On the day when braces come off, most people feel that their orthodontic treatment is over. When they are then asked to wear retainers, they may wonder what this additional requirement will accomplish. Wasn't the work of moving their teeth to desired positions already completed? To understand the answer to this question, you need to understand how orthodontics works.

How does orthodontic treatment remodel your smile?

Although they give the appearance of being stable and unmoving, teeth and their surrounding structures (gums, jawbones, and ligaments) are living tissues and are actually in a constant state of change.

Teeth are rooted in bone and are attached by a fibrous tissue called the periodontal ligament (from peri meaning around and odont meaning tooth). One side of the ligament attaches to the cementum (part of the tooth's root) and the other side is attached to the bone, with the tooth suspended in between.

These tissues are constantly remodeling themselves, but pressure from the lips and cheeks on one side and from the tongue on the other create a balance that keeps the teeth suspended in the same location. When mild forces are placed on the teeth, such as the forces from the wires used in orthodontic treatment, the tissues slowly adapt and rebuild, resulting in a new position for the teeth.

What are retainers?

Orthodontic retainers are devices usually made of a clear plastic section that is fitted to the roof of the mouth, with thin wires that fit over the teeth.

What is the purpose of retainers?

The remodeling process keeps going after the orthodontic treatment stops, so time is needed for the teeth to reach a new balanced state. The retainer stabilizes them in their new position so that bone and ligament can reform around the teeth and hold them there. This works well for adolescents, whose jaws are in a state of growth, but adults may need outside assistance to stabilize their teeth for a longer time. They may be asked to wear retainers indefinitely to make sure their teeth do not move from their new positions.

What happens if you don't wear your retainers?

If you don't wear your retainers, your teeth are likely to return to the positions they had prior to your orthodontic treatment. This can happen fairly rapidly, underscoring the importance of wearing retainers as instructed.

What are the different types of retainers?

Most retainers are removable devices as described above. For people who require long-term use of retainers, thin retainer wires can be bonded to the inside surfaces of their front teeth. Such wires are usually left in place for several years, relieving them of the need to remove and replace their retainers.

Contact us today to schedule an appointment to discuss your questions about orthodontics and retainers. You can also learn more by reading the Dear Doctor magazine article “Why Orthodontic Retainers?”

We'd like to take a moment to clarify why it is so important to wear the retainer(s) given to you after your orthodontic treatment. These devices, which literally “retain” your teeth in their new and improved positions, are not just for kids. Anyone who has recently had their teeth moved through orthodontics needs to wear them for the prescribed length of time. Here's why:

Though your teeth may now look perfectly aligned, research has shown that there is no “right” position for your teeth to be in that can assure they don't move again — no matter what age you are when treated for malocclusion (“mal” – bad; “occlusion” – bite). In fact, most people will see changes to their bite and tooth alignment as they get older, with or without orthodontic treatment.

For one thing, there is a natural tendency for bottom front teeth to undergo a gradual “uprighting” with age. This can cause them to crowd as they move toward the tongue. And it happens regardless of whether wisdom teeth are present.

In the case of teeth that have been straightened recently, a type of “memory” of their original position may cause them to drift back to it. This tendency gradually lessens, but it may be a problem for up to 18 months.

That's why it's crucial to follow our instructions for wearing retainers. Keep in mind that the plan we have given you is designed to achieve the best possible results in your individual case. Some people will need to wear retainers 24 hours per day, some just at night, and still others on an as-needed basis. You may have received a removable retainer or one that is secured to the back of your teeth. The important thing is to secure the results you've worked so hard to achieve.

If you have any questions about orthodontic retainers, please contact us, or schedule an appointment for an orthodontic consultation.

You can read more about this topic in the Dear Doctor magazine article “The Importance of Orthodontic Retainers.”

We tend to think of aspirin as a harmless medication. It is dispensed over the counter and is the most widely used OTC medication in the U.S. We take it without thinking we may be exposing ourselves to risks. But in certain situations aspirin can cause dangerous side effects.

What is aspirin, and how does it work?
The chemical name for aspirin is acetylsalicylic acid. It is used to reduce mild pain, inflammation and fever. When you take an aspirin, it blocks the formation of prostaglandins, substances your body creates that are associated with inflammation. Prostaglandins cause inflamed tissues to become red and swollen, but they also serve protective purposes, such as forming a barrier that protects the stomach from the acid it produces to digest your food. That's why long-term aspirin use can sometimes cause stomach bleeding and ulceration or other health problems.

Why do cardiac patients take aspirin?
Another effect of aspirin is to prevent blood platelets from clumping together. Blood platelets are structures in the blood, smaller than white or red blood cells, that aid clotting by sticking together at the site of an injury. This effect of aspirin can cause prolonged bleeding, but it may be beneficial to people who have cardiovascular (from cardio, meaning heart; and vascular, meaning vessel) disease with narrowed blood vessels.

Aspirin can keep blood flowing in the obstructed vessels and thus prevent heart attacks and strokes; but it can also increase the risk for strokes that are caused by bleeding in the brain. Most physicians attempt to lower such risks by asking their patients to keep their daily aspirin consumption to a low dose 81 mg “baby” aspirin.

How does aspirin affect your teeth and gums?
Be sure to let your medical and dental professionals know you are taking aspirin, and how much you take. Also tell us about other OTC medications you take, including herbal medications and supplements, because they may interact with aspirin to cause side effects.

If you have been told to take aspirin because of a cardiac condition or procedure, be sure to follow your recommended treatment. Do not suddenly discontinue aspirin therapy; doing so can increase your risk for heart attack and stroke. Ask us if you should stop taking aspirin before a major dental or oral surgery, but do not stop taking it on your own. We will consult with your physician about your medical condition and let you know our recommendation. In most cases you can continue your aspirin therapy without causing excessive bleeding during the dental procedure.

Contact us today to schedule an appointment. You can also learn more by reading the Dear Doctor magazine article “Aspirin: Friend or Foe?”

Periodontal (gum) disease, though it may be invisible to everyone but your dentist, can have a powerful effect on your entire body. Not only is it dangerous to your teeth and jaws, but it can increase your risk of heart attack and stroke, cause preterm births in pregnant women, and affect blood sugar control in diabetics.

Diabetics are our subject for today. Symptoms of diabetes include abnormally high levels of glucose (a form of sugar) in the blood, leading to frequent urination, excessive thirst, blurred vision, unexplained weight loss, and loss of energy. The disease can also cause severe complications in various parts of the body.

Normally, glucose, your body's main energy source, is kept under control by a hormone called insulin, which is made by an organ called the pancreas. In type 1 diabetes, a person's pancreas does not produce enough insulin to deal with all the glucose in his or her blood. In type 2 diabetes — a condition related to increased age, physical inactivity, overweight, and heredity — the pancreas may produce enough insulin, but the body is not able to use it effectively. This condition is called insulin resistance.

People with type 1 diabetes need insulin to survive. Type 2 may be treated with exercise, diet, medications, and insulin supplements.

Serious complications of diabetes range from kidney failure, blindness, and nerve damage to infections that do not heal, gangrene and amputation of limbs.

Diabetes and periodontal disease seem to have reciprocal effects on each other. Diabetics are more likely to have periodontal disease than non-diabetics; and those with periodontal disease are likely to face worsening blood sugar control over time.

Periodontal disease (from “peri”, meaning around and “odont”, meaning tooth), is caused by dental plaque — a film of bacteria that settles on your teeth and gums every day. It's what you remove with daily brushing and flossing. Any bacteria that remain cause inflammation, which can lead in the worst cases to loss of bone and eventual loss of teeth.

The close relationship of diabetes and periodontal disease probably results from changes in the function of immune cells responsible for healing. Inflammation is a part of normal wound healing — but chronic or prolonged inflammation can destroy the tissues it was meant to heal. This may be a major factor in the destructive complications of diabetes.

Many of these complications begin in the blood vessels. Like the eyes and the kidneys, gum tissues are rich in blood vessels. Gum tissues are also under constant attack from bacteria. If you are a diabetic, effective plaque control, along with regular professional dental cleaning, can have positive effects not only on periodontal disease, but also on control of your blood glucose level.

Contact us today to schedule an appointment to discuss your questions about periodontal disease and its connections with diabetes. You can also learn more by reading the Dear Doctor magazine article “Diabetes & Periodontal Disease.”

Expectant mothers expect to deal with tooth-related milestones in their child's early years, such as teething and even the eventual shedding of those baby teeth to the Tooth Fairy. But there are many facets of children's oral health that may not be as well known. For example, did you know that using sugary fluids in your baby's bottle too frequently could promote constant acid production in your child's mouth leading to early childhood decay? Did you know that parents and caregivers who have decay transmit the bacteria that cause decay to their children?

Baby or primary teeth serve as guides for permanent teeth and, therefore, their health sets the stage for the health and proper function of their permanent successors. A comprehensive examination during a child's first visit can help uncover any underlying conditions that might be indicative of future problems, like tooth decay that can start as early as the age of six months when their first teeth appear. So the “Age One Visit” is the right time for a first dental visit.

What else do you know or want to know? Take our short quiz to help your child. The answers are listed at the bottom of this article.

The Quiz

1. Mounting evidence suggests that a child's oral health is most closely tied to which relative?
1. Mother
2. Father
3. Brother
4. Sister
2. Parents should bring their children to see a pediatric dentist:
1. Once they turn two?
2. Before they start kindergarten?
3. Preferably before their first birthday?
4. When they start to lose their baby teeth?
3. Tooth decay that occurs in infants and young children is referred to as what?
1. Primary tooth decay
2. Early Childhood Caries
3. Diapers to Decay Disease
4. Pediatric Dental Caries Syndrome
4. To help diminish the likelihood that your baby/infant will develop a cavity, you should:
1. Restrict the amount of sugary fluids your child drinks to mealtimes
2. Maintain proper oral hygiene to reduce harmful bacteria
3. Use fluoride to make the teeth more resistant to acid attack
4. All of the above
5. Infants are most susceptible to tooth decay when:
1. Breast feeding
2. Drinking milk from a bottle during meal times
3. Sucking on a pacifier that has been dipped in jam
4. Sleeping on their sides

The Answers

1) a = mother 2) c = before their first birthday 3) b = early childhood caries 4) d = all of the above 5) c = sucking on a pacifier that has been dipped in jam

Your baby's first visit to the dentist will cover a lot of ground, including diagnosis, prevention, education, and treatment as we help start him or her on the path to long-lasting oral and dental health. Call our office to schedule an appointment now. You can also learn more about pediatric tooth decay by reading the Dear Doctor magazine article “Age One Dental Visit — Why It's Important For Your Baby.”

Dentists often recommend bone grafting to ensure the success of dental implants. And it is likewise common for people to squirm a bit at the thought. Bone graft? That sounds serious. And maybe a bit, well, unappealing. These feelings are completely understandable. After all, this may be something you've never had to consider before. But there's no reason to worry. Here’s why:

1. Bone grafting is not new or experimental. It is actually a very routine part of the implant process, as well as other types of oral and periodontal surgery. And it is very successful when performed by an experienced doctor.
2. Bone grafting materials are processed for safety. The grafts used — whether synthetic or from a natural source, such as cow or human bone — have been specially treated for medical use.
3. Only a small amount of this bone-grafting material is needed. Once placed in the site of the missing tooth, it serves as a helpful scaffold your body uses to build more of its own bone in that spot.
4. Your implant will be more ideally positioned and may work better. It needs a good, strong foundation with which to fuse. But when teeth are lost, this supporting bone is often lost, too. This loss is often unpredictable and bone grafting limits the change that occurs. In fact that's one of the main benefits of replacing missing teeth with implants: they help prevent bone loss just as a natural tooth does.
5. Your implant will look so much better! Think about it: Your original tooth was supported to a certain height by the underlying bone. If that bone is now gone, the replacement tooth is going to be much longer because of the missing bone height. It may not look quite right without that additional support.

So if you want the best-looking and best-functioning implant possible, have no fear of bone grafting. And please contact us to discuss any of your concerns, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “Can Dentists Rebuild Bone?”

A veneer is a cosmetic dental procedure that we use in some situations to correct discolored teeth, small spaces or gaps between teeth, small chips or oddly shaped teeth, and teeth that are slightly misaligned by placing a thin shell covering over the teeth. They are artistically hand-crafted by lab technicians out of tooth-colored porcelain using precise molds that we have made in our office. We attach veneers to the tooth's surface using a special adhesive that creates a chemical bond. Veneers are often a key component in a smile makeover.

Traditional veneers will require some tooth preparation, a process where we reduce or file down some of the facial (front, visible) portion of your tooth by 0.3 to 0.7 millimeters. For this reason this cosmetic procedure is not reversible.

How Long Do They Last?

Veneers can last from 7 to 20+ years depending on how you care for them. This may include sleeping in a protective, professionally made mouthguard. And while porcelain is a durable material that can withstand a great deal of pressure, you must remember that they are a type of glass. You could possibly shatter a veneer if you bite into anything that requires a hefty amount of twisting movement and biting pressure.

By using the latest technologies and procedures, we will create the naturally beautiful smile of your dreams and we will restore your mouth to full functionality and optimal health. Contact us today to discuss your questions or to schedule a consultation.

Want To Learn More?

Learn more about veneers when you continue reading the exclusive article from Dear Doctor, “Smile Design Enhanced With Porcelain Veneers.”

For some people, going to the dentist is just like any other routine healthcare visit that they manage without any qualms. For others, the experience can cause some trepidation or even anxiety. In fact, some people even contemplate canceling appointments and neglecting their oral healthcare. If the latter better describes how you or someone you know feels about going to the dentist — even for a routine exam and cleaning — then we have great news for you! We offer our patients oral sedation (sedation dentistry) that allows you to relax both your mind and body so that you can focus on feeling peaceful and at ease rather than anxious.

What is oral sedation?

Often referred to as “comfortable” or “relaxation” dentistry, sedation dentistry offers an approach to dentistry that includes gentle management of your anxiety by using an anti-anxiety prescription medication that simply dissolves away your anxiety. The medications are administered by mouth (orally) to help transition you from feeling nervous to a more comfortable state of being.

Is it easy to take?

Another reason oral sedation is so popular is because it does not require an injection (shot), so, if you are afraid of needles, you simply do not need to worry. Typically, a pill is first placed under your tongue (sub-lingually) where it dissolves and penetrates the skin going straight into your system and then the rest is simply swallowed. This method and the quick-acting sedation medication make relaxation both effective and safe.

Is it safe?

Pharmacists and health professionals measure medications' effectiveness by measuring their “therapeutic index.” The larger the number is on this scale, the safer the drug. The oral sedation medications we use have the highest numbers possible on this scale and thus they are the least likely to cause any adverse (negative) reactions.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more by reading the article “Oral Sedation Dentistry.”

How many of these questions can you answer correctly? The more you know about nutrition and oral health, the healthier you are likely to be.

What are free sugars?
“Free sugars” is a term for sugars including refined cane, beet and corn sugar, which are added to foods or occur naturally in honey, syrups or fruit juices.

You probably know that foods with added sugars are not healthy for your teeth. What is the maximum recommended sugar intake for oral health?
The recommended daily limit for free sugar is 10 teaspoons per day. Note that one can of soda contains over 6 teaspoons.

If a sugary snack is bad for your teeth, what could you substitute that would be better?
Fresh fruits and vegetables would be a better snack. Fresh fruits contain fructose, a sugar that has not been shown to be harmful to teeth if eaten in reasonable amounts.

How can you get enough fluoride to guard your teeth against decay?
If your water supply does not contain fluoride, or if you usually drink bottled water, you may or may not be receiving enough fluoride from your toothpaste. We can assess if you are receiving enough fluoride by examining your teeth, testing your plaque and reviewing your past history of tooth decay. If you are having a problem with tooth decay, we can create fluoride trays for you so you can apply a fluoride solution to your teeth daily.

What is dental erosion and how is it different from tooth decay?
Some acidic foods, particularly drinks such as juices and sodas, wear away your teeth's outer coating (the enamel) when exposed to the teeth's surface. Erosion does not involve bacteria, the cause of dental caries (tooth decay).

Can certain foods stop acidity from attacking your teeth?
Yes, there are foods that reverse the increase in acidity that comes from eating free sugars. One of these is cheese. Cheese stimulates saliva in your mouth, and it contains high levels of calcium, allowing calcium to be added back to your teeth. Many vegetables and starchy whole grain foods require thorough chewing, which also stimulates production of saliva and guards against tooth decay.

We hope you learned some useful facts from this nutrition quiz. If you modify your habits so that you eat less free sugar; drink more water (preferably fluoridated), drink fewer juices and sodas; and snack on fresh fruits, vegetables, and cheese, you can count on having healthy teeth and gums.

Contact us today to schedule an appointment to discuss your questions about diet and oral health. You can also learn more by reading the Dear Doctor magazine article “Nutrition & Oral Health.”

When it comes to sports, all athletes need to know how to assess their risk for experiencing a sports-related injury as well as how to prevent one. The first step to accomplish this is learning how sports and activities are classified, as they define risks from little-to-no chance of injury to highly susceptible for injuries. These categories include:

• Low velocity, non-contact sports: These sports and activities have the lowest risk, as they typically include sports where the athletes perform individually at reasonable speed without physical contact. Examples include: golf, Nordic skiing, weight lifting, running and swimming.
• High velocity, non-contact sports: These sports and activities are those where athletes move at high rates of speed but with no contact with other participants. While there is no contact, anytime you are moving at high rates of speed, accidents can happen. Examples include: bicycling, motocross, skateboarding, skiing and snowboarding.
• Contact sports: As the title states, these sports and activities include frequent body-to-body contact or body to equipment (e.g., a ball, glove, etc.) contact. Examples include: basketball, soccer, lacrosse, baseball and softball.
• Collision sports: With these sports and activities, strong, forceful, body-to-body or body-to-equipment contact is a primary goal of the sport. Examples include football, ice hockey, rugby, and boxing. Without the proper protective head and mouth gear, participants are highly likely to experience an oral-facial and/or head injury.

The good news is that you can dramatically reduce the odds of serious dental and oral-facial injury by ensuring that you wear a professionally made mouthguard in addition to a helmet, facemask, or other protective gear that is appropriate to the sport. This is especially true if you participate in the high velocity, contact and collision categories. These simple steps can help reduce worries for not only players, but also for parents, caregivers and coaches. For more information, read, “An Introduction To Sports Injuries & Dentistry.” You can also download a FREE, pocket-sized guide for managing dental injuries.

Whitening your teeth is an easy way for most people to achieve a brighter, more appealing smile. And for older adults, it can also contribute to a more youthful appearance. We are often asked how our tooth whitening products and services stack up when compared to the many over-the-counter (OTC) products available at discount and drug stores. The following are some key facts to understand about teeth whitening so that you can receive the results you want.

What is the real difference between professional products and ones I can buy over-the-counter?

Whether you purchase over-the-counter whitening strips, toothpaste, mouthrinses, or “paint on” tooth whitening products, you are basically receiving the same product, but with a lower concentration of carbamide peroxide, the chemical responsible for teeth whitening. And while some of the products may contain a slightly higher concentration of this solution, they all are under strict governmental guidelines for ensuring you experience little to no side-effects as long as you follow the instructions. However, with our bleaching products and services, you are under the care of a trained professional and thus can receive much higher concentrations without compromising your health or the health of your teeth. This fact means that under our care you can achieve more dramatic results faster.

How long will the results last?

Bleaching is not a permanent solution; thus, your results will diminish over a six-month to one year period of time. However, it doesn't take much to touch up or maintain your white smile in a single visit, or with custom-made whitening trays that we can provide for home use. You can also keep your brighter smile a little longer by avoiding food that stains your teeth. And when drinking coffee, tea, cola, wine and other drinks like these, sip them using a straw so that they are less likely to discolor your teeth.

Is bleaching safe for my teeth?

We pride ourselves on providing and promoting optimal oral healthcare and thus would never offer any products or services that are unsafe. Additionally, there are numerous studies supporting the overall safety of whitening your teeth. We are careful to avoid sensitivity, which is an occasional side effect of intensive bleaching, and we suggest protecting the teeth with fluoride.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”

Gum disease (gingivitis) and tooth decay are primarily caused by dental plaque. Dental plaque is a whitish, sticky film that accumulates daily along the gumline and on the surfaces of your teeth. Composed of bacteria, it is controllable through good oral hygiene habits — most importantly, effective brushing.

Controlling plaque and preventing gingivitis and tooth decay will make it more likely that you keep your teeth through your lifetime and will also improve your general health. Scientific studies have linked gum disease and diseases of the heart and circulatory system.

“I know how to brush my teeth. I've been doing it since I was a toddler,” you may be saying. But you may not be performing this daily ritual in the most effective way.

Let's take another look at tooth brushing. First, your grip: Hold the brush in your fingertips with a light pressure. Position the brush so the bristles are at a 45 degree angle to your gumline, and then brush with a gentle scrubbing motion. Don’t scrub too hard, or you may damage your sensitive gum tissue.

Some electric brushes can remove plaque more quickly than a regular hand-held brush, but if you brush well any kind of brush works. A brush will last several months. Get a new one when the bristles become worn or splayed out.

Use a toothpaste that contains fluoride. When used consistently, fluoride toothpastes make your teeth more resistant to decay. Spit out the toothpaste after brushing, but don't rinse or you will wash the fluoride away.

After brushing, complete your cleaning job by using floss to clean between your teeth where the brush does not reach. Wrap it in a “C” shape around each tooth and move it vertically up and down, removing plaque from the tooth surfaces where your teeth meet. You can also use an antibacterial mouth rinse.

Thoroughly clean your teeth at least once a day, brushing and flossing. A plaque film takes 12 to 24 hours to form itself again.

To be certain you are brushing correctly, ask our office or one of our hygienists to demonstrate brushing techniques for you in your own mouth. You can also assess the quality of your brushing technique by checking with your tongue after brushing to make sure your tooth surfaces feel smooth and slick. Your gums should not bleed after brushing. Bleeding is a sign of infection. If you have a habit of consistent brushing but your gums continue to bleed, it's time for a visit to our office.

Contact us today to schedule an appointment to discuss your questions about oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Oral Hygiene Behavior.”

The medical term for dry mouth is xerostomia (“xero” – dry; “stomia” – mouth), something that many of us have experienced at some point in life. However, for some people it can be a chronic condition that is ideal for promoting tooth decay. It can also be a warning sign of a more serious health condition.

Dry mouth occurs when there is an insufficient flow of saliva, the fluid secreted by the salivary glands. Your major salivary glands are located in two places: inside the checks by the back top molars and in the floor of the mouth, with about six hundred tiny glands scattered throughout your mouth. And many people are surprised to learn that when they are functioning normally, saliva glands secret between two and four pints of saliva per day! While this may sound like a lot (and it is), saliva is key for buffering or neutralizing acids in the mouth. Without this powerful protection, tooth decay can increase quickly. This is especially true for older individuals who have exposed tooth root surfaces.

It is also important to note that there are times when mouth dryness is perfectly normal. For example, when you wake, you will probably have a slightly dry mouth because saliva flow slows at night. Another example is if you are dehydrated when it is simply a warning sign that you need to drink more fluids (especially water). Other causes for temporary dry mouth include stress as well as what you consume: coffee, alcohol, onions, and certain spices.

You can also have a dry mouth due to a side effect from an over-the-counter (OTC) or prescription medication. If it turns out that this is the cause in your case, you need to talk to the prescribing physician to see if there is something else you can take to avoid this side effect. If there are no substitutes, one tip you can try is to take several sips of water before taking the medication followed by a full glass of water, or chew gum containing xylitol, which moistens your mouth and decreases the risk of tooth decay.

Another cause of dry mouth is radiation treatment for cancer in the head and neck region. Yes, these treatments are crucial for fighting cancer; however, they can inflame, damage or destroy salivary glands. You can also have dry mouth from certain systemic (general body) or autoimmune (“auto” – self; “immune” – resistance system) diseases, diabetes, Parkinson's disease, cystic fibrosis and AIDS (Acquired Immune Deficiency Syndrome).

To learn more, continue reading the Dear Doctor magazine article “Dry Mouth.” Or, you can contact us today to ask your questions, discuss your circumstances or schedule an appointment.