss.

Dentrix Practice Management Software

Digital dental practice software enables our office to easily manage your appointments, your treatment needs, your treatment history and all your records electronically. This software also merges seamlessly with our digital x-ray system and intraoral photography to provide instant access to your records from anywhere in the office. This software also allows us to schedule your appointments chair side to save you time and enable us to schedule your appointments easily.

Consult-Pro Patient Education System

Over 800 patient education slides and videos are available chair side to make complicated treatment explanations a breeze. It is simple and to the point. Should you desire, we can also print out a patient brochure for you to take home with you!