As a successful author, interior design guru (with 127 makeovers in eight years on The Oprah Winfrey Show), and host of his own television program, The Nate Berkus Show, Nate Berkus understands the important role a beautiful smile plays in one's life and career. In a recent interview with Dear Doctor magazine, Nate discussed his oral health history. Berkus credits his all natural smile — no cosmetic dentistry here — to the treatments he received as a child from his dentist. “I'm grateful for having been given fluoride treatments and sealants as a child.” He then added that, “healthy habits should start at a young age.”

Dental sealants are important because they help protect developing young teeth until the enamel has matured. Without dental sealants, the newly erupted immature enamel of teeth is more permeable, meaning that the acids produced by bacteria in the mouth can damage these teeth more easily. This makes the teeth less resistant and thus more susceptible to tooth decay.

Regardless of how much your children brush their teeth, the reality is that toothbrush bristles cannot reach down to clean out the crevices found in the deep grooves (“pits and fissures”) of teeth. And if not removed, the bacteria found in these grooves produce decay-causing acids as a byproduct of metabolizing sugar. However, when sealants are used in combination with fluoride, good hygiene and nutrition (including lower sugar consumption), the odds of having tooth decay is dramatically reduced.

We refer to dental sealants as “pit and fissure” sealants because they protect the grooves found in the top of back teeth and the back of front teeth. Sealants also may reduce the need for subsequent treatments as your child grows older — just as it did for Nate Berkus. For these reasons, sealants are definitely something that all parents and caregivers should consider for their young children.

To learn more about dental sealants, contact us today to schedule an appointment so that we can conduct a thorough examination, discuss any questions you have as well as what treatment options will be best for you or your child. Or to learn more about sealants now, you can continue reading the Dear Doctor magazine article “Sealants for Children.” And to read the entire interview with Nate Berkus, please see the Dear Doctor magazine article “Nate Berkus.”

Cat Cora, philanthropist, author, chef, restaurateur and the first female chef on the Food Network's hit series Iron Chef America is a dynamo driven by a desire to change people's lives for the better. And she is no different when it comes to tackling her most challenging role: caring for the needs of her four active young sons. This includes monitoring the food they eat, their oral hygiene habits and protecting their teeth from injuries.

During an interview with Dear Doctor magazine, Cat describes a backyard accident in which one of her boys, Zoran, was accidentally knocked in the mouth by another child while jumping on the family's trampoline. While her son was not seriously injured, it did cause her to take proactive steps to avoid future injuries. She had her dentist make a custom-fitted mouthguard to protect his newly erupted adult teeth. He now wears the mouthguard while on the trampoline and when playing soccer.

If you and/or your children routinely participate in contact sports — boxing, football, hockey, lacrosse, soccer, water polo, rugby and basketball, for example — or other forms of vigorous physical activity, you too should consider getting a professionally made mouthguard. A properly fitted mouthguard can help prevent injuries to the jaws, lips and teeth. And unlike those cumbersome “boil and bite” mouthguards you can purchase at a drugstore, the ones we make will stay in place, making it easier for you to breathe and talk.

If you are still not convinced, consider these facts: According to the American Dental Association, an athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard. And the US Centers for Disease Control reports that sports-related dental injuries account for more than 600,000 visits to the emergency room each year. Furthermore, people who do not have a knocked out tooth properly reserved or replanted may face a lifetime cost of $10,000 to $20,000 per tooth, according to the National Youth Sports Foundation for Safety.

To learn more about mouthguards, continue reading the Dear Doctor magazine article “Mouthguards.” Or if you are interested in obtaining a mouthguard for yourself and/or your child, contact us today to schedule an appointment. And to read the entire interview with Cat Cora, please see the article “Cat Cora.”

Christie Brinkley's world-famous smile has graced the covers of countless magazines for over 30 years. In fact, in her own words from an interview with Dear Doctor magazine, the supermodel said, “I think my smile was really my passport to success in the modeling industry.” And while most of her smile's appeal comes naturally, Christie does give it a boost with good oral hygiene, regular dental checkups and tooth whitening. As Christie says, “When it comes to teeth, keep it as natural as possible. Do not go overboard on whitening. You want your teeth to compliment your face…your friends should not be required to wear sunglasses when you smile!”

Aside from some potential minor side effects such as tooth sensitivity, whitening teeth through bleaching is a relatively inexpensive way to brighten your smile conservatively and successfully. There are three common methods, as described below:

• An external or vital approach where “vital” (living) teeth are bleached through direct contact to the tooth's surface.
• An internal or non-vital approach where the tooth is whitened from the inside during a root canal treatment.
• A combination approach in which both internal and external bleaching techniques are used.

But what causes teeth to become discolored?

Tooth discoloration can be caused by a traumatic blow to your teeth resulting in nerve tissue (pulp) death. However, there can be many other causes: consuming or using products that stain the teeth such as coffee, tea, cola, tobacco products and red wine, to name just a few. Aging is another factor, as it results in changes in the mineral structure of the tooth as the enamel, the outermost layer, loses its beautiful and youthful translucency. Other causes include exposure to high levels of fluoride; tetracycline, an antibiotic, administered during childhood; inherited developmental disorders and jaundice in childhood; and tooth decay.

The good news is that we routinely brighten smiles through tooth whitening. To learn more about brightening your smile, continue reading the Dear Doctor magazine article “Teeth Whitening.” Or if you are ready to have your teeth professionally whitened, contact us today to schedule an appointment so that we can conduct a thorough examination and discuss your whitening treatment options. And if you want to read the entire feature article on Christie Brinkley, continue reading “The Secret Behind Christie Brinkley's Supermodel Smile.”

Here's an interesting tidbit of information on Wheel of Fortune host Vanna White: like many people, she grinds her teeth at night. In a detailed interview with Dear Doctor magazine, Vanna explained how she had to replace a filling in a back tooth several times because of her grinding habit. Eventually, she had her dentist make her a nightguard to protect her famous smile.

“I really try to sleep with it every night,” Vanna told the magazine. “I try to keep it on my nightstand so when I go to bed, I remember to put it in. Or I will put it by my toothbrush so I can put it in after brushing my teeth at night.”

The habit of teeth grinding or clenching is often associated with stress and/or sleep deprivation. It is referred to as “parafunctional” (“para” – outside, “function” – normal), meaning it can generate biting forces well outside the normal range — perhaps 10 times normal. This excessive force can affect many areas of the oral system. Teeth may become worn, chipped or loose; jaw joints or muscles can go into spasm; and some grinders (or “bruxers” as they are also called) may even experience discomfort of the head, ears, neck or back. Many times, a person with a grinding habit does not become aware of it until it is pointed out by a sleep partner or dental professional.

Like Vanna White's dentist, we often recommend a nightguard to those with nocturnal bruxing habits. It is made of a very thin, wear-resistant plastic that fits over the biting surfaces of the upper teeth only. The lower teeth are then free to glide or skate over the guard, which prevents them from biting into the upper teeth. Some people wear their guards during the day if they tend to clench their teeth when under stress.

If you are concerned about teeth grinding or interested in learning more about nightguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Vanna White, please see “Vanna White.” Dear Doctor also has more on “Stress & Tooth Habits.”

Dental implants are replacements for missing teeth. They are very stable and can be made to look as good as or better than the teeth they replace. How do we do it? Here are seven frequently asked questions.

What are the parts of a dental implant?
The implant consists of a root, usually made of a titanium alloy, which extends below the gum tissue into the bone; and a crown, which emerges from the gum and resembles the crown of the original tooth.

Why is a dental implant so stable?
Titanium has a property of fusing with the bone of the jaw, so that it actually becomes part of the bony structure. The new implant's stability depends on having the needed volume of bone and gum tissue in the right position to anchor the implant.

How can you make sure I have enough bone?
When a tooth is lost, the bone in which it was anchored will resorb or melt away if care is not taken. It is important to minimize trauma during tooth removal to preserve bone tissue. If tissue has been lost it can be built up by bone grafting techniques.

What factors make a crown on an implant look real?
How real the crown looks depends on its shape, particularly as it emerges through the gum tissues, its color and its position relative to the teeth around it.

What is the emergence profile?
This term refers to the way the crown emerges through the gum tissue. It involves both the shape of the implant and how far it is placed into the gum and bone tissues.

How do you match the color of the crown?
We analyze your tooth color using shade guides and/or photography to provide the dental lab with as much information as possible to create the best color match. This is part of the artistry of reconstructive dentistry.

How will my gums look with my dental implant in place?
When people use the word “gums” they are often referring to the small pink triangles of tissue that fill in the spaces between teeth, called “papillae.” An implant must be placed at the correct distance from adjacent teeth and at the correct depth below the gum tissue for natural looking papillae to form.

You can see that success in matching of color, shape, and location of an implant is not simple and depends on the skill, artistry, and experience of your dental team.

Contact us today to schedule an appointment to discuss your questions about dental implants. You can also learn more by reading the Dear Doctor magazine article “Matching Teeth & Dental Implants.”

Losing a baby tooth is an important milestone in a child's life. Be sure to take a photo of that toothless smile — it will be something you treasure as your child grows up.

You may be wondering what is really happening when a baby tooth becomes loose and eventually falls or is pulled out. Read on for some answers.

What are baby teeth?
An infant's teeth begin to form before birth, by the fifth to sixth week after conception. When the baby is born, 20 primary (baby) teeth are almost completely formed inside the jaws. These first teeth, also called deciduous teeth, begin to erupt through the gums at about the time the baby begins to eat solid food. The front teeth (incisors) are usually the first to come in, at age six months to a year.

Why are they called deciduous teeth?
Deciduous means “falling off at maturity.” The same term refers to trees that lose their leaves every fall. In many mammals, including humans, it refers to the first teeth, which need to come out to make room for the larger permanent teeth to come in.

What causes the deciduous teeth to become loose?
While your child is using his primary teeth to bite and chew, his adult (permanent) teeth are quietly growing inside his jawbone. Starting with tooth “germs” (the word comes from germination, meaning the start of growth), the top part of each tooth, called the crown, grows first. Then the bottom part, or root, begins to grow and elongate. As the roots develop and the permanent teeth take up more room in the child's jaw, they begin to push against the baby teeth. This causes the roots of the baby teeth to melt away or resorb. Eventually little or nothing is left to hold the baby teeth inside the child's gums, they become wiggly, and finally they can easily be pulled out. This may leave a little bleeding gum tissue that quickly heals.

What should you watch for in the transition from primary to permanent teeth?
As the permanent teeth erupt (push through the gums and become visible), you may notice that they are too crowded, have too much space between them, or are crooked. It's a good idea to have an orthodontic (from ortho, meaning straight and dont, meaning tooth) evaluation at age five to seven. Watch to see that the baby teeth are lost in the right sequence. If one is lost prematurely, for example from decay, make sure that the space that it occupied is maintained to make room for the adult tooth that will replace it. We can help you with this.

Contact us today to schedule an appointment to discuss whether your child's baby teeth are being lost in the right sequence and if the adult teeth are coming in correctly. For more information see the Dear Doctor magazine article “Losing a Baby Tooth.”

Having someone tell you that you have bad breath can be humiliating, but it can also be a sign that you need to see your dentist. Bad breath (or halitosis) can be a sign of an underlying dental or health problem, so before you run out and stock up on breath mints, make an appointment with our office. Using breath fresheners will only disguise the problem and not treat the root cause.

It's important to remember that if you have bad breath, you're not alone — it's the third most common reason people seek a dental consult. We use a systematic approach to determine the cause of your halitosis and offer a solution.

Causes: Ninety percent of mouth odors come from mouth itself — either from the food you eat or bacteria that may be present. Most unpleasant odors originate from proteins trapped in the mouth that are processed by oral bacteria. When left on the tongue, these bacteria can cause an unpleasant smell. Dry mouth, sinus problems, diet and poor oral hygiene can also cause bad breath. In rare cases, a medical condition may be the cause.

Treatment: The best solution will depend on determining the real cause of your halitosis. If bad breath emanates from the mouth, it most commonly is caused by gum disease or even tooth decay, which need to be treated to correct the problem. If halitosis is of systemic (general body) origin, a more detailed examination might be needed from a physician. But the solution may also be as simple as demonstrating how to effectively remove bacterial plaque from your teeth, or offer instruction on proper tongue cleaning. If the cause is gum disease, we may suggest a deep cleaning and possible antibiotic therapy.

Contact us today to schedule an appointment to discuss any questions you may have regarding bad breath. Read more about this topic in the Dear Doctor magazine article “Bad Breath: More Than Just Embarrassing.”

Designing a better smile sometimes requires a change in the size, shape, or color of your teeth. Porcelain laminate veneers (thin layers of dental ceramic material) enhance your appearance by replacing the natural enamel on the outside of your teeth. A veneer is physically bonded to the surface of a tooth, in essence, becoming part of it.

Traditionally, a small amount of the natural tooth enamel is drilled away to allow room for the veneer. But today, in some circumstances, it is possible to use an approach where enamel reduction or preparation is not necessary because the veneers can be bonded directly onto the tooth's natural surface. These are called “Prepless” or “No-prep” veneers, and are used to create aesthetically pleasing and natural looking restorations. An advantage of the prepless procedure is that the process is reversible so that you can give your new smile a “test drive.”

You may be a good subject for Prepless veneers if:

• Your smile is narrow because the teeth in the sides of your smile are positioned inward and do not show from a frontal view.
• There is spacing between your teeth, and the teeth appear too small.
• You have a fairly common genetic condition in which one or both of the teeth directly next to the two upper front teeth are very small and peg-shaped.
• There is an imbalance between the size of your lips and teeth (large lips and small teeth), which are not in proportion to show off your best smile.

Prepless veneers are probably not for you if:

• Your teeth are not aligned properly in your bite.
• Your teeth are very crowded, resulting in poor facial profile.
• Your teeth are already relatively large or positioned forward.

In these cases you may need to have some form of orthodontic treatment to move your teeth into better position. Sometimes veneers can be used to create an illusion of proper tooth alignment, but some amount of tooth reduction may be required.

We can assess whether prepless veneers are right for you. There is no substitute for an expert dentist's talent and expertise with the various cosmetic techniques available today. These skills combined with a thorough diagnostic evaluation, and a clear understanding of your goals, are the keys to providing you with a successful and beautiful smile.

Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can also learn more about prepless veneers by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

When you say “ahhhhh,” are you worried about all your unsightly metal fillings? If so, did you know that your dentist can resolve your concerns through the use of tooth-colored fillings?

The public's demand for aesthetic tooth-colored (metal free) restorations (fillings) together with the dental profession's desire to preserve as much natural tooth structure as possible has led to the development of special adhesive tooth-colored restorations. And the demand is not limited to just the front teeth. In fact, many people are opting to replace all of their metal fillings — not just those in the front teeth — so that all of their teeth appear younger, fresher and as if they have never had any cavities.

Can you really mimic natural teeth? Proper tooth restoration is a lot more than just filling holes. It is a unique art applied with scientific understanding. Each tooth's internal shape and structure is the guide to how it must be rebuilt to successfully restore it. However, choosing which material to use to restore or rebuild teeth is a critical one based on scientific understanding, experience and clinical judgment — expertise we use daily in our office. The most popular options include composite resins and porcelains, as they allow us to mimic natural tooth colors and shapes. But for the most life-like, natural tooth-colored filling, your best option is porcelain. Porcelain, which is built up in layers, can be made to mimic the natural translucency and contours of tooth enamel.

But what about matching the color? Will it really match? Absolutely! Whether we use resins or porcelain, through our artistry we will create absolute tooth-like replicas. You will never know your teeth have fillings! And unlike metal alloys, these newer materials bond directly to the remaining enamel and dentin of which the teeth themselves are made, thus stabilizing and strengthening them. These techniques are even suitable for children's teeth and can incorporate fluoride to reduce decay.

Still undecided? If so, we understand. Feel free to contact us today to schedule an appointment to discuss your questions about tooth-colored restorations. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth-Colored Fillings.”

When treating Temporomandibular (jaw joint) Disorder (formerly known as Temporomandibular Joint Disorder, TMJ), we feel we have two equally important challenges facing us. First, we must start your treatment by relieving the symptoms of pain and discomfort. We typically accomplish this with heat, mild pain medications, a diet of soft foods, and some simple jaw exercises. Once we have begun to relieve your pain, our second critical objective is to identify and remedy what is causing the pain. It could be the result of an injury or trauma to the jaws and/or teeth or it could be due to a bite issue or a filling or crown that is too high and thus causing a misaligned bite. There are many other reasons, so it is first necessary to obtain a thorough medical history and conduct a comprehensive evaluation so that we can properly diagnose and treat the TMD condition and what is causing it.

Next to stress resulting in clenching and grinding habits, the four most common causes leading to TMD include:

• Underlying dental conditions that are triggering muscle pain
• Internal joint derangement (displaced or improperly positioned jaw joint)
• Osteoarthritis (degenerative joint disease)
• Synovitis — the painful inflammation of a synovial joint-lining membrane that is characterized by swelling, due to effusion (fluid collection)

If you or another family member suffer from chronic jaw pain, please let us know so that we can properly address your concerns and conduct a thorough examination. Or if you are in constant or severe pain, contact us as soon as possible to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

1. Xylitol is a kind of sugar.
   True or False
2. Xylitol is made from
   1. Bark of birch trees
   2. Coconut shells
   3. Cottonseed hulls
   4. All of the above
3. Xylitol is a natural “sugar alcohol” similar to other so-called sugar alcohols such as mannitol and sorbitol.
   True or False
4. Xylitol is broken down by decay-causing bacteria to produce acid.
   True or False
5. Decay-causing bacteria are transmitted from a parent to a child through oral contact such as a simple lip-to-lip goodnight kiss.
   True or False
6. Researchers have found no difference in prevention of tooth decay in gum made from xylitol compared to gums containing sorbitol/xylitol and sucrose.
   True or False
7. Other xylitol products such as mints, candy and cookies also seem to decrease the incidence of tooth decay.
   True or False
8. Xylitol products increase salivary flow and allow saliva to neutralize acids in your mouth.
   True or False
9. The only side effect of too much xylitol ingestion is a possible mild laxative effect.
   True or False
10. The target dose of xylitol is one to two teaspoons spread throughout the day.
    True or False

1. True. Xylitol is a kind of sugar that does not contribute to tooth decay.
2. All of the above. It is also found naturally in some fruits and vegetables.
3. True. The others, mannitol and sorbitol, are used as sugarless sweeteners.
4. False. Unlike sucrose (table sugar), xylitol is NOT broken down by bacteria to produce acid. Xylitol also stops saliva from becoming acidic so your mouth becomes an unfriendly environment to acid-producing bacteria.
5. True. However, xylitol inhibits growth and attachment of the bacteria to your teeth, so it also inhibits transmission to your children.
6. False. Systematic use of xylitol chewing gum significantly reduces the relative risk of caries (tooth decay) when compared to chewing gums containing sorbitol/xylitol and sucrose. Xylitol gum also appears to halt the development of tiny cavities when compared to other types of chewing gum.
7. True. Use of these products seems to stop the progression of active decay.
8. True. Xylitol and your saliva combine to re-mineralize (harden) your teeth after an acid attack.
9. True.
10. True. This means two pieces of xylitol gum or two pieces of xylitol candy or mints should be consumed for five minutes four times a day after eating meals or snacks.

Contact us today to schedule an appointment to discuss your questions about xylitol and other methods of preventing tooth decay. You can also learn more by reading the Dear Doctor magazine article “Xylitol in Chewing Gum.”

Temporomandibular Disorder (TMD), which was formerly known as Temporomandibular Joint Disorder (TMJ), is a condition that is unusual in that it frequently is quite hard to diagnose, because it often mimics many other conditions. For this reason, many healthcare professionals refer to it as “the great imposter.” The condition arises when there are problems inside the temporomandibular joint and the muscles that attach to it causing pain. The pain is most often due to muscle spasm, thereby limiting the ability to open and close the jaw and to function normally. TMD can impact anyone and has a wide range of similar symptoms.

One of the common causes of TMD is stress, and it may manifest itself through clenching or grinding of teeth while awake or asleep. These habits are often completely subconscious until pointed out by a dental professional or sleeping partner. With stress-induced TMD, the pain often comes and goes in cycles. In other words, it may be present when you are stressed, seem to disappear for a while, and then reappear when you are stressed again. Another cause of TMD can be from an injury or trauma, such as a blow to the jaw. However, regardless of the cause of TMD, the pain is real and needs to be treated properly.

If you feel that you might have TMD, please let us know so that we can address your concerns, starting with a full history and conducting a thorough examination. Or if you are in constant or severe pain, contact us immediately to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

While the long-term success rate for a dental implant is well over 95%, there are factors that can compromise their success. For this reason, our office has put together this list so that you can be prepared should you ever need a dental implant. We feel that by providing our patients with this type of easy-to-understand information, we can educate, address any concerns and help produce the best results.

The three most common categories for classifying factors that influence dental implant success are: general health concerns, local factors and maintenance issues. As you may suspect, general health concerns include factors such as:

• Whether or not you smoke or use tobacco products.
• Certain prescription and over-the-counter medications you are currently taking or have recently taken.
• If you have or have a family history of osteoporosis (“osteo” – bone; “porosis” – sponge-like).
• If your medical history includes any cancer or radiation treatment to the jaws.
• Or if you have a compromised immune (resistance) system.

The second category is “local factors” and includes bone quantity and quality — there must be sufficient bone to anchor implants. Other considerations that fall into this category include whether or not you clench or grind your teeth or have additional bite concerns, as all of these can have negative impacts on both the short and long-term success of an implant.

The last category concerns maintenance. While dental implants are superior works of technology that can last a lifetime and produce results that are nearly identical to natural teeth in looks and durability, they do require routine maintenance. This includes daily cleaning (brushing and flossing) and routine visits to our office for evaluation and professional care to make sure they are functioning properly.

To learn more on this subject, continue reading the Dear Doctor magazine article “Factors which can influence implant success.” You can also contact us today to schedule an appointment to discuss your questions about dental implants.

One of the most common treatments we are asked about is a root canal and the unfortunate bad reputation associated with it. The truth is that the procedure actually relieves the pain associated with the problem and not visa versa. And here's why.

A root canal or endodontic treatment (“endo” – inside; “dont” – tooth) is a necessary procedure in which diseased pulp tissue — and the nerve, which responds by causing the pain — is removed. This is followed by cleaning and sealing the root canals. This usually results from pulp inflammation and infection as a result of a severe decay or in a heavily filled tooth. Root canal treatment is typically performed by general dentists who have taken specialized training or by endodontists, dentists who specialize in the diagnosis and treatment of root canal problems. We perform them here in our practice to save a tooth, literally, from further damage and/or loss.

Here is a quick overview of the procedure. We will begin by making a small opening in the chewing surface of your tooth so that we can access the tooth's root canal. We use small instruments to remove the dead and dying tissues of the pulp. The root canals are cleaned and disinfected. The canals are then sealed with a biocompatible filling material. Lastly, we will seal the access hole with a filling material. You will then need to get a permanent restoration or crown to protect the tooth fully.

If you feel that you have the symptoms of a root canal problem and may need a root canal treatment, contact us to schedule an appointment. And to learn more about the signs, symptoms, and what to expect after root canal treatment, read the article “Common Concerns About Root Canal Treatment.”

While the goal of restorative dentistry is to return all of the destroyed or lost dental tissues of the teeth to full form (shape) and function, when you blend this goal with the artistry of cosmetic dentistry, the results can be dazzling. Today's modern techniques and materials enable replacement of missing tooth structure that allows bonding directly to the tooth so that it not only is an exact color match but also actually strengthens the tooth. And tooth-colored fillings are not just for front teeth. They can dramatically improve the appearance of all teeth — even your back molars — so that it appears you've never had tooth decay at all!

All of this is accomplished through the use of either tooth-colored dental porcelain or composite resins. Porcelains are a form of ceramic material formed by the action of heat. They are available in many colors and shades made from a powder corresponding to the primary color of the natural tooth structure that is mixed with water and placed into an oven for firing (hence their ceramic nature). When built up in layers by highly trained dental ceramicists, they can be made to mimic the exact natural translucency, staining and contours of tooth enamel.

Dental composite resins are the most common materials used for tooth-colored adhesive restorations today and have properties similar to tooth structure. They consist of resin or special plastics and fillers that are made of silica, a form of glass. The fillers give the composites wear resistance and translucency (see through properties).

It is important to note that besides providing the appearance of beautiful teeth, properly restored teeth function and wear better. But most important to you, they appear indistinguishable from natural teeth! Furthermore, scientific studies and clinical experience have validated their use as both safe and predictable. In fact, these techniques are also suitable for children's teeth and can incorporate fluoride to reduce decay. Together, all of these changes have so significantly impacted the way modern dentistry is practiced that many believe we may have entered into the so-called “post-amalgam (silver metal-colored dental fillings) era.”

Contact us today to schedule an appointment to discuss your questions about tooth-colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you are unhappy with the appearance of your smile and would like to change it, we can help you determine what will work best, from a simple whitening to brighten your smile to a complete smile makeover — the possibilities are almost limitless! Consider a “Smile Design” customized just for you. One method of improving your smile is with porcelain veneers. Porcelain laminate veneer tooth restorations are thin layers of dental ceramic — a glass-like material created by dental laboratory technicians, the “artists” who exactly mimic natural teeth making them straighter, whiter, and brighter. They are used to replace worn, dull-looking stained enamel. In addition to making your teeth and smile whiter and brighter, veneers can even be used to change tooth shape and color, close small spaces, and reshape slightly crooked or mis-shapen teeth.

In order to determine if porcelain veneers are a viable solution to help you achieve the smile you have always longed for, consider the following questions:

• Do you want to permanently alter the appearance of your smile?
• Are you hoping to make improvements to your smile that don't take a very long time to complete?
• Are you looking for a way to improve your smile with minimal or even no removal of your natural tooth material?
• Would you like to have more evenly aligned teeth?
• Do you want to change the color of your teeth?
• Do you want whiter teeth and a brighter smile?

If the answer to one or more of these questions is yes and whitening or other treatments have not given you the smile you want, we can help you assess the feasibility of porcelain veneers as one of the many options to enhance and improve your smile. We can fully discuss all the benefits, risks, alternatives, and costs associated with improving your smile.

Call us to make an appointment for a Smile Design consultation and we can get started. If you would like to read more information about porcelain veneers, as well as see a few before and after photos, read the Dear Doctor magazine article “Smile Design Enhanced With Porcelain Veneers.”

Your son just crashed his skateboard and cracked a tooth, or maybe your daughter fell off the monkey bars at school and now has a chipped front tooth. For children, and some adults, repairing chipped or damaged teeth with tooth-colored restorative materials directly bonded to the teeth may be the perfect solution to restore their smiles.

What is Involved: Composite bonding is a technique that has been developed to correct chipped teeth and other minor dental imperfections. It may also be used to correct mild crookedness or gaps between teeth. The procedure requires the application of a tooth-colored composite resin material to the surfaces of teeth, which is then sculpted to the desired shape. It can be performed in a single visit for one or multiple teeth. The procedure usually takes between one and two hours, and the end result is a beautiful, natural-looking smile.

Advantages for Kids and Adults: Composite resin bonding is a good choice for kids and teens since their jaws are still growing and developing, and they may still be engaged in high-risk activities. After your child's teeth and jaws are fully developed, we can discuss options for more permanent restorations such as porcelain veneers or crowns. These require removal of more tooth structure, which could compromise the long-term health of your child's teeth if done too soon. Composite resin restorations, which bond straight to the teeth and require little to no tooth preparation or drilling are therefore a good option for fixing chipped teeth, and they're less expensive than choosing veneers.

Disadvantages: The longevity of composite resin restorations is related to how well you maintain your teeth. Many people can go for ten or fifteen years before they need to have the bonded resins repaired or replaced. Others will tend to stain and wear after only one or two years and will need some touch-up work.

Contact us today to schedule an appointment to discuss any questions you may have regarding dental bonding. Read more about this topic in the Dear Doctor magazine article “Repairing Chipped Teeth.”

Dental implants are a fascinating treatment option that can be life changing when used properly. They have also experienced tremendous scientific advancements and press over the years making them highly desirable by people of all walks of life. See how much you really know about dental implants by taking our quick and easy true/false self test.

1. Dental implants can produce lifelike results that are indistinguishable from natural surrounding teeth.
   True or False
2. Many dental professionals consider dental implants as a “third set of teeth,” as they can last a lifetime when properly maintained.
   True or False
3. A dental implant is a safe option that is suitable for all patients regardless of age.
   True or False
4. When properly placed and maintained, dental implants have a 90% success rate.
   True or False
5. If you do not have enough bone to support a successful dental implant, there is not much that can be done.
   True or False
6. When teeth are missing, the face tends to have a sunken-in appearance called, “posterior bite collapse.”
   True or False
7. One of the positives of dental implants is that they do not affect adjacent teeth.
   True or False
8. Dental implants typically cost significantly more than other options, such as a bridge, over the course of a lifetime.
   True or False
9. Dental implants are always more desirable than bridgework or other treatment options for missing teeth.
   True or False
10. Dental implants can lead to improved health due to better nutrition and proper digestion.
    True or False

1. True. Dental implants can appear as beautiful, natural teeth.
2. True. When properly maintained, implants provide the same function as natural teeth roots.
3. False. Dental implants are not suitable for replacing primary teeth or permanent teeth in young children or teenagers. They are best used when facial and jaw development is complete.
4. False. They have a 95% success rate.
5. False. If you do not have enough bone for a dental implant, you may be a candidate for a bone graft — a process in which we “grow” the bone we need for the implant.
6. True. This condition is often totally reversible once teeth have been restored through implants or bridgework.
7. True. Unlike bridgework, dental implants do not affect surrounding teeth.
8. False. They are less expensive in the long run.
9. False. Sometimes a bridge is better than an implant.
10. True. Once teeth are restored, chewing and digesting food is easier; thus health improves.

To learn more, continue reading the Dear Doctor magazine article “Dental Implants, Your Third Set of Teeth.” Or, you can contact us today to schedule an appointment or to discuss your questions.

When involved in high impact sports or vigorous activities, it is important to protect your mouth and teeth. This statement is backed by the fact that there are over 600,000 sports-related dental injuries treated in emergency rooms across the US each year according to the US Centers for Disease Control (CDC).

In addition to absorbing and distributing the forces that impact the mouth, teeth, face and jaws an athlete receives while participating in sports such as baseball, football, basketball, hockey (ice and field), skateboarding and wrestling, the American Dental Association (ADA), also recommends the use of custom mouthguards for other activities such as acrobatics, bicycling, handball, racquetball, skiing, and even weightlifting.

These facts make two things clear: (1) it is vital that you obtain a professionally made mouthguard that you wear during these types of activities and (2) that you also understand how this mouthguard protects you. Below are just a few ways.

1. Lacerations. A custom-fit, professionally made mouthguard covers the sharp surfaces of the teeth to protect the soft tissues of the cheeks, lips, gums and tongue from lacerations that can occur from a blow or sudden jolt.
2. Mouth Impact. Just as a mouthguard protects against soft tissue lacerations, it can also help prevent injuries to the jaws and teeth. This includes but is not limited to chipped teeth, fractured teeth, broken teeth and teeth that are partially or fully knocked out of their natural position.
3. TMJ (jaw joint) Trauma. Wearing a properly fitted mouthguard can reduce the potential for jaw displacement and joint fractures by cushioning the jaws against damage from an impact.
4. Direct Jaw Impact. Anytime a person receives a direct impact to his/her jaw, having a mouthguard in place may help prevent more serious injuries to teeth and jaws. This is especially important for anyone diagnosed with TMJ.
5. Jaw Fracture. A custom-fit, professionally made mouthguard both absorbs and distributes impact forces so that jaws are protected. And it is this reduction in force that can help prevent the jaws from fractures.
6. Under Chin Impact. Receiving a blow under the chin can obviously damage teeth; however, it can also cause damage to the jaws as well as inflame or cause TMJ issues.

You can learn more about mouthguards by continuing to read the Dear Doctor magazine article “Athletic Mouthguards.” Or you can contact us today to schedule an appointment.

Nightly snoring can be a sign of a dangerous condition called sleep apnea (from “a” meaning without and “pnea” meaning breath). When someone snores the soft tissues in the back of the throat collapse onto themselves and obstruct the airway, causing the vibration known as snoring.

If the obstruction becomes serious, it is called obstructive sleep apnea, or OSA. In such cases the flow of air may be stopped for brief periods, causing the person to wake for a second or two with a loud gasp as he attempts to catch his breath. This can cause heart and blood pressure problems, related to low oxygen levels in the blood. The obstruction and mini-awakening cycle can occur as many as 50 times an hour. A person with this condition awakens tired and faces the risk of accidents at work or while driving due to fatigue.

Studies show that sleep apnea patients are much more likely to suffer from heart attack, congestive heart failure, high blood pressure, brain damage and strokes.

What can be done to treat OSA?
Snoring, apnea, and OSA occur more frequently in people who are overweight. So start with losing weight and exercising.

At our office, we can design oral appliances to wear while sleeping that will keep your airway open while you sleep. These appliances, which look like sports mouth guards, work by repositioning the lower jaw, tongue, soft palate and uvula (soft tissues in the back of the throat); stabilizing the lower jaw and tongue; and increasing the muscle tone of the tongue.

Another approach is to use a Continuous Positive Airway Pressure (CPAP) bedside machine. These machines send pressurized air through a tube connected to a mask covering the nose and sometimes the mouth. The pressurized air opens the airway so that breathing is not interrupted.

Much less frequently, jaw surgeries may be recommended to remove excess tissues in the throat. These would be done by specially trained oral surgeons or ear, nose and throat specialists.

Diagnosis and treatment of OSA is best accomplished by joint consultation with your physician and our office. Contact us today to schedule an appointment to discuss snoring and OSA. You can learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Snoring and Sleep Apnea.”

Test yourself on your knowledge of this dental procedure.

1. A root canal is
1. A canal shaped structure in the root of your tooth
2. A blood vessel carrying blood from your gum to your tooth
3. An instrument used by your dentist in performing dental surgery
2. Which of these are symptoms of root canal infection?
1. Sharp, acute and intense pain, which is difficult to pinpoint
2. Sharp pain when biting down on your tooth or on food
3. Lingering pain after eating hot or cold foods
4. Dull ache and pressure
5. Tenderness (accompanied by swelling) in the nearby gums
6. All the above
3. If you don't feel any pain you do not have a root canal infection.
1. True
2. False
4. Root canal treatment is a very painful experience.
1. True
2. False
5. Root canal treatment is called endodontic therapy. What does this word mean?
1. Bringing the end of your problems
2. Inside your tooth
3. Fighting gum disease
6. You need root canal treatment if
1. The inside or pulp of your tooth becomes inflamed or infected
2. Your tooth needs to be gently moved in order to correct your bite
3. Acid erosion is damaging your tooth
7. During root canal treatment the canals in your teeth are cleaned out and sealed off.
1. True
2. False
8. Who is qualified to perform root canal treatment?
1. General dentists
2. Endodontists
3. Both of the above

1. a. A root canal is a canal shaped space within the root of a tooth that holds the tooth's pulp — which contains the tooth's nerves and blood vessels.
2. f. — all of the above
3. False. It is possible to have an infection that has stopped hurting but is still present and causing damage.
4. False. Root canal treatment doesn't cause pain, it relieves it.
5. b. The word comes from roots meaning “inside” and “tooth.”
6. a.
7. True. A small opening is made in the chewing surface of your tooth to gain access to the pulp. Dead and dying tissue is removed and the pulp is cleaned and disinfected. The canals are shaped and then sealed with filling materials to prevent future infection.
8. c. All general dentists have received training in endodontic treatment and can perform most endodontic procedures. They often refer people needing complicated root canal treatment to endodontists, who have had specialized training in endodontic diagnosis and treatment.

If you fear a visit to the dentist, you are not alone. Studies have shown that up to 75% of people surveyed have some fear of dental visits, and 10 to 15% fear the dentist so much that they avoid any dental treatment. This can have serious repercussions, leading to toothaches, infections, and loss of teeth. Poor oral health can even negatively affect your general state of health.

Here's the good news. Even people who are the most afraid of the dentist can learn to reduce their fear and feel calm and safe during a dental visit.

Dental fears develop when people have bad dental experiences. For many, the problem is a sense of loss of control. Sometimes, fears are based on stories people have heard or even movies they have seen.

The feeling of being afraid reinforces your fear. If you experience the rapid heartbeat, sweaty palms, tensed muscles, and other symptoms of fear while in the dentist chair, you are likely to remember these unpleasant feelings afterward and become even more fearful. In order to reverse this process, you need to begin to associate dental visits with good experiences and a sense of control. Here's how we can help you do this:

• Know that you are not alone and we are here to help you.
• Talk to us about your fears. We are sure to listen and not be judgmental. If you don't talk about it, you can't get over it.
• We will start by doing things that cause only mild or no anxiety. We want each visit to be a good experience, so you are able to leave our office with a feeling that it was okay, and you can do it again.
• Our goal is for you to overcome your fear. We will make this a priority and that priority is as important as “fixing your teeth.” We will be happy to talk about the time and fees associated with your treatment so that you can overcome your fear and gain a sense of control of the situation.
• It took a while for your fears to develop, so you should realize that it will also take a while to get over them. We will spend as much time as you need to get over your fears and will not rush you into doing anything for which you are not ready.

Contact us today to schedule an appointment to discuss your questions about any fears you may have. You can also learn more by reading the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”

Lost teeth can cause a host of problems, including a loss of your jaw bone and a collapsing appearance of your face, along with difficulty chewing and speaking.

Clearly, it is important to replace missing teeth as soon as possible. Options for replacement include the more traditional methods and the newest technique — dental implants. We believe that implants are your best choice for the following reasons.

1. Implants prevent bone loss.

   Dental implants are substitute tooth roots. Like the roots of your original teeth, they stabilize the bone into which they extend — but in a different way.

   The part of the bone that encases the teeth is called alveolar bone, from the word root meaning “sac.” This bone has a special relationship with the teeth it surrounds. It develops as they first erupt into the mouth. If they are lost, the alveolar bone goes, too. It resorbs, or melts away, giving an impression that the bone, gums, and sometimes the lips are collapsing.

   Implants are made of titanium, which has the ability to join biochemically to bone. It takes the place of the original tooth root and prevents resorption.

2. Implants support adjacent teeth.

   Your teeth work in harmony, an all for one, one for all relationship with each other. If one is missing, the remaining teeth will slowly move and shift causing them to receive forces that may not be well received. Losing any tooth increases the pressure on the remaining teeth. Losing a back (posterior) tooth can put pressure on the front teeth and they can be forced out of position. All these movements can change a person's appearance as well as in their ability to speak, bite and chew.

3. They are easier to clean than “traditional” options.

   Fixed bridges are non-removable tooth replacements that attach to adjacent natural teeth. These teeth that are adjacent to the missing tooth have to be cut into small peg shapes on which the bridge is attached. The removal of their enamel may make them more prone to tooth decay and gum disease.

   Older replacement methods include removable options such as plastic “flippers” and partial dentures. These replacements rest on the teeth and gums, making the teeth they attach to receive greater pressure causing more mobility. In addition, they exert pressure on the gums, causing additional bone loss and increasing the potential for bone loss on the neighboring teeth.

   Full dentures, in cases where all teeth are missing, are kept in place by pressing on the gum tissues. This causes even more pressure on the bone, leading to bone loss and changing facial structures.

4. They are longer lasting.

   Studies have shown that removable partial dentures are replaced about every five years; bridges are only 67% successful at 15 years; and implants are over 95% successful for 20 or more years.

5. They are cost effective in the long term.

   Because implants last longer than other alternative tooth replacements, they may seem more expensive at first; but they will be cost effective over the long term.

Contact us today to schedule an appointment to discuss your questions about dental implants. You can also learn more by reading the Dear Doctor magazine article “Dental Implants. Evaluating Your Options.”

It is important to brush your teeth every day to remove plaque (that sticky white film, composed of bacteria, on your teeth near your gums), but it is possible to overdo it — particularly if you find that your teeth are becoming sensitive to hot and cold or to variations in pressure.

Brushing your teeth too hard or too many times per day can aggravate tooth sensitivity, which can range from a mild twinge to a severe pain. You can accomplish the goal of tooth brushing — plaque removal — by using a soft brush with a very gentle action. Repeated aggressive brushing with a hard brush is not required and can even be harmful to your teeth and gums.

To understand how teeth become sensitive, you need to know about the internal structure of your teeth. Teeth are covered by enamel, a hard mineralized coating that protects them from changes in temperature and pressure. If the enamel is worn away, it exposes the next lower layer of the tooth, the dentin. The dentin is a living tissue containing nerve fibers that connect to the nerves in the tooth's root.

Excessive tooth brushing can irritate your gums and cause them to shrink away from your teeth, particularly if you have thin gum tissues. The thickness or thinness of your gum tissues is something you inherit from your parents, so you can't change it. Hard brushing can begin to wear away the enamel covering of your teeth. Exposure to acids or sugars in the foods you eat and drink can continue the damage.

Acidic foods and drinks such as fruit juices dissolve some of the minerals in your teeth by a process called “demineralization.” Fortunately, your saliva can interact with the enamel and bring back minerals that are leaving the tooth's surface. This process is called “remineralization.” It is important to let your healthy saliva wash your teeth's surfaces for a while before brushing so that dissolved minerals get a chance to be returned to your enamel. It takes between twelve and twenty-four hours for plaque to form on your teeth, so you don't need to brush more than twice a day.

The best way to make sure you are brushing your teeth properly is to have us evaluate your brushing technique at your next dental appointment. We will be able to tell you whether you need to change the angle of your brush or the pressure you are applying for the most effective removal of plaque with the least wear on your teeth and gums. Tooth brushing serves an important purpose, but remember that you can actually have too much of a good thing.

Contact us today to schedule an appointment to discuss your questions about tooth brushing and oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Sensitive Teeth.”

Just as you would expect, we highly recommend the use of protective mouthguards to anyone participating in contact sports or rigorous physical exercise. The primary reasons we feel this way are substantiated by evidence-based research and experience within our practice. If you don't think mouthguards are helpful, here are some facts you should know:

• Research conducted by the American Dental Association (ADA) found that individuals are 60 times more likely to damage their teeth when not wearing a mouthguard while engaged in contact sports or rigorous physical exercise. This shocking fact alone illustrates the importance of protective mouthguards.
• A study reported by the American Academy of General Dentistry (AAGD) found that mouthguards prevent more than 200,000 injuries to the mouth and/or teeth each year.
• Sports-related injuries often end-up in the emergency room; however, the US Centers for Disease Control (CDC) reports that more than 600,000 of these visits involve injury or damage to the teeth and mouth.
• In addition to the trauma of having a tooth (or teeth) knocked out, individuals who have suffered from this type of injury may end up spending $10,000 to $20,000 per tooth over a lifetime for teeth that are not properly preserved and replanted. This staggering statistic is from the National Youth Sports Foundation for Safety.
• While protective mouthguards were first used in the sport of boxing during the 1920s, the ADA now recommends their use in 29 (and growing) different high contact sports and activities. Some of these include acrobatics, baseball, basketball, bicycling, field hockey, football, handball, ice hockey, lacrosse, martial arts, skateboarding, skiing, soccer, softball, volleyball and wrestling.
• It used to be that only males were considered when it came to needing mouthguards. However, recent studies have revealed that the growing interest and participation of females in these same sports and activities makes it just as important for them to protect their teeth.

To learn more about the importance of mouthguards, continue reading the Dear Doctor magazine article “Athletic Mouthguards.” You can also contact us today to schedule an appointment or to discuss your questions about protecting your mouth and teeth. And if you have already suffered from a dental injury, let us evaluate the damage and work with you to restore the health and beauty of your teeth.

Parenthood comes with no manual — if it did it would surely include many essential tips to make your job easier while improving your children's lives. One important fact that surprises many people, is the age you should take your children to the dentist for their first dental appointment, age one. The reason that the age one dental visit is so important is that it establishes the foundation of oral healthcare for the rest of their lives. Unfortunately, some parents wrongly assume that because primary teeth “fall out anyway,” they do not need to worry about them. Nothing could be further from the truth!

One problem children may face is Early Childhood Caries (ECC) tooth decay. This is a type of tooth decay that occurs from sucking on a bottle filled with sugary liquids such as formula, juices and fruity drinks for extended periods of time and from a sleep-time bottle. ECC can affect all the primary (baby) teeth in infants soon after they come into the mouth.

Bringing your children into our office for their age one dental visit enables us to establish a friendly, trusting relationship with the whole family while we assess your children's oral health. During this consultation we will identify if the teeth and jaws are developing correctly, whether habits such as sucking on baby bottles are causing tooth decay or if there are other underlying issues that may indicate future problems. And this ounce of prevention often enables us to stop an anticipated problem before it even starts.

Considering that over 90 million Americans suffer from chronic bad breath and everyone else has dealt with some form of it at one time or another, we want to address some common causes and cures so you are prepared if it happens to you.

What are the most common causes of bad breath?

Halitosis or bad breath most often occurs when you have poor oral hygiene and/or routinely consume odorous foods and drinks. In fact, 90% percent of mouth odors come from the food you eat or bacteria that’s already there, according to the American Dental Association. Other causes for halitosis include:

• Excessive bacterial growth in the mouth and especially on the tongue
• Known and characteristically odor producing foods and drinks such as onions, garlic, coffee, tobacco and alcohol products
• Diabetes and diseases of the liver and kidneys
• A poorly hydrated body (and mouth) from not drinking enough water everyday

What should I do if I feel (or people tell me) I have chronic bad breath?

Contact us to schedule an appointment for a proper diagnosis and plan of action for returning your mouth to optimal health.

What are some tips I can do to prevent occasional bad breath?

In most cases, bad breath is totally preventable when you follow the tips below:

• Brush your teeth in the morning and at bedtime using a fluoride toothpaste and a proper (and gentle) brushing technique.
• Floss your teeth at least once a day.
• Clean your tongue after brushing your teeth with either a scraping tool you can purchase at a drug or discount store or by gently brushing it with your toothbrush.
• Keep your mouth moist by drinking plenty of water during the day.
• Be prepared by having some mouth cleaning tools (floss, a toothbrush, toothpaste or some sugar free gum) handy to freshen your mouth after consuming bad smelling foods, drinks or using tobacco or alcohol.
• Eat fresh fruits and vegetables to increase saliva production in your mouth and help remove food particles that can lodge between teeth.
• Maintain regular dental check-ups.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more about halitosis by reading the Dear Doctor article, “Bad Breath — More than Just Embarrassing.”

A veneer is a thin layer of dental ceramic tooth-colored restorative material, usually made of porcelain, which replaces some of the tooth's enamel and is physically bonded to it.

You might want to consider porcelain veneers:

10. If your teeth are severely discolored. (For best results we may recommend that your teeth be whitened before veneering them.)
9. If your teeth cannot be evenly whitened or matched by other means.
8. If your teeth are misshapen or worn, you can change their size or shape for optimum aesthetic appeal.
7. If you don't want to have your teeth prepared (drilled), prepless veneers may be an option to change your smile.
6. If you want as little natural tooth structure prepared as possible to improve your smile.
5. If you would like something temporary first to “test-drive” your new smile, then:
4. “Provisional veneers” allow you to try out your new smile and give us feedback before the final permanent veneers are placed.
3. If you want to improve your smile for just one tooth or even multiple teeth.
2. If you want long-lasting restorations — veneers can last from seven to twenty years or more.

And the top reason is:

1. Porcelain laminate veneers are among the most aesthetic ways to create a more beautiful, yet normal, looking smile.

Tell us what you want to change about your current smile, and we can tell you whether veneers are right for you. Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can learn more by reading about porcelain veneers in Dear Doctor magazine.

A dental crown is a tooth-shaped “cap” or cover that we place over a tooth that is badly damaged from trauma or decay to restore its shape, strength, size and functionality. We also use them for cosmetic reasons to improve a tooth's appearance with natural, life-like results. Crowns are generally handcrafted by dental laboratory technicians using high-quality dental porcelains (ceramic materials) that are made to fit on precise replicas (molds) of the prepared teeth. In our office, we generally make temporary crowns to protect the teeth to keep them comfortable and functional while the permanent crown(s) is being made. And once a crown is placed (cemented into position), it fully encases the entire visible portion of the tooth that lies at and above the gum line.

When Are They Necessary?

There are many reasons a crown may be needed. Some of these include:

• To repair a tooth that is worn down, broken or badly damaged by decay or injury.
• To restore a tooth so severely damaged by decay that the tooth's structure is no longer intact enough to place a filling or where a filling can't restore the tooth to its former strength.
• To protect a tooth that has minor cracks or fractures from further damage.
• To create a bridge to replace a missing tooth, in which the teeth on either side, known as abutments, must be “crowned” to attach to the “pontic” (from the French word, “pont” that means bridge).
• To create the visible part of the tooth that sits atop a dental implant.
• To improve the appearance of a tooth providing a more appealing shape and color.

To learn more on this topic, read the Dear Doctor article, “Porcelain Crowns & Veneers.” You can also contact us to discuss your questions or to schedule a consultation.

Many youngsters look forward to finding a surprise under their pillow after a visit from the “tooth fairy.” This fable may comfort children who wonder why their first teeth come out. Parents need to know that losing baby teeth, also called primary or deciduous teeth, is completely normal, but at the right time and the right “space.”

A child's first set of teeth must be lost to create room for the adult or permanent teeth that have been forming beneath them. The buds of the permanent teeth grow within a child's jawbone just under the baby teeth. The tops, or crowns, grow first, followed by the roots. Then as the roots develop, the permanent teeth push the baby teeth above them up through the gum tissues. As this happens, the roots of the baby teeth are resorbed, or melted away.

With their roots gone, eventually the baby teeth become so loose that they can be easily removed or fall out on their own, making room for the adult teeth to appear. Sometimes, when a baby tooth is so loose, it can be wiggled out. It leaves a little bleeding gum tissue that heals easily. This is also normal.

Besides making sure the tooth fairy comes, parents need to be sure that their children are evaluated to determine whether baby teeth are being lost in the right sequence so they will act as guides for the adult teeth. If teeth are lost prematurely because of decay or trauma, it is important that space is maintained for the adult teeth when they come in.

Contact us today to schedule an appointment or to discuss whether your child's baby teeth are being lost in the right sequence and the adult teeth are coming in correctly. To read more about losing baby teeth, see the article “Losing a Baby Tooth: Understanding an important process in your child's development.”

While we have gained recognition for our role in creating gorgeous smiles with porcelain veneers, the often overlooked or unknown key contributors in this process are the dental laboratory technicians. These behind-the-scenes artists are the trained professionals in the art of using dental porcelain to hand-craft veneers and crowns into near exact replicas of natural teeth in shine, opacity, translucence and shape.

Through the use of precise molds and excellent communication skills, we share detailed information with the laboratory technician to create veneers or crowns specifically for enhancing and improving your smile. In fact, communication must be so exact that it often demands correct lighting, cameras and computers to produce optimal results. This process also requires a variety of colors, shapes and translucency, created so that once we cement them into place, they appear as beautiful natural teeth. If your veneers are part of a smile restoration or makeover and you are getting them for several front teeth, the end results are typically brighter and whiter than your natural teeth. However, they must blend with surrounding teeth if those teeth are not also receiving veneers. So it is often recommended to have your natural teeth whitened before the veneers are replaced.

Good dental porcelains in the right hands can make for spectacular tooth imitations by mimicking tooth enamel perfectly. And now that you have these facts, you begin to understand all of the expertise, artistry, and the technology required by laboratory technicians to produce the most dazzling porcelain veneers.

To learn more about porcelain veneers, continue reading the Dear Doctor article, “Smile Design Enhanced With Porcelain Veneers.” Or if you are ready to see what cosmetic dentistry can do for you, contact us to schedule a consultation.

For generations, root canal treatment has received a bad rap. Thought to cause pain, it is actually just the reverse. The truth is that root canal treatment does not cause pain but actually relieves it. Not only does root canal treatment relieve pain, it literally saves the affected tooth or teeth from further damage and/or loss.

To get started, let's define this procedure. A root canal treatment is a procedure in which the diseased pulpal tissue in the root canals are removed, disinfected, cleaned, and sealed. This is usually necessary following inflammation and infection of the pulp — which is the cause of your pain — as a result of severe decay or in a very heavily filled or damaged tooth.

However, if left untreated, an infected tooth can spread into the bone and even cause an abscess — and that can be more painful and impact your overall general health. The good news is that once a tooth has had the appropriate endodontic treatment (“endo” – inside; “dont” – tooth) followed by a proper restoration, it can last as long as your other teeth. The key is to take proper care of your teeth, have routine cleanings, and visit our offices as soon as you feel you have a problem with a tooth.

If you are having pain from a tooth or several teeth, you may need a root canal treatment. Please contact us today to schedule an appointment before it gets worse. To learn more about the signs, symptoms, and treatment for a root canal, read the article “Common Concerns About Root Canal Treatment.”

Are you are considering a cosmetic procedure such as porcelain veneers? To assist you in making this decision, we developed the following list of questions you should consider asking before getting porcelain veneers.

• Am I a good candidate for porcelain veneers?
• Can you show me examples of your work?
• How much will my veneers cost?
• Will my insurance cover any portion of my procedure?
• Do you offer any financing for my procedure or can you make any recommendations for financing?
• How will you chose what color to make my veneers?
• How long will it take from my initial consultation until I receive my final, permanent veneers?
• How much tooth reduction (drilling) will you need to do before placing my veneers?
• How do veneers attach to my teeth?
• Can you create a prototype or temporary veneers so that I can “test drive” my new smile before my permanent ones are made?
• What do I need to do to clean and protect my veneers?
• How long can I expect my veneers to last?
• If at some point in the future I decide I want my veneers removed, what can I expect?

We hope that the above questions help you obtain all the answers you need as you consider getting porcelain veneers. If you have other questions, concerns, or if you are ready to take the next step and schedule a consultation, please contact our office.

What causes stains on teeth?

Staining can occur on the outside surfaces of teeth and is caused by foods such as red wine, coffee, and tea, as well as by tobacco use. They can also be developmental, affecting the structure of the teeth due to excessive fluoride levels or from tetracycline antibiotics given during childhood to name a few. Changes in a tooth's enamel or dentin during tooth formation, or as teeth age, can also cause discoloration.

What is going on inside a tooth's structure that makes it look stained?

Most of a tooth's covering (95 percent) is composed of highly mineralized enamel. The crystals of enamel are contained in a framework, or matrix, of organic matter. Dentists believe that various organic compounds that get into this matrix can cause staining.

How do whiteners work?

Tooth whiteners or bleaches expose the teeth to a peroxide compound. This creates reactive oxygen that breaks down highly colored organic compounds within the tooth's sub-surface matrix, making the tooth look whiter, but without changing its internal structure.

What professional in-office whitening techniques are available?

During treatment, a high concentration of peroxide solution in the form of a gel is applied directly on the teeth, often with activation by a heat or light source. These systems use custom tailored trays fitted to an individual's mouth. Silicone barriers or protective gels are used to keep the peroxide gel away from the gums or sensitive membranes in the mouth.

How are professional home whiteners different?

Home whiteners involve a less concentrated solution of peroxide in a gel form. It is delivered to the tooth surface by a bleaching tray that is custom-made in your dentist's office. Over-the-counter whiteners such as whitening strips or paint-on formulas can also be used, but they take longer and they're not as effective — the more diluted solutions are used for safety.

Can toothpastes really whiten teeth?

Mild abrasives in toothpastes clean surface stains but cannot change the underlying tooth color or remove significant staining.

How long do the results last?

Usually, the results last from six months to two years, but effects will diminish over time. You can make them last longer by avoiding the foods and habits that cause staining.

Are teeth whiteners safe to use?

Teeth whitening products are safe if used according to our recommendations or the product manufacturer's directions. Peroxide products may be toxic if used in excess of recommended intervals and amounts.

Read more about teeth whitening in the article “Teeth Whitening, Brighter, Lighter, Whiter...” Contact us today to schedule an appointment or to discuss whether tooth whitening is right for you.

FAQs About This New and Miraculous Procedure

How can sinus surgery contribute to the replacement of missing back teeth with dental implants?
Dental implants must be anchored the in bone to be successful. Maxillary sinus surgery can help regenerate bone that has been lost and is critically needed to anchor dental implants.

What are the maxillary air sinuses?
Inside the upper jaw, or “maxilla,” are structures known as the maxillary air sinuses, one on either side of the upper jaw. Each sinus is an air-filled space lined by a membrane. Upper back teeth are normally encased in the bone of the maxilla, below the sinuses.

Why is it important to replace missing back teeth?
Replacing back teeth restores the ability to eat, chew, and talk properly. The back teeth also provide facial and cheek support.

Why use dental implants?
Dental implants are the state-of-the-art method for replacing missing teeth.

Why does bone loss occur?
Unless special precautions are taken to prevent it, when teeth are lost, the bone supporting them is also lost.

If there is insufficient bone to anchor dental implants, what are the alternatives?
If all the back teeth are lost and dental implants cannot be placed, removable upper dentures may be the only alternative.

How do you determine whether a sinus surgical procedure is necessary?
The size, shape, and remaining bone of the maxillary sinuses influence whether you can have dental implants with or without a sinus surgical procedure.

How does surgery grow bone?
A small window is created in the sinus wall above where implants need to be placed. The sinus membrane is lifted and the space thus created filled with bone grafting and biologically active bone generating materials. The window is then closed and simply heals.

How is the surgery done?
The surgical procedures are performed from inside the mouth in the area just above the missing back teeth. They are generally carried out under local anesthesia (small shots, just like for a filling), sometimes with the addition of sedation or anti-anxiety medication.

How do bone grafts work?
Bone grafts act as scaffolds that the body replaces with its own bone. The most well researched bone substitute grafting material is currently bovine (cow) bone. All grafting materials are approved by the Food and Drug Administration. They are specially treated to render them completely sterile, non-contagious, and free of rejection factors.

What can I expect after surgery?
Moderate swelling and discomfort after surgery generally lasts for a few days to a week, about the same as having an upper impacted wisdom tooth removed. Supportive treatment usually includes a course of antibiotics to prevent infection and prescription strength medication of the aspirin or ibuprofen type. A decongestant may also be prescribed, if necessary. Healing is generally uneventful.

Who performs this surgery?
Maxillary sinus augmentations are usually carried out by oral surgeons, periodontists, or appropriately trained general dentists. Proper assessment of your situation and diagnosis are critical pre-requisites to the right procedure.

If you are missing upper back teeth, contact us today to schedule an appointment and discuss maxillary sinus augmentation. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery: Creating Bone for Dental Implants out of Thin Air.”

Sucking their fingers or thumbs makes young babies feel secure and is completely normal behavior. Babies have been observed to suck their fingers or thumbs even before they are born. But like many comforting habits, over-doing pacifier, thumb, or finger sucking habits may be harmful.

Stop Pacifier Use by 18 Months

Studies have shown that pacifier use after the age of two may cause long-term changes in a child's mouth. We recommend that pacifier use should stop by about 18 months. A pacifier habit is often easier to break than finger or thumb sucking.

Stop Thumb and Finger Sucking by Age Three

Most children naturally stop thumb and finger sucking between two and four years of age, but some children continue this habit much longer. This may cause their upper front teeth to tip towards their lips or to come into position improperly. It can also cause their upper jaw to develop incorrectly. The American Academy of Pediatric Dentistry recommends that children stop these habits by age three.

Use of Behavior Management to Encourage Quitting

We offer creative strategies for gentle ways to cut back and stop pacifier use, including behavior management techniques that use appropriate rewards given at predetermined intervals. Meanwhile, make periodic appointments with us to carefully watch the way your child's teeth and jaws develop.

When your child is old enough to understand the possible results of a sucking habit, just talking about what may happen to teeth as a result can often encourage him/her to quit. As a last resort, a mouth appliance that blocks sucking may be needed.

If you are worried about your child sucking a pacifier, thumb, or fingers, please visit us to put your mind at rest. For more information read “Thumb Sucking in Children” in Dear Doctor magazine. Contact us today to schedule an appointment to discuss your questions about children's thumb sucking.

“Smile, and the world smiles with you,” the old saying goes. For people who are afraid to smile because they don't like how their smile looks, the twenty-first century offers a myriad of solutions. Smiling shows your teeth in their various shapes, colors, and sizes, your gums and gum line, your tooth alignment, spacing, and bite all in relation to the rest of your face. Any of these can now be improved.

Through the knowledge, skills, and combined experience of our dental team, it is now possible to make teeth whiter, brighter, and more evenly aligned, to alter tooth shape and size, and to make the teeth and gum line more proportionally balanced. Here are some options for cosmetic dentistry:

• Polish. Remove unwanted stains on outside tooth surfaces by having your teeth polished.
• Teeth Whitening. If teeth are stained or have just lost their luster, whitening is a safe and effective way to lighten a smile.
• Porcelain veneers. Applying a thin layer of dental porcelain restorative material to replace stained or damaged tooth enamel can truly change a smile.
• Porcelain crowns. If teeth are damaged by decay or trauma, porcelain crowns can replace the parts of the teeth that show above the gum line.
• Orthodontics. For teeth that are not in their correct and functional position, a variety of orthodontic techniques can be used including traditional braces, clear aligners and more—to improve crooked teeth or a malaligned bite.
• Dental implants. Nothing ruins a smile more than missing teeth. Entire teeth can be replaced, including the roots and the crowns, using dental implants. These are exact replicas of the natural teeth and can be made to match their neighbors exactly.

To learn more about all types of cosmetic dentistry, read “Cosmetic Dentistry, a Time for Change.” Or if you prefer, you can contact us to discuss your questions or to schedule an appointment.

The third molars, called “wisdom teeth” because they usually become visible when a person is 17 to 25 — supposedly the time we achieve wisdom, may have adverse effects on adjacent teeth. Most adults have four wisdom teeth, although some people have more; and some, none at all. The wisest thing to do about wisdom teeth may be to have them removed if they are poorly positioned.

What is an impacted wisdom tooth?

If a wisdom tooth is pushing against gums, other soft tissues, or adjacent teeth at an awkward angle, it is referred to as “impacted.” Usually this occurs when there is not have enough room in the jaws for these last molars to fit next to their adjacent teeth. They can disrupt the gum tissue attachment of their neighboring teeth and the surrounding bone leading to periodontal disease and, ultimately, their loss.

In many cases, impacted teeth are painless, and those who have them have no warning of the problem. Thus it is important to have routine dental exams during the time when the third molars are coming in.

When should wisdom teeth be removed?

It is better to remove wisdom teeth early rather than waiting until periodontal (gum) disease has set in. As individuals age, keeping their wisdom teeth may lead to more serious problems. Periodontal defects tend to get worse in the presence of retained third molars. Furthermore, there is a higher incidence of postoperative symptoms in people over 25.

What are the pros and cons?

Removing impacted third molars can have a negative influence on the periodontal tissues of adjacent second molars. A number of techniques, such as scaling, root planing, and bacterial plaque control, can be used to minimize periodontal problems and promote healthy healing.

Surgical removal of wisdom teeth will involve some mild to moderate post-operative discomfort. Use of aspirin or ibuprofen for a few days after surgery will provide pain relief and control most swelling and symptoms. Antibiotics may be prescribed to ensure infection-free healing. It is important to keep the socket area clean by washing and rinsing with saline or antibacterial rinses. Careful surgery will promote good healing with minimal periodontal consequences to adjacent second molar teeth.

To decide whether your wisdom teeth should be removed, you will need an evaluation to assess the clinical health of the wisdom teeth, the neighboring teeth, and other vital structures. X-ray and digital imaging techniques play an important role in determining the exact position of the wisdom teeth in the jaw. A full assessment and consultation will include all the risks, benefits, likely consequences, and alternative treatment options. This will provide you with the wisdom you need to determine what is best for your wisdom teeth.

To learn more about wisdom teeth, read “To Be or Not to Be: What are the consequences of an impacted wisdom tooth?” Or contact us today to discuss your questions or to schedule an appointment.

Treatment of OSA depends on the severity of symptoms, magnitude of the complications and etiology of the upper airway obstruction. CPAP therapy has proven effective for many patients, but a Kribbs study showed that 54% of the subjects used the CPAP less than 4 hours per night. Studies continue to be done and new treatments have been found that are more convenient and easier to use.

New oral appliances have been found to be effective in treating snoring in mild and moderate OSA patients. Our practice is now equipped to fit you for an appliance that can hopefully be worn up to 3 hours longer than the CPAP.

Dr. Hartmann will soon be working with area ENT's to help coordinate treatment between offices. We are able to bill most medical insurances. Please contact our office (708/366-6760) or visit our web site (www.hartmanndds.com) if you are interested in learning more about getting a good night's sleep and possibly reducing your risk of many other respiratory or cardiac issues.

Our office is now utilizing the NuCalm System. Through the use of natural supplements, dark glasses and neural stimuli, this system allows the patient to leave feeling relaxed, refreshed and rejuvenated.

NuCalm is unique because it creates deep relaxation without using narcotics or controlled substances. This means NO side effects and it requires no recuperative time or supervision.

Over 9,000 patients across the United States have used NuCalm with zero adverse events. Of these, 97% would recommend NuCalm to their family and friends.

News of this amazing technology is spreading fast. You don't have to avoid the dentist anymore. It has even been featured on ABC 7 Chicago News Health Beat. The link can be accessed through our website at www.hartmanndds.com and click on the pain management tab.

NuCalm relaxes you, yet allows you to remain in control and aware at all times. You leave your appointment feeling relieved and rejuvenated.

FEAR DENTAL APPOINTMENTS NO MORE! Call us for more information or to set up your next appointment using the NuCalm System.

As we move forward with our blog, we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Hartmann and his staff.

We hope you find our blog to be helpful, engaging and informational to ensure your best dental health.
As always, feel free to contact us with any dental questions or concerns.

--Dr. Hartmann

Can chewing gum prevent cavities? Yes! It can if the gum is sweetened with xylitol.

What is xylitol?
Xylitol is a type of “sugar alcohol,” similar to sorbitol and mannitol, sugar replacements that are used in many low calorie foods. Xylitol occurs naturally in many fruits and vegetables and is obtained from the bark of birch trees, coconut shells and cottonseed hulls. It looks and tastes like sugar and is a diabetic-safe, low-calorie carbohydrate.

How does xylitol stop cavity formation?
Decay starts when certain bacteria break down sucrose (regular table sugar) and produce acids that dissolve the minerals in the enamel, the outer protective layer of your teeth. When the decay-causing bacteria try to consume xylitol, they are unable to break it down, and instead they begin to starve.

A normal mouth contains a large population of bacteria, and it is better for your teeth to have more “good” bacteria of the kind that do not cause cavities. Xylitol also stops your saliva from becoming acidic, so your mouth becomes a better environment for the “good” bacteria.

Chewing xylitol gum also increases your flow of saliva. Saliva contains calcium and fluoride and helps give these minerals back to your teeth (re-mineralization), undoing some of the effects of the cavity-causing bacteria. This makes chewing xylitol gum a particularly good solution for people who suffer from dry mouth.

How much xylitol do you need to prevent cavities?
We recommend that you chew or suck on two pieces of xylitol gum or two pieces of xylitol candy for five minutes following meals or snacks, four times daily — if you are at moderate to extreme risk for cavities. The target dose of xylitol is 6 to 10 grams (one or two teaspoons) spread throughout the day. Prolonged gum chewing is not advised, so most xylitol-sweetened products contain flavor that only lasts a short time to discourage excessive chewing. The only side effect of too much xylitol ingestion is that it may have a mild laxative effect.

I don't like chewing gum. Is there another way to get xylitol?
People who don't like to chew gum have the option of using xylitol in mints, candies, mouthwash, toothpaste, or mouth sprays. For these individuals, a minimum dose is 5 to 6 grams (one teaspoon) three times per day.

So now you can add xylitol to the list of ways to fight cavities: daily brushing and flossing, and regular professional cleanings — and chewing xylitol gum.

Contact us today to schedule an appointment to discuss your questions about xylitol and other methods of preventing tooth decay. You can also learn more by reading the Dear Doctor magazine article “Xylitol in Chewing Gum.”

If you have ever suffered from tooth sensitivity, you know all too well how real the pain can be — anything from a slight twinge to pain that can be downright excruciating. Sensitivity may be experienced several times throughout the day or just every once in a while. However, as we say, a little knowledge can go a long way. And we can provide you with the know-how and steps to help minimize your tooth sensitivity.

One of the first steps we will take is to review your brushing habits, as an improper brushing technique can not only cause tooth sensitivity, but it also can make the sensitivity worse once it is present. We will teach you how to remove dental plaque safely without damaging your delicate gum tissues, which can cause gum recession leaving the dentin exposed. Another step we may take is to provide you with a special toothpaste containing fluoride or one specifically targeted to sensitive teeth. The fluoride increases the strength of tooth surfaces and thus makes teeth more resistant to acid attack and sensitive to sweets. Or if the sensitivity is severe and/or constant, we may need to apply a barrier to cover the sensitive areas. These barriers may range from concentrated fluoride varnishes to bonded filling materials to cover the sensitive areas. If the pain is severe and constant, it may be possible that the pulpal tissue containing the nerves in your tooth are inflamed and you may need a root canal treatment to relieve your pain and save the tooth.

If you are experiencing tooth sensitivity or have questions about this condition, please contact us to schedule an appointment. Or you can learn more about this topic by reading the article “Sensitive Teeth.”