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Smiles by Dr. Gibson of Promenade Dental Internal

As a dentist, educating patients each day is a part of my routine. The simplest dental terms can often be difficult to understand for the patient. I make it my job to be sure that my patients understand procedures and terms. That includes answering the questions you submit to me through this column.

Monica asks, “Dr. Gibson my dentist tells me I need a deep cleaning. What is this and why do I need it?”

When you go to the dentist he not only looks for possible problems above the gum line, but also potential problems below the gum line. This includes your dentist checking the health of your gum tissue and bone level. I know this isn’t always an enjoyable visit, but one that is extremely necessary to keep your teeth and mouth healthy.

The process beings with your dentist usually taking his instrument to check your gum tissue around your teeth below the gum line (called probing). This is to see if you have gingivitis (the bleeding of the gum tissues because of bacteria), periodontal disease (loss of bone level and pockets around your gum line), and the buildup of plaque under the gum line which can lead to bone loss and possible loss of your teeth.

When your dentist sees a potential problem like this in your mouth, (usually after taking x-rays) they must do a “deep cleaning” to help scale away the bacteria and plaque attached to your tooth under them gum line / root. To avoid this procedure only adds to your problems down the road. I would strongly recommend that you follow your dentist’s suggestion and get this procedure done to insure your dental problems stay away.

You may ask “why me?” The answer could be a number of responses. It could be completely genetic regardless of your dental hygiene. That’s just an unfortunate luck of the draw. However if you know that your family has a history of periodontal disease, you can help prevent it with routine checkups and cleanings. I fall into this category. My family has a history of periodontal disease and now I have to watch it very closely in my personal life. In more advanced cases, alternating your visits between your dentist and periodontist (gum specialist) is always helpful.

The other obvious reason you may have periodontal disease is once again, personal dental hygiene.

Question: Dr. Gibson: I’m 34 years old and have had a number of fillings. My dentist told me that I now need a crown. Can you explain exactly what a crown is?

As you know, a filling is something that your dentist does to replace the area of your tooth that the dentist had to drill away because of tooth decay. It’s usually not a very large area and can be done in one visit.

As the holiday season quickly approaches, we scurry around in a panic looking for last-minute gifts. Traditionally, people start the new year with a resolution to lose weight and eat healthier. Why not consider starting out the new year with a whiter, brighter smile with either a take-home or in-office tooth whitening gift? It might just be what the doctor ordered in making your new year a new smile year.

Professional teeth whitening options vary with either a one-time in-office visit (approximately one to two hours) or the at-home whitening system, which is a two-week process.

There are also many over-the-counter types of home bleaching products, but they do not have the whitening concentration that the professional products contain. There are also many over-the-counter whitening toothpastes available. These toothpastes contain mild abrasives that take off surface stains. They do not change the overall color or internal shade of your teeth, as do the professional products dental offices provide. So, what type of professional whitening system should you consider? Let's take a more in-depth look at tooth whitening.

You should have your dentist examine your teeth and gum tissue to make sure they are healthy. You should complete any restorative work (your cavities must be taken care of first) before you whiten your teeth. If you become a candidate for tooth bleaching or whitening, your dentist will suggest which whitening procedures will be effective for you and give you your options.

Depending on how yellow, brown or gray your teeth are, results will vary. Some individuals with very dark brown or gray hues may not find this a great option, as whiteners do not correct all types of discolorations. Individuals with previous dental work on their front teeth may not benefit from the in-office option either, because the whitening solutions will not affect the color of these materials. In these situations, other options to consider may be veneering, bonding or crowns. Individuals with white spot lesions may have to discuss a fluoride treatment, bonding or porcelain veneers.

The in-office whitening, or chairside bleaching, will give you an immediate result in just one sitting. But again, results do vary. A protective gel or shield is usually placed to isolate and protect the oral soft tissues. A bleaching agent is then applied to the teeth, and a special light is used to enhance the action of the agent. In-office whitening products generally contain hydrogen peroxide, with concentrations ranging between 15 percent and 35 percent. Some of the brand-name systems that dentists purchase for in-office whitening are Zoom!, BriteSmile, LaserSmile, LumaArch and Rembrandt Sapphire.

As for take-home bleaching from your dental office, results may also vary. The intended use of these products is generally one to two weeks. The first step in the home bleaching procedure is your dentist making a custom-made mouth guard so the trays fit precisely. This mouthpiece allows the patient to dispense the bleaching gel into the tray, and it protects the rest of the mouth from contact with the bleaching chemicals. Most dentists recommend you wear your mouthpiece overnight or for several hours during the day or night. Be sure to follow your dentist's recommendations.

If you have a sensitivity issue, your dentist may recommend that you lessen the number of hours for whitening or provide you with a lower concentration of solution. They might also provide you with a professional fluoride dentrifice or toothpaste. Speak to your dentist if you are concerned about side effects. Pregnant women are also to avoid whitening procedures.

As procedures have become more available and affordable, tooth whitening is considered an elective cosmetic treatment. Insurances do not cover these procedures. Whitening treatments will also require possible reapplication to maintain that healthy white smile.

As the holiday season and new year approach, why not consider giving a gift that enhances your or someone else's smile? A smile says a thousand words. ... Why not make it a beautiful white smile?

Many parents have heightened anxieties about pediatric dental sedation as a result of the recent tragic death of a 5-year-old Chicago girl after she received treatment at a dental clinic.

As a general dentist specializing in cosmetic dentistry, I am not an expert in pediatric sedation. When I have a child in need of this treatment, I refer my patients to a specialist who deals specifically with this component of treatment.

Philip H. Hunke, D.D.S., M.S.D, President of the American Academy of Pediatric Dentistry, said sedation is safe for children.

"Sedation is a safe procedure that allows a child to cope better with dental treatment. This can help prevent injury to the child from patient movement and promote a better environment for providing dental care, which is integral to quality care," Hunke said in a statement.

According to the AAPD, children who have a level of anxiety that prevents good coping skills or are very young and do not understand how to cope in a cooperative fashion should be sedated. Parents should discuss all sedation options with their pediatric dentist.

The AAPD offered the following additional recommendations:

Parents should be aware of special instructions from their pediatric dentist prior to and following the sedation appointment.

To alleviate potential anxiety in your child, your pediatric dentist may recommend minimal discussion of the dental appointment with your child. Should your child become ill, contact your pediatric dentist to see if it is necessary to postpone the appointment. It is very important to follow the directions of your pediatric dentist regarding fasting from fluids and foods prior to the sedation appointment.

Your pediatric dentist should not discharge your child until the child is alert and ready to go. Children who have been sedated are usually requested to remain at home for the rest of the day with adult supervision. Discuss specific post-sedation instructions with the dentist, including appropriate diet, physical activity and requested supervision.

When do I start to bring my child to the dentist for an appointment? When do they start getting teeth as infants? How many teeth will they have? When do children start brushing?

Parents of new babies will no doubt have several questions about the care of their child's teeth.

The tooth count
Baby teeth are called primary or deciduous teeth. They are the first set of teeth that form during the first trimester of pregnancy (first 12 weeks). Primary teeth start to erupt through the gum tissues at around 6 months. Every child will vary slightly on eruption timeframe. Usually the two upper and lower central teeth will be present by about 5 to 12 months. All 20 primary teeth are typically erupted by the time a child is about 3 years old. The baby teeth are all replaced with a total of 32 permanent teeth (which includes the wisdom teeth, or third molars).

All teeth that erupt in the mouth - whether they be baby teeth/primary teeth or adult teeth/permanent teeth - are different and perform different functions to help you eat. Incisors (front teeth - centrals and laterals) have sharp, thin edges for cutting food. Canines or cuspids (corner teeth) are designed for cutting and tearing teeth. Premolars or bicuspids (back teeth), which are only in the adult dentition, have cusps or points to grasp and tear food. Molars (back teeth) have short, blunt cusps for grinding solid food.

Having some knowledge as to when teeth erupt gives some parents comfort so they can prepare for when a child begins teething, or when to bring him to his first dental visit. Between 8 to 13 months, your child will have approximately six baby teeth (four upper-centrals and laterals and two lower-centrals). At about 13 to 19 months, a total of 12 baby teeth will be present (six teeth on both arches to include four centrals/laterals and two molars). When your child is 16 to 23 months old, approximately 16 baby teeth are present (on each arch there will be four centrals/laterals, two canines, two first molars).

As your child is 2 to 3 « years old, all 20 primary or baby teeth are present. Your child will start to lose his first tooth at around 6 to 8 years of age unless there is an accident or trauma that causes a tooth to be lost early. Each child will vary and should there be any concerns about your child's teeth, schedule an appointment with your dentist to have them evaluated.

Dental care
Just before new teeth start to come through in infants, teething occurs. You will generally notice some heavy drooling and red cheeks. Your baby may be gumming at everything. Chilled items such as a washcloth, teething rings or even a baby toothbrush can help ease the pain of the irritated gums. Even before teeth start to erupt or to become visible, it is also important to keep your baby's mouth clean. Introducing a soft infant toothbrush and rubbing it against the baby's gum and new teeth is a beginning. Do not use toothpaste for infants. Once your child turns 1 year old, you can introduce nonfluoridated children's toothpaste. When your child turns about 5 or 6 years old or when he learns how to spit, you can switch to fluoridated toothpastes. There are many types of brands of soft toothbrushes as well as brands and flavors of toothpastes, which may keep your child interested in brushing his teeth and cleaning his mouth.

Children may be afraid of dentists for many different reasons. Often it may be to a new environment with the strange-looking chairs and lighting, or to the sights and sounds of drills that can be scary. I recommend parents to schedule their routine dental visit and bring their child to see the dental setting and the care the parents go through. The American Association of Pediatric Dentistry recommends scheduling your child's first dental visit shortly after his first birthday. This is not a full examination or cleaning but an appointment that allows the dentist to introduce himself and attempt to count the number of teeth in your child's mouth. It is more an educational visit for both you and your child about future visits. Often, your child can have her teeth looked at while sitting on a parent's lap and tooth brushing can be demonstrated or discussed.

Don't forget the flossing as well. As we mention to all our adult patients to floss and brush daily, this also applies to your child's primary or mixed dentition (baby teeth and permanent teeth stage). Primary teeth are usually spaced out nicely. When your child has primary teeth that are very close together, I often recommend parents floss their children's teeth for them because of dexterity issues. I suggest that parents help with the routine flossing, as it can be difficult for your child in the beginning. There are flavored flosses out there that can interest your child to floss and at least to get them to place floss in their mouth. Ask your dentist or hygienist for pointers. Your child may be about 10 years old when flossing and brushing become routine. Flossing early and doing it regularly allow your child to develop good oral health-care habits.

There are many issues when it comes to your child's dental health and keeping on top of it is worth it.

Good habits now will fight off long-term oral health problems such as gum disease and cavities.

You take a drink of iced tea, eat some cake or ice cream, or sip some hot coffee and the pain sensation is sharp and unbearable. Are you one of millions of people suffering from sensitive teeth? Let's take a look at some of the reasons for sensitive teeth and how you can find relief.

One reason for tooth sensitivity is because of the wearing of the tooth's surface or gum tissue. As we age, sensitivity becomes more prevalent due to the wear and tear on our teeth. I often explain to my patients that the flattened tooth structure or the irregular wear patterns on their teeth reveal an issue of bruxism, clenching or grinding (very common). These damaging parafunctional habits wear down the protective tooth enamel, exposing the underlying dentin, which then sends a sharp shooting pain. In this case, I recommend wearing a protective night-guard (occlusal guard) while sleeping to help prevent further damage to your teeth.

Sometimes a cracked, chipped, or broken tooth can create the same sensitivity sensation because of the build up of bacteria from plaque, which enters the tooth and irritates the nerve or pulp causing inflammation. Most people won't go to the dentist until they have tooth decay (a cavity) causing pain because it has been left untreated. Be sure not to let a chipped or broken tooth go too long without repair.

Individuals who try to bite into any foods and experience a very sharp pain on one particular tooth may also be experiencing a cracked filling or tooth. Both can create a sharp sting. A person with a cracked tooth may experience more than sensitivity issues and should be seen immediately for further evaluation. The tooth may require root canal treatment should the sensitivity and pain be of longer duration. Very seldom will pain go away on its own, and in most cases, it only worsens without seeing your dentist.

The most common cause of tooth sensitivity is exposed tooth roots due to receding gums.

The roots, which are not covered by protective enamel layers, as do the clinical crowns, contain very many small microscopic tubules or canals that lead to the tooth's nerve center, the pulp. When protective layers to the tooth's root are worn and exposed, the stimuli of hot, cold or sweet foods reach the cells and the nerves in the tooth to trigger the pain you feel.

When gum tissues separate from your teeth and form pockets or spaces that trap bacteria, sensitivity and pain will also occur. The presence of plaque build up can also cause discomfort, especially on root surfaces. Recession of gum tissues due to periodontal disease can cause sensitive teeth and can become more serious if left untreated. I also stress to my patients to brush with a soft toothbrush and be sure they brush correctly. Brushing your teeth too hard or aggressively can also injure your gum tissues and expose tooth roots.

Certain foods are very acidic in nature. Regular consumption of acidic foods such as citrus fruits or tomatoes can cause enamel erosion, which results in sensitivity issues. Whitening products and toothpastes with tartar control, baking soda and peroxide can also contribute to sensitive teeth. In-office and home bleaching can cause sensitive teeth due to dehydration and open dentinal tubules.

Usually, to help relieve your pain, your dentist will provide you with a special toothpaste, fluoride rinse or gel, or apply a desensitizing agent or a protective coating in the affected area. Products with a stannous fluoride gel or a toothpaste containing fluoride, potassium nitrate, strontium chloride, or a paste such as MI Paste with bio-available calcium and phosphate all can help to relieve sensitivity issues with daily use. These ingredients help block transmission of sensation from the tooth to the nerve.

Sensitive teeth can make life miserable because the pain can be sharp, sudden and shoot deep into the nerve endings of your teeth. It affects one out of four adults. Be sure to tell your dentist if you're experiencing sensitive teeth as it can be successfully treated, bringing much needed relief.

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