Oral Hygiene and Your Teenager

Oral Hygiene and Your Teenager

Teenagers can be tough on their teeth. They may be so busy with school, jobs, sports and social activities that they don't find time to brush. They also tend to eat a lot of junk food. Combine the two and you've got a situation ripe for tooth decay. Not surprisingly, many teenagers develop a lot of cavities. Here are a few tips to help your child get through the teen years cavity-free: Encourage your teenager to take good care of his or her teeth. This means brushing at least twice a day and flossing daily. Teenagers care a lot about how they look. Help your teen understand that bad oral hygiene can lead to stains, bad breath, missing teeth and many other dental problems. Set a good example. If you take good care of your teeth, your teenager will see that good oral hygiene is important to you. Your talks and warnings will not seem hypocritical and will carry greater weight. Have plenty of oral health-care supplies on hand. Keep soft toothbrushes, colored or flavored floss (or plastic flossers) and good-tasting toothpaste out in the bathroom. You can even keep them in the kitchen for quick use when teens are in a hurry. Don't buy junk food. Instead, keep lots of fruits and vegetables in the house for snacking.

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Fillings: the Basics

Fillings: the Basics

Determining If You Need a Filling Steps to a Filling After a Filling Temporary Fillings Why Replace a Filling? Determining If You Need a Filling Your dentist may use several methods to determine if you have tooth decay, including: Observation — Some discolored spots on your teeth may indicate decay, but not all of them. Your dentist may use an explorer, a metal instrument with a sharp tip, to probe for possible decay. Healthy tooth enamel is hard and will resist pressure by the explorer. Decayed enamel is softer. The instrument will stick in it slightly. Explorers must be used with caution. Pressing too hard with an explorer can damage a healthy tooth. Cavity-detecting dye — This can be rinsed over your tooth. It will stick to decayed areas and rinse cleanly from healthy ones. X-rays — X-rays can help your dentist see decay that doesn't show on the surface. However, X-rays are often not accurate in detecting smaller cavities on occlusal (top) surfaces. Current fillings or other restorations also may block the view of decay. Laser fluorescence cavity detection aids — These small wands measure changes caused by caries (tooth decay). They are especially useful for pit and fissure areas. Decay is not the only reason you may need a filling. Other reasons include: Cracked or broken teeth Teeth that are worn from unusual use, such as: Nail-biting Tooth grinding (bruxism) Using your teeth to open things Steps to a Filling When you visit your dentist to get a filling, you may be given local anesthesia to numb the area if necessary. Next, your dentist will remove decay from the tooth, using hand instruments or a drill. Air abrasion and lasers also can be used to remove decay. A drill, which dentists call a handpiece, uses metal cones called burs to cut through the enamel and remove the decay. Burs come in many shapes and sizes. Your dentist will choose the ones that are right for the size and location of your decay. At first, your dentist will use a high speed drill (the one with the familiar whining sound) to remove the decay and unsupported enamel of the tooth. Once the drill reaches the dentin, or second layer of the tooth, the dentist may use a lower speed drill. That's because dentin is softer than enamel. Once all the decay is removed, your dentist will shape the space to prepare it for the filling. Different types of fillings require different shaping procedures to make sure they will stay in place. Your dentist may put in a base or a liner to protect the tooth's pulp (where the nerves are). The base or liner can be made of composite resin, glass ionomer, zinc oxide and eugenol, or another material. Some of these materials release fluoride to protect the tooth from further decay. If your dentist is placing a bonded filling, he or she will etch (prepare) the tooth with an acid gel before placing the filling. Etching makes tiny holes in the tooth's enamel surface. This allows the filling to bond tightly to the tooth. Bonded fillings can reduce the risk of leakage or decay under the filling. That's because the etched surface of the tooth and the filling material form a mechanical bond. Bonding is generally done with composite fillings. Certain types of fillings get hardened by a special light. With these fillings, your dentist will stop several times to shine a bright light on the resin. This cures (hardens) the material and makes it strong. Finally, after the filling is placed, your dentist will use burs to finish and polish the tooth. After a Filling Some people feel sensitivity after they receive a filling. The tooth may be sensitive to pressure, air, sweet foods or cold. Composite fillings often cause sensitivity, but other types of filling materials can, too. In most cases, the sensitivity will subside over one to two weeks. Until then, try to avoid anything that causes it. If your tooth is extremely sensitive or your sensitivity does not decrease after two weeks, contact your dentist's office. It's important to let your dentist know about any sensitivity you are feeling. The next time you need a filling, he or she may be able to use a different material and make changes to reduce sensitivity. People vary in their response to different materials. Your dentist has no way of predicting if your tooth will react to a particular material. When you talk to your dentist about the sensitivity, try to describe it as precisely as possible. This information will help decide what should be done next. Your dentist may take out the filling and put in a new one. He or she may add a base, liner or desensitizing agent on the tooth as well. If the filling was very deep, you could need a root canal treatment to solve the problem. Besides sensitivity, some people feel discomfort when they bite down. There are two types of pain, each with a different cause. The first type occurs when you bite, and worsens over time. This is caused by a filling that is too high and interferes with your bite. Once your anesthetic wears off, you would notice this right away. Contact your dentist. You will need to return to the office to have the filling reshaped. The second type of discomfort is a very sharp shock that appears only when your teeth touch. This is called galvanic shock. It is caused by two metals (one in the newly filled tooth and one in the tooth it's touching) producing an electric current in your mouth. This would happen, for example, if you had a new amalgam filling in a bottom tooth and had a gold crown in the tooth above it. Your dentist polishes the filling after it is placed, but occasionally sharp edges may remain. You can't detect this at first because of the anesthesia. If you find one, contact your dentist and arrange to have it smoothed as soon as possible to avoid injury to your tongue or mouth. Temporary Fillings You may receive a temporary filling (usually white, off-white or gray) if: Your treatment requires more than one appointment. Your dentist wants to wait a short period of time for the tooth to heal. You have a deep cavity and the pulp (containing the nerve and blood vessels) becomes exposed during treatment. You need emergency dental treatment. A temporary filling may make your tooth feel better. This is because the filling seals the tooth, protecting the pulp from bacteria and reducing sensitivity. Temporary fillings often contain eugenol, an ingredient in over-the-counter toothache remedies. Eugenol is also a component of oil of cloves, which people use for toothache pain. Temporary fillings are not meant to last. Usually, they fall out, fracture or wear out within a month or two. If you get a temporary filling, make sure you visit your dentist to get a permanent one. If you don't, your tooth could become infected or you could have other problems. Why Replace a Filling? Fillings don't last forever. They can become discolored. Composite, tooth-colored fillings pick up stains, and yellow or darken over time. When you chew, your teeth and any fillings in them are subjected to tremendous pressures. Even if no other problems develop, some fillings will wear out over time and will need to be replaced. A filling will need to be replaced earlier if it falls out, leaks or cracks. Food debris and bacteria can seep down under a filling that is cracked or leaking. Since you can't clean there, the bacteria feed on the food debris and form the acid that causes tooth decay. Decay under a filling can become extensive before you notice it or it causes you pain. This is why you should have your fillings checked regularly and get them replaced when problems are found. Fillings That Fall Out Fillings can fall out for several reasons: You bite down too hard on a tooth that has a large filling, and break the filling or the tooth. The filling material that was used cannot withstand the forces placed upon it. For example, if you have broken a large piece of your front tooth, a porcelain (tooth-colored) crown is probably a good treatment choice. In some cases, a dentist may place a composite filling instead. This may look good or acceptable. However, if the composite is too large, a strong biting motion may break the plastic material. The cavity is contaminated with saliva when the filling is placed. For composite resins, this will disrupt the bonding of the material. As a result, the bond will not stick well to the tooth and it may fall out. Cracked Fillings Both amalgam and composite fillings can crack, either soon after they are placed or after the fillings have been in place for some time. Cracks can occur soon after a filling is placed if the filling is higher than the rest of the tooth surface, and must bear most of the force of biting. Cracks also can occur over time, as the forces from chewing and biting affect the filling. Small cracks also can occur at the edges of a filling. These usually are caused by wear over time. These cracks often can be repaired. Leaking Fillings A filling is said to be leaking when the side of the filling doesn't fit tightly against the tooth. Debris and saliva can seep down between the filling and the tooth. This can lead to decay, discoloration or sensitivity. Both amalgam and composite fillings can leak. An amalgam filling sometimes leaks slightly after it is placed. You would notice this as sensitivity to cold. This sensitivity decreases for the next two to three weeks. Then it disappears altogether. Over that period, the amalgam filling naturally corrodes. The corrosion seals the edges of the filling and stops any leaks. A composite filling could be contaminated with saliva. This would weaken the bond between the filling and the tooth and allow for leaks. Other times, there may be small gaps where the tooth and filling meet. These gaps are caused by shrinkage when your dentist places the filling. Sensitivity after receiving a composite filling may disappear over time. If it doesn't, the filling may need to be replaced. Fillings also can leak as a result of wear over time. These fillings should be replaced. Worn-Out Fillings Some fillings can last for 15 years or longer. Others, however, will have to be replaced in as little as five years. Your dentist can determine if your fillings are worn enough that they need to be replaced. Clenching and Grinding If you clench or grind your teeth, you may have more problems with your fillings. The forces placed on your teeth can lead to tooth sensitivity and extra wear on your fillings. Clenching or grinding also can cause your teeth and fillings to crack or develop small craze lines. These are fine cracks you can see if you shine a light on your tooth. Keeping Your Fillings Although some fillings can last for many years, the average life of an amalgam filling is about 12 years. Composite fillings may not last this long. Your dentist will examine your fillings at your checkup visits. You may need X-rays if your dentist thinks a filling might be cracked or leaking, or to see whether decay is occurring under the filling. Make an appointment with your dentist: If a tooth is sensitive If you see a crack If part of a filling appears to be missing You should visit your dentist regularly for cleanings, brush with a fluoride toothpaste, and floss once a day. If you have many fillings or very large fillings, your dentist may prescribe a fluoride gel you can use at home. The fluoride will help strengthen the enamel of your teeth and help to prevent future cavities. Your dentist or hygienist also can apply a fluoride varnish around the edges of these teeth at your checkup visits. Replacing a Filling Before removing your old filling, your dentist will discuss treatment options with you. It is often possible to repair an old filling instead of removing it and replacing it completely. However, if the entire filling has to be replaced, the dentist may reevaluate what filling material to use. Talk with your dentist about how you would like the filling to look. Then he or she can select the material that is best for you.

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What Is Fluoride?

What Is Fluoride?

Fluoride is a natural mineral found throughout the earth's crust and widely distributed in nature. Some foods and water supplies contain fluoride.

Fluoride is often added to drinking water to help reduce tooth decay. In the 1930s, researchers found that people who grew up drinking naturally fluoridated water had up to two-thirds fewer cavities than people living in areas without fluoridated water. Studies since then have repeatedly shown that when fluoride is added to a community's water supply, tooth decay decreases. The American Dental Association, the World Health Organization and the American Medical Association, among many other organizations, have endorsed the use of fluoride in water supplies because of its effect on tooth decay.

How Does Fluoride Work?
Fluoride helps prevent cavities in two different ways:

• Fluoride concentrates in the growing bones and developing teeth of children, helping to harden the enamel on baby and adult teeth before they emerge
• Fluoride helps to harden the enamel on adult teeth that have already emerged

Fluoride works during the demineralization and remineralization processes that naturally occur in your mouth.

• After you eat, your saliva contains acids that cause demineralization a dissolving of the calcium and phosphorous under the tooth's surface
• At other times when your saliva is less acidic it does just the opposite, replenishing the calcium and phosphorous that keep your teeth hard. This process is caused remineralization. When fluoride is present during remineralization, the minerals deposited are harder than they would otherwise be, helping to strengthen your teeth and prevent dissolution during the next demineralization phase

How do I Know if I'm Getting Enough Fluoride?
If your drinking water is fluoridated, then brushing regularly with a fluoride toothpaste is considered sufficient for adults and children with healthy teeth at low risk of decay.

If your community's water is not fluoridated and does not have enough natural fluoride in it (1 part per million is considered optimal), then your dentist or pediatrician may prescribe fluoride tablets or drops for your children to take daily. Your dentist or pediatrician can tell you how much fluoride is right for your family, so be sure to ask for his or her advice.

If your water comes from a public water supply, you can find out if it's fluoridated by calling your local water district. If your water comes from a private well, you can have it analyzed by an independent environmental testing company that provides water-testing services.

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X-Rays

X-Rays What Are X-Rays? X-rays are a form of energy that travels in waves. X-rays can enter solid objects, where they either are absorbed or continue to pass through. X-rays tend to be absorbed by denser objects but pass easily through less dense objects. Teeth and bone are very dense, so they absorb X-rays. X-rays pass more easily through gums and cheeks. That's why cheeks and gums appear dark and without detail on a dental X-ray, but teeth show up much lighter. Restorations such as crowns and fillings, which are even denser than bone, will show up as solid, bright white areas. Dental decay and caries (cavities) will appear on an X-ray as a darker patch. What You See on an X-Ray • Call Now San Francisco Dentist Request for appointment at: (415) 391 - 7751 450 Sutter street, Suite 1905 San Francisco, CA, 94108 http://malidds.com/ ©2001-2007 Aetna All rights reserved. 12/12/2006

What are the Stages of Gum Disease?

 

What are the Stages of Gum Disease?

What is Gum Disease?
Gum disease is an inflammation of the gums that can progress to affect the bone that surrounds and supports your teeth. It is caused by the bacteria in plaque, a sticky, colorless film that constantly forms on your teeth. If not removed through daily brushing and flossing, plaque can build up and the bacteria infect not only your gums and teeth, but eventually the gum tissue and bone that support the teeth. This can cause them to become loose, fall out or have to be removed by a dentist.

There are three stages of gum disease:

• Gingivitis: this is the earliest stage of gum disease, an inflammation of the gums caused by plaque buildup at the gumline. If daily brushing and flossing do not remove the plaque, it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. You may notice some bleeding during brushing and flossing. At this early stage in gum disease, damage can be reversed, since the bone and connective tissue that hold the teeth in place are not yet affected.
• Periodontitis: at this stage, the supporting bone and fibers that hold your teeth in place are irreversibly damaged. Your gums may begin to form a pocket below the gumline, which traps food and plaque. Proper dental treatment and improved home care can usually help prevent further damage.
• Advanced Periodontitis: in this final stage of gum disease, the fibers and bone supporting your teeth are destroyed, which can cause your teeth to shift or loosen. This can affect your bite and, if aggressive treatment can't save them, teeth may need to be removed.

How do I Know if I Have Gum Disease?

Gum disease can occur at any age, but it is most common among adults. If detected in its early stages, gum disease can be reversed so see your dentist if you notice any of the following symptoms:

• Gums that are red, puffy or swollen, or tender
• Gums that bleed during brushing or flossing
• Teeth that look longer because your gums have receded
• Gums that have separated, or pulled away, from your teeth, creating a pocket
• Changes in the way your teeth fit together when you bite
• Pus coming from between your teeth and gums
• Constant bad breath or a bad taste in your mouth

How is Gum Disease Treated?

• The early stages of gum disease can often be reversed with proper brushing and flossing. Good oral health will help keep plaque from building up.
• A professional cleaning by your dentist or hygienist is the only way to remove plaque that has built up and hardened into tartar. Your dentist or hygienist will clean or "scale" your teeth to remove the tartar above and below the gumline. If your condition is more severe, a root planing procedure may be performed. Root planing helps to smooth irregularities on the roots of the teeth making it more difficult for plaque to deposit there.

By scheduling regular checkups, early stage gum disease can be treated before it leads to a much more serious condition. If your condition is more advanced, treatment in the dental office will be required.

	Healthy Gums - healthy gums are firm and don't bleed. They fit snugly around the teeth.
	Gingivitis - gums are mildly inflamed, may appear red or swollen and may bleed during brushing.
	Periodontitis - gums begin to separate and recede from the teeth. This allows plaque to move toward the roots, supporting fibers and bone.
	Advanced Periodontitis - supporting fibers and bone are destroyed. Teeth become loose and may need to be removed.
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What is Plaque?

What is Plaque?

Plaque is a sticky, colorless film of bacteria and sugars that constantly forms on our teeth. It is the main cause of cavities and gum disease, and can harden into tartar if not removed daily.

How Do I Know if I Have Plaque?
Everyone develops plaque because bacteria are constantly forming in our mouths. These bacteria use ingredients found in our diet and saliva to grow. Plaque causes cavities when the acids from plaque attack teeth after eating. With repeated acid attacks, the tooth enamel can break down and a cavity may form. Plaque that is not removed can also irritate the gums around your teeth, leading to gingivitis (red, swollen, bleeding gums), periodontal disease and tooth loss.

How Can I Prevent Plaque Buildup?
It's easy to prevent plaque buildup with proper care. Make sure to:

• Brush thoroughly at least twice a day to remove plaque from all surfaces of your teeth
• Floss daily to remove plaque from between your teeth and under your gumline, where your toothbrush may not reach
• Limit sugary or starchy foods, especially sticky snacks
• Schedule regular dental visits for professional cleanings and dental examinations

	During scaling, plaque and tartar are removed from the crown and root of the tooth.
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All About Cavities

All About Cavities What's in Your Mouth? How Your Teeth Decay Types and Stages of Decay Preventing Cavities What's in Your Mouth? To understand what happens when your teeth decay, it's helpful to know what's in your mouth naturally. Here are a few of the elements: Saliva — Your mouth and teeth are constantly bathed in saliva. We never give much thought to our spit, but this fluid is remarkable for what it does to help protect our oral health. Saliva keeps teeth and other parts of your mouth moist and washes away bits of food. Saliva contains minerals that strengthen teeth. It includes buffering agents. They reduce the levels of acid that can decay teeth. Saliva also protects against some viruses and bacteria. Plaque — Plaque appears as a soft, gooey substance that sticks to the teeth a bit like jam sticks to a spoon. It is, in fact, colonies of bacteria, protozoa, mycoplasmas, yeasts and viruses clumping together in a gel-like organic material. Also in the mix are bacteria byproducts, white blood cells, food debris and body tissue. Plaque grows when bacteria attach to the tooth and begin multiplying. Plaque starts forming immediately after a tooth is cleaned; it takes about an hour for plaque to build up to measurable levels. As time goes on, different types of microorganisms appear, and the plaque thickens. Calculus — If left alone long enough, plaque absorbs minerals from saliva. These minerals form crystals and harden the plaque into calculus. Then new plaque forms on top of existing calculus. This new layer can also become hard. Bacteria — We have many types of bacteria in our mouths. Some bacteria are good; they help control destructive bacteria. When it comes to decay, Streptococcus mutans and Lactobacilli are the bacteria that cause the most damage to teeth. How Your Teeth Decay The bacteria in your mouth need food to live and multiply. When you eat sugary foods and other carbohydrates, the bacteria use them as food, too. The bacteria then produce acids that can dissolve tooth enamel (outer layer of the tooth). It's not just candy and ice cream we're talking about. All carbohydrate foods eventually break down into simple sugars. These include glucose and fructose. Some of this process begins in the mouth. Foods that break down into simple sugars in the mouth are called fermentable carbohydrates. These include the obvious sugary foods, such as cookies, cakes, soft drinks and candy. But they also include pretzels, crackers, bananas, potato chips and breakfast cereals. Bacteria in your mouth turn the sugars in these foods into acids. These acids begin to dissolve the mineral crystals in teeth. The more times you eat each day, the more times your teeth are exposed to an acid attack. This attack can lead to tooth decay, also known as dental caries. First, the acid begins to dissolve calcium and phosphate crystals inside a tooth. A white spot may appear on the enamel in this weakened area. But the loss of minerals develops beneath the surface of the enamel. The surface may still be smooth. At this stage, the tooth can be repaired with the help of fluoride, proteins and minerals (calcium and phosphate) in the saliva. The saliva also helps reduce the acid levels from bacteria that attack the tooth. Once the decay breaks through the enamel to cause a cavity, the damage is permanent. A dentist must clean out the decay and fill the cavity. Left untreated, the decay will get worse. It can destroy a tooth all the way through the enamel, through the inside dentin layer and down to the pulp or nerve of the tooth. That's why it is important to treat caries at a very early stage, when the process can be reversed. Types and Stages of Decay Young children can get a type of decay called baby bottle tooth decay or early childhood caries. It destroys enamel quickly. This type of decay is common in children who are put to sleep with a bottle of milk or juice. The bottle exposes the teeth constantly to carbohydrates through the night. Bacteria can grow rapidly and produce acid that decays teeth. Decay can become worse if the parent does not clean the child's teeth. It can eat through enamel and leave a large cavity in a matter of months. In older adults, the exposed roots of teeth can develop cavities. This is called root caries. Older adults are more likely to have receding gums caused by years of hard brushing or periodontal disease. They also are more likely to have dry mouth (xerostomia). The decrease in saliva results in less protection of the teeth. This increases the risk of decay. Many common medicines can cause dry mouth. Be sure to ask the doctor or pharmacist if any of your medicines cause dry mouth. Decay can form beneath fillings or other tooth repairs, such as crowns. Sometimes bacteria and bits of food can slip between the tooth and a poorly placed filling or crown. This also can happen if the filling cracks or pulls away from the tooth, leaving a gap. Preventing Cavities Do you or your family members get cavities often? Dental research has found out that certain factors can affect your risk of tooth decay. These factors include The current number of decayed or filled teeth Your fluoride exposure Family history of decay How well you take care of your teeth The amount of saliva and the balance of minerals, enzymes and buffering agents it contains How often and what types of foods you eat (especially carbohydrates) Ask your dentist about the best ways to reduce your risks and limit dental decay. To prevent your teeth from decaying, you can do two things: Strengthen your teeth's defenses with fluoride, sealants and agents that contain calcium and phosphate ions. Reduce the number of bacteria in your mouth. Fluoride penetrates into teeth. It strengthens them by replacing minerals that acid has destroyed. The benefits of fluoride to teeth were first discovered in the 1930s. Dentists started to notice that people who drank water that naturally contained fluoride had less tooth decay. In 1945, communities started to add fluoride to water supplies. Adding fluoride to water systems has been the most successful cavity prevention method to date. In the early 1960s, fluoride also began to be added to toothpaste. This also had a major impact on cavity prevention. Now almost all toothpastes contain fluoride. Everyone should brush with a fluoride toothpaste every day. Dental offices sometimes recommend higher levels of fluoride in toothpastes, gels and mouth rinses for both children and adults. More recently, agents containing calcium and phosphate have been developed. MI Paste and MI Paste Plus both contain Recaldent (the calcium-phosphate ingredient). Your dentist can apply them to your teeth. Recaldent also also can be found in chewing gum (some Trident products) and toothpaste. These agents help prevent and reverse early decay that has not yet led to a cavity. Sealants are protective coatings placed over the tops of the back teeth — molars and premolars. They block bacteria and acids from sticking in the tiny grooves on the chewing surfaces of these teeth. Sealants can be placed in adults and children. Children can have sealants on their baby molars, and also on the permanent molars once they come in. Dentists can put sealants on molars with signs of early decay, as long as the decay hasn't broken through the enamel. You can never get rid of all the bacteria in your mouth. But you can take steps to control bacteria: Brush twice a day. Floss daily. Reduce the number of times each day that you consume fermentable carbohydrates. Some prescription mouthwashes (those that contain chlorhexidine) reduce bacteria in your mouth. This can help prevent decay. Chewing sugarless gums, especially those with xylitol, can help reduce bacteria levels and increase the flow of saliva. Most importantly, visit your dentist regularly. Then the dentist can find any decay early, when it can be treated and reversed. ©2002-2009 Aetna All rights reserved. 3/22/2009

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