Ask the Dental Experts

Why don’t the posts that you use in implants hurt when you put them in your gums? What are the posts (or whatever you call them) made of?

Dental implants are permanent fixtures of titanium posts anchored to the jawbone and topped with either individual replacement teeth or a bridge that screws or cements onto the posts. These posts act like tooth roots. Once the titanium implant has been placed into the bone, the bone adapts into the shape of the implant. During the healing period in which the implant has no load placed upon it, (usually 3-6 months), the bone attaches to the implant in the same way that it attaches to natural teeth. Once this attachment has occurred, the strength is remarkable. Chewing pressure on the prosthetic post (or on the final restoration placed on an implant) feels like pushing on a natural tooth. Implant technology and materials used today in the United States were developed more than 30 years ago. The success rate for implants is remarkable: 98 % for lower implants and 91 % for upper implants. Implant technology truly allows us to restore strength and support for a patient who has lost teeth.

Why do my teeth ache when I eat or drink hot or cold food?

There can be many reasons why you have sensitive teeth. Many people experience sensitive teeth when they eat or drink cold foods or liquids. A lot of this is due to root surface exposure at the gumline. Root surface exposure (recession)is the main culprit in tooth sensitivity.

If you have many old fillings that have worn and leaking margins they can be the cause of tooth sensitiviy. If this is the case then it is wise to see your dentist to have a thorough evaluation and check-up.

If you have a tooth or teeth that are sensitive to hot foods and liquids then you may have a more serious underlying problem. Sensitive teeth are most likely associated with cold foods and liquids. When a tooth is sentivie to hot liquids and foods an abscess may be present. If you have an abscessed tooth then it is important to have it evaluated and treated.

I welcome you to come and see us at our office to have your sensitive teeth checked.

My dentist is a D.D.M. Is this different from a D.D.S.?

Thanks for the question: D.D.S. or D.D.M. First of all, D.D.M. should be D.M.D. These three initals designates that the doctor you are seeing has graduated from a dental school. Most of the dentists that graduate today have D.D.S. behind their name. D.D.S. stand for Doctor of Dental Surgery. Just like M.D. stands for Medical Doctor. Many years ago when the first dental schools opened up some schools chose to award the D.D.S. degree or the D.M.D. degree. D.M.D. stand for Doctor of Medical Dentistry. This may be due to the fact that these schools had close ties to a medical school. Nowadays, a dental school is affiliated with a University and all of the curriculum is nearly identical at all of the dental schools. If you go to a dentist that has a D.D.S. or D.M.D. it does not really matter. Both degrees mean the same thing. You are under the care of a dentist!

Someone told me that teeth grow. Is this true and if so, what are some of the stages?

Yes, teeth do grow. Actually, our teeth start growing when we are in our mother's womb (in utero). Tooth buds are the predecessors to teeth. Baby tooth buds are the first to form. We have twenty baby teeth. These teeth start erupting when we are ten to twelve months old and we usually lose the last of our baby teeth when we are twelve years old. While we are in utero our adult (permanent) teeth start to grow in the tooth bud. Most people end up with 32 adult teeth. sixteen teeth on the top and sixteen teeth on the bottom. We start to get our adult teeth when we are in first grade. We start to lose our lower anterior baby teeth first. By the time we are 18 to 21 years of age we have all of our adult teeth. By this time a lot of people will already have had their wisdom teeth removed. The answer to your question is “yes” – teeth do grow.

What do blood pressure ranges mean?

120/80 A normal blood pressure for most adults is less than 120/80.

135/85The risk for heart attack and stroke double for each 20/10 your blood pressure exceeds 115/75.

140/90Blood pressure medication is usually needed at this point.

175/105The risk for heart attack and stroke is now 8 times more than a patient with normal blood pressure.

Important Reasons to Treat High Blood Pressure--Your heart will beat 100,000 times today. That’s 100,000 times your high blood pressure could be damaging the blood vessels leading to your eyes, heart, brain and kidneys. This can increase your risk of stroke, heart attack, eye damage and kidney disease.--High blood pressure (hypertension) contributes to cardiovascular disease, the #1 killer of U.S. adults each year.

I've heard a lot about amalgam fillings not being good. Can you tell me why? What do you recommend if you have amalgam fillings? What is an "amalgam" filling anyway?

In our opinion, the use of dental amalgam fillings (Silver-Mercury Fillings) is no longer the best or wisest choice for simple fillings.

The material was developed during the civil war, and is still widely used in most parts of this country. The filling is mainly a mix of silver and mercury. It softens when the two are mixed, and hardens in a short time. There are many reasons that we no longer offer this type of filling for our patients.

The mercury component of these fillings can be as high as 55% in a new amalgam filling. Over a period of time this mercury does leach out of the filling. On average the mercury component has dropped to 27% in 5 years, approaching zero in 15 years. We just don't feel that there is a reason to have our patients ingest this toxic material. Mercury shows up in the liver and kidneys, in mother's milk, and passes the placental barrier. There is insufficient evidence to link this mercury contamination to a host of diseases that are mentioned periodically in the media, but there is a concern.

The reasons for the continued use of amalgam is multifaceted. It continues to be taught as a technique in most dental schools. It is easy to place, and therefore cheap to do. Many insurance companies (never an advocate for optimum care), encourage the use of this material to minimize the benefits they have to pay out.

We also find it amusing that the amalgam scraps that are removed from patient's teeth have to be stored in a labeled hazardous waste container, and have a special pickup for disposal. It seems the only safe place to place this material is in the hazardous waste container, or in a patient's mouth!

The safety of the material was grandfathered when the federal government and the ADA (American Dental Association) began testing dental materials for safety. It would be highly unlikely the material, if just invented, would be approved today. The more important reason behind our decision to go "Mercury-Free", has to do with the expansive nature of the mercury itself. Mercury is placed in thermometers for a reason. It is very sensitive to temperatures. I can put a thermometer in a child's mouth and tell a two degree difference, due to the mercury expanding that much. Why would we put a filling with 55% mercury into a brittle tooth, knowing the patient will be eating ice cream, then washing it down with hot coffee? In short, these fillings are perhaps culprits in tooth fracture. We feel that these fillings are partly responsible for the amount of crowns that are placed on adult molars.

Lastly, we find that most patients actually desire their teeth to look natural. With the materials available today a properly trained dental professional can make most teeth look brand new.

When I go to the dentist I often hear some terminology that confuses me. Can you tell me what "apicoectomy" means? How do you pronounce it? I know I probably don't need to know, but I was just wondering.

The very best way to explain this term that most patients never hear is to refer you to the following site: http://www.chclibrary.org/micromed/00064030.html

I have been considering having my teeth whitened by by dentist with a laser procedure. I have heard that this can cause your teeth to become sensitive and sometimes painful. Is that true?

Thanks for the question. First of all, most in office whitening procedures are done with out a laser. In the past, a laser was used to warm the bleaching solution to speed up the bleaching process. Numerous studies and our clinical experiences have shown this can cause your teeth to be very sensitive. The degree of sensitivity ranged from no discomfort to extreme discomfort. In all cases of bleaching sensitivity the discomfort experienced by the patient was completely resolved with in two to three days.

As a result of sensitivity problems from laser bleaching we have switched to using a high-density light that gives us the same results as a laser with little or no sensitivity. We recommend a combination of in-office and at-home bleaching because we’ve found that this method works best to lesson and control sensitivity while obtaining maximum whitening results.

Our patients are very happy with the significant drop in sensitivity and with their whitening results. They are able to keep their teeth at maximum white by using the home bleaching trays one or two days every four to six months.

Again, I want to thank you for your bleaching question. I welcome you to call for an appointment to further explore your bleaching options.

At what age should a child start to visit the dentist?

This is a very important question. For more information, please refer to our FAQ on this topic at http://www.cosmetic-dentistry-center.com/PPF/Parameters/101_309_/cosmetic-dentistry-center.asp. Most children should start seeing a dentist no later than 3 years of age. At the age of three a child can tolerate having their teeth polished by the hygienist. If a child comes in on a regular basis they should have had about 6 cleaning visits by the age of six. This is important because if a child were to have a dental problem, or is in the need of a filling, the child will have been a patient for a long time and will tolerate the procedure much better than if it is their first dental visit. Many adults who have dental phobias received dental care on an emergency basis when they were young. If that patient had been coming to the dental office on a regular basis from an early age their dental experience would have been much better and most likely not have resulted in a dental phobia later on in life.

What do you do when a tooth cracks?

Some minor craze lines seen in teeth need no attention at all. Other teeth have symptomatic cracks that cause sensitivity or pain and need immediate attention. Since most cracks or fractures do not show up on radiographs (x-rays), these problems can be difficult to figure out.·

Craze lines are tiny cracks that are superficial - primarily in the outer enamel layer of the teeth. These are common in adult teeth, and they need no treatment. They are the result of "mileage - wear and tear" on the teeth. These are often seen on the anterior teeth.·

Asymptomatic cracks that do not hurt are difficult to evaluate. Many times it is important to reinforce these teeth early, BEFORE they become a problem.

Symptomatic cracks cause pain that can vary from minor sensitivity to a throbbing toothache.Commonly it’s not until teeth become painful that the dentist gets involved. A crack can make a tooth sensitive due to movement of the fractured edges and leakage into the pulp.

Treatment of the tooth that hurts can vary - a bonded filling or a crown can reinforce the tooth - more serious damage to the nerve of a tooth requires root canal treatment to save the tooth.

Occasionally a tooth that has a fracture in it that cannot be fixed at all and must be extracted. Does your tooth give a "zing" when you bite? Do you clench your teeth so hard that there are visible cracks in your back teeth? Are your teeth very sensitive to hot or cold? If so, don’t waste any time - problems develop quickly. Have it checked out by your dentist as soon as possible.

Can cold sores be prevented? What is the newest and best treatment for them?

Response to question, as copied from An independent guidefrom the Herpes Viruses Association -Registered charity no. 291657

What is a "cold sore virus"?Cold sores are caused by herpes simplex virus. There are two types, called type 1 and type 2. Either type can be caught on any part of the body: lips and genitals are the most common places.

What’s the difference in the types?On the face, herpes simplex type 1 is more likely to recur than type 2.

How can it recur?Once you have caught this virus, it hides in nearby nerve sheaths and can sometimes reactivate. There are other viruses that also hide and come back later: for example chickenpox/shingles, glandular fever and cytomegalovirus (CMV) but they do not cause cold sores.

How did I get my cold sores?You catch it the first time by being kissed by someone who has cold sore virus on his or her face. This may have been when you were too young to remember – or just the other day. It is only caught by direct skin contact, not through sharing cups, cutlery, towels, etc.

How is it passed on?You pass it on by kissing someone when you have a cold sore or when you feel that one may be coming. If the other person does catch it from you, sores appear on the bit of body you kissed. Oral sex is a common way of passing on cold sores from one person’s mouth to another person’s genitals (genital herpes).

Can anyone get cold sores?Yes, but you can’t give cold sores to someone who already gets them. This means that you cannot give this virus back to the person you caught it off, even on a different part of his/her body.

How many people get cold sores?Cold sores are very common. About six in ten people carry the virus. However, most of them don’t know because they have never noticed any symptoms. Only a quarter of the people who catch this virus will notice any symptoms at all.

What is a cold sore like?· First a small red patch appears · A blister or cluster of blisters develops. You may just get a shallow ulcer inside your mouth. · The blister bursts, leaving a small raw area. · The raw area begins to heal and scab. · Moving your mouth can cause the scab to crack. This will delay healing, so keep the skin soft and moist – see our self-help ideas below. · Picking at the scab will also delay healing. If you have eczema or other skin problems, be careful not to allow the virus to spread to this open skin during this first infection.

When it comes back, have I caught it again?You only catch the virus once. What happens is that herpes simplex virus can hide away harmlessly in the junctions of your nerve cells (ganglions) and it can reappear later on. There are other viruses that do this too – some are listed in the third section.Whichever herpes simplex type you have, you could catch the other type, in the same place or elsewhere. Infection with the other type, however, is likely to be very mild and is often unnoticed. This is because the antibodies that have developed to fight the first virus repel the other one.

Can I tell if a cold sore is coming back?Usually you will feel an itch or tingling first. About half these warning signs go no further because your immune system overcomes the virus before it develops into a sore. Repeat cold sores are usually much milder than the first ones.

Why has it appeared by my nose?It likes the soft moist skin that lines the lips, mouth and nose. But sometimes it will can be caught on ordinary skin if there is a break in the skin to allow entry. If you caught your cold sore on your lips, it can reappear anywhere on your face. Don’t worry, it will not reappear anywhere else on your body. Your immune system will prevent you from catching it on another area.

Can cold sores make you ill?Occasionally, when a person first catches it, he/she gets ulcers inside the mouth and throat as well as, or instead of, the usual sores on the lip. There could be a fever and other flu-like symptoms. A painkiller can help: aspirin, ibuprofen or paracetamol - always follow the instructions on the packet.

Can cold sores ever be serious?Rarely. A few unlucky people get them too often. Antiviral tablets or medicine can be prescribed by a doctor – or see our self-help ideas below.People who have areas of broken skin (like eczema), or people who have other serious illnesses, must be careful during their first infection as it can spread over all the area of broken skin. Rarely, people develop erythema multiforme following each cold sore; they may be given antiviral tablets.Even more rarely, a cold sore may reappear in your eye. If one eye is tingling and sore or red your GP may do a fluoroscein stain, this is to see if the cause is herpes simplex virus. If it is you may be referred to a specialist eye hospital.

What triggers a recurrence?Triggers vary from person to person: try and learn what provokes your cold sores and then you can try prevent them. Common reasons for recurrences are tiredness, illness, stress, being run down, menstruation, too much alcohol or the ultraviolet rays from sunlight or sunbeds. Can I prevent cold sores?Look after yourself. Avoid any triggers you have identified.· Get enough sleep. · Improve your diet. · Try taking a multi-vitamin. · If sunlight is one of your triggers, use a good quality sun block. What can I do if a cold sore starts to erupt?· Apply well-wrapped ice for 90 minutes to chill the area.Apply topical anaesthetics to stop any soreness if a cold sore does break through. · Aciclovir creams may prevent a sore from developing if used within a few hours of the first tingle, however they do not help with healing once the blister has appeared. Do not use Aciclovir cream on the lip itself or for a long period of time, as it may irritate the skin.

What treatments are prescribed?Antiviral tablets have been shown to help stop repeated recurrences.

Can I speed up the healing process?· Cold used tea-bags applied hourly can help. · Geranium oil, tea tree oil also soothe and speed healing. · To prevent scabs from cracking and coming off too soon, keep the skin soft and moist with an unscented product such as Vaseline.

Any other considerations?Don’t be over-sensitive about your cold sores. They always seem bigger to you than they appear to anyone else. Don’t be influenced by advertising campaigns designed to stigmatize people with cold sores. Making people feel ashamed is a common method of advertising. What does the Herpes Viruses Association offer?We have advice and information leaflets on all herpes viruses. These include more suggestions to stop cold sores from returning and lots of help in dealing with genital herpes simplex (cold sores on the genitals). For details of services and a list of leaflets, take a look at the subscription form here www.herpes.org.

Why do we get cavities?

Please refer to our FAQ section on cavities at http://www.cosmetic-dentistry-center.com/PPF/Parameters/101_311_/cosmetic-dentistry-center.asp.