What’s in a dental fee?

A dental fee is the cost of a highly trained and skilled professional treating your teeth in a hygienic, comfortable environment.

As well, fees represent the costs of the up-to-date equipment and materials, staff, laboratory fees, infection control measures, premises, utilities and furnishings.

There are many factors affecting fees for dental treatment. The complexity of the treatment received, and the costs involved in running the dental practice you visit are such factors. The cost of maintaining correct infection control procedures alone can be very high. Dentists also need to pay ancillary staff wages and maintain equipment.

The ADA recommends you obtain a written estimate or quote for any major dental work required, so you know how much you are likely to be out of pocket.

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Is there a recommended dental fee scale and how does this relate to Health Fund rebates?

There is no such thing as a ‘recommended fee’ for any dental treatment. A dentist charges what he or she thinks is appropriate for the service they provide, taking into account all their costs and the particular circumstances of each treatment. The suggestion that some dentists depart from an ‘approved’ or recommended level of fees, thereby creating ‘gaps’ between the fee and the Health Fund rebates is both false and misleading. In fact, it is against Trade Practices law for dentists to collude in the maintenance of any set fee scale.
Health Funds set their rebates at a level that suits their commercial needs. Those rebates are not related to any recognised fee scale. The responsibility of adequately adjusting rebates lies with the Health Funds.

You can telephone the Association for further information on fee setting mechanisms, but remember there are no ‘recommended’ fees.
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Do I have to pay my dental account on the same day as my treatment?

Dentists, as anyone who provides a service, are entitled to determine their own terms.

Many dentists expect payment on the day of treatment. This practice reflects the problems dentists have traditionally experienced of lack of payment of accounts, and the widespread availability of payment methods such as credit cards. If you are a new patient to a practice, it is usually expected that you be prepared to pay for the first visit at least, before you are approved for any account facilities. This is no different to any other business.

If you are applying for an account, you may be expected to supply enough information to establish your identity and offer some commitment to pay for the treatment.
Often the large laboratory costs incurred by dentists for such things as crowns and dentures will be asked to be paid at the commencement of treatment. Your dentist will inform you of your obligations in this regard.
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Does the dentist have to itemise my account?

Although most dentists charge and invoice on a fee-for-service basis, a dentist is able to issue an account which states the treatment performed with a total cost.

However, at the request of a patient, an itemised account must be supplied. Occasionally, problems can arise with dental benefit funds where some dentists establish their fees on a time basis exclusively. The fund then makes an arbitrary division of the total fee between the items nominated.

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When do teeth appear?

Teeth begin to erupt at about six months of age. The tooth appears first and the root begins to develop underneath. When a child’s mouth is fully developed there should be 20 teeth — 10 on the bottom and 10 on the top.

However, the top and bottom teeth erupt at different times.

Top Teeth — The central incisors, or very front teeth, are the first to erupt between 6 to 12 months. The teeth next to them, called the lateral incisors, erupt between 9 to 13 months. The canines erupt between 16 to 22 months. The first molars erupt between 13 to 19 months. And the second molars erupt between 25 to 33 months.

Bottom Teeth — The central incisors erupt between 6 to 10 months. The lateral incisors erupt between 10 to 16 months. The canines erupt between 17 to 23 months. The first molars erupt between 14 to 18 months. The second molars erupt between 23 to 31 months.

Under all this activity, the 32 adult teeth are forming. In fact, the adult teeth began developing when the baby was three months old.

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What are the different types of sedation available?

Many people are nervous or anxious about visiting and being treated by the dentist. Fortunately there are a number of techniques dentists have at their disposal to help their patients. These include inhalation sedation, intravenous sedation and general anaesthetic.

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Sedation type 1. – Inhalation sedation

The most common technique is the use of a nitrous oxide and oxygen mix or the so-called ‘laughing gas’. The Nitrous Oxide mixture

 

  • Reduces pain,
  • Reduces anxiety, and
  • Reduces the gag reflex.

Patients will often experience a feeling of well-being and euphoria.
The technique involves placing a mask over your nose, and then breathing through your nose.
The gases have a slightly sweet smell and are well tolerated by even the most sensitive noses. The dentist will adjust the percentage of nitrous oxide to oxygen to suit you.

What are the advantages of Inhalation sedation?

The technique has a number of advantages over other techniques:

  • It is less expensive than other techniques
  • It is simple
  • No escort is required
  • No fasting is required
  • There is a rapid onset and fast recovery
  • It is suitable for children

Who is it not suitable for?
Unfortunately the technique is not suitable for all. Some anxious and phobic people require a deeper form of sedation. In general, pregnant women should not receive inhalation sedation. People with nasal obstructions and mouth breathers may also find this method unsuitable.

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Sedation type 2. – Intravenous sedation

For people who require a greater degree of sedation, or if the procedure is of a nature that requires the patient to be sedated, intravenous sedation may be suitable. With this technique a sedative is injected into a vein in the arm by a qualified sedationist or anaesthetist.
What are the advantages of Intravenous sedation?

The advantages are

  • Patients usually remember nothing of the procedure, and
  • It is suitable for a wide range of people and procedures.

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Sedation type 3. – General Anaesthetic

The ‘ultimate’ technique for the phobic patient is for the patient to be completely anaesthetised by an anaesthetist. Some surgeries offer this technique ‘in house’ or at their local hospital / day surgery.
For more information the Australian Society of Dental Anaesthesiology can be emailed dstewart@asda.net.au.

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At what age should my child visit the dentist?

Children should visit the dentist for the first time between the ages of six months and one year. Do not wait for the child to be in pain to bring him or her to the dentist. Most procedures are pain free, and your child should know that a trip to the dentist can be a comfortable and fun experience.

Regular brushing should become a part of a child’s daily routine as soon as he or she can hold a brush. Parents should also swab infant’s gums to prevent plaque buildup. Children’s teeth should be brushed and flossed as soon as they erupt.

Although the enamel of a child’s tooth is stronger than that of an adult, it is also thinner, so cavities develop more quickly. Children’s primary teeth require as much care as their permanent teeth. Untreated cavities in primary teeth can adversely affect the development of permanent teeth. Such cavities result in a roughening of adult teeth, or may result in primary teeth that erupt with cavities.

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Are “baby teeth” important?

Your child’s primary teeth are extremely important. Without them your child cannot chew food properly and will have difficulty learning to speak clearly.

Children who lose their primary teeth too soon require a space maintainer until their permanent teeth erupt. Otherwise, the teeth will tilt toward the empty space, causing the permanent teeth to come in crooked.

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What dental problems can a baby have?

The most important reason for an early dental visit is to create a practical prevention program. A major concern for the dentist is the presence of baby bottle tooth decay, which occurs when your baby continuously nurses from the breast or from a bottle of milk, formula, or juice during naps or at night. The sugars in these liquids pool around teeth, creating acid attacks that destroy the tooth enamel. The result is rampant tooth decay at a very early age.

Also, the earlier the dental visit, the better the chances of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly and smile with confidence. It’s important to start your child on a lifetime of good dental habits and that’s why an early visit to the dentist is crucial.

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How can I prevent tooth decay from breastfeeding or baby bottles?

Protect your child from severe tooth decay by putting them to bed with nothing more than a pacifier or bottle of water. Do not dip the pacifier in any kind of sweetened liquid.

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When do permanent teeth erupt?

The permanent teeth do not erupt until the child is almost 8 years of age. They continue to erupt until the child is about 13 years of age. Girls’ teeth tend to erupt a little earlier than boys’. The only teeth to appear after that are third molars, or wisdom teeth. They usually form between the ages of 12 to 16, and do not erupt until 17 to 20 years of age.

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Why are baby teeth so important?

Even though baby teeth eventually fall out, they are very important because they reserve space for permanent teeth when they come in. If a baby tooth is lost too early, new teeth may grow in crooked.

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How do I prepare my child for the first dental visit?

Be low-key about the visit. Your baby has no reason to be afraid of the dental visit but can sense fear from a parent or other relative. However, there is nothing to fear. During a first visit, your child may enjoy a “ride” in the dental chair, play with a mirror, and generally experience the sights and sounds of the dental office. And relax — dentists who are experienced in dealing with kids do not expect perfect behavior.

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How do I make my child’s diet safe for his or her teeth?

The most important thing you can do is make sure your child has a balanced diet. Also, check how often your child eats foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips. Many foods contain sugars, including processed foods such as condiments or salad dressings. A peanut butter and jelly sandwich has sugar not only in the jelly, but probably in the peanut butter too. Limit the number of starches and sugars your child eats and make sure he or she brushes afterwards. Also, watch your child’s consumption of soda pop because the sugars erode the enamel on teeth. Most important is that children should limit snacks during the afternoon and when it does occur, snacks should be those that don’t contribute to tooth decay.

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When should I start cleaning my baby’s teeth?

At birth! Early care acclimates the baby to a lifetime of good oral care. Begin immediately to clean your baby’s gums with a clean, damp washcloth. Use a tiny dab of fluoride toothpaste if your dentist advises fluoride protection.

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What can I do about teething pain?

When teeth begin erupting, some children may have sore or tender gums. Teething, which may start around 6 months and continue until age 3, can make them irritable. Gently rubbing your baby’s gums with a clean finger, a small cool spoon, or a wet gauze pad can be soothing. You also can give the baby a clean teething ring to chew on. Contrary to popular belief, fever is not normal for a teething baby. If your infant has a fever while teething, call your physician. Under no circumstances should a child be given a teething ring dipped in alcohol. This is dangerous to the child and is ineffective in relieving pain.

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How can I help my child prevent cavities?

Children are the most cavity-prone of all age groups. It is critical that children brush twice each day and floss once each day to remove plaque, the colorless film of bacteria that forms on teeth and leads to decay and gum disease. A well-balanced diet and limited snacking also promote good oral health. Fluoride toothpastes and mouth rinses provide important protection. And, of course, regular dental checkups are important.

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Why is fluoride so important for my child’s teeth?

Fluoride forms mineral crystals in the tooth enamel, which protects teeth from the acid produced by bacteria. Very simply, fluoride keeps the bacteria from being able to attach to teeth. Fluoride is present in the water supply of many communities. It also is found in foods such as tea, fish and vegetables. Many studies show that children who drink fluoridated water have fewer cavities than children who don’t. For a nursing infant, a vitamin supplement with fluoride in it is often the best way to provide the infant with the fluoride needed. Even if the mother is drinking fluoridated water, the baby will not get any fluoride. Ask your dentist what is best for your infant.

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Should I worry about thumb sucking?

That depends on the duration and the severity of thumb sucking. In other words, how long and how severely does the child suck his or her thumb? In severe cases, prolonged thumb sucking can create crowded, crooked teeth and bite problems. Thumb sucking is perfectly normal for infants and generally they stop by the age of 2 years old. If your child doesn’t stop by the age of 4, consult your dentist.

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When and how often should my children brush their teeth?

Dentists recommend brushing at least twice a day — after breakfast and before bedtime.

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How much toothpaste should my child use?

Parents should place no more than a pea-sized amount of fluoride toothpaste on the child’s brush. Many children cannot adequately spit out the toothpaste after brushing, so they swallow it. Too much fluoride can cause a condition known as fluorosis, or discoloration in tooth enamel.

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How can I be sure my child is brushing properly?

Parents should be brushing the teeth of their children under the age of 6 years, because small kids do not yet have the dexterity, or the desire, to brush their own teeth. Even when they are older, parents should continue to supervise and monitor their children’s tooth brushing skills. Ask your dentist to demonstrate appropriate tooth brushing techniques.

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What kind of toothbrush should my child use?

Most dentists recommend a soft brush with round bristles made of nylon and a flat brushing surface. The toothbrush head should be small enough to reach all of the sides of each tooth. Nylon brushes are most effective in removing the plaque from the teeth without causing gum irritation. The child’s brush should be replaced every three months. Also, the brush should carry the American Dental Association’s Seal of Approval.

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What type of toothpaste should my child use?

One which contains fluoride and also carries the ADA Seal. It is not necessarily for children to use whitening toothpaste.

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When should my child begin flossing?

Children should begin flossing as soon as any two teeth touch. This generally occurs when the permanent teeth begin to erupt. Parents generally need to assist with flossing until the early teenage years. Again, check with your dentist to determine the appropriate method of flossing.

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Why are sealants necessary?

When back teeth are developing, grooves are formed on the chewing surfaces. They are impossible to keep clean because the bristles of a toothbrush cannot reach into them. Therefore, pits and grooves are snug places for plaque and bits of food to hide. Sealants are clear, shaded plastic materials that can be painted onto these decay-prone surfaces of the teeth. By forming a thin covering over the pits and fissures, the sealants keep plaque and food out of the crevices in the teeth, reducing the risk of decay. However, children must continue to brush and visit the dentist.

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How often should my child visit the dentist?

Most children need appointments every six months. However, children who are experiencing cavities or other dental problems may need to see the dentist more frequently.

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Why will some dentists cover a perfectly good tooth with gold? This is most noticeable on the front teeth. I�m sure you have seen some cases where not only one tooth, but several are covered with gold. Can this process be reversed with success or is it permanent? In addition, this must be extremely expensive. Why would a dentist perform such a procedure to a perfectly normal tooth?

The gold around the tooth is actually part of a dental crown or cap used to rebuild a damaged tooth. It only looks like gold around the edges of a �normal� tooth because the rest of the crown is either made of a white material (acrylic), or is all gold and has a window that exposes the middle of the tooth. This type of crown is common in many places, such as Mexico, South America and other parts of the world.

Most of the people with these crowns do not want a dentist to change them. The process involves removing their crown and replacing it with a new one. You should also keep in mind that to these people, gold teeth are a symbol of beauty and status.

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My tongue feels pasty and burns when I wake up. My dentist has not found anything wrong with my teeth or gums. Do you have any suggestions?

You may be suffering from �burning mouth syndrome,� This disorder can be caused by a deficiency in vitamin B or iron, known as pernicious anemia or iron deficiency anemia; dry mouth, caused by Sjogren�s syndrome or medications; a fungal infection (candidiasis); diabetes; hormonal imbalances; or trauma related to certain dental procedures. I suggest you see an oral surgeon and your family doctor to explore the possibility of this disorder. In some cases, certain blood tests are needed.

If nutritional deficiencies are found, replacing the missing dietary components can sometimes cure burning mouth syndrome. Certain drugs, such as nystatin or clotrimazole can cure a fungal infection. In some cases, the cause has several different components, and multiple types of therapy are needed. If no cure can be found, topical anesthetics like viscous lidocaine or topical steroids may be helpful in reducing the burning sensation. However, please consult a doctor for diagnosis before taking any drugs.

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What’s all the fuss about amalgam fillings?

The ADA policy remains, on the basis of the research available, that the use of dental amalgam produces no harmful effects.
There has been much publicity regarding the safety of dental amalgam. The World Health Organisation and the International Dental Federation have released a joint statement confirming the safety of dental amalgam as a filling material.
The Association believes there is no positive gain in having dental amalgam fillings replaced with other materials, other than for aesthetic reasons.

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If amalgam is so great, why does my dentist use white or ‘tooth-coloured’ fillings?

White fillings have been used in front teeth for decades. In recent times, scientists have developed strong white filling materials for back teeth to be used as an alternative to the dark colour of amalgam. The reason for this is the public demand for tooth-coloured fillings in visible areas of the mouth. These materials have not been in use for enough time to test their long-term comparison with amalgam but results are encouraging.
In 1983-4, amalgam was used in 68% of all fillings in Australia. By the late 1990’s this had reduced to less than 30% (NHMRC 1999)

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What is an amalgam filling?

Amalgam fillings are used to repair teeth for hundreds of thousands of people each year in Australia. Dental amalgam is a popular choice, as it is strong, relatively inexpensive and can last a lifetime.

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What makes up an amalgam filling?

Dental amalgam is an alloy of silver, tin, copper and mercury.

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Is it true that amalgam is dangerous for my baby?

If you already have amalgam fillings, there is no evidence to suggest you or your baby will be harmed because of them. However, general principles of public health during pregnancy suggest that it is prudent to avoid any dental treatment that can be deferred. This includes the removal or placement of amalgam fillings during the pregnancy and during the subsequent period of breastfeeding. The NHMRC Working Party report states: �� general public and environmental health principles dictate that where possible exposure to mercury from dental amalgams be reduced where a safe and practical alternative exists. This becomes more prudent in special populations, including children, women in pregnancy and persons with existing kidney disease.

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Should I have my amalgam fillings replaced?

Dentists replace amalgam fillings for a variety of reasons including recurring decay, fracture, endodontic treatment and appearance.
If you seek replacement of quite satisfactory amalgam fillings for other reasons, such as a concern about the effects of mercury, you may create problems that otherwise would not have occurred, such as: Possible damage to or weakening of teeth.

  • Sensitivity or pain after the filling.
  • Financial problems.

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What Type of Braces are Best? (ceramic, metal, invisible, etc)

Ceramic braces? Invisalign? Traditional metal? Golden metal? Self-ligating brackets? Viazis Brackets? What about Lingual braces? These days, there are many choices available to adults, and it gets confusing! Which type of braces should you choose? Can you choose, or is it strictly up to your dentist? These questions come up time and again in our Metal Mouth Message Board.

 

The type of braces you get depends on a number of factors:

 

  • The extent of your treatment, such as:
  • The severity of your bite or tooth crookedness problems
  • If extractions are necessary
  • If jaw surgery is necessary
  • If headgear or other special appliances are necessary
  • The amount of time you will need to wear braces
  • The preferences of your dentist or orthodontist
  • How much you are willing to pay
  • How long you will be in braces to correct your problems
  • What you, yourself desire. Would you feel embarrassed in metal? Are you only willing to straighten your teeth if Invisalign is used? Do you prefer the look of ceramic or sapphire? Or don’t you care, as long as the outcome is good?

 

This section will try to answer some of your basic questions by presenting the pros and cons of each type of braces. Please remember, your final choice is a combination of your preferences and your orthodontist’s technical expertise!

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How Much Do Braces Co$t?

The short answer is: in 2004, in most parts of the US, two years of full traditional braces costs (on average) about $5,000. Ceramic brackets are about $500 extra. These costs do not include x-rays, extractions, or special appliances. Invisalign treatment (in most cases) costs about the same as traditional braces.

But that varies. Let me explain.

If you have a health insurance plan that covers orthodontics, you might pay less, especially if you go to a provider that is in your insurance network. But be careful. Just as you wouldn’t choose a medical specialist only because he is on your plan, don’t choose an orthodontist soley based on this criteria. Get a consultation (usually free or minimal cost) and see how comfortable you are with that person. No amount of money saved can make up for two years with an orthodontist you don’t like or don’t have confidence in. Also, remember that most dental plans cover braces only before treatment begins. So if you’ve already started treatment, you may be out of luck.

OK, that said, let’s move on. If you live in Europe or other parts of the world, there may be government health plan that covers your braces. Again, remember to scope out the other professionals in your area. You may pay more for an independent dentist, but it may be worth the extra cost.

If dental insurance isn’t an option and you don’t want to pay full price, you may consider going to a nearby dental school. Usually orthodontic treatment is done under the watchful eye of an instructor who has many years of professional orthodontic experience. Call your local dental school and ask how much they charge.

The following information has been provided by ArchWired readers over the past few months.In some cases, the cost has been averaged.

United States

US residents can use this handy dental cost calculator, which will give you a general starting point.

NorthWest

Idaho N. Idaho $5,184 (Damon brackets)
Oregon Portland suburbs $5,500
Washington Seattle $5,700
Wyoming Casper $4,200

SouthWest & California

Texas unknown $4,500
Texas Austin $5,500
Texas Houston $4,800
California San Jose area $5,620
California SF East Bay area $4,500
California Los Angeles $4,000
California SF Peninsula area $5,000
Arizona Phoenix $4,200
Arizona Phoenix suburbs $3,250
Central States
Illinois Chicago suburbs $5,500
Illinois Chicago city $3,975
South Dakota Sioux Falls $5,225
Wisconsin SE area $4,600
Indiana Logansport $4,500
Ohio Cleveland $2,500
Ohio Cincinnati $5,000
Michigan Ann Arbor $5,000
Iowa Central area $3,700
NorthEast
Washington D.C. Washington suburbs $3,600 (speed braces)
Connecticut New Haven $5,200
New Hampshire Manchester suburbs $5,980
Virginia Fishersville $4,650
Maryland Annapolis $4,000
SouthEast
Georgia Atlanta $4,700
North Carolina Raleigh $5,985 (with expanders)
North Carloina Charlotte $4,600
North Carolina Ashville $4,245
Florida Orlando $5,000
Tennessee Nashville $2,850 (six months)

Canada

Vancouver C $5,557, $5400
Montreal C $4,800
Newfoundland (Grand Falls) C $1,200 (top treatment only)
Edmonton C $5,500
Ontario C $5,200
Ottawa C $6,900

Mexico, and Central and South America

No data available yet

Europe and the UK

Poland Warsaw PLN 5,200
France 3,500 Euro
Scotland 2,200 Pounds
Ireland Galway 3,500 Euro
Ireland Dublin 5,500 Euro
Great Britain Somerset 2,100 Pounds (Damon Brackets)
Germany 3,660 Euro
Finland Helsinki 3,000 Euro

Africa and South Africa

South Africa Capetown R17,000

New Zealand

unknown city NZ $4,500
unknown city NZ $3,800

Austrialia

Melbourne suburbs AU $4,400
Melbourne city AU $5,500+
Sydney (New South Wales) AU $5,770

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Getting Teeth Extracted for Braces

One very common question on our Metal Mouth Forum involves extraction. Often, adults may need teeth extracted to make room so their other teeth can move into their proper positions. It’s so easy for someone else to tell you that you need teeth removed. After all, the teeth are not coming from their mouth! And as you know, after teeth are removed, you can’t put them back. It’s the permanence of the procedure that makes this a very difficult decision for adults.

Let me tell you my story. My teeth were never perfectly straight, and they got more crooked as I got older (despite 4 impacted wisdom teeth being removed in my early 20s). By my early 30s I wanted braces, but every orthodontist that I saw (and I saw plenty) told me that I needed 4 teeth extracted. Well, I didn’t like that one bit. In fact, I was totally against it. So I just resolved to live with crooked teeth.

Fast forward 10 years. Here I am, at age 43 in braces, with a near-perfect smile, which was only achieved by — you guessed it — extracting 4 second bicuspids. Boy, do I wish I’d had this done 10 years ago. Now I feel really silly for being so scared and waiting so long.

The orthodontist who finally treated me tried very hard to fix my teeth without extracting, but it just didn’t work. (I applaud his earnest efforts on my behalf). Six months into treatment, it was evident to me (and to him), that the extractions were necessary. At this point I felt better about it because at least we had TRIED the other way.

Was I remorseful about losing those perfectly healthy teeth for the sake of beauty? Yes, of course I was! I felt sick about it! After the extraction, I kept thinking, “Oh God, have I done the right thing?” But soon I got over it. Now that the extraction gaps have closed and my smile looks great, I know I made the right decision. I was worried that extracting teeth would negatively impact my facial aesthetics (which, IMO, didn’t need any changing). But you know what? The change is very subtle, and in fact, it is actually good.

But that is my experience and it may not be the same as your experience. Sometimes if the mouth and smile are already “small,” depending on your facial bone structure, extractions may result in your face looking “sunken in” over time because the underlying structure has been changed. Before you decide on extractions, you should get several opinions, ask how your facial aesthetics may change, and think about it carefully. In some cases, other methods can be used to make space, such as “shaving” the teeth or using Damon-type brackets (whose manufacturer claims that they eliminate the need for extraction in some patients). This orthodontist’s web pagetalks a little bit about why he feels Damon brackets help eliminate some extractions. As time goes on, there may be other methods developed which also help to reduce the need for extractions.

If you want to read a detailed account of what my extractions felt like, click here.

If you are hanging on the fence, not sure what to do, then this article will give you some information to help you decide the best course of action.

Why are Extractions Necessary?

By the time we are adults, our jaws have stopped growing. Sometimes our palate can be expanded, but other than that, there is limited room for improvement. If your teeth are crowded, you may need to have some of them taken out to make room for the other teeth to move into better positions. Usually an orthodontist will start with the wisdom teeth. If there still isn’t enough room, the back bicuspids are usually chosen next. Because your smile must be symmetrical, the same teeth usually must be taken from the top and the bottom. If two teeth are taken from one side, your midline (the place where your front top and bottom teeth meet) may be thrown off, and you may be stuck with a crooked smile. This is why teeth are often extracted in either 2s or (more commonly) 4s.

Extractions and Children: Be Careful!

What about children? Personally I do not advocate tooth extraction in children because they are still growing. Years ago, extraction for children was common, but this is not the case today. Some orthodontists still routinely extract children’s teeth. If you encounter this, please seek several additional opinions before making your decision.

There are many other methods that can be used to meld children’s jaws to make room (palate expansion, headgear, or guided growth methodology). Extracting teeth from children can result in less than optimal facial aesthetics. In other words, you child’s face may not wind up looking as good as it could have, because it will grow longer and flatter instead of fuller.

One exception involves a Class III malocclusion. Class III cases are technically much more difficult and often involve jaw surgery. If you need more information about Class III malocclusion, read about it in our

FAQ.

Q: Who Performs the Extraction?

A: Usually an oral surgeon extracts teeth. Other types of dental professionals with training in tooth extraction may also perform the procedure.

Q: Does Extraction Hurt?

A: Extraction of wisdom teeth is quite involved, with sedation, stitches, pain, possible bruising, and inconvenience.

Extraction of bicuspids and other teeth is a piece of cake compared to wisdom teeth. There is virtually no pain afterwards (yes, I know that’s hard to believe, but it’s true). You can either get local anesthetic or get “put out” for the procedure. It takes only about 20 minutes total to extract four bicuspids! There is usually no stitches, very little bleeding, and usually no bruising. [Please do not take any anti-inflammatory or pain medicines beforehand — they prevent clotting, which could result in more bleeding. So, take no Advil (ibuprofen), no Tylenol (acetaminophen), and no aspirin beforehand! If you take a regular dose of an anti-inflammatory medication for arthritis or other chronic condition, tell your dentist!]

Afterwards, the oral surgeon will give you some strong prescription pain pills such as Vicodin. In my case, I had so little pain that I took only one when I got home (as a precaution), but didn’t need any more than that! By the way, I have a relatively low pain threshold — so you see, it barely hurt at all! You will be told to eat soft food and not to suck on straws for several days. After that, you can do whatever you want.

Q: Can There be Complications?

A: It is rare, but sometimes complications can result from tooth extractions. If the hole doesn’t heal properly, you may develop what is known as a dry socket, which may get infected. The following information comes from the website Ask an Oral & Maxillofacial Surgeon.

“A dry socket occurs when the blood clot is lost from an extraction site prematurely. Basically, the blood clot in the socket serves the same two functions as a “scab” on a skin surface cut. First, it assists in the cessation of bleeding and second, it protects underlying structures during the healing process. Like the child who “picks at a scab” the area heals in time but is painful for far longer than if the “scab” had been left alone.

“When the blood clot is lost before the underlying structures have had time to heal, bone is exposed to the oral environment along with fine nerve endings. This is an exquisitely painful but otherwise relatively harmless situation. There are packing materials which the oral surgeon can place to help ease the discomfort both by physically blocking the wound and by the action of the chemicals in the pack on local nerve endings. Generally, patients return to have the pack changed every day or two and most patients do not require more than 2 or three dressing changes. Some patients require no dressing while others may require 4 or 5 changes of packing. Tincture of time and good oral hygiene usually resolve the situation.

“There are some activities which may increase the propensity for dry socket formation…smoking, drinking carbonated beverages in the first 24 hours after surgery, spitting or drinking through a straw in that same time period…but often “dry sockets” occur for no particular reason at all.”

Q: When Are The Braces Put On?

A: After an extraction, braces can be put on almost immediately. (I already had braces, so my arch wires were taken off first. After the extractions, the arch wires were replaced the following week).

Q: What About Eating and Talking?

A: Yes, eating with several gaps in your mouth is very strange. Be sure to take small bites and chew slowly and carefully. You will need to change the way you chew for a while, until the gaps begin to close. Food may get stuck in gaps, which is annoying.

As time passes and the gaps close, this will become less of a problem. Just hang in there and deal with it. Also remember that your bite will change as time passes, so your teeth will meet differently, and you will chew differently as you go through the stages of gap closure and teeth straightening.

If frontal teeth have been extracted, you will have to deal with other people noticing your gaps. Yes, this can be a bit embarrassing, but remember that it is only temporary. In a few months, the gaps will be gone (particularly the top gaps, which tend to close more quickly).

Q: How Long Does It Take to Close The Gaps?

A: The length of time to close extraction gaps depends on your unique case. But the short answer is: between 4 months and one year.

The gaps on top often close faster than those on the bottom. My orthodontist said that typically the teeth move about one millimeter per month. Your orthodontist may use power chains or other methods of linking the teeth together to close the gaps.

It took 21 months to completely close all of my extraction gaps (I needed closing loops, as shown in the next section), but I am an exception — I had a couple of stubborn lower teeth! In fact, the top gaps closed within 9 months.

Each month, your orthodontist can measure the gaps between your teeth with a special ruler. By doing this, you can see solid results from month to month. This is a good idea, because at first it will seem like your teeth aren’t moving at all — when in fact, they are!

Here’s a photo of my teeth after the gaps on both top and bottom were completely closed. You’d never know that I had two teeth extracted on the bottom, and two on the top!

Q: How Do They Close The Gaps?

Extraction gaps are usually closed with power chains or other special methods of linking teeth together. White power chain is shown linking my teeth in the photo on the left. Notice the extraction gap between the molar and the bicuspid. The power chain is attached to the hooks on some brackets, and also put directly on the brackets in place of ligatures. (I don’t recommend white color power chains, because they show a lot of stains. I’ve had great success with “smoke” grey color, which is almost invisible. Smoke-colored chains are on the top teeth in the large photo below. Notice that you can barely see them! They “resist” curry stains quite well.)

In some cases, the orthodontist makes a loop in the arch wire to close the gaps. This is sometimes called a “finishing loop” or “closing loop” because it is usually done near the end of treatment to help close stubborn gaps that are not helped by other methods.

Arch Wire Displacement (otherwise know as “a poking wire”)

When extraction gaps are closing, the arch wire will often be displaced and the “extra” bit will poke into the end at your cheek. This is very common, and it hurts like hell! If this happens to you, do not wait — call your orthodontist immediately to get the wire trimmed! You can temporarily remedy the situation by globbing some wax or chewing gum at the end of the wire (but this frankly doesn’t work very well). Sometimes, teeth move “all of a sudden” and you find yourself making an emergency trip to your orthodontist to have the wire trimmed. You can purchase a pair of orthodontic pliers for emergency clippings — but personally my husband was afraid to even try to clip the end of my wires (and you can’t really do it on yourself).

Although arch wire displacement is literally a big pain, it is positive. It means that your teeth are moving and the gaps are closing!

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What is a bridge?

A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.

 

A conventional fixed bridge consists of crowns that are fixed to the teeth on either side of the missing teeth and false teeth rigidly attached to these crowns.
An enamel bonded bridge uses a metal or porcelain framework., to which the artificial teeth are attached, then resin bonded to supporting teeth.

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My gynecologist recently prescribed prenatal vitamins for me to take throughout my pregnancy. Do you recommend taking a fluoride supplement as well?

The use of fluoride supplements during pregnancy is a controversial issue. Fluoride is obtained from water and other beverages, foods, prescription drops and tablets, and other sources. A major function of fluoride taken systemically throughout the body is the strengthening of developing teeth, from infancy to adolescence. Fluoride strengthens teeth by the formation of harder enamel (hydroxyapatite crystals are converted to fluorapatite) that is less vulnerable to damage from plaque acids.

 

Fluoride intake by a pregnant mother may have a positive effect on the unborn child. Several recent studies support the use of prenatal fluoride supplements. In the first study, pregnant women in their second and third trimester would take a daily 2.2 mg tablet of sodium fluoride along with fluoridated water.

 

The results demonstrated that 97 percent of the offspring of these women had absolutely no cavities for the first 10 years of their lives. These children also had no medical dental side effects from the prenatal fluoride treatment. Another study contained 1200 pregnant women; half were given a fluoride supplement and the other half were not. A five-year follow up of the offspring revealed that the fluoride group had only about half as many cavities as the non-fluoride group, and 96 percent had no cavities at all.

 

The use of fluoride in the form of supplements, in toothpaste, mouthwash and in drinking water has been clearly established for both children and adults. Recent studies concerning the use of fluoride during pregnancy are encouraging, and may provide a safe and cost-effective way of reducing cavities in children. I recommend that you talk to your gynecologist about the use of fluoride supplements during your second and third trimester of pregnancy.

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We have a 16-month-old, and she gets upset when we try to brush her teeth. What do we do? Do we try to continue the good habit we have started or should we hold off?

At your daughter’s age, it is not uncommon for her to fight tooth brushing, because it is foreign to her and can be abrasive to her gums. What you can do is use a moist washcloth to clean her teeth, especially before bed. Do not allow her go to sleep with a bottle of milk or juice that leads to destructive “baby bottle cavities.”

After about two months, re-introduce the brushing with a child-sized toothbrush that has soft bristles. Also, experiment with different child-dosed toothpastes. Your daughter may just not like the taste of the toothpaste you are using. Always use a very small pea-sized quantity of toothpaste because high amounts can be harmful. Even when she does let you brush her teeth expect a little fight — it�s only natural. You may also want to consider giving her a small reward after each successful brushing.

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When can my child brush and floss their own teeth?

We recommend that parents brush their children’s teeth for the first five to seven years of life, since young children lack the manual dexterity of proper tooth brushing. The toothbrush should be a child’s size, with soft nylon rounded bristles. Toothpaste should not be used until the child is able to spit (three to four years of age) to avoid swallowing it. A pea-sized drop should be dispensed by the parent for young children. Flossing should be performed by the parent prior to brushing. Most children lack the proper manual dexterity to floss on their own until the age of 10 and will need a parent’s help and supervision.

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Why are baby teeth important? Don’t they fall out?

Baby teeth serve the important function of eating, speech and aesthetics (self-image). These teeth not only help form the developing jaws, but they hold space for the permanent teeth so that a normal bite occurs. The last baby tooth falls out at about 12 years of age. A decayed baby tooth can become so badly decayed that it can do damage to the permanent tooth. At times severe infections of the face, head and neck can be caused by infected baby teeth.

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What are the signs of teething, and what can I do to make my child more comfortable?

The signs of teething are drooling, irritability, restlessness and loss of appetite. Fever, illness and diarrhea are not symptoms. If your child presents with the latter signs, they need to be evaluated by his or her pediatrician. The best solution to comfort the child is to have the child chew on a cold or frozen rubber teething ring. Topical anesthetics are not recommended.

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I have heard that a nursing bottle can cause cavities on toddlers. At what age should I take my child off the bottle?

Your child should stop using a bottle when they are old enough to hold a cup. This usually occurs around one year of age. After this age a child should not be placed to sleep with a bottle because this may cause dental decay, increase the incidence of ear infections, and prolong the use of the bottle. If you put your child to sleep with a bottle, the best way to stop this habit is by placing only water in the bottle, or progressively diluting it until it is all water. Then be firm with the child. Juice or milk in a cup will not cause the severe decay that a bottle will. This may cost the parents a bit of sleep, but it is important for future dental health.

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My child sucks his/her thumb or finger. What effect can it have on the bite, and when should I work on stopping the habit?

Most children stop sucking their fingers between the ages of three to five. Sucking of a finger can have a significant effect on the bite. Flaring of the upper front teeth producing a protrusion, and backward positioning of the lower front teeth are common. Also a crossbite or narrowing of the upper jaw can occur producing an openbite, where the front teeth don’t touch. The amount of these bite effects depend on the frequency, how long the child does it each time, and intensity of the finger habit. If your child continues this habit past the time of the eruption of the first permanent tooth, then it can have a permanent effect on the adult bite. The habit should be stopped before these teeth come in. From a preventive point of view, infants should be given pacifiers, as they will do much less harm than finger habits, and most children will discontinue their use earlier.

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My child’s permanent lower front tooth is coming in behind his baby tooth. What should be done?

If the baby teeth are moderately to very loose, there is no immediate treatment. Patience is recommended. This is a normal process. The tongue will push the permanent lower front teeth forward. If the teeth are not very loose, your child should be seen to take an X-ray and evaluate the situation.

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My child is over one year old and has no teeth. Should I worry?

Even though most children that age have a number of teeth, some children may have delayed tooth eruption. There is usually no concern about this.

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Should I be giving my child fluoride drops or tablets?

No, if the water supply in your area is fluoridated. If you are not sure if your water is fluoridated, contact your local health department.

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When should my child first visit the dentist?

The first dental visit should be between one year and 18 months of age.

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How can you prevent dental caries?

If you have a sensible diet, a good flow of saliva, a cleaning routine and your teeth get an appropriate fluoride exposure, you are unlikely to get decay. So, you can prevent decay by:

1. being careful with how often you eat sugary foods or have sugary drinks.
2. brushing and flossing your teeth carefully to reduce the amount of bacteria on their surfaces.
3. using fluoride toothpaste. This will make the surfaces of teeth more resistant to acid. The fluoride in our water supply strengthens the developing teeth of infants and children.

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What is dental caries?

Dental caries, or dental decay, is a common disease, which causes cavities and discoloration of both permanent and “baby” teeth. As the disease progresses in a tooth it becomes weaker and its nerve may be damaged.

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What causes dental caries?

Dental decay occurs when bacteria in the mouth make acid which then dissolves the tooth. Bacteria only produce this acid when they are exposed to sugar.

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Why is saliva important?

Saliva is the best natural defense against decay. The acid from bacteria can be neutralised by saliva. A reduced flow of saliva (dry mouth) can increase your risk of decay. Causes might include:

1. Medications that you may be taking that may have a drying effect in the mouth

2. Excessive intake of caffeine. Caffeine is found in coffee, tea, chocolate and cola drinks. It draws fluid from the body and reduces saliva.

3. Working in a dry environment and not rehydrating often enough

4. Some specific diseases or conditions such as Sjogren’s syndrome
If you have a constant dry mouth, you should consult your dentist to find the cause.

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What happens when my saliva is not adequate?

In the mouth, there is a constant demineralisation (tooth being dissolved by acids) and remineralisation (tooth being re-deposited on the teeth from saliva). If your demineralisation is happening at a greater rate than remineralisation, you get loss of tooth substance.

If your mouth is acidic a good deal of the day from, say, excessive and constant intake of acidic soft drinks or constant sugar intake, then the demineralisation wins and you have problems.

If you are careful with the diet, then your saliva is more neutral and you will get good remineralisation to constantly repair the teeth.

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How important is my diet in preventing and treating dental caries?

Being careful about how often you have sugar in your food and drinks is the best way to prevent and treat dental caries.
How often you have sugary food and drinks is more important than how much sugar you have in your food and drinks.
Other ways you may help prevent dental caries with your diet are:

> Rinse your mouth with water after having sugary food or drink

> Have a small amount of cheese after sugary food or drink. This will help to neutralize the acid produced by oral bacteria.

> Using sugarless chewing gum may help protect your teeth by stimulating extra saliva. Saliva is very important in protecting your teeth from decay.

> Do not put any sugar or other sweeteners in babies’ bottles.

> Remember the drying effect of excess caffeine.

> Remember that smoking changes the saliva to a more harmful consistency.

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How do dentists treat dental caries?

Early dental caries is reversible. Mineral can be deposited back onto the tooth surface if you can modify your diet and oral hygiene. Your dentist can treat early areas of caries with topical fluoride, and if you are careful with your diet and cleaning no other treatment may be required.

A more advanced area of dental caries will require a “filling”. Your dentist will remove the damaged and infected soft tooth structure and repair the tooth. It is important to have this done as early as possible to preserve the strength of the tooth and prevent bacteria damaging the tooth pulp.
It is very important to listen to your dentist’s advice on how to eliminate the cause of your caries. Don’t think that just fixing a cavity will stop the disease from occurring in other areas of the mouth.

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What is Cosmetic Dentistry?

In today’s age of technology, your dentist has a range of options to help your teeth look great. Stained teeth, dark teeth, chipped teeth, crooked teeth, and even teeth that are missing altogether, can be repaired or replaced. Cosmetic or aesthetic dentistry is the broad heading under which many dental procedures that improve the appearance of teeth may be described.

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What are the latest developments in cosmetic dentistry?

The latest developments in dentistry include tooth whitening treatments, micro-abrasion, bonding and veneers. These techniques can whiten and improve the shape and colour of your teeth, even close gaps.

Tooth Whitening – treatments are designed to whiten your own teeth without any artificial additions. There are several ways dentists can whiten your teeth:
1. With very high peroxide gel concentrations, the dentist may very carefully apply the gel and use some heat from a light source (sometimes a laser is used) to whiten the teeth in a short time. This technique is not common and is usually expensive.
2. Plastic trays are custom-made by your dentist using models of your teeth.

a. Sometimes dentists will ‘kick-start’ the whitening in the surgery with high-strength bleach gels in the trays.
b. This is followed by home treatments you do yourself using safe-strength gels. Home treatment alone is the most popular and least expensive method.

 

Home bleaching works in most cases although the result depends on the initial level of staining of the teeth and the type of staining. It is less predictable on teeth that contain some specific discolourations such as those caused by tetracycline intake in childhood. Home bleaching usually takes about two weeks, wearing trays either during sleep or for a few hours a day, depending on the technique. Home bleaching will not whiten fillings, and it may be necessary to have visible tooth coloured fillings replaced with ones that more closely match the final tooth colour after whitening is completed.
Micro-abrasion – can be used to remove discolouration in the surface layer of the enamel. A paste containing acid and an abrasive is used to remove the outer surface of the tooth enamel. If the discolouration is deep in the enamel your dentist may need to remove the affected enamel with a bur and place an adhesive tooth coloured filling. Usually an anaesthetic is not required.
Bonding – is a process whereby your dentist cleans and prepares the surface of your teeth and then bonds tooth coloured resin fillings to them. Bonding can be used to repair chipped teeth, close small gaps between teeth, alter the shape of teeth and sometimes cover discolouration in teeth. Bonded resins are simple to re-polish and replace if they eventually discolour.
Veneers – are thin (usually about 0.5mm thick) pieces of porcelain, which are bonded to the front surface of the teeth. Veneers can be used to improve the appearance of teeth by changing the shape of the teeth, by changing the colour of the teeth, by masking stains and by replacing small fractured pieces of teeth.
To construct veneers, your dentist will need to remove a small amount (0.4-0.5mm) from the front surface of the tooth.
Your dentist will then take an impression of your teeth. This is sent to a dental technician, who makes the veneers. At the next appointment (usually one to two weeks later), your dentist will carefully clean the repaired surfaces of the teeth and bond the veneers in place. In some cases, because so little tooth is removed, no provisional restorations are needed between the two visits.
Porcelain is a very hard, wear resistant, non-porous material that will keep its appearance far longer than tooth coloured resins. Porcelain, however, is brittle and can chip if hit by hard objects. If you have porcelain veneers, it is advisable to cease habits such as fingernail biting, pen and pencil chewing, biting into stone fruits and barbecue chops and opening packets with the teeth.
Bleaching, micro-abrasion, bonding and veneers can improve many cosmetic problems with teeth. However if the teeth are badly aligned, severely broken down or teeth are missing, it may be necessary to have orthodontic treatment, crowns or bridges constructed or implants placed.

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Who does cosmetic dentistry?

All general practice dentists use bonding as part of their everyday practice and are trained in and quite skilled at the above procedures.
State Dental Boards are responsible for registering dentists and dental specialists and there is no specialist category of “Cosmetic Dentist”.

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What is the best way to whiten the teeth?

There are many excellent ways to whiten the teeth and all have advantages and disadvantages. Since each case is different there is no one best way.

When staining is present on the surface, an ADA dentist can professionally clean the teeth, often producing a fresher, whiter appearance.

On the other hand, when staining is actually in the tooth, below the surface, there are a number of ways to whiten the teeth. Sometimes simply replacing old, worn out fillings that are failing at the edges can produce better looking front teeth. Alternatively, when the enamel is heavily stained, crowns or facings may be the best option. ADA dentists have access to continuing education in the latest dental techniques and they can give advice as to the best choices for you.

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What is home bleaching?

Home bleaching involves wearing very thin, transparent plastic trays molded to your teeth, which are used to hold a bleaching agent in contact with the tooth surface. They are normally worn for approximately ten days.
The active agent in the bleach is usually carbamide peroxide. This is a chemical that quickly breaks down to hydrogen peroxide, which is the chemical that lightens the teeth.

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How effective is home bleaching in whitening the teeth?

Home bleaching does not make the teeth as white as chalk. If it did the teeth would not look natural. Usually the whitening is subtle, but a real difference can usually be noticed between, for instance, upper teeth that have been bleached and lowers that have not. Home bleaching seems to be slightly more effective for younger rather than older people.

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Is home bleaching safe?

Yes. Hydrogen peroxide (the whitening agent) is actually produced in the body in small amounts and the effects have been studied for many years. Dentists know that the whitening process should not be abused, because bleaching teeth well beyond the recommended level can lead to damage of the enamel. When bleaching is carried out according to an ADA dentist’s instructions, it appears to be a safe, simple procedure.
The only minor complications are rare cases of slight gum irritation and heightened cold sensitivity in the enamel. It would also be wise to check first with your dentist to see if all your teeth will be likely to bleach evenly. Bleaching will be unlikely to alter the staining effects of certain types of antibiotic drugs (e.g. tetracycline) that may have been used during childhood.

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How long does the bleaching last?

This may vary depending upon the circumstances, however teeth can still become dirty and they will continue to age in a normal way with the passage of time. You should keep the trays and obtain new bleach stocks from your dentist to repeat the whitening periodically (usually once a year). The trays will continue to fit your mouth for many years in most cases.

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Are whitening toothpastes very effective?

Whitening toothpastes are really aimed at whitening stains that are on the surface of the teeth, not whitening into the tooth surface. Whitening toothpaste needs to be in contact with the teeth for many minutes to have the slightest effect. The active ingredients of bleaching toothpastes are present in much lower concentrations than those in home bleaching kits, and they tend to be quickly washed off the tooth surface by saliva. Many people choose whitening toothpastes because they may get some whitening as well as the benefits of fluoride in the paste.

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Which dentist can bleach my teeth?

Home bleaching involves wearing very thin, transparent plastic trays molded to your teeth, which are used to hold a bleaching agent in contact with the tooth surface. They are normally worn for approximately ten days.
The active agent in the bleach is usually carbamide peroxide. This is a chemical that quickly breaks down to hydrogen peroxide, which is the chemical that lightens the teeth.

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What is a bridge?

A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.
A bridge is made up of two crowns for the teeth on either side of the gap –these two anchoring teeth are called abutment teeth– and a false tooth/teeth rigidly attached in between. The false teeth are called pontics. The bridge can be made from gold, alloys, porcelain or a combination of these materials.

An enamel-bonded bridge uses a metal or porcelain framework to which the artificial teeth are attached, and then resin bonded to supporting teeth.

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Why are crowns more expensive than fillings??

A crown is more complicated than a filling. Laboratory fees are incurred in its preparation and the materials used are more expensive than normal filling materials.
Two or three visits are usually required for the dentist to reduce the size of the existing tooth, make a mould, fit a temporary crown and finally adhere the permanent crown in place.

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What is a crown?

Dental crowns (also sometimes referred to as dental caps or tooth caps) cover over and encase the tooth on which they are cemented. Dentists use crowns when rebuilding broken or decayed teeth, as a way to strengthen teeth and and as method to improve the cosmetic appearance of a tooth. Crowns are made in a dental laboratory by a dental technician who uses moulds of your teeth made by your dentist.

The type of crown your dentist recommends will depend on the tooth involved and sometimes on your preference. They include porcelain crowns, porcelain-bonded-to-metal crowns, which combine the appearance of tooth coloured material with the strength of metal, gold alloy crowns and acrylic crowns.

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What type of forces cause teeth to crack?

Front teeth usually break due to a knock, an accident or during biting.
Back teeth can also be fractured from a knock. They are much more likely than front teeth, to crack from forces applied by the jaws slamming together rapidly. This is why sportspeople wear mouthguards to cushion the blow.
Other forces occur during sleep because people grind their teeth with a much greater force than they would ever do while awake. The first sign of problems may be what we call “cracked tooth syndrome” � a sore or sensitive tooth somewhere in the mouth that is often hard for even the dentist to find. In some individuals the grinding, called bruxism, causes tooth wear rather than fracture.

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Why does a cracked tooth hurt?

The crack will expose the inside of the tooth (the ‘dentine’) that has very small fluid filled tubes that lead to the nerve (‘pulp’). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain.

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How can I prevent my teeth from fracturing?

Most fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by

  • trying to eliminate clenching habits during waking hours,
  • avoiding chewing hard objects (eg bones, pencils, ice),
  • avoiding chewing hard foods such as pork crackling and hard-grain bread

If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you.

It is very important to preserve the strength of your teeth so they are not as susceptible to fracture.

Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled.
Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces.
Relaxation exercises may be beneficial.

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How does the dentist treat a cracked tooth?

It depends on the direction and severity of the crack. If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam fillings will hold the tooth together making it less likely to crack.
Sometimes the cracked part of the tooth fractures off during the removal of the filling and this can be replaced with a new filling.
Your dentist may first place an orthodontic band around the tooth to keep it together. If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface). Other options include the placement of gold or porcelain fillings or even a crown.

If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one. (See bridgework, denture, and implant)

 

The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.

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Will my tooth become better?

Unlike fractures elsewhere in the body, this crack will never heal. There is a small chance that the crack will get worse even with a crown placed. This may lead to the need for root canal treatment, or even removal of the tooth. However, many cracks can be fixed without root canal or tooth removal.

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What should I do in a dental emergency?

Toothache: Very persistent toothache is always a sign that you need to see a dentist as soon as practicable. In the meantime, you should try to obtain relief by rinsing the mouth with water and trying to clean out debris from any obvious cavities. Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth). If swelling is present, place a cold compress to the outside of the cheek (DO NOT HEAT). Take pain relief if necessary, using pain medicines that you know you are safe with. Remember, no pain relief tablets will work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin).

Braces or retainers:

If a wire is causing irritation, cover the end of the wire with a small cotton ball or a piece of gauze or soft wax. If a wire is embedded in the cheek, tongue or gum tissue, DO NOT attempt to remove it: Let the dentist do it. If there is a loose or broken appliance, GO TO THE ORTHODONTIST OR DENTIST.

Knocked out tooth:

If dirty, rinse tooth in milk holding it by the crown (not roots). If not available use water (few seconds only) or have patient suck it clean, then put the tooth back in the socket. If the tooth cannot be replanted, wrap in Glad Wrap or place it in milk or in the patient’s mouth inside the cheek. Go to a dentist within 30 minutes if you can. Time is critical for successful replanting.

 

Broken tooth:

Try to clean debris from the injured area with warm water. If caused by a blow, place a cold compress on the face next to the injured tooth to minimize swelling. Try to find all the bits that are missing and bring them to the dentist, keeping them moist. Some broken bits can be bonded back onto the teeth almost invisibly. Go to the dentist as soon as practicable.
Bitten tongue or lip:

Apply direct pressure to bleeding area with a clean cloth. If swelling is present, apply cold compress. If bleeding doesn’t stop readily or the bite is severe, go to the dentist or hospital.
Objects wedged between teeth:

Try to remove the object with dental floss. Guide the floss in carefully so as not to cut the gums. If unsuccessful, go to a dentist.

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Hey, do those whitening toothpastes really work?

Over-the-counter whitening toothpastes have only been shown to whiten teeth two shades. In contrast, a dentist-supervised tooth whitening system can whiten teeth 12 to 15 shades.

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Whats up with these multiple varieties of toothpastes anyway? You’ve got your tartar control, your extra whitening, your mint flavor gel, etc. How do I know which toothpaste to buy these days? Help!

That’s a good question. The type of toothpaste you use should be based on the condition of your teeth and gums. Your dentist is the best person to suggest what toothpaste you need based on the condition of your mouth. I would point out, however, that the frequency of brushing, flossing and regular visits to the dentist play a much greater role in improving oral health than which brand of toothpaste you are using.

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I’ve heard that you aren’t supposed to have your teeth cleaned while pregnant. Is this true? Why?

No, that is not true. In fact, hormonal changes during pregnancy can make the gums more susceptible to irritation and inflammation. You should have your teeth professionally cleaned at least twice during pregnancy. It is recommended that routine checkup X-rays be avoided during pregnancy. If a tooth is infected, however, dental X-rays can safely be taken without any danger to the unborn child.

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I use mouthwash and it actually hurts my gums when gargling. Is this normal?

Yes, some people do experience discomfort when using mouthwash at full strength. I recommend that you dilute the mouthwash with water by at least 50 percent (half mouthwash, half water). That should solve the problem. I would also recommend that you see your dentist to evaluate your teeth and gums.

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Is it safe for small children under the age of 8 to use mouthwash?

I would not recommend the routine use of mouthwash unless directed by your dentist. If a mouthwash is recommended, its use should be supervised with small children.

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What are some alternatives to braces? Also, if my dentist tells me I need them, should I get a second opinion?

If your dentist believes that you need braces, you should go to an orthodontist for his or her opinion. If the teeth need to be straightened, there are some alternatives to braces that your orthodontist can offer. One recent development is that the orthodontist, working with a high-tech lab, can make a series of customized mouthguards (clear acrylic) that can move the teeth and straighten them in some cases. If you are looking for a cosmetic alternative to braces, porcelain veneers can also make teeth appear straight without the use of braces. Good luck!

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I’m quite a chain smoker and I’m getting my wisdom teeth removed this weekend. My dentist warned me not to smoke for a while after the procedure, but I know I will. Is it really that bad? Will a few cigarettes cause problems?

Yes, smoking after dental extractions can increase the rate of complications. Some of the complications that can occur from smoking after oral surgery include increased bleeding and increased likelihood of a painful infection of the extraction socket (dry socket). If you must smoke and know that you cannot stop for 24 hours, my only suggestion would be to take very light drags of the cigarette and direct the smoke away from the areas where the teeth have been removed. However, it is best to stop smoking for at least 24 hours after the procedure.

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What can I do if I’m scared about dental treatment?

The best way to overcome your fear is to discuss your concerns with your dentist.

Experiences as a child may become distorted by time and reinforced by outdated media presentation of stereotypes. Much has changed, thanks to technology and education, and dentists are skilled professionals in dealing with patients who are apprehensive about seeking treatment.

This will obviously be a team approach between you and your dentist and his/her staff. Communication is the key. You must feel comfortable expressing your fears and concerns and have a sense that you are being listened to.

There are various forms of anaesthesia and relaxation that can be used effectively to change your negative thoughts into a positive experience.

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Do all dentists use “happy gas”?

“Happy gas”, “laughing gas”, “relative analgesia”, “nitrous oxide” are all describe the same form of sedation which can be used for patients who are apprehensive of treatment done with local anaesthesia.

Not all dentists utilise these options, but referrals can be made. Likewise, you may elect to have extensive procedures done under full general anaesthesia in a hospital or day centre.

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Can I have my dental records?

A patient’s dental records and x-rays are the property of the dentist.
They are a professional’s working notes used in the planning and performing of treatment.

You may seek access to the information held about you and the dentist will provide this access without undue delay. This access might be by inspection of your dental records at the time of appointment or by special access or copying of information at other times.
There will be no charge made for requesting this information but there may be fees levied just to cover the costs associated with the processing of this request or the copying of information.
Under the some state regulations, the owner of the x-ray equipment is required to provide a copy of an x-ray on receipt of a written request from the patient, but at the expense of the patient.
If you are changing dentists, you could give written permission for your new dentist to seek a copy of a record of your treatment from your previous dentist, or request your current dentist to forward them on to your new dentist.
It is far better for all records to be forwarded directly from dentist to dentist to prevent the loss of these important records during your move. Some dentists provide a summary of relevant treatment which is usually all that is needed by the new dentist.

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What are Dentures?

A denture is an appliance that replaces teeth. You remove it to clean it and it may be replacing all the teeth (full denture) or some of them (partial denture).

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What is the difference between a denture and a crown or bridge?

Removable dentures are those dentures (plates) the wearer can remove and replace at will. These types of dentures can replace one tooth, all your natural teeth, or any number of missing teeth in between. A crown or a bridge is fixed or cemented in place and cannot be removed.

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What steps are involved in getting a denture?

Before any denture treatment is undertaken, it is recommended that you have a thorough dental check-up. If you are having full dentures, it will involve an examination of the mouth and an assessment of the health of the gums.

If you are having a partial denture, this check-up will include a full examination of your teeth, gums and other soft tissues of your mouth. At this check-up radiographs may be taken to ensure the teeth are healthy, and strong enough to help support a denture. Remember, the only oral practitioner who has the training and is legally able to undertake such a thorough check-up is your local dentist.

You then have impressions, bite records, trial wax insertions and then the final insertion and instructions.
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How are dentures made?

Many removable dentures rely on some of your remaining natural teeth to help keep them in. Your natural teeth were never designed to help support a denture. In most cases, some minor modification of your natural teeth would be desirable to improve the wearability and life of your denture. Your dentist has the required training to be able to modify your teeth to ensure the highest quality removable denture is constructed around your natural teeth.

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How long will I have to go without any teeth?

Some removable dentures are made to be inserted immediately after the removal of a tooth or some teeth. These types of removable dentures are commonly termed immediate dentures. They can be constructed to replace only one tooth or many teeth. Your local dentist can undertake all the required stages involved in immediate dentures. This will mean that one person will oversee the whole treatment, assuring you of the highest possible standards.

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How often should I have my denture checked?

If you currently wear removable dentures of any kind, it is advisable that you have these checked regularly. It is recommended if you have any remaining natural teeth you should have these and your dentures reviewed every six months or as directed by your dentist. If you have no natural teeth and wear removable full dentures, your dentures should be reviewed at least every two years.

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Why does my denture need to be relined?

The rapid shrinkage of bone following extractions means the denture will soon need to have the fitting surface relined once that shrinkage has slowed down enough. After a reline, patients report a much better fit. This relining maybe done between three and six months after an immediate denture has been fitted. Your dentist will advise you when an immediate denture is ready to be relined.

Relining involves an additional fee, but this is going to be cheaper than a new set of dentures and it is often very much appreciated.
All dentures lose their fit through natural changes in your mouth. Chewing gum, biting your nails or grinding your teeth can accelerate this. You should see your dentist yearly for a denture check, when refitting or relining may be necessary. For example, many patients report that their full dentures are loose after a period of rapid weight loss.

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How long after fitting can I keep going back to have my new dentures adjusted free of charge?

A dentist will be happy to see you and make any necessary adjustments free of charge in the initial stages of fitting your denture. The number of visits you will require is related to the nature of the job and your dentist will be the best person to advise you about this before you proceed.

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What is a filling?

A filling is a plug of material that is placed into a tooth to replace missing tooth substance and/or structure.

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Can all teeth with holes or fractures be filled?

Most teeth with small to moderate decay or fractures are easily restored to function with fillings. Where decay is extensive or fractures are large, more complex treatment may be required. Some teeth can be so badly broken down or fractured that they are unable to be saved.

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Can fillings be repaired rather than replaced?

Some fillings can be repaired when they fracture, or the tooth around them fractures, but only if there is no tooth decay present.

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How are fillings done?

Tooth preparation, prior to filling placement, is usually done under local anaesthesia (making the tooth numb). Once all the decay is removed and the tooth is washed and dried, the filling is packed into the cavity and it sets.
After the filling is placed, it is shaped to match the original tooth contour and the bite is checked.

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How do I know if I need a filling?

You may not know if you need fillings in your teeth. Many small to medium holes in teeth are asymptomatic, giving no pain. In fact, decay can sometimes eat out two-thirds of the tooth from the inside and you would have no idea it is happening.
Dental radiographs (X-rays), which are taken on a regular basis as part of your check-up, may show early decay that has not yet given any symptoms. You may be able to see a change in the colour on some of your teeth which may indicate early decay.
If your teeth are sensitive to hot, cold, or sweet food and drink, you may need fillings. All persistently sensitive teeth should be checked by your dentist. Toothache that lasts for more than a few minutes at a time should be investigated by your dentist. Teeth that cause severe pain may require fillings, or in some cases will require more extensive treatment such as root canal treatment.

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How long do fillings last?

The position, shape, material, and functioning pressure, all influence how long dental fillings will last. Larger fillings that bear a heavy functional load tend to break down more quickly than smaller fillings that bear little force. This is why it is impossible and meaningless to try to state categorically how long fillings should last.
However, when placing a filling, the dentist may have an idea of the expectation of the life of the filling. For example, a very small filling in the groove of a tooth away from biting pressure could be there for decades whereas a very large one in the mouth of a person who grinds their teeth may be lucky to last a few years and really should have a crown.
In a checkup, your dentist is constantly monitoring the state of your fillings, looking for signs of weakness, cracking, decay or discolouration.

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Is it possible to avoid fillings?

With proper attention to diet, oral self-care, regular dental check-ups, and the correct use of mouthguards to prevent injury, the need for fillings can be eliminated, and the frequency of filling re-placement can be extended.

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Should baby teeth have fillings too?

Yes, baby teeth should be filled to prevent toothaches, to maintain the baby teeth for eating, and to hold the right amount of space for the adult teeth. If the baby teeth are going to be exfoliated (fall out) soon, then it is not always necessary to fill the teeth. This should be discussed with your dentist.

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Yes, baby teeth should be filled to prevent toothaches, to maintain the baby teeth for eating, and to hold the right amount of space for the adult teeth. If the baby teeth are going to be exfoliated (fall out) soon, then it is not always necessary to fill the teeth. This should be discussed with your dentist.

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What are fillings made of?

Dental amalgams (silver fillings) are made from a silver/tin/copper alloy that is mixed with mercury. The alloy is in powder form prior to mixing with the mercury, which is liquid at room temperature.

Dental composite (tooth coloured fillings) consist of a resin matrix with filler particles. The resin is the liquid component that hardens with time by chemical reaction. The filler particles are made from solid substances such as glass or pieces of set resin.

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Are there alternatives to water fluoridation?

There are no other cost-effective preventive schemes that benefit the total community like water fluoridation. Health conscious parents and individuals outside fluoridated areas can use personal fluoride supplements such as tablets and drops. But they do not work as well as fluoride in drinking water, are more expensive, require continuous motivation and compliance, and only reach a small part of the population. There is also the danger of accidental overdose with any tablets or drops.

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What is fluorosis?

Dental fluorosis is seen as small white flecks in the surface enamel of teeth. In minor cases it is usually not visible to patients but in more advanced cases it appears as large white patches or occasional pits in the tooth surface. After some years, stains may penetrate the white patches and they can appear brown.
Receiving excess doses of fluoride during the formation of teeth causes fluorosis. This can occur by eating or swallowing excessive amounts of toothpaste or exceeding the dose when taking fluoride tablets. It can also occur where there is excess fluoride in natural water supplies or a combination of all three. In extreme or severe cases of fluorosis the teeth are unsightly and may need treatment to improve their appearance.
Water fluoridation alone does not cause fluorosis but it can happen in combination with other sources of fluoride.

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Does My Water Filter Remove Fluoride?

Some filters do and it is important to check with the manufacturer or supplier.

Generally speaking:

Filters That Remove Fluoride:
Ion Exchange Filters
Reverse Acinous Filters and Distillers

Filters That Don’t:
Carbon Filters
Ceramic Filters

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Common questions about fluoride

Q:  What Is Fluoride?

A: Fluoride is the ion that comes from the naturally occurring element, fluorine. Fluorine is never encountered in its free state in nature because it combines with other elements as fluoride compounds in the earth. Water dissolves these compounds, creating fluoride ions that are present in all water sources, including the oceans.

Q: How Does Fluoride Stop Tooth Decay?

A: Fluoride reduces the number of cavities an individual will develop in their life by about half. This is because it makes the enamel of the tooth more resistant to the acid attacks of plaque bacteria. Resistance occurs initially when the fluoride is incorporated into the teeth during their formation and secondly, as fluoridated water washes over the surface of the erupted teeth.

Q: Are Some People Allergic To Fluoride?

A: There has never been a case of an allergy to fluoride. If a person was allergic to fluoride they could not drink present water supplies because all water contains some fluoride. Similarly, because of its natural abundance in nature, fluoride is contained in virtually all food and drinks. People allergic to fluoride would also be allergic to tea, coffee, mineral water and seawater.

Q: Are There Alternatives To Water Fluoridation?

A: There are no other cost-effective preventive schemes that benefit the total community like water fluoridation. Health conscious parents and individuals outside fluoridated areas can use personal fluoride supplements such as tablets and drops. But they do not work as well as fluoride in drinking water, are more expensive, require continuous motivation and compliance, and only reach a small part of the population. There is also the danger of accidental overdose with any tablets or drops.

Q: How Much Fluoride Is In Fluoride Toothpaste?

A: Children’s toothpaste contains between 400 and 500ppm (parts per million). One part per million is the equivalent of one milligram per litre. Adult’s toothpaste contains between 1000 and 1100ppm. Toothpaste should not be used on children under the age of two years. Over two years of age only a ‘pea-sized’ smear of toothpaste should be used, as young children have not developed an adequate spit-out mechanism.


Q: what is fluorosis?

Dental fluorosis is seen as small white flecks in the surface enamel of teeth. In minor cases it is usually not visible to patients but in more advanced cases it appears as large white patches or occasional pits in the tooth surface. After some years, stains may penetrate the white patches and they can appear brown.
Receiving excess doses of fluoride during the formation of teeth causes fluorosis. This can occur by eating or swallowing excessive amounts of toothpaste or exceeding the dose when taking fluoride tablets. It can also occur where there is excess fluoride in natural water supplies or a combination of all three. In extreme or severe cases of fluorosis the teeth are unsightly and may need treatment to improve their appearance.
Water fluoridation alone does not cause fluorosis but it can happen in combination with other sources of fluoride.
See http://www.ada.org.au/OralHealth/flnfront.aspxfor more detailed information on fluoride and water fluoridation.

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How much fluoride should I give my child?

Given at optimal levels, fluoride can strengthen teeth and help prevent tooth decay. The correct amount of fluoride to give your child depends upon his or her age and whether or not the local water contains fluoride. Your dentist is the best person to advise you on the amount of fluoride needed to meet your child�s needs.
See http://www.ada.org.au/OralHealth/flnfront.aspxfor more detailed information on fluoride and water fluoridation.

 

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Who should use fluoride toothpaste?

Regardless of the presence or absence of water fluoridation, or the taking of fluoride supplements, everyone should be encouraged to brush their natural teeth with fluoride toothpaste.

Fluoride toothpaste tubes should carry advice that for children under the age of six years, brushing should be supervised, and only a “pea” sized smear of toothpaste should be placed on the brush. Thorough rinsing is recommended and children should be instructed not to swallow the toothpaste.

See http://www.ada.org.au/OralHealth/flnfront.aspxfor more detailed information on fluoride and water fluoridation.

 

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Where can I find more information on fluoridation?

The following website provides extensive information on fluoridation:
http://www.ada.org.au/OralHealth/flnfront.aspx

 

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Common questions about water fluoridation

Q: What Is Water Fluoridation?
A:  All water supplies have some natural fluoride in them and the water fluoridation process just involves adding or removing fluoride to the level that protects dental health. It does not involve adding anything to the water that is not already there. There is no chemical difference between fluorides present naturally and that which is added to the water supply.
Q: what are the benefits of water fluoridation?
A:  Drinking fluoridated water increases the resistance of teeth to decay, resulting in fewer cavities. This means fewer fillings, fewer extractions, fewer visits to the dentist and lower dental bills – resulting in better smiles, fewer dentures and less pain and suffering. Fluoridation will help to reduce the number of school or working hours or days that are lost due to dental problems or visits to the dentist.
Fluoridation will also help in the prevention of aesthetic problems associated with decay, especially in the front teeth, problems with discomfort and problems with self-esteem. Fluoridation also indirectly reduces orthodontic problems.
This benefit applies to all teeth (baby and adult) and to all age groups in our community. All teeth, at all ages, benefit as the fluoridated water has a continuous topical action.
Despite the availability of other sources of fluoride (tablets, drops, toothpaste, professional applications), water fluoridation is still shown to be the most appropriate means of reducing tooth decay in the twenty first century. The magnitude of the fluoridation benefits has decreased in recent decades, but they are still in the range of a 20-40% reduction in tooth decay in fluoridated areas.
There is ample evidence that if water fluoridation ceases, the rate of tooth decay increases despite the use of fluoride toothpaste and supplements. The decay rate decreases again when fluoridation is re-introduced.

A community that fluoridates its water today will have teeth with approximately half as many cavities in 10 years� time.
Q: If i live in a non-fluoridated water area, what amount of fluoride supplement should i take?
A: Fluoride tablets or drops should be used according to the following guidelines proposed by the Dental Health Committee Discretionary Fluoride Panel of the National Health and Medical Research Council.

Daily fluoride supplements are to be used ONLY in cases where the natural fluoride content of your drinking water supply is less than 0.3 mg per litre.

If you are not sure whether you water supply is fluoridated, check with a local dentist or your local water supply authority.
Daily Fluoride Dosage (in milligrams) by Age Group
Fluoride in Watermg/litre 6 months – 4 years 4-8 years 8+ years
Less than 0.3 mg/litre 0.25mg 0.5mg 1.0mg

0.3 – 0.5 mg/litre 0 0.25mg 0.5 mg

More than 0.5 mg/litre 0 0 0
If a day is missed, DO NOT double up the next day. Keep fluoride supplements out of the reach of children.

Individual fluoride tablets should contain no more than 0.5 mg.
2.2 mg of sodium fluoride provides 1.0 mg of fluoride.
When you buy your tablets from the chemist, make sure he or she explains the dosage.
Remember that fluoride in toothpaste should be also taken into account. Children should use only a small amount of child-strength fluoride toothpaste when under fluoride supplements.

Q: Who Benefits From Water Fluoridation?

A: People of all ages benefit from water fluoridation.

Children benefit from the tooth decay preventive effects of water fluoridation with less tooth decay in their first and second set of teeth. Existing fillings in teeth last longer where water is fluoridated as there is less decay starting again where the filling meets the tooth surface.
The elderly and those with disabilities that prevent adequate cleaning of their teeth (including those in nursing homes), or those who require assistance with tooth brushing, will benefit from water fluoridation. This group is particularly susceptible to decay around the gum line of their teeth and water fluoridation would lower this risk factor.
Water fluoridation reduces decay and lessens the need for dental intervention. Dental treatment creates additional problems for some (e.g. diabetics, haemophiliacs, transplant patients, the immune compromised) for whom a healthy mouth is essential.
Water fluoridation is particularly beneficial in providing a preventive health measure to lower socio-economic groups who may have difficulty in implementing their own preventive care. Public health education has been shown to be effective only in the higher socio-economic groups.
An enormous amount of research has been published on the safety of water fluoridation, including any effects on the older members of the community who may have very few teeth or none at all. This extensive research has revealed no adverse health effects on the elderly or any other age group.

Q: Is Water Fluoridation ‘Mass Medication�?

A: No. Fluoridation is not mass medication any more than other disease prevention health measures. It is not a ‘foreign chemical’ in a water supply, but a naturally occurring element that reduces dental disease. Along with pasteurisation, water purification, and immunization, fluoridation is considered one of the four most important and successful public health measures of the twentieth century.

Q: Does My Water Filter Remove Fluoride?
Some filters do and it is important to check with the manufacturer or supplier.
A: Generally speaking:

Filters That Remove Fluoride:

Ion Exchange Filters

Reverse Acinous Filters and Distillers
Filters That Don’t:

Carbon Filters

Ceramic Filters

Q: Are There Any General Health Side Effects?

A: No. Drinking optimally fluoridated water is not harmful to human health.
Many cities throughout the world have large amounts of natural fluoride in their water supply without water fluoridation. Artificial water fluoridation was introduced over 50 years ago, providing many opportunities to study fluoridation’s side effects. The only effects of water fluoridation that have been scientifically proven are those that benefit teeth.
Numerous studies have shown that consumption of fluoride in community water supplies at the level recommended for optimal dental health has no harmful effect in humans. For generations, millions of people have lived in areas where fluoride is found naturally in the drinking water in concentrations as high as or higher than those recommended to prevent tooth decay. Research conducted among these groups confirms the safety of fluoride in the water supply.
Fluoride’s safety has been monitored for the past fifty years through over 30,000 studies, and no evidence has ever been found that water fluoridation causes any health side effects.

Q: Has The Issue Been Fully Investigated In Australia?

A: Five major inquiries have addressed the issue of water fluoridation in Australia. Most were prompted by claims that new evidence showed water fluoridation to be either harmful or ineffective. Each investigation took many months to examine all available information. All the inquiries found the allegations to be unproven and fluoridation to be safe, effective and economical.
These reports are:
> Report of the Royal Commissioner into the Fluoridation of Public Water Supplies (Hobart, 1968),

> Report of the Committee of Inquiry into the Fluoridation of Victorian Water Supplies for 1979-80 (Melbourne, 1980),
> Inquiry into Water Fluoridation in the ACT by the Standing Committee on Social Policy (1991),
> The National Oral Health Survey 1987-1988 (which provided a database for Australian oral health), and

> Report by the National Health Medical and Research Council on the Effectiveness of Water Fluoridation (1991). See NHMRC document �The Effectiveness of Water Fluoridation�.

Q:  Who Supports Fluoridation?

A: Water fluoridation is supported by the World Health Organisation (World Health Assembly, 1978), the Australian Dental Association, the Australian Medical Association and the National Health Medical and Research Council.
75% of Australia is currently fluoridated. In 1995, enabling legislation was passed in California for water fluoridation, so virtually all major cities in the United States of America are fluoridated.

Q: How Cost-Effective Is Water Fluoridation?

A: Water fluoridation is the most cost-effective and socially equitable method of tooth decay prevention for all members of a community.

Cost varies with the size of the population fluoridated, but averages about $1 per person per year according to American figures (Garcia, 1989). Therefore it is likely to cost less to provide a lifetime of fluoridation to an individual than it costs for a single dental filling.

 

CONCLUSION:

Water fluoridation is a safe, equitable, cost-effective public health initiative that responsible state and local governments should implement to reduce dental pain and disease throughout Australia.

Q: Where Can I Find More Information On Fluoridation?
A: The following website provides extensive information on fluoridation:

 

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My son hates the fluoride treatment, even though it’s supposed to taste good. He’s 10 years old and his dentist recommends this treatment for at least another four years. Should we stop any sooner?

No, I do not recommend stopping any sooner. In fact, I recommend continuing fluoride treatments until he’s age 18. Professional fluoride treatments are essential for strengthening teeth and helping to prevent cavities in the future.

You might consider asking your dentist for a different flavor of fluoride. Perhaps other people do not like the taste of the brand that he uses as well. I would caution, however, that your son should not swallow the high concentration fluoride used in the fluoride treatment. It can cause upset stomach.

 

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I haven’t been to the dentist for years and it shows, but I would like to start going. Besides brushing and flossing, can you recommend a good way for me to get them in a little better shape before I visit a dentist? I am embarrassed to go as they are right now.

Aside from brushing and flossing, there is really no other way to improve the overall appearance of your teeth and gums. I think what you are really concerned about is that the dentist will scold you about the condition of your teeth. Every day in my office, people come in with that same fear. I remind them that I’ve seen teeth in far worse condition than what they have come in with — from teeth that are all black and broken down to no teeth at all. Your teeth will not shock the dentist, I can assure you. You need to find a dentist who has a reputation for being skilled, caring and compassionate. That should allay any of your fears about coming to the dentist. Good luck!

 

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I’ve been wearing a retainer behind my lower teeth for several years. The retainer was put in after my braces were removed. I’ve left the retainer in for fear my teeth may separate if removed, but if it’s no longer needed, I would like to have it removed.

A permanent retainer is useful in preventing teeth from shifting after braces have been removed. They can present a problem because they collect food and plaque and make cleaning the teeth more difficult. You should ask your family dentist and orthodontist whether they feel that the retainer can be removed at some point. Sometimes, a removable retainer can be made and only worn part time to prevent teeth from shifting.

 

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Is drinking a lot of soda bad for the teeth?

Yes, any sugar-containing beverage can increase the risk of tooth decay. Drinking soda with frequent sips throughout the day is more harmful than drinking it all at once in one sitting. The reason is that every time the sugary solution contacts the teeth, bacteria in the mouth can use that sugar to create damaging plaque acids. These acids cause dental cavities. If you drink soda, you should brush your teeth directly afterwards.

 

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Can you recommend a dentist to me?

As our members pay to be a part of our Association, it would be unethical of us to recommend one of our members over another. Choosing a dentist is a personal thing, and what works for one person may not work for another. It is most important that you find a dentist that makes you feel comfortable. The Association recommends you talk to family and friends about their dentist.

 

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How do I find a good dentist?

10 TIPS ON FINDING A GOOD DENTIST
1. ADA MEMBER

Look for an ADA (Australian Dental Association) Member.ADA Members- agree to abide by a code of ethics- participate in on-going education.
2. PERSONAL RECOMMENDATION

Ask your friends, neighbors, co-workers, family doctor or previous dentist for their recommendation.
3. LOCATION

Will your dentist be located near your home or work? Will the surgery be convenient for you? Ask about the availability of after-hours emergency services.
4. COMMUNICATION

Consider the friendliness and helpfulness of the dentist and his/her staff. Are they willing to answer your questions and readily provide information?
5. CLEAN

Is the practice clean, tidy and hygienic? If you have questions on infection control are they answered?

Are instruments sterilsed? Do staff wear gloves and masks, and offer you protective eyewear?
6. RESPECT

Does the dentist appreciate that your time is important, allowing, of course, for the unpredictability of

some procedures, e.g. emergencies?
7. MEDICAL HISTORY

Does your dentist take interest in your medical and dental history and listen to your concerns about having dental treatment?
8. EXAMINATION

Does the dentist examine all your teeth and your gums thoroughly and regularly?
9. OPTIONS & ESTIMATES

Does the dentist present you with treatment options and explain them so that you understand? Does the dentist give you pre-treatment cost estimates and inform you of variations as they occur?

10. SHARED PLANNING

Does the dentist have a long-term view of your dental health – with a plan that you arrived at together, including seeing you regularly to help maintain optimal health?

 

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What is a dental specialist?

Dentists who undergo further training after their initial dentistry degree are called specialists. Dental specialists restrict their practice to a specific area of dentistry. Your local dentist has had extensive training to be an oral physician. This training enables your dentist to treat you as a person and understand all your dental requirements. In most cases, your local dentist will be able to undertake most of your treatment needs. In some cases, he or she may elect to have the assistance of specialist dentists to ensure you receive the highest quality treatment. There are many forms of dental specialties, some of which are outlined below.
Endodontists diagnose, treat and help to prevent diseases of the root canal (dental nerve) and its surrounding tissues;
Oral/maxillofacial surgeons surgically treat injuries, abnormalities, and diseases of the tissues of the oral cavity and its adjacent parts and are called upon to remove difficult wisdom teeth and place dental implants.

Orthodontists rearrange the natural teeth for functional and cosmetic reasons. They diagnose and treat wrongly-spaced, crooked, misplaced or prominent teeth in children or adults.
Paediatric dentists deal with children’s oral health needs from birth to 18 years of age including those with special health care needs. Paediatric dentists focus on prevention and management of disease or growth disturbances in the infant, child or adolescent involving either the primary or permanent dentitions. Treatment under conscious sedation or general anaesthesia is an integral part of specialist practice.

Periodontists treat gum diseases and are called upon to place dental implants.
Prosthodontists undertake the advanced restorative treatment of teeth and surrounding tissues by artificial means (replacement of missing teeth and supporting structures e.g. dentures, crowns, bridges and implants).

 

Oral Pathologists diagnose pathological conditions in the mouth.

Dental Radiologists provide specialist diagnosis.of xrays.
Sometimes your dentist will refer you to a specialist for an expert opinion and/or treatment.

 

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Who will treat my disabled child?

Not all dentists have the facilities to treat disabled children. Some children and adults may need general anaesthetic before a dentist can treat them. Contact the Australian Dental Association office in your state for a dentist in your area that may be able to help you.

 

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I have a question about dental assisting can you help me?

ADA has limited information about dental assisting, as we are primarily a professional association for dentists. We are able to answer some queries regarding industrial relations and awards, employment and training. Contact the Dental Assistants Association in your State; they may be better able to answer your questions. Some ADA State Branches also have information on dental assistant employment and training.

 

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I have a question about dental assisting can you help me?

Some people claim that the mercury in dental amalgam can cause or affect a wide range of medical conditions. In providing advice on this matter to its member dentists, the ADA draws its opinion from credible scientific and medical bodies such as the World Health Organisation and the National Health and Medical Research Council (NHMRC) in Australia.
The World Health Organisation and the World Dental Federation have released a joint statement confirming the safety of dental amalgam as a filling material.
The NHMRC released a working party report in 1999 that looked at this issue. You can view a summary here or view the entire report at www.nhmrc.gov.au. This report concluded that:
No pivotal study has been published over the past 5-10 years providing unequivocal evidence of any hazard from the levels of mercury presently resulting from dental amalgam restorations.

 

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Does a dentist provide a guarantee for workmanship?

No treatment can be “guaranteed”, either in terms of its ‘cure’ or by a length of time.
A dentist is a skilled professional who practices with the utmost care and responsibility. A dentist cannot foresee what may or may not happen due to natural causes (“Mother Nature”) or unpredictable complications.
A dentist should discuss with a patient the prognosis, or likely outcomes of various treatment options, on which a patient can base a final decision.
If you feel dissatisfied with work that has been provided, you should first discuss the matter with your treating dentist. After this discussion if you still feel you wish to take the matter further, you could seek a second opinion and/or contact the ADA Community Relations Officer, or the Health Services Commissioner. Both Officers have conciliatory roles in trying to resolve the situation to the satisfaction of the parties concerned.

 

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Gum Disease Introduction

Teeth are meant to last a lifetime. Periodontal disease (previously known as Pyorrhea) is a major cause of tooth loss in our population. Most of the time, periodontal disease is preventable.

 

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What is gum disease?

“Gum disease” describes a range of conditions that affect the supporting tissues for the teeth. The supporting tissues comprise both the surface tissues that can be seen in the mouth and also the deeper tissues of the bone, root surface and the ligament that connects the teeth to the bone.

 

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What causes periodontal disease?

Periodontal disease is caused by bacteria. Bacteria form a plaque which is a sticky, colourless film that forms on your teeth, particularly around the gum line. Other bacteria thrive deep in the gap between the gum and the tooth (the pocket). Some people are much more at risk of developing periodontal disease  smoking is one of the major risk factors. Other conditions such as diabetes, stress, pregnancy and various medications can all be contributing factors.

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What are the most common forms of periodontal disease?

Infection affecting the surface tissues is called Gingivitis. This may progress to affect the deeper supporting tissues and is called Periodontitis (previously called pyorrhea). The effects of gingivitis are largely reversible with appropriate care. Once this has progressed to periodontitis there is permanent damage to the ligament and bone that supports and holds the teeth. Often a space develops between the gum and the tooth called a pocket. The pocket forms a protected environment for more bacteria and the condition progresses. If left untreated periodontitis may cause abscesses and tooth loss.

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Can gum disease be treated successfully?

Yes.

In the vast majority of cases the progression of gum disease can be arrested with appropriate care. Management of gum disease becomes more difficult and less predictable the more advanced the disease. Therefore, the sooner periodontitis is diagnosed and treated the better. Regular dental examinations are important to check for the presence of gum disease.
The cause of gum disease is bacteria. To manage it, the bacteria must be reduced to a level the body’s defense mechanisms can handle. Treatment classically involves:

  • achieving the best possible home care
  • professional cleaning of the teeth above and below the gum line (into the pockets) to remove the plaque and hard deposits (calculus / tartar), and
  • regular reviews
  • trying to remove risk factors such as smoking.

Gum disease causes permanent damage to the supporting tissues; therefore the aim of treatment is to stop the progression of the disease through controlling the bacteria. This is an ongoing, lifelong activity.

Your general dentist is trained in managing periodontal problems. They may also use a hygienist to assist in your care. You may be referred to a Periodontist if your dentist considers your condition needs more advanced care. A specialist periodontist has gained additional qualifications and experience to satisfy the requirements of the State Dental Board and may therefore use the title “Periodontist”.

Prevention is best. To a large extent periodontitis can be prevented by good oral hygiene and early intervention when problems are identified. See your dentist regularly.

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My gums bleed. Is that OK?

No. Bleeding gums are common but not OK. In a healthy state gums do not bleed. Bleeding is often an indication that the gums are inflamed. The inflammation is generally a response to the bacteria on the surface of the teeth. The surface inflammation is Gingivitis. The bleeding may also arise from Periodontitis or traumatic cleaning. Bleeding gums are sometimes associated with serious medical conditions.

A dental practitioner should check bleeding gums.

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My mother lost her teeth when she was pregnant. Will that affect me?

There is no reason why a pregnancy should cause you to lose your teeth unless you ignore them totally.

During pregnancy the gums become more sensitive to bacterial irritation and may show an increased inflammation response. The type of bacteria around the teeth may also change to a type more associated with the cause of periodontitis. It is very important to maintain good oral hygiene and have regular dental checks during pregnancy.
Periodontitis can show a family tendency. So if a mother or father has periodontitis then there is an increased risk for their children to have periodontitis. Regular dental checks for periodontitis are even more important for those at higher risk for periodontitis.

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Who gets periodontitis?

Anyone.

Many people will have a small amount of periodontitis, which gradually increases with age. However approximately 15% of the population will have a significant degree of periodontitis. The destruction of the tooth’s supporting tissues caused by periodontitis gets worse over time when left untreated, and is often seen more severely in the 45+ age group. However the different types of periodontitis may affect people of all ages.
The risk for periodontitis is increased with poor oral hygiene, smoking, diabetes, a family history of periodontitis and a range of medical conditions, in particular those affecting the immune system.

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What are some of the warning signs of periodontal disease?

  • Bleeding gums when you brush your teeth.
  • Bad breath or a bad taste in your mouth.
  • Receding gums.
  • Sensitive teeth or gums.
  • Loose teeth or teeth that have moved.

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What can you do?

Visit your dentist, who will examine your gums as part of a normal dental check-up. X-rays are often needed to help diagnose any gum problems.
Good dental hygiene is one of the most important factors in preventing gum disease. Your dentist will show you proper brushing and flossing techniques that will help ensure healthy teeth and gums.
You may need to be referred to a Periodontist who is a specialist in treating gum disease. Treatment involves careful, deep cleaning of the teeth to remove the cause of the problem. This can be done with local anaesthetic.

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Implants Introduction

Whether you have lost all your teeth, a few of them, or even just one tooth, dental implants should be considered as an option for your oral rehabilitation program.
To help you decide if the exciting benefits of implants are suitable for you, contact your dentist today. A consultation will clarify what type of treatment you require.
Eating and correct chewing is essential for a healthy body. It is also one of the greatest human pleasures. Thousands of people, both young and old, no longer have their own teeth. Some manage quite well with dentures, for others they are unsatisfactory.
If you feel embarrassed or uncomfortable about gaps, missing teeth, dentures that are loose or unexpectedly drop down or you are unable to chew properly, yet you feel you deserve the best today’s modern restorative dentistry can provide, dental implants may be the solution.

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What is a dental implant?

A dental implant can be thought of as an artificial tooth root that is submerged into the jawbone. When dental work such as a crown, fixed bridge or a full set of dentures is added, one or more missing teeth can be replaced. A dental implant is fabricated from a very strong, biocompatible material placed in a simple procedure that, generally, is as convenient as a tooth extraction. After an initial healing period, during which the implant is buried in bone and left undisturbed under gum tissue, it is uncovered and connected to a small metal post that secures and supports the artificial tooth.
The implant material is extremely biocompatible. The bone grows to the implant and bonds to it. This makes the implant very strong. The process is called ‘osseointegration’.

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How long does it take?

It depends on the type of bone, and where the implant is placed into your jaw. It can range from a few months to over 9 months. Generally, implants in the front lower jaw need around 4 months; the back upper jaw needs around 9 months and elsewhere in the mouth around 6 months. These times may need to be lengthened if bone needs to be grown or grafting has taken place.

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Is everyone suitable?

Some people may not be suitable for this procedure. Conditions such as alcoholism, some psychiatric disorders and uncontrolled diabetes can cause problems. Your dentist will also need to check to see how much bone you have and whether there is enough space for an implant. The adjacent teeth roots will also need to be away from the implant. If you don’t have enough bone, it is possible to grow bone or even graft bone from elsewhere in the mouth or places like your hip.

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What are the advantages of the implant treatment?

The adjacent teeth are not damaged or cut in any way. It helps to prevent bone loss. Implants are also used to stabilise loose dentures or even replace them with fixed bridges

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What happens if an implant fails?

This means the implant has not attached or integrated to the bone. It usually fails at the second stage surgery. The failed implant is unscrewed, the bone left to heal for a while and a new implant placed. Other options such dentures or bridges are also available

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What is the procedure for implant treatment?

The gum is folded back and the bone drilled to receive the implant. You may have this done in the chair with local anaesthetic or go into the hospital for a general anaesthetic. The implant is generally covered over and left to heal until the implant is osseointegrated. Your oral surgeon or periodontist may also leave the implant uncovered by the gum at this first stage. A second operation may then be needed to uncover the top of the implant. Your dentist or prosthodontist can usually start construction of your crown or a bridge after a month.

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What is the success rate?

The success rate depends on where in the jaw the implants are placed. The lower jaw has a very good chance of success (98%). The further back in the mouth you go, the lesser the prognosis, but this is generally over 90%. If you smoke, the chances of success drop by at least 10%.

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Why is implant treatment expensive?

Because it is a complex process requiring expensive precision components and instruments.

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Why dental implants?

A dental implant is the closest thing to a natural tooth your dentist can give you. They feel much more natural and secure than traditional removable dentures, especially if these are loose fitting because of extensive bone loss. If several adjacent teeth are missing, a fixed bridge may be attached to dental implants as an alternative to a removable partial denture plate. Dental implants allow for the replacement of a missing tooth without modifying adjacent teeth. Your dentist will be happy to discuss alternatives for restoring your dental function with you.

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Are implants complicated?

The simple answer is no, if sufficient bone is available to accept the implant. The procedures can all be done in the dental surgery, using only local anaesthesia. In the first stage of surgery, the implant root component is inserted into the bone site.
This surgery generally takes about sixty minutes to complete. After six to ten days, the stitches are removed and the buried implant is allowed to heal for about three to six months. During this time, bone grows into the implant surface to secure it.
The second stage of surgery is very simple and lasts only about thirty minutes. During this stage, the buried, secure implant is uncovered using a small incision in the gum tissue. A post is attached to the implant until the final prosthesis is complete, which can take as little as two weeks. There is minimal discomfort associated with either of these surgical steps, certainly no more than having a tooth extracted, and usually less. Dentist prescribed medication can alleviate any uneasiness. Improved aesthetics, function and quality of life follows in a few weeks with your new prosthesis fitted.

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How long will an implant last?

This is impossible to predict. Though research has demonstrated a long life once the implants have been integrated with bone, each patient is different, and longevity may be affected by overall health, nutrition, oral hygiene and tobacco usage. Individual anatomy, the design and construction of the prosthesis and oral habit s may also have an influence.

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What is the cost of an implant?

In general, costs are closely comparable to those of other prostheses involving fixed bridgework. The uniqueness of each patient’s restorative needs means this should be discussed with your dentist.

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Are there any limitations?

Discuss this with your dentist, as there are a few medical reasons preventing the use of implants. Sufficient bone to accept the implant is the major limiting factor. This can be assessed radiographically (x-rays), and bone can even be augmented where it is deficient.

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Are dental instruments sterilised after each use? Answer

Dentists use an autoclave that is a steriliser which uses steam under pressure to achieve a rapid high heat sterilisation of instruments.

Dentists use autoclavable equipment and instruments. Otherwise they can use disposable items wherever possible. The general standard of infection control in all surgeries in Australia is excellent.

An independent survey conducted by Coopers and Lybrand in 1994 showed that each dentist is spending an additional $24,000 (approximate) per year on implementing responsible infection control measures.

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Do dentists and assistants have to wear gloves during treatment?

Gloves should be worn wherever there is a risk of exposure to blood or body substances, which is almost always the case.

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Should dentists and patients wear protective eyewear and face shields?

Such protection should be worn during procedures where splashing, splattering or spraying of blood or other body substances may occur.

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Where can I get more information on infection control in dentistry?

The National Health and Medical Research Council document “Infection Control in the Health Care Setting – Guidelines for the prevention and transmission of infectious disease” is available from “Australian Government Publishing Service”, telephone 132 447, at a cost of $12.95

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Injuries Introduction

Injuries can occur almost anywhere, not just when playing sport. So, it is important that you know how to deal with an injury to the mouth and teeth.

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What do I do first?

This is dependent on the severity of the problem. If there is a slight bruise or cut to the lip or tongue there may be no need for treatment. More severe lacerations will require treatment by your doctor of dentist. Any chips or fractures of teeth should be assessed and /or treated by a dentist. Traumatic injuries to the teeth and oral structures must be followed up in order to assess healing of tissues and provide further definitive treatment where indicated.

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What if a tooth is broken, loose or missing?

It is common for a small chip to break from a tooth, a tooth to fracture, a tooth to be pushed out of position, or a tooth to be completely knocked out. Generally speaking, you should not try to replace a loose baby tooth, but you should always make an appointment with your dentist to have it checked. However, a loose, displaced, or knocked out adult tooth is a different story and requires immediate attention from your Dentist!

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What can be done?

It is common for a small chip to break from a tooth, a tooth to fracture, a tooth to be pushed out of position, or a tooth to be completely knocked out. Generally speaking, you should not try to replace a loose baby tooth, but you should always make an appointment with your dentist to have it checked. However, a loose, displaced, or knocked out adult tooth is a different story and requires immediate attention from your Dentist!

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Will a root canal be necessary?

Your dentist will monitor the vitality of any injured tooth and advise you if endodontic (root filling) treatment is necessary.
Teeth that have been knocked out commonly require endodontic (root filling) treatment.
SAVE THAT KNOCKED OUT TOOTH
An adult tooth that has been knocked out should be immediately put back into the socket if possible, and you should see a dentist immediately! You should avoid touching the root section of the tooth. If the tooth is very dirty, rinse it quickly, preferably with milk, and replace it in the socket, using the position and shape of the teeth either side as a guide.
If the tooth has been out for a period of time it may be difficult to replace correctly . You can hold the tooth in position by folding several thickness of aluminium foil over the tooth and the teeth either side or hold in place with fingers. If you can’t replace the tooth in its socket, the next best thing is to put it in a glass of milk and take it to a dentist immediately. If you don’t have access to milk, place it in plastic wrap, and again, get to a dentist straight away! Handle the tooth as little as possible and do not touch the root section of the tooth. The sooner a knocked out tooth is replaced, the better the long-term prognosis for the tooth. Teeth replaced within thirty minutes have a good chance of surviving long term, but it is well worth replacing a tooth even if it has been out for a number of hours.
Your dentist will stabilise a knocked out tooth by joining it to the neighbouring tooth for a period of time while the injury heals

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Will laser treatment mean I don’t have to have the drill?

The ADA is waiting for further research to be conducted before it formulates its policy on the use of laser treatment in dentistry.
Laser treatment is relatively new in dentistry and there are not many dentists in Australia who use this technique. Presently, its uses are normally restricted to soft-tissue procedures and the whitening or desensitising of some teeth. It remains to be seen whether laser treatment will have any more than a small place in cutting hard tissues such as teeth in the foreseeable future.
Patients should be wary of testimonials and media reports that imply drill-free, injection-free dentistry with lasers. Many of these procedures can be carried out equally as painlessly with existing technology. Although lasers remove tooth coloured filling materials easily, they are not recommended for the removal of old amalgam fillings because of workplace health issues with mercury vapour.
The ADA views the development of laser treatment in dentistry as promising. However, the ADA only considers these products to be useful for the removal of initial tooth decay and preparation of cavities in small to moderate-sized lesions in adult patients. The ADA is cautiously optimistic that future research will demonstrate that laser systems may prove useful for other restorative procedures involving deep cavities (i.e., hard tissue procedures close to the pulp chamber), in children, and for the removal of existing fillings.
The ADA is aware of laser systems under evaluation and believes laser technology to be a promising and rapidly changing field in dentistry. The ADA will review any relevant new information on the safety and clinical application of these evolving technologies as it becomes available.

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I want to find out which dentists use laser treatment can you help me?

The ADA does not keep a register of the equipment used in each member’s practice.
The reasons for choosing one dentist over another are many and varied and include rapport, availability, staff friendliness as well as the level of technology. Your own dentist will be informed about lasers and will be able to advise you if laser treatment can be used for you and arrange a referral if considered necessary.

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What is a mouthguard?

A mouthguard is a removable rubber or polyvinyl shield worn over your teeth, most commonly the upper teeth, to protect the teeth and jaws from traumatic injury during sporting activities.

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Are there different types of mouthguards?

There are two basic types of mouthguards available:
(1) The custom fitted mouthguard is available from your dentist. This mouthguard is constructed directly from a mould taken of your teeth in the dental surgery and fits tightly and comfortably over your teeth. This type of mouthguard is the type recommended by the dental profession and is the most effective in preventing injuries to the teeth and jaws.
(2) The “do it yourself” mouthguard, available at many pharmacies are usually poorly fitting and uncomfortable to wear. Dentists do not recommend these as they offer little protection to the teeth and patients are encouraged to obtain the custom-fitted guard as a bare minimum.

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Do mouthguards come in different colours?

Custom mouthguards are available in a variety of colours. Popular team colours from AFL, ARL and NBL teams are also available.

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For which sports is a mouthguard recommended?

Mouthguards should be worn during any sport where there is the chance of a knock to the face.

There are three types of sport when we consider the chance of injury:
1. Contact sports where contact is part of the game. These include football, rugby, martial arts and boxing. The mouthguard should be compulsory.
2. Collision sports where contact often happens but it is not expected or allowed. These include basketball, hockey, water polo, lacrosse, netball, baseball, softball, squash, soccer, BMX bike riding, horseriding, skateboarding, in-line skating, trampolining, cricket (wicket keeping or batting without a helmet), water skiing and snow ski racing. A mouthguard is highly recommended.
3. Non-contact sports where contact is a rare occurrence. These include such sports as tennis where a mouthguard is not needed.
Mouthguards should be worn during all competitions as well as during training sessions, as this is when many injuries occur. This should be stressed to children in junior teams.

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How do I care for my mouthguard?

After use, mouthguards should be rinsed in cold, soapy water. They can be disinfected occasionally with a mild disinfectant solution or mouth rinse.
A mouthguard should be stored clean and dry in a plastic container ready for its next use. As mouthguards can distort under higher temperatures, they should be kept in a cool place, not in the back of a hot car on a sunny day.

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How much will a custom fitted mouthguard cost?

The cost of providing a mouthguard will vary from dentist to dentist, but would be no more than the latest pair of sporting shoes. It would be best to contact your local dentist to find out their charges. But remember, whatever the cost, it will be minimal compared with the cost of repairing broken teeth with bonding, root canal treatment or crown and bridge work, not to mention the heartache and inconvenience.

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Where are mouthguards available?

Most dentists are able to provide custom fitted mouthguards. It requires a brief visit to take impressions of your teeth. Usually, the mouthguard will be ready within a few days.

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Why do I need a mouthguard?

Teeth are at risk of damage when playing sport and can result in long and potentially expensive treatment to restore them to normal function and appearance.
Mouthguards also help to reduce the risk of jaw fractures and concussion caused by a collision.

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Will a mouthguard affect my speech or breathing?

A properly fitted custom made mouthguard will not affect breathing and should only minimally affect your ability to talk.

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What if my child has bands on the teeth?

If the child is in the middle of orthodontic treatment, they may be encouraged to avoid contact or collision sports for the duration because of the potential of lip lacerations. However, there are ways of making mouthguards that still fit reasonably well if sport must continue.

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What does it mean to be board certified?

What is oral and maxillofacial surgery?

Oral and maxillofacial surgery encompasses the art and science of diagnosis, surgical and related treatment of diseases, injuries, deformities, defects, and aesthetic aspects of the oral and maxillofacial area. The word “maxillofacial” refers to the jaw and face.

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What does it mean to be board certified?

Your board-certified surgeon has graduated from an accredited dental school and is licensed in the state in which he or she practices. In addition, this individual has completed an oral and maxillofacial surgery residency program approved by the American Dental Association’s Commission on Dental Accreditation.

During his/her oral and maxillofacial surgery residency, your board-certified oral and maxillofacial surgeon received graduate training in other disciplines such as general surgery, plastic surgery, medicine, anesthesia and pathology. Oral and maxillofacial surgeons are trained to treat patients in the hospital, outpatient facilities, surgery centers and in private offices.
The American Board of Oral and Maxillofacial Surgery is recognized by the American Dental Association as the specialty board for oral and maxillofacial surgery. The board is responsible for reviewing all applicants for board certification, as well as administering the examinations involved in the certification process.

In order to become board certified, an individual must complete an intensive application and examination process. Applicants for board certification in oral and maxillofacial surgery must provide verified written evidence of their educational and training qualifications. In addition, these individuals must provide evidence of their experience in all aspects of oral and maxillofacial surgery. Letters of recommendation from board-certified oral and maxillofacial surgeons attesting to an applicant’s acceptable ethical and moral standing in the profession and community are also required as part of the certification procedure. The applications of all candidates are reviewed by the board’s Credentials Committee.

Finally, your board-certified oral and maxillofacial surgeon was required to pass both a thorough written qualifying examination and a rigorous oral certifying examination to be certified as a Diplomate of the American Board of Oral and Maxillofacial Surgery. Diplomats are encouraged to maintain current competence by ongoing continuing education. Diplomats are recertified in current competency every 10 years by a comprehensive written examination.
Continuing professional education is an important tool keeping oral and maxillofacial surgeons current on new developments in the field. This is accomplished through national meetings, seminars, lectures, special courses, panels, symposia and self-study. The board-certified oral and maxillofacial surgeon has a demonstrated commitment to continual professional development. The American Board of Oral and Maxillofacial Surgery encourages it diplomates to continue their professional development through various educational experiences.

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What services do board-certified oral and maxillofacial surgeons provide?

Removal of Diseased and Impacted Teeth — Oral and maxillofacial surgeons remove impacted, damaged and non-restorable teeth.
Sedation and Anesthesia — Oral and maxillofacial surgeons also provide sophisticated, safe, and effective anesthesia services in their office including intravenous (IV) sedation and general anesthesia.

Dental Implants — Oral and maxillofacial surgeons, in close collaboration with restorative dentists, help plan and then place implants used to replace missing teeth. They can also reconstruct bone in places that need bone for implant placement and modify gingival (gum) tissue surrounding implants when necessary to make teeth placed on implants look even more natural.
Facial Trauma — Oral and maxillofacial surgeons care for facial injuries by repairing routine and complex facial skin lacerations (cuts); setting fractured jaw and facial bones; reconnecting severed nerves and ducts; and treating other injuries. These procedures include care of oral tissues, the jaws, cheek and nasal bones, the forehead and eye sockets.
Pathological Conditions — Oral and maxillofacial surgeons manage patients with benign and malignant cysts and tumors of the oral and facial regions. Severe infections of the oral cavity, salivary glands, jaw and neck are also treated.
Reconstructive and Cosmetic Surgery — Oral and maxillofacial surgeons correct jaw, facial bone and facial soft tissue problems left as a result of previous trauma or removal pathology. This surgery to restore form and function often includes moving skin, bone, nerves, and other tissues from other parts of the body to reconstruct the jaws and face. These same skills are also used when oral and maxillofacial surgeons perform cosmetic procedures for improvement of problems due to unwanted facial features or aging.

Treatment of Facial Pain — Oral and maxillofacial surgeons possess skills in the diagnosis and treatment of facial pain disorders including those due to temporomandibular (TMJ) problems.
Correction of Dentofacial (Bite) Deformities and Birth Defects — Oral and maxillofacial surgeons, usually in conjunction with an orthodontist, surgically reconstruct and realign the upper and lower jaws into proper dental and facial relationships to provide improved biting function and facial appearance. They also surgically correct birth defects of the face including cleft lip and palate.

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What is Oral Pathology?

Oral pathology / oral medicine is a specialty area of dentistry that is concerned with the health of the mouth and the diagnosis and management of diseases of the oral region. It may also include the oral and dental treatment of patients who are medically compromised, that is, those that have serious medical problems.

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What are the most common types of oral pathology?

Dental decay and periodontal disease are the most common diseases in the oral cavity, but there are other diseases that can affect the mouth and surrounding structures. Some of these conditions may be painful or result in gingival (gum) bleeding or halitosis (bad breath), which may prompt the patient to seek treatment. Other conditions, however, may give no symptoms until late in their course, or may be a manifestation of an underlying systemic disease. It is very important to have regular dental examinations to check on the health of both the teeth and soft tissues of the mouth, as early diagnosis of problems often results in better treatment.

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What about oral cancer?

Cancer can occur anywhere in the mouth and is often painless in the early stages. The major risk major risk factor in western countries being tobacco smoking. Cancers of the lower lip occur more commonly in people who have a high exposure to UV sunlight, such as outdoor workers. By not smoking and always using sun protection on exposed skin and lips, patients can decrease their risk of developing these cancers. Your dentist will examine and assess any non-healing ulcer or change in the appearance or texture of the skin. In most cases, the earlier the treatment, the better the outcome. Cancer of the mouth is both a preventable and potentially curable disease if it is detected early enough.

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Why doesn’t my toothache go away and what can I do about it?

There are a number of conditions that can cause pain which seem to be associated with a tooth. These conditions are associated with nerve injury and are not tooth-related, although the pain may seem to be in the tooth or gum. Trigeminal neuralgia is the most commonly known condition. It is characterized by sharp electric-like pain that is often confused with a cracked tooth. Another toothache-like pain is atypical odontalgia. The pain of this condition is continuous and aching and is not electric-like. Often the pain will briefly subside when dental work is done in the area, only to return. These conditions cannot be treated with dental procedures or extraction of teeth. The treatment involves taking medications that control nerve activity.

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What is fibromyalgia and myofascial pain and why is it worse when I am stressed?

These conditions are similar, but Fibromyalgia implies widespread chronic muscle pain, and Myofascial pain is more localized or regional muscle pain. When patients have either problem, the muscle is tender and hard bands of muscle fibers can often be felt in the body of the muscle. This is caused by the shortening of some of the muscle fibers. One on the common signs of myofascial pain is limited range of motion and pain due to the muscle fiber shortening. When an individual reacts to stress, the muscles often tighten, aggravating any areas of myofascial pain. In addition, it is known that stress decreases the body’s ability to modulate or filter out pain. Both Fibromyalgia and Myofascial pain is best treated by stretching the painful muscles and employing stress management techniques.

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Where can I read more about these problems?

Whether you are a patient or a consulting doctor or dentist, the best approach to getting current information about any topic is to conduct your own search of literature at a good biomedical library using medline or a similar service.

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What is orthodontics?

Orthodontics is the specialty of dentistry that involves the treatment of malocclusion, which is when the upper and lower teeth or jaw do not meet correctly. Individuals may need to be treated by an orthodontist if they have problems with their bite (such as an over or underbite), crooked teeth or overcrowding in the mouth. An orthodontist may move the teeth into position or correct the bite using braces, which are appliances bonded to the teeth and use brackets, wires, rubber bands or other ways of moving the teeth. An orthodontist may also use removable appliances to reposition the teeth. In more serious cases, a patient may need jaw surgery to align the bite. Children and adults can be treated for malocclusion. A dentist or orthodontist can perform an initial evaluation to determine if braces are needed.

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What if my teeth are not straightened?

Left untreated, an individual may suffer from chewing or jaw (TMJ or temporomandibular joint) problems because the bite is off, increased tooth decay because teeth may be difficult to clean, or gum disease. An individual with crooked teeth and an unattractive smile may suffer from low self-esteem, social problems or even depression.

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What are the types of problems?

There are three main types of malocclusions, including:

Type I — The upper and lower jaw are proportionally related from front to back, but there are problems with the teeth lining up straight within the jaws.

Type II — The upper jaw is too far forward and/or the lower jaw is too far back resulting in an overbite, and there may also be problems with alignment of teeth.

Type III — The upper jaw is too far back and/or the lower jaw is too far forward resulting in an underbite, and the teeth may also be crooked.

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When should treatment begin?

It’s never too late to correct the teeth and bite. One Chicago area dentist reports successfully treating a 78-year-old woman with braces. Interceptive treatment (first stage) may begin with the baby teeth or later on permanent teeth. A dentist or orthodontist should evaluate a youngster by the age of 6. The dentist will analyze the problem and determine when treatment should be started. Every case is different and there is no blanket rule that applies to the treatment of malocclusion. Treatment depends on the severity of the problem.

As a general rule, however, functional problems — such as TMJ disorders, tongue thrusting or speech/lip function problems — are usually corrected at an early age, such as 6 to 9 years old. Skeletal or structural problems, such as when the teeth and jaw don’t line up, are generally corrected at a later age when the permanent teeth are available.

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How long will treatment take?

It’s impossible for an orthodontist to project the actual treatment time. In most cases, however, treatment will range from 15 to 48 months for those with severe problems. In calculating total treatment time, the “resting stages” between multi-stage treatment periods (when the teeth are not actually being moved), should not be included. If a patient does not follow instructions from the dentist (e.g., to wear rubber bands or appliances), treatment may take longer. If the interceptive stage is a success, subsequent stages may be avoided. An orthodontist develops a tailored treatment plan for each patient.

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How effective is treatment on adults?

More and more adults are getting braces. There is an array of treatment options for adults on the market — including ceramic braces and removable appliances — but they may have limited applicability and effectiveness. Many dentists report that metal braces are still the most effective and least expensive option.

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What is orthodontics?

Orthodontics is the branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities (malocclusion). It generally involves the use of such things as braces, removable appliances, functional appliances or headgear to move the teeth or jaws into an ideal relationship.

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What is a malocclusion?

Malocclusion is a technical term for crooked, crowded or protruding teeth that do not fit together properly. These problems may be inherited or acquired. Common malocclusions include crowding of teeth, prominent teeth, too much space between teeth, extra or missing teeth and a variety of irregularities of the jaws and face. Thumb sucking, tongue thrusting, dental disease, premature loss of primary or permanent teeth, or accidents can cause malocclusions.

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What are the benefits of orthodontic treatment?

Orthodontic treatment is frequently performed to improve a persons appearance by straightening the teeth. However, an attractive smile is just one of the benefits. Crowded and overlapping teeth are harder to clean and can increase the risk of tooth decay, gum disease and eventual tooth loss. Having your teeth straightened will make it easier for you to look after them.

A malocclusion may also contribute to speech impairments and increase the risk of trauma if teeth are prominent. Abnormal or uneven wear of tooth surfaces can also occur if there is poor alignment of the teeth or jaws. In cases of deep bite, the lower front teeth can bite into the gum behind the upper front teeth causing damage. Bringing the teeth, lips and jaws into proper alignment results in better function, easier cleansing, increased confidence and self-esteem.

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Who can benefit from orthodontics?

At one time, most people believed braces were only for children. However, teeth can be moved at any age as long as the gum and bone is healthy. Because the basic process involved in moving teeth is the same in adults as in children, orthodontic treatment can usually be successful at any age. However, because an adult’s facial bones are no longer growing, some severe malocclusions cannot be corrected with braces alone. In such cases, orthodontic treatment combined with jaw surgery can achieve dramatic improvements.

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When should orthodontic treatment begin?

It is usually wise to have an orthodontic consultation around nine years of age. Some orthodontic problems are easier to correct if detected early, rather than waiting until jaw growth has slowed. Early examination allows the orthodontist to detect and evaluate problems and plan appropriate treatment. Early treatment may prevent more serious problems from developing or make treatment at a later age shorter and less complicated. However, in other cases, treatment will not commence until all the baby teeth have been lost.

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What are braces?

Braces are the most efficient and accurate way of moving teeth. Brackets are adhered to each tooth with special dental glue and are usually made of stainless steel or a clear plastic material. These brackets act like a handle on the tooth so that it can be moved into its correct position using wires. The brackets remain on the teeth for the entire duration of treatment. Generally adjustments are made to the braces every four to six weeks.

During treatment, patients may need to wear such items as rubber bands. These provide important extra forces for the correction of the bite

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How long will I need to wear braces?

On average, orthodontic treatment is approximately eighteen to twenty-four months in duration. However, the length of treatment will depend on the severity of the original malocclusion as well as the type of treatment carried out, and the co-operation of the patient.

At the completion of the active part of orthodontic treatment, the braces are removed and retaining appliances (retainers) are fitted to hold the teeth steady in their new position. These appliances may be removable plates or wires fitted behind the teeth. Retainers play an important role in orthodontic treatment for, if they are not worn according to instructions, the teeth may move back towards their original position.

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Are there any risks involved in orthodontic treatment?

Yes. Successful orthodontic treatment depends on the understanding and cooperation of the patient. Although there are many benefits to be gained from orthodontic treatment, there are also potential risks associated with this type of treatment. Although these risks are generally not serious, they still should be considered when making the decision to undergo orthodontic treatment.

Oral health Tooth decay, gum disease, and permanent markings (decalcification) on the teeth can occur if orthodontic patients eat foods containing excessive sugar. This may occur without orthodontic treatment but the risk is greater when wearing braces. Inflammation of the gums and loss of supporting bone can occur if bacterial plaque is not removed regularly with good oral hygiene. Be sure to continue to visit your family dentist at least every six months while orthodontic treatment is progressing.

Relapse Teeth may have a tendency to change their position after treatment. This is called relapse. The faithful wearing of retainers should reduce this tendency. Teeth can however, move at any time whether or not they have been orthodontically treated. This may be caused by eruption of wisdom teeth, growth and maturational changes, mouth breathing, playing a musical instrument and other oral habits.

Root shortening Some patients suffer problems in the jaw joints, including joint pain, clicking, headaches, or ear problems. Generally, the literature demonstrates that orthodontics play a neutral role in regard to jaw joint problems. Therefore, these problems may occur with or without orthodontic treatment. However, any of the above symptoms should be reported to the orthodontist.

Tooth vitality Where a tooth has been injured by a previous accident or contains a large filling, damage to the nerve of the tooth may result. In rare instances, this may lead to loss of tooth vitality and discolouration of the tooth requiring root canal treatment or other dental treatment to restore the colour of the tooth.

Treatment time The total time required to complete treatment may exceed the estimate. Poor cooperation, poor oral hygiene, broken appliances and missed appointments can lengthen the treatment time and affect the quality of the result. Cooperation throughout treatment is your contribution to a pleasing appearance and good bite. Failure to cooperate may require the orthodontist to change the goals of your treatment.

General health General medical problems can affect orthodontic treatment. You should keep your orthodontist informed of any changes to your medical health or any medication you may be taking.
Soft tissue damage Braces may cause some irritation to the soft tissue of the mouth. If improperly handled, the headgear may also cause injury to the face or eyes. Patients are warned not to wear headgear during times of rough play or competitive activity. Although our headgears are equipped with a safety system, we urge caution at all times.

Mouthguards – It is strongly recommended that you obtain a special mouthguard if you play any form of sport that may result in injury to the teeth. Ask your orthodontist to provide the mouthguard as the braces are fitted.

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Who does Orthodontics?

Any dentist may carry out orthodontic treatment, but the vast majority of cases are handled by specialist orthodontists who have restricted their practice to orthodontics exclusively.

A specialist orthodontist has gained additional qualifications and experience to satisfy the requirements of the State Dental Board and therefore use the title “Orthodontist”.

Orthodontia requires a teamwork approach that involves, at the very least, a general practitioner dentist and an orthodontist. Some severe orthodontics cases also require oral and maxillofacial surgery, which may involve considerable extra cost. The coordination of the course of care must be through a referring dentist.

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Can anyone have orthodontic treatment

Generally orthodontic treatment is best carried out in children, but many adults have orthodontic treatment too.

Orthodontic treatment involves a full examination of your teeth, which includes taking x-rays and making plaster models of your teeth from impressions, and possibly taking photographs.

Orthodontic treatment is carried out using a range of appliances, which may be removable or fixed temporarily to your teeth, depending on your treatment needs. It is usually necessary to adjust any orthodontic appliance at 4-6 weekly intervals.

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Where may I obtain more information on Orthodontics?

For more information on orthodontic treatment, talk to your dentist or make an appointment with an orthodontist.

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What are Orthodontic Spacers?

Your orthodontist may have told you that you need to have spacers before your braces go on. What does this mean?

Some of your teeth may need brackets that are attached to metal bands that go all the way around the tooth.* Usually, the bands are used only on molars. If the space between your molars is very tight, it will be difficult for the orthodontist to put the bands on the teeth. Therefore, space must be opened up to fit the bands in. This is where spacers come in.

Spacers are little rubber nodules that fit between the teeth. In some cases, your orthodontist may use a metal spacer, which looks like a tiny metal hinge. The spacers stay between your teeth for several days and move the teeth apart slightly. You wear the spacers 24/7 until your orthodontist removes them. Do not floss teeth that have spacers between them (it will be impossible)!

Are spacers uncomfortable? Yes, they usually are. It feels like you have something stuck between your teeth — and you do! In some cases it may be more than just uncomfortable; it may ache. If so, take pain reliever (such as ibuprofen) as needed.

Spacers usually stay between your teeth for several days; sometimes for as long as 10 days. The spacers are taken out before your braces are put on. The braces don’t hurt like the spacers; in fact, when the spacers are removed, it feels so much better, even after the braces are put on!

Many people on Metal Mouth Forum have remarked that spacers were the worst part of the entire process. Perhaps that’s not very encouraging, but remember, they’re only in your mouth for a short period of time. You can deal with it. They’ll be in, then they’ll be out, and you’ll be done with it. Hang in there, you’re on your way to a better smile!

*Why do some teeth need metal bands instead of regular brackets? Fillings. If you have a filling that protrudes to the outside of your tooth, brackets cannot be glued to these fillings. Therefore, a metal band must be wrapped around the tooth instead. The bracket is attached to the metal band.

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About Tightening/Adjustment

Every 4 to 6 weeks, you go to your orthodontist to get your braces “tightened” or “adjusted.” Sounds awful, doesn’t it? Well, cast aside your visions of Medieval torture devices. Nothing is really “tightened.” It’s really very simple.

This is usually what happens during an orthodontic adjustment:

The orthodontic assistant removes your elastic ligatures (the little rubber bands that hold each bracket to the arch wire).
Then the arch wire is removed.
At this point, you can brush and floss almost sans braces.
The orthodontist may come over to examine your teeth’s progress. Depending on the situation, a new arch wire may be needed. If you need anything new (such as power chains or elastics), the orthodontist should tell you.
The arch wire (new or previous) is put back onto your brackets. New elastic ligatures are put on. If this is one of the first times you’re getting an adjustment, this may hurt a little because of the pressure placed on the teeth. Don’t worry, in future months, it won’t hurt anywhere near as much! This is why they call it “tightening;” the braces feel tighter when the new ligatures are put on because of the renewed pressure on the teeth.
If the arch wire pokes your cheek at all, tell your orthodontist immediately! The arch wire should not poke you! If it does, the orthodontist or assistant must shorten the arch wire with clippers. Sometimes, the arch wire does not poke you immediately, but suddenly starts poking after one or two meals. This is good — it means your teeth have moved! See your orthodontist ASAP to get the wire clipped. Otherwise, the arch wire will tear up the inside of your cheek, which is very uncomfortable.

That’s it! Do your teeth hurt? Take some pain reliever to help you deal with it. The discomfort will probably last a few days, then dissipate. You may need to eat only soft foods for a few days. Protein shakes, such as the Atkins or Slim Fast shakes, made ideal meal replacements if chewing even soft food is uncomfortable. Within a week, most people an usually eat normal food again. After a few months, adjustments won’t hurt as much (really!)

After you have had braces for more than 6 months, your teeth get used to the extra pressure. At this point, an adjustment might not hurt at all, but your teeth usually feel sore for about a week afterwards. For some people, the teeth don’t feel sore again until the next adjustment. But for others, the pain dissipates for a week or two, and then a week before the next adjustment, the teeth are sore again. Why is this?

The cell regeneration process occurs after an adjustment. Your teeth are under force and move and causes some cells (bone, tissue) to break down and new cells to regenerate. After the regeneration happens the teeth and supporting structures begin giving and moving again and the cycle continues. This is why most orthodontists see patients every 4-5 weeks. The cell regeneration process typically takes about 3 weeks and that gives patients enough time after an adjustment to be ready for another one.

Because today’s wires move teeth slowly over a long period of time, the whole cell regeneration doesn’t stop/go/stop/go as it used to with older style wires, now it just moves your teeth continually. Movement continues until the wire is fully back to the original size and shape, at which time you are ready for a stiffer and larger arch wire.

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Can I Change My Own Ligatures? (o-rings)

Here’s a topic that comes up frequently on our Metal Mouth Message Board: changing your own ligatures (or powerchains).

Let’s say you ate some curry and now your ligatures (“o-rings”) are stained. They look yucky. You really want them to look nice again. Hey, maybe you could go online and buy some ligatures to change them yourself! After all, who wants to walk around with yucky looking ligatures for weeks on end until the next ortho appointment? How hard can it be? Well, it’s not so simple and it’s not a good idea, according to several orthodontists as well as a website that sells ligatures!

Dr. Christopher Jernigan, DMD of Columbia, South Carolina says, “Changing ligatures yourself seems harmless but you could be adversely affecting your treatment. When a ligature is used it begins to stretch and “decay” (as well as discolor). At this point the force applied to your teeth is “deactivating”. This is normal and healthy. Many times at an adjustment, all we do is re-tie your ligatures. In effect, doing this at home is actually reapplying new forces to your teeth not under the supervision of an orthodontist. If things were moving poorly at first then one could be making it worse by re-ties at home.

Dr. Jeffrey S. Genecov, DDS, MSD, FICD, FACD of Dallas, Texas adds, “Any damage that’s done to the braces, having them come loose, accidental injury, etc from unpracticed hands could slow down and extend treatment times. While all of these skills are learned and learnable, this what we do every day all day. That’s why in my office we encourage patients to come in and have their ligatures changed whenever they need to — and also one reason why we’re almost 75% using self-ligating brackets.”

Several other orthodontists and dentists were asked the same question and all agreed that changing your own ligs is not a good idea. In addition, the owners of JawProducts.com, a website that sells ligatures stated, “We do not recommend you changing your ties yourself. Please follow the advice of your orthodontist.”

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Help! Did I Stain My Braces?

One of the most common questions we get involves ceramic brackets stained from foods, particularly curry. Well relax, your brackets are NOT stained. The brackets themselves are still white, but the elastic ligatures have become stained. The ligatures are those little rubber bands on each bracket that hold the arch wire in place.

Yes the brackets will look stained. But believe me, in most cases, it’s only the elastic ligatures. And those get changed by your orthodontist every 4-6 weeks. So the next time you have an adjustment, the stained ligatures will be replaced with fresh new ones and your braces will look white and perfect again.

But what if it will be weeks until your next adjustment? How can you get rid of stains from curry, mustard, coffee, tea, or smoking? Well, here’s the bad news: it’s very difficult. You can try brushing with whitening toothpaste, but that has very limited results. The yellowish tinge will probably still be visible to some degree. If you have an important engagement and need your braces to look white again, you must visit your orthodontist and get your ligatures changed.

Here are some suggestions to help you avoid this problem in the future:

Instead of clear or white ligatures, choose light blue, or smoke color. The light blue ligatures turn bright green immediately from curry, but after a few brushings with regular (non-whitening) toothpaste, they settle into a pleasant light teal color. Or go bold. Bolder colors don’t stain as easily.
Readers have recently reported that there is a new opalescent pearl color of ligature that resists some stains (although it does not resist curry stains at all).
If all else fails, ask your orthodontist to use tie wires instead of elastic ligatures. Tie wires do not stain at all.
Eat curry only in the days before an adjustment (not really an option for us curry addicts!)
Give up smoking. Easier said than done, but better for your health!

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Soft Food Suggestions

The first weeks or months in braces can be frustrating because you can’t eat some of the normal food you enjoy. And once your teeth stop hurting, the pain may return for a few days when you get an adjustment, putting you back on a soft food diet. Some of the suggestions on this page will help you deal with those painful days.

Remember that whatever you eat, cut it into small pieces and chew carefully and slowly. To get more protein into your diet, try adding protein powder or tofu to some of your meals or drinks.

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All About Power Chains

Your orthodontist may have told you that you need to have power chains on your braces. What does this mean?

Power chains are made of the same type of elastic material as the elastic ligatures (the o-shaped elastics that hold your arch wire to each bracket). In essence, power chains are like a bunch of ligatures linked together. Placed on your teeth, they form a continuous band, from one tooth to the next. Usually, you wear power chains instead of ligatures. Sometimes, your orthodontist can put both a ligature (or tie wire) and power chains on your teeth. It depends on what is attempting to be accomplished. Occasionally, some orthodontists decide to give you “power chains” made of wire (where a continuous piece of wire is twisted around each bracket).

Why would you need power chains? The most common reason is to close a gap between your teeth. Power chains apply extra force and help move your teeth faster. If your treatment includes extractions, then power chains will probably be in your future. Sometimes your orthodontist may keep the power chains on, even after the gap has closed. This is to ensure that the gap remains closed for the balance of your orthodontic treatment.

Power chains are changed just like elastic ligatures — at each orthodontic adjustment. Like elastic ligatures, they come in a variety of colors, and yes, they DO stain from coffee, tea, red wine, and most notably, curry. From trial and error, I have found that the best colors for power chains are silver or smoke. You can also try light blue (the ones in the above photo). Light blue will stain bright green with curry, but after a few brushings, will turn a pleasant dull light teal. (Like ligatures, the “tooth-colored” chains will stain bright yellow if you eat curry; I don’t recommend them unless you do not eat curry at all).

Power chains come in three different types. The best way to describe them is with a simple illustration:

000000000000000

0-0-0-0-0-0-0-0

0–0–0–0–0–0

Your orthodontist will determine which type of power chain best fits your needs.

Now here comes the most important question: how do they feel? Do they hurt? When you first get them put on, yes, they do make your teeth ache. You may need to go back on a soft food diet for a few days. But if you’ve already had braces for a few months, the pain should subside quickly — within a week at the most.

How long does it take for the power chains and braces to close extraction gaps? Each person is different. Some people see dramatic changes in a few weeks. For others, it can take 6 months or more. Your orthodontist can measure (in millimeters) the width of your gaps at each appointment. You may be surprised to realize that the gaps are indeed closing, even if you don’t see progress yourself!

Is it harder to clean your braces with power chains? Only slightly harder. You get used to it. A little more food debris gets trapped, but it’s rather inconsequential.

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Ouch, I Have a Canker Sore!

Canker sores. Everybody hates them. When you have braces, you hate them even more. Before we go into ways of treating canker sores, let’s explore the reason we get them in the first place.

Canker sores are the most common type of mouth ulcer. It is a misconception that they are a form of herpes virus. This is not true, and canker sores cannot be passed between people.

Nobody knows for sure what causes canker sores, but there are many theories. For example, it is believed that toothpastes and mouthwashes containing sodium lauryl sulfatecan dry the mouth tissues and encourage canker sores. Stress, immune system reactions, family history, and mouth trauma may cause them. Women may sometimes get them at certain points in their menstrual cycle from hormonal changes and fluctuations. Some food allergies or intolerances (such an intolerance to gluten or Celiac Disease) may be responsible. In addition, deficiencies of vitamin B-12, zinc, folic acid or iron may play a part.

The presence of other ulcerative diseases, such as Crohn’s Disease, IBS, or digestive ulcers may have an effect as well. Doctors now believe that some of these ulcerative diseases may be caused by H. pylori and other bacteria. A simple blood test will tell you if you have H. pylori bacterium, which is treated with oral antibiotics. If you get frequent mouth sores that do not heal well, especially if you also have other ulcerative or digestive problems, you should talk not only to your dentist about it, but your medical doctor, because it could be a symptom of a larger problem.

But no matter the cause, canker sores are bothersome and painful, especially if they occur inside your lip near a bracket.

Most canker sores last 10 to 14 days and can be treated with over-the-counter remedies. If you get frequent canker sores, talk to your dentist about it, because there are some prescription-strength products that he/she might recommend instead, such as Amlexanox (Aphthasol)or Debacterol. Doctors also use steroids such as dexamethasone (Decadron)mouth rinse or prednisone (Orasone)tablets. Antibiotics, such as tetracycline (Sumycin) mouthwash, are also sometimes prescribed.

If you get a canker sore only occasionally, you can treat it with many products readily available without a prescription at your local pharmacy or on the Web. There are many options. The following list isn’t meant to endorse any of these products, it’s just to inform you about what’s currently on the market:

Products that form aprotective film over the sore for several hours can help it to heal. These include Zilactin-B, Colgate Ora-Base Soothe-n-Seal, Rincinol PRNmouth rinse, Orajel Mouth Sore Discs, Orajel Film-Forming Gel, Canker Cover, and Ora-5.
Products that help kill some of the bacteriain your mouth may help. These include Biotenemouth rinse and Colgate Peroxylmouth rinse. (Mouthwashes containing alcohol, such as Listerine, may sting too much for you to use comfortably). Also, CankAid oral antisepticmade of carbamide peroxide, the same ingredient used to bleach teeth!
Products that temporarily numbthe area bring short-term relief, such as Anbesolor Orajel.
Products that don’t contain certain irritating chemicals such as sodium lauryl sulfate may help. This retail websitethat has a number of “sls-free” toothpastes. In addition, there is Vita-Myr toothpaste, and Herbal Choice toothpaste.
Perhaps you’d rather try a more natural approach. Here is a list of holistic remediesyou may want to try. Also, here are some herbal suggestionsand homeopathic suggestionsfor canker sores.
Some alternative productsare sold on the Web that claim to help heal and prevent canker sores, such as Ulcer-Ease and Ora5. These can be found at canker-sores.com, and ora-5.com. Another product, Canker-Rid, is made from honey bee propolis and claims to work.
Readers from our Metal Mouth Message Boardhave told us about a couple of sensible and interesting remedies:
Rinse your mouth with salt water. This is a good way to ease a lot of oral or throat irritations. The salt water also acts as a mild antibacterial.
Avoid acidic foods which can irritate your mouth sores (e.g., citrus juices, tomato-based products, oral vitamin c)
Ask your dentist or orthodontist about a prescription mouth rinse (often called “Miracle Mouthwash”) made up of Diphenhydramine (Benedryl), Lidocaine, and Maalox-type aluminum/magnesium antacid. Several Message Board readers claim that this works very well.

Here are a few websitesthat provide copious information about canker sores:
Familydoctor.org
Brigham and Women’s Hospital
Animated-teeth.com
American Dental Association
Medline
U.S. Dept of Health

Try several remedies and see what works best for you. If the canker sore is irritated by a nearby bracket, you can also ease the pain by applying plenty of dental wax or dental silicone on the offending bracket. This forms a barrier between your the bracket and the sore. Doing this, in combination with the remedy of your choice, will help heal the sore.

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Changing Orthodontists During Treatment (Moving)

It happens sometimes: we begin orthodontic treatment, and life takes us to a new destination. Changing orthodontists mid-treatment can be tricky. You have all this stuff in your mouth, and somebody has to take care of it!Here are a few suggestions to make things easier for everyone.

If you are planning to move, or even if it is a mere possibility, tell your orthodontist ASAP.

Most orthodontists work on a “pay as you go” plan. In other words, you pay a certain amount of money at the outset of treatment (for the molds, consultations, and having the braces installed). Then, each month, you pay a percentage of the rest of your balance. So, if you move away from your orthodontist, be sure to tell him/her ASAP so that you will not be charged extra. You orthodontist will probably “pro-rate” your balance or refund some of your money. Be sure to ask what your doc’s policy is in this situation!

2. Get your records.

Request your dental records and x-rays, or ask your orthodontist to forward them to your new orthodontist once you arrive at your new location.

3. Try to identify a new orthodontist before you move, if possible.

Your current orthodontist may know of a colleague in your new area. If you have friends or relatives in your new area, that’s a good resource, too. Other ways to identify a new orthodontist include:

the local chamber of commerce
the local chapter of the orthodontic or dental association
ask pediatric dentists where they refer their patients
query a local online forum or message board

4. Get them talking to each other.

Orthodontists vary in their treatment approaches. Ask your “former” ortho to call your “new” ortho and talk about your treatment plan. This way, you know that your “new” ortho is continuing your original treatment plan — or not.

5. Don’t be surprised if you need to spend more money.

You may wind up paying a few hundred dollars more to your new orthodontist. After all, this new doc has never seen you before, and you are a new patient to him. Hopefully, changing orthodontists mid-treatment won’t raise your treatment costs too much.

6. Ask questions!

Know all the facts about your new orthodontist and treatment before committing. Some of the questions you need to ask include:

Will my treatment cost more? If so, how much?
How do you bill your patients?
Are you going to continue my previous orthodontist’s treatment plan, or do you have other ideas for my treatment?
Will my treatment take the same amount of time (will my braces come off when I had expected them to originally)?
What are your office hours? What is your procedure if I have a poking wire?
I have “XYZ”-type braces. Can you continue my treatment with them?

7. A note on dental insurance

Here’s a great scenario: you take a new job and move. Your new job offers orthodontic benefits! But wait — did you know that most orthodontic benefits are for new treatment, not for existing treatment? So, no matter how wonderful those orthodontic benefits are, chances are you won’t be able to use them. Be sure to look into this!

Also, if you’re on a dental plan that offers a list, call and ask if they have any orthodontists in your new area. Maybe they do!

8. A note on payment plans

It’s not a good idea to pay for your entire treatment up-front. Most orthodontists have a “make a deposit, then pay-as-you-go” plan. Why don’t you want to pay up-front? Several reasons: what if you move again? What if you decide to change orthodontists again?

And….unlikely, but….what if your orthodontist is unscrupulous? Yes, there are true stories about dentists who took full payment from their patients — and then closed their practices! Some of their patients had to pay the full amount (in excess of $5,000) again to the new orthodontist, and some just couldn’t afford the unexpected expense and had to stop their treatment. Don’t let this happen to you!

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Braces and Romance

The question comes up time and again on the Metal Mouth Forum: will the gals (or guys) find my braces to be a turn-off? Will I be destined to spend the next few years in a dateless wasteland?

If you’re single and getting braces, this is a serious question. Whether you are 18 or 48, you don’t want to be alone just because you have some brackets on your teeth for a few years.

Before you head to the nearest rooftop and scream, “So I have braces, what’s the big friggen deal?” read on…

I’ve seen this question asked many times, and the answer is always the same: the men worry that they look like geeks, and the woman re-assure them that if they are nice guys and are attractive in other ways, it does NOT affect the way others see them. Generally, men seem to have a harder time with braces than women. Perhaps this is because women have other factors at work — and that teenage cheerleader look isn’t always a bad thing when it comes to attracting men.

In reality, how the object of your affection reacts to you has little to do with what’s in your mouth, and a lot to do with other things. Like your image, your self-confidence, and your willingness to work just a little harder to win over the person you want. I’ve never known anyone to say, “Ewww, he/she has braces, I’d never consider dating him/her.” And if anyone DOES say or think that, just tattoo a big L on their foreheads, because they are shallow losers — and you wouldn’t want to date them anyway!

Sure, braces are a stereotype. The little girl in Finding Nemo is the perfect example — slightly ugly, nerdy and mean. On the other side of the spectrum, in real life, there is Tom Cruise. Would any woman kick him out of bed because of his ceramic brackets? (well, ok, Nicole Kidman kicked him out of bed, but I don’t think his braces had anything to do with it…)

For that matter, would any man have kicked Gwen Stefani or Nikki Taylor out of bed for their metal mouths? OK, I rest my case. (Photo to the right here is Tom Cruise in his Clarity ceramic brackets).

Also keep in mind the some people have a fetish for braces. So if someone who didn’t pay attention to you previously suddenly gets very interested after you get braces, that may be the reason.

You are spending major bucks to get your teeth straightened. When you are done, your teeth will look great. What about the rest of you? Use this time as an opportunity to improve other things about yourself, especially if you weren’t a dating champion before the braces went on. Think of this as your “transformation time.”

Here’s the main idea: if you look better, you’ll feel better; if you feel better, you’ll be more confident. And if you look good and are confident, you are sexy and attractive to other people. (Photo to the left here is Gwen Stefani in metal brackets).

Ideas for Women

This is a great time to spend a few extra bucks and have a professional make-over. Take a good look at yourself. What could be changed? Your makeup? Your hair? Your wardrobe?

Many day spas and salons offer hair and make-up consultations for reasonable prices. Get yourself out of any rut you may be in and splurge on a new or updated look. If your make-up looks better, they’ll be looking at your beautiful eyes and that great hair, and won’t notice your teeth.

Color consultants were big in the 1980s, and they’re still around today. A color or image consultant can help you update your wardrobe and dress you in colors compatible with your complexion. If you want to do it without professional help, take a trusted fashion-savvy girlfriend or relative (NOT your mother) on a trip to the mall. Take a good look at what’s out there and buy yourself a few great new outfits that accentuate your coloring and your figure.

Are you in shape or near your ideal weight? If not, start an exercise and sensible eating plan and try to stick to it. I know, easier said than done, but it’s worth it.

Ideas for Men

Have you seen the show “Queer Eye for the Straight Guy”? If not, the premise is: five gay guys invade the life of a hopelessly fashion-blind straight guy and turn him into an enthusiastic and well-groomed metrosexual, often to the drooling delight of their significant other.

I’m not implying that you are fashion blind, but everyone can use a little look-over now and again, just to get out of a fashion rut. You don’t necessarily need five gay guys with TV cameras to do this for you — you can do some of it yourself.

The pages of GQ or Details are a good place to start, but if that’s too daunting, go to a high-quality (and/or trendy) men’s store in your area and ask a salesperson for ideas. I know it sounds perilous, but you don’t have to actually buy anything, just see what somebody else thinks would look good on you, and think about it. If you are friends with a fashion-savvy guy, or a trusted woman with hip good taste (sister, aunt, cousin — NOT your mother) see if they’ll come along to help you. Go out on a limb and buy an outfit or two that looks great on you. Women appreciate a well-dressed guy.

Next, don’t be shy about heading over to a day spa for a skin consultation. You’d be surprised how many men get skin treatments these days. Have you ever had a facial? If not, you’re missing something really nice! The idea here is: improve your skin, if necessary.

Then, there’s the haircut. Have you had the exact same haircut for more than 5 years? If so, maybe it’s time for something a bit updated. You don’t need to look like you just stepped out of an artsy-fartsy hairstyle catalogue — you just need a style that looks good on you and is appropriate for your age and in step with today’s styles.

Finally, consider getting to your ideal weight and improving your physical appearance and strength overall. If a good-looking, in-shape man in nice clothes approached me for a date, I wouldn’t give a hoot about a little bit of metal in his mouth — I’d be looking at the rest of him, and listening to what words were coming out of his mouth!

Ideas for Anyone

Aside from this, you might want to take a few hours — or even days — to assess your life as a whole. Are you happy? What do you want to change? What do you want to get out of your life? What type of partner would fit into your ideal life? Put it down on paper or type it into your word processor! Don’t be restrained by reality — dream a little bit.

Seeing it there in black and white can be very helpful. I did this years ago, and when I met my future husband, I looked at that sheet of paper and realized that he had all the qualities I was looking for, and even more. Right then and there, I knew he was worth seriously considering as a life partner. And so he has been, 18 years and two kids later…and he’s the one who really pushed me to get braces a few years ago! In fact, nowadays I thank him for marrying me, despite my crooked teeth!

Sometimes finding the right person means knowing who you are and what you want. I’ve heard it said before, and I’ve seen it work: “Know and love yourself, and others will find you.”

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Braces in the Bedroom (adult content, over 18 only)

Here’s a rather cloistered topic that many adults think about but rarely bring into the open: how does having braces affect your sex life? This topic recently arose in the Metal Mouth Forum and received a large number of responses — so after much debating, I decided to create a web page devoted to this delicate topic. After all, we are adults!

There’s no easy answer to this question, because it depends on the individual or the parties involved. Aside from your partner having a braces fetish, it really depends on each person’s tastes and prejudices — not to mention, the type of braces you have (regular or lingual) — and any appliances you may wear (Nance device, bite plate, palate expander, headgear, tongue thrust spikes, etc). I suppose the rule of thumb is: if it’s sharp, then Houston, there may be a problem.

Season three of the HBO series Sex and the City ended with Miranda getting metal braces (to fix her TMJ headaches). She found dating disastrous with braces, and her date made an off-hand joke about oral sex being “out of the question.” Humiliated, Miranda had her braces removed (I suppose her TMJ headaches just cured themselves). Well, that may work in TV Land, but in real life, it just isn’t an option. This page exists to tell the Mirandas of the world (and their dates or significant others) that yes, there is sex after braces. So have no fear, fix your teeth, and continue to enjoy yourself in the bedroom.

Your Kiss is On My List…

After an initial adjustment period of, say, a month or two, you will probably be able to kiss normally with braces on your teeth. Braces don’t have much of an affect on your pucker power unless you have other hardware in your mouth, such as an expander or such.

Regular ‘ol kissing is usually fine — the real challenge may lie in what happens when you open your mouth. Some people don’t want to feel brackets on their partner’s teeth, or may be afraid that their tongue will get cut or stuck. Depending on your hardware, this is a possibility. If your tongue gets cut up from your brackets, chances are your partner’s will, too.

Run your tongue over your brackets and use copious amounts of dental wax or dental silicone on the rough spots. (If that doesn’t work, perhaps your orthodontist can smooth the rough spots with a special tool). Be careful kissing areas with short body hairs. Take it slowly, and soon you’ll be smooching away to your heart’s content.

Members Only…

One female wrote, “my husband is afraid for me to go down on him with these braces on my teeth.” Indeed, it’s probably not for everyone. Some couples just put a moratorium on this activity until the braces are off. If both parties agree, then of course there’s nothing wrong with abstaining from oral sex for a year or two. Men are quite serious about their “members” and the thought of “Mr. Johnson” getting poked by a wire or a bracket…well let’s just say…ouch!

Again, dental wax may help alleviate his fears, along with good and caring technique (being sure to cover all the brackets with your lips). One ArchWired reader wrote that “lots of lubrication (lube, water, etc.) is essential”. However, if you have lingual (behind-the-teeth) brackets, appliances with rough posts/hooks, tongue-thrust spikes, or a palate expander, there may not be much you can safely do. Unless your partner is into kinky risk, and unless you are extremely careful, it might not have the best….outcome.

You must be careful not only for him, but for yourself — so you don’t knock anything loose or hurt your gums or the inside of your mouth with all the friction. Here’s a great suggestion from another reader: “If you’re at all worried, try your technique on a hot dog or popsicle… if anything is cut/torn/chipped/broken then I would say it is definitely a no no.”

Another suggestion would be to wear a silicone or plastic guard that covers your brackets, such as the Morgan Bumper. One reader, however, didn’t think it would stay securely in place, so as they say here in cyberspace, your mileage may vary.

Also, if he is wearing a condom, be sure your brackets haven’t made microscopic tears in it. It might be good practice to use a new one for intercourse to ensure protection from pregnancy or STDs.

If this is something that your partner wants you to do, and you are apprehensive, just take it slowly.

Remember that good technique includes not only your mouth, but your tongue and also your hands. Creativity — not to mention a sense of humor — can make up for lack of classic technique. Who knows, you might discover a new pleasure that will carry over when the braces are removed.

Down In the Valley…

The challenge for braced males (or females with female partners) is probably not quite as risky, but, as one male wrote, “I’m afraid to get her hair caught in my brackets.” Ouch again!

The obvious solution here would be for the female (receiving) partner to take a trip to South America. Go “Brazilian” and have a close shave or wax in your nether regions. If there isn’t any (or much) hair — or if the hair is trimmed really short, the chances of a hair getting caught will be greatly reduced.

If your significant female other is a bush supporter (sorry, couldn’t resist the political pun there), then you obviously must be more careful. It’s doubtful that you’d get anything more than a hair caught in a bracket. But if you tend to have a more aggressive technique, just remember to be careful — not only down in the valley, but up in the hills and dales, too.

AfterGlow

In conclusion, having braces doesn’t have to mean the end of certain sexual pleasures. It might mean tweaking your technique…or just plain being more careful. In the words of one enlightened reader, “practice makes perfect.” And if you decide to abstain…well, as they say, absence…or maybe in this case abstinence…will make it all the fonder until the braces are off.

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Can babies get tooth decay?

Parents and would-be-parents beware; tooth decay can still be a common problem in infancy and childhood. Over the past few decades, despite the general reduction in dental tooth decay, early childhood tooth decay is still common.

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Are baby teeth essential?

The approach that baby teeth are not essential is a fallacy. We would not be born with them otherwise. Baby (milk) teeth are necessary not only for appearance, eating and smiling, but also serve to hold spaces for developing permanent (adult) teeth. In addition, baby teeth play a role in the development of speech.

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What are the most common dental decay problems seen in preschool children?

The most common dental decay problem seen in infants and younger children is nursing decay. Dental decay can affect baby teeth extensively. Teeth normally affected are the top front teeth. The back teeth in top and bottom may also be affected. Bottle and breast-fed babies are both susceptible. Babies left with a bottle as a pacifier and those who are frequently nursed, especially at night, run the danger of bottle or nursing decay due to the prolonged exposure to milk (human milk is no exception) or juice.

Another common decay problem seen in preschool children is due to frequent exposure to sugary, starchy and acidic foods, including all forms of juices, cordials and soft drinks. Snacking generally promotes dental decay, because the mere presence of food in the mouth feed the plaque that produces acid, causing decay.

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At what age should I schedule my child�s first visit to the dentist?

Early visits can prevent minor problems from becoming major ones. Your dentist will be able to detect early decay. Teach good habits early, as good habits start young for a lifetime of healthy teeth and gums. Brush frequently to keep plaque levels low, reduce snacking and begin dental visits early.

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Should dental treatment be postponed while pregnant?

If your cavities are minor, you may want to wait to have them filled. However, if you have a substantially sizable cavity, the risks of getting a filling placed are offset by the risks of bacteria from your cavity in your system! Another potential risk you would face is that of the anesthetic in your blood stream during treatment, so if you can complete the filling without anesthetic you are also better off. Sometimes, we can also place a less invasive temporary filling until you are out of any risk. Your dentist will be able to assess the risks vs. needs for you.

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Is it safe to get an extraction while pregnant?

Women are often safer having an infected tooth extracted than leaving the bacteria in the tooth and risking the chance of an infection, which could compromise the health of you and your baby. Your dentist can assess the extent of risk for you and I recommend that you inform him or her before your appointment of your pregnancy. Ordinarily, however, if your oral health is not at risk, such procedures are delayed until postpartem.

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Is it safe to bleach your teeth while you’re pregnant?

That is an excellent question. Unfortunately, the effects of bleaching during pregnancy are not well studied and are essentially unknown. I strongly recommend waiting until after your child is born before risking any effects that bleaching materials might have on the fetus. Many dentists do provide an in-office bleaching procedure in which the teeth to be bleached are completely isolated using a rubber dam, reducing, but not eliminating, the risk of bleaching materials entering your system. However, small the risk might be, any elective medical procedures should be postponed.

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What should I do if I notice my top teeth rotting away?

You may be experiencing the results of pregnancy gingivitis. This condition arises in many expectant mothers and consists of inflamed and puffy gums during pregnancy. This inflammation can be controlled with dedicated cleaning of the teeth. During these bouts of gingivitis, it is quite common for cavities to form in the pockets underneath the gums. As the gingivitis later improves, the gums then recede to a more normal level, exposing the cavities. I strongly recommend visiting a dentist as soon as possible to have your cavities treated.

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Can I see the dentist if Im taking blood pressure medication?

Yes, you may certainly see the dentist while on high blood pressure medication, as long as you inform him or her of your condition.

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What does root canal treatment really mean?

Root canal or endodontic treatment is a process whereby inflamed or dead pulp is removed from the inside of the tooth, enabling a tooth that was causing pain to be retained.

Dental pulp is the soft tissue in the canal that runs through the centre of a tooth. Once a tooth is fully formed it can function normally without its pulp and be kept indefinitely.

After removing the pulp, the root canals are cleaned, sterilised and shaped to a form that can be completely sealed with a filling material to prevent further infection. The treatment can take several appointments, depending on how complex the tooth is, and how long the infection takes to clear.

Subsequently a crown or complex restoration to restore or protect the tooth may be a necessary recommendation, as a tooth after undergoing treatment may be more likely to fracture.

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Why do I need root canal treatment?

If you have a damaged tooth, root canal treatment may help to save it. Inside your tooth is soft tissue containing nerves, and blood and lymph vessels, known as the tooth pulp. When the pulp cannot repair itself from disease or injury, it dies. A fracture in a tooth or a deep cavity commonly cause pulp death, as the pulp is exposed to bacteria found in your saliva.

When the pulp becomes infected, it is best to remove it before it spreads to the tooth and surrounding tissues. The whole tooth may be lost if the infection is left untreated. Root canal treatment can save your tooth.

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What is root canal treatment?

Your dentist may perform root canal treatment to find the cause of your tooth�s problems. It is a safe way to save teeth. The diseased pulp is removed, while you keep your tooth.

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What is the dental pulp?

As outlined above, the pulp is the soft tissue inside your tooth that carries the vessels (blood and lymph), nerves and connective tissue. It extends from the crown of the tooth right to the tip of the root (in the bone of the jaw).

What happens if the pulp is injured?

If the pulp cannot repair itself from disease or injury, it will die. A cracked tooth or deep cavity can allow bacteria to enter the pulp and cause pulp death. If the infection is not treated, an abscess can form in the root tip. This can eventually cause damage to the bone around the teeth.

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Why does the pulp need to be removed?

Initially, you may experience pain and swelling from an infection. Damage to the bone surrounding your tooth can also result. Without root canal treatment, your entire tooth may have to be extracted.

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What does treatment involve?

Root canal treatment may involve one to three visits to the dentist. A general dentist or an Endodontist (a specialist in pulp problems) will remove the pulp of the tooth. They will then clean and seal the pulp chamber and root canal/s.

STEPS INVOLVED IN ROOT CANAL TREATMENT:

1. An opening is made through the crown of the tooth into the chamber where the pulp is found.

2. The pulp is removed, and the root canal/s are cleaned and shaped into a form that can be filled easily.

3. Medications to prevent infection may be placed in the pulp chamber.

4. Your dentist may leave the tooth open in order for it to drain, however often a temporary filling is placed in the crown of the tooth to protect it until your next visit. Antibiotics may be prescribed to help prevent infection.

5. The temporary filling will be removed, and after cleaning, the pulp chamber and root canal/s will be filled.

6. Finally, your dentist may place a crown (either porcelain or gold) over your

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How long will the restored teeth last?

If you look after your teeth and gums, your root canal treated tooth may last a lifetime. However, you must have regular checkups to ensure that the tissues around it are nourishing the root of your treated tooth.

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Can I protect my mouth if I smoke?

No. However, there are two things that a smoker should do to help protect his or her oral health.

1. Arrange to have a regular half yearly check-up with a dentist.

2. Give up smoking. If smoking is stopped in time it is often possible to maintain a healthy mouth and keep the teeth for a lifetime. In 3-5 years after stopping smoking the chance of getting oral cancer is halved and gets less and less with time.

The Quit program from the Anti-Cancer Council gives excellent advice on how to help you give up smoking (www.quit.org.au).

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Does smoking affect the teeth, gums or mouth?

Yes. Most people are becoming aware that smoking poses a problem to general health. It contributes to heart disease, stroke, and to a third of all cancer deaths, to name just a few conditions. In 1992 it was estimated that almost five thousand deaths in Victoria resulted from smoking.

What is less well known is the effect it has in the mouth.

The main damage is to the gums and mucosa, or lining of the mouth. Smokers develop more oral cancers than non-smokers (about five times more) and invariably suffer some degree of gum or, periodontal disease.

Other than staining, smoking does not affect the teeth. However, it also has a profound effect on the saliva, promoting the formation of the thicker mucous form of saliva at the expense of the thinner watery serous saliva.. There is a reduction in the acid-buffering capacity of their saliva.

This effect of nicotine explains why some heavy smokers get decay even if they are brushing well

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Does smoking always lead to gum disease?

No, but it increases your chance of getting it by about six times and increases the severity by the same factor. However, it can hide the signs of periodontal disease which can take years to progress. The condition can be very advanced before a person actually notices the damage. Gum disease is normally coupled with plaque and calculus that collects at the base of the tooth, which leads to bacteria infecting the gums. Smoking reduces the body’s ability to combat this condition.

Slight infections around the edges of the gums are common and easily treated, but smoking allows the condition to progress more deeply and seriously. Plaque and tobacco are a dangerous combination. X-rays taken of the teeth of even young smokers usually show that bone support has begun shrinking away from the tooth roots.

Flossing and careful brushing tends to slow down the deterioration, but smokers often have reduced sensation in their mouths and it is difficult to detect and remove all the plaque at the gum margins. (See Gum Disease)

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Does smoking lead to oral cancer?

Yes, smoking is a major cause of cancers in the mouth. It is the single biggest risk factor.

Even when cancer is not present, dentists can often detect changes in the lining of the mouths of young smokers. When these changes become pronounced they predispose to cancer. The mucosa becomes hard and white and develops corrugations. Such areas should be observed routinely and are one more reason why people should have regular dental check-ups.

Detecting and treating precancerous lesions and early cancers is vital in improving survival rates.

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Does smoking make the teeth loose?

Yes. Smokers are six times more likely to have serious gum (periodontal) disease. Periodontal disease is a deep-seated form of gum disease. It involves not just the pink gum, but also the supporting bone and the membrane that holds the teeth in place. When gum disease damages these supports, the teeth become less stable and move too easily. Eventually they can become painful and loose, and need to be extracted.

Smoking affects the immune system and lowers its ability to reduce harmful bacteria that can cause gum disease.

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Does smoking stain the teeth?

Yes. Tobacco staining on the teeth is often superficial in the first few years of smoking and your dentist can usually readily remove it. Unfortunately, as the years pass, the staining tends to spread into microscopic cracks in the enamel (the outer layer of teeth) and this is far more difficult to remove. Teeth can become permanently stained.

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How will a smoker know if their gums are being damaged?

Attend your dentist for regular checkups because a major problem of smoking is that it tends to disguise the damage taking place. At a glance the gums of smokers look as if they are healthy.

Usually infected gums are red, puffy and bleed easily when they are brushed. Smokers’ gums are not like this – they are pale and thin and do not bleed readily. The appearance, however, is very deceptive.

The nicotine in tobacco smoke is called a vaso-constrictor – it acts on blood vessels to contract them (in a similar way to when a garden hose is being twisted) reducing the blood flow to the gum and bone. The lessened blood supply does two things; it masks the signs of disease and also undermines the body’s ability to combat the infection.

In the meantime chemicals in the smoke combined with plaque bacteria continue to damage the gums and bone. Most of the deterioration is deep and out of sight. Unfortunately, there are only a few early warning signs.

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What technique should I use?

When brushing your teeth it is best to place your toothbrush at a 45-degree angle to your teeth, aiming the bristles of your brush toward the gum line. The join between the teeth and the gum is a nice niche for bacteria and plaque to accumulate, so it is important to get to this area.

Once you have the brush at the correct angle, all you need to do is jiggle the brush gently back and forward, only brushing one or two teeth at a time. Don’t be excessively vigorous but also don’t be too mild.

Remember. Your are trying to penetrate the bristles into the gaps between teeth to remove a very soft plaque.

You need to be systematic brushing all teeth in order, inside and outside and you really should do it in front of a mirror so you can see what you are doing.

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How long should I brush?

Proper brushing should take two to three minutes.

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How often should I brush?

You should brush your teeth at least twice a day. Remember it is important to have the right brushing technique as poor brushing techniques can cause harm to the teeth and gums.

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Is brushing alone enough?

NO. Good brushing is very important to help prevent dental decay and periodontal disease, however brushing alone is not enough. It is also very important to clean between your teeth. This is why flossing is so important.

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How often should I floss?

You should floss every day.

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What is the correct way to floss?

Holding floss is the key. You should have a decent length and make sure it is tightly wrapped around and locked onto the middle finger of each hand. Some companies also make small flossing aids. You should floss using a gentle sawing motion, against the sides of your teeth. If you find this tricky � speak to your dentist. They will be able to advise you on the best oral hygiene aids for you, and show you exactly how to use them. Remember � prevention is the aim!!

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What should I do if brushing or flossing makes my gums bleed?

If your gums bleed or become sore after flossing, do not panic. If you have not been flossing regularly then the gums will be inflamed and will bleed more easily. If the bleeding persists see your dentist.

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Choosing a toothbrush

The best toothbrush is one with a small head and soft bristles. Electric toothbrushes can also be very good, particularly for people who find proper brushing techniques difficult to master.

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Choosing a toothpaste

Always use a toothpaste containing fluoride. Fluoride combines with minerals in your saliva to toughen your tooth enamel and help stop decay.

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What is the ADA’s position on tongue and lip piercing?

The Australian Dental Association has warned the public on a number of occasions of the dangers of tongue piercing.

It is of interest to note that recently the American Dental Association, representing 143,000 members, cited oral piercing as a public health hazard.

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Tongue Piercing

Body piercing is becoming more popular these days. As people run out of body parts to impale, many are turning to cheeks, lips and, most commonly, the tongue.

Tongue piercing involves a needle going through the midline of the tongue to insert a stud (or studs), hoop/s or a barbell-shaped piece of jewelry. Oral piercing is usually done without anaesthetic. With no complications, healing usually takes four to six weeks.

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Is tongue and lip piercing safe?

If you have your tongue pierced and have inserted a stud (or other adornment), you are risking painful damage to your teeth � like the eighteen year-old who needed repairs to six fractured teeth.

Tongue piercing carries a risk of injury to the vital structures within the tongue, as it is full of muscle fibres, blood vessels and nerves. Apart from its function in speech, the tongue also acts as the carrier of many specialised taste buds.

It is advisable to contact your dentist prior to having oral piercing done so areas at risk can be located and you are given enough information about future complications to make an informed decision.

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What are the most common problems?

Piercing can result in serious problems, such as trauma to teeth (due to constant hitting with a metal object), interference with chewing and speaking, hypersensitivity to metals, foreign debris in the pierced site leading to infection, and difficulty in breathing from airway obstruction due to swelling from infection.

The mouth is teeming with bacteria, which cause no harm unless they get into deeper tissues. Piercing allows these bacteria to penetrate to the inner tissues of the tongue, where they have the potential to cause serious infections.

Piercing also puts you at risk of contracting blood borne hepatitis. Additionally, this can result in secondary infection, which can also be serious.

Dentists point out that metal inserted into the tongue constantly hits the teeth and can chip or fracture the enamel, sometimes leaving the nerve exposed. Microscopic cracks, which are difficult to diagnose, may also appear, causing severe pain. Damage can be so severe a full crown may be the only way to save the tooth and the smile.

Horror stories have also been reported of studs dislodging and pins becoming “lost” inside the tongue, requiring oral surgery to retrieve them.

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Who is qualified to do tongue or lip piercing?

People thinking about tongue and lip piercing are urged not to presume that the person performing the piercing procedure has been trained and that the levels of infection control expected in dentistry are practised. Whilst local Government inspectors regulate body and skin piercing premises, there are no regulations restricting the practice of body piercing to licensed operators. The operators are not currently licensed, and there is no guarantee that they know what they are doing. Where people are considering having their tongues pierced, they must ensure that the practitioner providing the piercing is aware of their oral anatomy.

In the ADA submission to the Health Act 1958 Review, we have urged the Government to look more closely at regulation of those undertaking tongue and lip piercing activities, as well as requiring registration of premises at which these activities are carried out.

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Should teeth be white?

Teeth in adults contain a mixture of yellow, red and grey colours, and between individuals there is a wide range of tooth shades that are normal. There is no one correct colour that teeth are supposed to be. It is normal for healthy unfilled teeth to darken and yellow with advancing age. Moreover, because of natural aging process within teeth, the effects of tooth whitening can not last forever, and in several years there may be a need for a “touch up” whitening treatment.

The portrayal of tooth shade in the mass media is not realistic since tooth shades are often manipulated by digitally touching up images, to remove yellowness from teeth. In addition, some models, actors and television personalities have had porcelain veneers or porcelain crowns placed on their teeth, and the shades of these may be lighter than the range of normal shades. Trying to achieve these more extreme shades of white by bleaching may be impossible or may involve using products well in excess of the manufacturers recommendations.

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Which dentist can bleach my teeth?

All dentists have the skills to assess your teeth for whitening and advise you on the chances of a good result. It largely depends on how badly your teeth are stained and what colour they are naturally as to whether the treatment will work. It is best to see your dentist and discuss your options.

There is a concern that when whitening treatments are not supervised by a dentist, people can become “bleaching junkies” and attempt to gain tooth shades which are unnaturally white. A consequence of excessive treatment and �over-bleaching� is that the teeth become opaque and lose their natural translucency.

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What are the likely causes of tooth discolouration?

Surface stains (also known as extrinsic stains) are superficial stains located on the surface of the tooth. Common surface stains are dental plaque and calculus, tars (in tobacco), tannins (in tea or coffee), coloured foods such as soy sauce, cola drinks, and the ingredients in some dental mouthrinses when these rinses are used very often.

Internal stains (also known as intrinsic stains) are coloured molecules and pigments that have become incorporated into the internal structure of the tooth. This can occur as the tooth is developing, or after the tooth has been present in the mouth. Some fifty conditions have been associated with changes to tooth structure as it forms.

Examples of these developmental discolourations include:

Severe illnesses and fevers in childhood

Antibiotics such as tetracyclines taken in childhood

Uncommon genetic conditions where there is a pattern of inheritance

Medical conditions affecting the blood system or liver in childhood

Excessive levels of fluoride intake in early childhood because of swallowing toothpaste, which can

result in areas of whiteness (opacity).

Conditions which can lead to internal colour changes in teeth that have already erupted in the mouth include:
Advancing age, which leads to greater yellow colouration of teeth

Corrosion products from amalgam restorations, which can give grey stains
Tooth decay

Problems with the dental pulp (nerve), after decay, root canal work, or damage to the tooth in an injury.

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Why is it important to know the likely causes of tooth discolouration?

Reaching an accurate diagnosis of the cause of dental discolouration allows your dentist to select the most appropriate treatment options. Over-the-counter products may not be effective against some types of discolouration, and your dentist can advise you whether the problem can be managed by various professional lightening or whitening treatments, or whether more extensive cosmetic procedures (such as veneers or crowns) are needed. Some patterns of tooth shade change such as whiteness from fluoride intake can be treated using methods other than whitening to return tooth enamel to its normal colour. They can also provide advice on the type of improvement expected and the duration of treatment. Documenting the tooth shade using a dental shade guide (or taking photographs) is normally undertaken before starting a whitening treatment.

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How are surface stains treated?

There are at least 3 options to consider.

Surface stains can be removed by a dentist or dental hygienist using a number of cleaning and polishing methods. This is the quickest method, and it can also achieve tooth lightening (see below).
The second option is to use a whitening toothpaste. These have special abrasives included in the paste which allow them to also remove some surface stain from easy-to-reach surfaces during normal toothbrushing.
The third option is a paint-on whitening treatment (see below), since these have ingredients which can dissolve surface stains.

Regardless of which option you choose, lifestyle factors need to be considered since surface stains can reform quickly depending on your dietary and other habits.

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What are conventional whitening toothpastes and how do they work?

Conventional toothpastes marketed for whitening contain ingredients that help remove external stains by a gentle abrasive or polishing action, however they will not be able to change the natural tooth colour. Conventional whitening toothpastes use abrasive particles such as modified silica, titanium dioxide, alumina, dicalcium phosphate, sodium bicarbonate, calcium carbonate, or similar particulate substances.

Many of these products also contain phosphate compounds (such as pyrophosphates and polyphosphates) to reduce the formation of calculus (�tartar�) and thus keep the tooth surface clean, to give an additional cosmetic benefit, even though this is not a direct whitening action in itself. Detergents in these toothpastes also help to remove loosely attached surface stains.

There is no physical or chemical mechanism by which products based solely on abrasives can influence chromogenic (coloured) organic and inorganic materials (�stains�) within the enamel or dentine of teeth, since their actions are entirely of a surface nature.

Typical products:

� Colgate: Total Plus Whitening (silica); Colgate Whitening (silica, pyrophosphate); Colgate Whitening Plus Tartar Control (silica, polyphosphate, pyrophosphate); Colgate Baking Soda and Peroxide (silica, sodium bicarbonate, calcium peroxide, polyphosphate, pyrophosphate)

� Macleans Advanced Whitening Ice (silica)

� Pearl Drops Electric (silica, alumina); Pearl Drops ToothPolish Advanced Whitening (silica,

pyrophosphate, dicalcium phosphate)

Cedel Whitening Plus Tartar Control (silica, dicalcium phosphate, pyrophosphate)

Coles Persona Whitening (silica); Coles Persona Total Care Plus Whitening (silica, dicalcium phosphate,

pyrophosphate)

WhiteGlo Whitening Toothpaste (silica, calcium carbonate)

Sensodyne Gentle Whitening (silica)

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What is tooth lightening?

Removal of surface stains and professional polishing of the tooth surfaces by a dentist or hygienist is a physical treatment makes them reflect more light and thus appear lighter. It does not use peroxide or other bleaching chemicals. Special polishing pastes can be used in sequence to give a high surface polish to the natural teeth and to any fillings which may also be present.

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How are internal stains treated?

Internal stains are normally treated using oxygen-releasing chemicals such as peroxides (typically hydrogen peroxide, carbamide peroxide, or sodium percarbonate peroxide) or chlorites which can penetrate into the tooth and give a bleaching effect. A level of 10% carbamide peroxide in the presence of water releases 3.5%, so this numerical relationship must be taken into account if comparing products with carbamide peroxide with similar products containing hydrogen peroxide.

These chemicals can be applied in a variety of ways:

In an advanced whitening formula toothpaste where special activators are included to enhance the action of peroxides within the toothpaste

As a paint-on treatment where liquid is applied to the teeth as an at-home treatment
As adhesive films which are applied to one tooth at a time and left in place overnight
In a gel applied to the teeth for several hours using a stock tray or a custom-made tray. This is often called nightguard vital bleaching.

As a professional treatment in the dental surgery in which a gel is applied to the teeth and then activated using high intensity lights, lasers or ozone. This is called power bleaching.
For teeth which have already had root canal treatment, whitening materials can be applied internally within the tooth and sealed in place for a longer period of time. This is known as a walking bleach.

When staining is inside the tooth, well below the surface, there are a number of other ways to improve the appearance of the teeth. Sometimes simply replacing old, worn out fillings that are failing at the edges can produce better looking front teeth. Alternatively, when the teeth are heavily stained, veneers or crowns may be a useful and better option. ADA dentists have access to continuing education in the latest dental techniques and they can give advice as to the best choices for you.

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Are there issues with oxygen-based bleaching methods?

They do not change the colour of dental fillings. After a whitening treatment, it may be necessary to have fillings resurfaced or replaced to match the new shade of the natural tooth structure.

The one (partial) exception to this principle is for teeth that have porcelain veneers bonded to their front surface, the use of whitening gel applied in custom-made trays may cause a lightening of the natural tooth enamel from the inside. The colour of the veneer itself does not change, but because of its translucent nature, some improvement in the overall shade may result.

They elevate the level of oxygen in the outer (enamel) surface of the tooth, and because this can affect dental adhesives used for bonding, any procedures on the same teeth which require bonding must be delayed for at least 2 weeks after the end of the bleaching treatment.

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Are peroxides safe to use?

Hydrogen peroxide (the active agent of whitening systems) is actually produced in the body in small amounts, and its effects have been studied for many years. When bleaching is supervised and is carried out according to the dentist’s instructions, it appears to be a safe, simple procedure.

The only minor complications are rare cases of slight gum irritation and of heightened sensitivity of the teeth particularly to cold stimuli. It would also be wise to check first with your dentist to see if all your teeth will be likely to bleach evenly.

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What are advanced formula whitening toothpastes and how do they work?

These use activators to maximize the effect of the peroxide which they contain. A typical product will contain hydrogen peroxide, a catalyst (such as manganese gluconate) to facilitate its breakdown, together with silica and pyrophosphates, to gain an effect on both internal and external stains. Used under normal conditions (brushed twice daily for 2 minutes each) these toothpastes can physically remove external stains, bleach external stains, and reduce internal stains.

One such product is Colgate Simply White advanced whitening toothpaste.*

* Refer to Australian Dental Association Inc Seal of Approval at

http://www.ada.org.au/oralHealth/sealofApp.aspxfor other suitable products.

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Paint-on whitening treatments

This consumer-level treatment can be applied selectively to just a single darkened tooth, or to many teeth to achieve an overall whitening action. They are not suitable for handling intense internal stains, but can give a useful effect where the discolouration is age-related and mild. They typically contain either hydrogen peroxide (6%) or carbamide peroxide, and are applied once daily for up to 14 days.

The treatment is inexpensive, easy to apply, and does not require a tray. The materials are clear and so it is not obvious to others that a bleaching treatment is being used. Most users can achieve coverage of about 85% of the area of their front teeth under normal domestic (bathroom) lighting conditions. The material contains binding agents which adhere to the tooth surface. It is important to remove the film of saliva from the teeth before applying the liquid as saliva will break down peroxides rapidly. For this reason, it is also recommended to avoid rinsing, eating, and drinking after applying the gel since these will affect the material. Any residues of the bleaching material can easily be removed by toothbrushing. While paint-on teeth treatments should be regarded as an introduction to whitening techniques, they may also be useful to help maintain the results of professional whitening treatments since they can break down surface stains. When used as directed, paint-on treatments rarely cause irritation to the soft tissues of the mouth, and they do not damage the natural tooth surface or the surface of fillings.

Product examples*:

Colgate Simply White and Colgate Simply White Advanced whitening gel

Macleans Brilliant White whitening treatment gel

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Adhesive strips

These use a thin flexible strip made from polyethylene or a similar plastic material to deliver a hydrogen peroxide bleaching gel to the front teeth. Once in position, the strips are pressed into place to gain the greatest contact with the tooth surface. This “trayless” delivery system provides for extended contact of peroxide (released from the undersurface of the strip) with the outer surface of the tooth. There are different shapes of strips to fit the upper and lower front teeth.

The strips typically carry 150-200 milligrams of whitening gel distributed uniformly across the strip surface, resulting in a hydrogen peroxide concentration of 6%. They are typically worn for 30 minutes twice daily for 14 days or longer. Adhesive strips are able to influence internal stains, and like paint-on products, can be applied to individual teeth.

When used as directed, adhesive strips can cause mild chemical irritation to the soft tissues of the mouth (particularly the gums), however they do not damage the natural tooth surface or the surface of fillings. Some patients will experience tooth sensitivity from the action of the peroxide within the teeth. The potential for experiencing this side effect is related to the concentration of the peroxide in the product being used (6% versus 10%), however it will just take longer to gain the same whitening effect with a lower concentration product. Usually any sensitivity experienced will be mild, and will resolve within a few days after the treatment has ended.

Product example: Macleans Brilliant White dental whitening strips*

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Home tray vital bleaching

With this treatment, a gel containing typically 5% hydrogen peroxide or 10% carbamide peroxide is applied to the teeth for several hours, or overnight, using a tray. When the applicator tray is of the �stock� design (�one size fits all�), more gel is needed and there is greater contact of gel with the gums, which can result in irritation. Stock trays are also bulky and uncomfortable. A custom-made tray is vacuum-formed onto a model of the individual mouth, and allows the dentist to determine the amount of gel which contacts the teeth. The design of the tray insures that there is close contact between the bleaching gel and the surface of the teeth, without the tray impinging on the gums and causing discomfort. The tray also prevents contact between the gel and the saliva. Custom-made trays are more comfortable to wear, and less visible to others as they can be made of a clear material. Irritation of the gums can occur because of chemical irritation from the peroxide, or from physical contact of the tray. Both of these are more likely to occur with stock trays because of their poor fit. With custom-made trays, all of the excess gel can be removed easily by wiping it away from the edges of the tray as soon as the tray has been inserted into the mouth and pushed home into position over the teeth.

Gels supplied by dentists for home use in �Home tray vital bleaching� have higher levels of peroxide compounds than over-the-counter products and thus are more effective at treating internal stains. As with the adhesive strips, it is reasonably common to experience mild tooth sensitivity (particularly to cold and hit foods) from the action of the peroxide within the teeth, which resolves within several days after the treatment has stopped. Several professional products may have desensitizing agents such as potassium nitrate or fluoride included, which means that problems of tooth sensitivity will be less. Sensitivity can be reduced by using a desensitizing product supplied by your dentist, and by reducing the number of hours that the trays are worn each day, or by using the trays every alternate day. Patients whose teeth are sensitive to thermal changes before whitening commences are likely to notice an increase in this sensitivity during the whitening treatment.

You should keep the trays and obtain new stocks of bleaching gel from your dentist to repeat the whitening periodically (usually once a year). The trays will continue to fit your mouth for many years in most cases.

Bleaching using home trays will be unlikely to alter the staining effects of certain types of antibiotic drugs (e.g. tetracycline) that may have been used during childhood. Home bleaching seems to be slightly more effective for younger rather than older people.

Product examples:

Colgate Platinum Overnight �, Colgate Platinum Gentle Sensitive�*

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Power bleaching

During this treatment, which is undertaken in the dental surgery, eye protection is first put on, and then a retractor is placed to hold the cheeks and lips away from the teeth. A material such as a flowable white resin is placed to protect the gums and any exposed root surfaces from chemical irritation from the gel, and from accidental heating if a high intensity light source is to be used. This material is simply peeled away from the teeth at the end of the appointment. The whitening gel is then mixed from powder and refrigerated hydrogen peroxide solution, typically resulting in a final hydrogen peroxide concentration of 35%. The gel is then activated, and left in place for some time to allow the oxygen products to penetrate into the teeth. The gel is then washed off and the fresh gel applied. Any leakage of the whitening gel onto the gums can cause irritation, and vitamin E may be applied to neutralize the peroxide and prevent any long term damage to the gums.

The treatment sequence can be repeated several times in the one appointment. Activation of the gel can use a chemical agent (such as ozone), or high intensity light sources that give controlled heating of the gel and break down the peroxide compounds within it. This response is termed photo-thermal bleaching. One system has been developed which uses visible light energy to directly energize oxygen molecules, a process termed photo-chemical bleaching.

While the effects of power bleaching are immediate, depending on the effect achieved it might be necessary or desirable to repeat the treatment over several appointments to achieve the desired level of whitening. A home product may also be supplied as a follow-up to the treatment, or for maintenance of the result over the ensuing months. As a generalization, for simple age-related shade changes, a one hour session of power bleaching using a state-of-the-art system may produce the same tooth whitening effect as using a professional level at-home gel in custom trays over several weeks.

Because of rapid penetration and greater levels of oxygen products within the teeth, some patients will experience sensitivity in the teeth during �power bleaching�, particularly when the energy source (light or laser) is applied. The dentist may reduce the exposure level of the tooth to the light source to reduce any discomfort. Sensitivity after the visit may be due to dehydration of the teeth or the body�s natural defense system which neutralizes the peroxide. Sensitivity is self-limiting and will resolve within several days. The dentist may recommend a desensitizing agent or an analgesic medication depending on the nature and severity of the symptoms experienced.

Product examples:

SDI Pola-Office (with halogen resin curing light)

Opalescence Xtra Boost (with halogen resin curing light)

Zoom (with mercury vapour halide light)

LaserSmile (with diode laser)

OpusWhite (with diode laser)

Rembrandt (with blue/green plasma arc lamp)

BriteSmile (with blue/green plasma arc lamp)

Smartbleach (with blue/green argon ion laser or KTP laser)

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Is home bleaching safe

Yes. Hydrogen peroxide (the whitening agent) is actually produced in the body in small amounts and the effects have been studied for many years. Dentists know that the whitening process should not be abused, because teeth being bleached repeatedly past the recommended level can damage the enamel. When bleaching is carried out according to an ADA dentist’s instructions, it appears to be a safe, simple procedure.

The only minor complications are rare cases of slight gum irritation and heightened cold sensitivity in the enamel. It would also be wise to check first with your regular dentist to see if all your teeth will be likely to bleach evenly. Bleaching will not alter the effects of certain types of antibiotic drug use which may occur during childhood.

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What is home bleaching?

Home bleaching involves wearing a very thin, transparent plastic tray molded to your teeth, which is used to hold a bleaching agent in contact with the tooth surface. It is normally worn for approximately ten days.

The active agent in the bleach is usually carbamide peroxide. This is a chemical which quickly breaks down to urea and 7% hydrogen peroxide. It is the hydrogen peroxide which lightens the teeth.

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Are bleaching toothpastes very effective?

No. The active ingredients of bleaching toothpastes are present in much lower concentrations than those in home bleaching kits, and they tend to be immediately washed off the tooth surface by saliva.

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How long does the bleaching last?

The bleaching is permanent, however teeth can still become dirty and they will continue to age in a normal way with the passage of time

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How effective is home bleaching in whitening the teeth?

Home bleaching does not make the teeth as white as chalk. If it did the teeth would not look natural. Usually the whitening is subtle, but a real difference can usually be noticed between, for instance, upper teeth that have been bleached and lowers that have not. Home bleaching seems to be slightly more effective for younger rather than older people.

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What are wisdom teeth?

Wisdom teeth, or third molars, are a set of four teeth that erupt into the back four corners of the mouth, behind the 12 year old molars. This usually occurs between the ages of 17 to 21.

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Does everyone have wisdom teeth?

No, some people are naturally missing one or more of their wisdom teeth.

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What is impaction?

Your dentist may advise you your wisdom teeth (or third molars) are impacted and that they need to be removed. What this means is that your wisdom teeth will not grow or erupt into a position that allows them to be functional teeth.

Impaction may be due to soft tissues (i.e. gums), or hard tissues such as other teeth or bone. Teeth that become impacted are generally more likely to cause problems.

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My wisdom teeth are impacted. So what?

The common problems that can arise with impacted teeth are infections of the gum around the teeth, decay and resorption of adjacent functioning teeth, and gum disease around the molar teeth.

Rare complications are cysts and tumours that can grow around impacted teeth.

Some people feel that impacted wisdom teeth can contribute to crowding.

For those who play contact sport, most fractured jaws occur at the site of impacted teeth, as they can create a point of weakness. Most footballers who have broken their jaws have not had their wisdom teeth removed.

Infections are by far the most common problem, and although they can respond to antibiotics, the only real way to treat it is to remove the source of the problem. A small number of people who do not treat these infections seriously, especially people with other health problems, can have severe, even life threatening complications with wisdom tooth infections.

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My wisdom teeth don’t bother me now. Why not wait until they cause me problems?

Some people do elect to wait until they are having trouble with their wisdom teeth. The only trouble is, sometimes the damage is done without any warning. Some people leave their wisdom teeth until they are older than sixty or seventy years. Often they have other health problems at this age and are much slower to recover than teenagers who have the same operation.

As a rule, your wisdom teeth will get more difficult to remove the older you are.

If they are impacted, an ounce of early prevention is better than a ton of late cure.

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Who can remove my wisdom teeth?

All dentists are trained in removal of teeth, however sometimes you may need to be referred to a specialist Oral and Maxillofacial Surgeon who can remove your wisdom teeth for you.

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Can there be problems with extraction of wisdom teeth?

Yes, as with any surgery, post operative pain, swelling, bruising and infection can occur. Other consequences of wisdom tooth removal may include, difficulty in opening the mouth, sore lips, and bleeding.

There is a small risk with the extraction of lower wisdom teeth, of nerve damage that may cause numbness of the lip or tongue.

Discuss the above risks and consequences of wisdom teeth surgery with your dentist and/or Oral and Maxilofacial Surgeon before having your wisdom teeth out.

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Does everyone need to have his or her wisdom teeth out?

No. When there is adequate room the wisdom teeth can erupt into the mouth in the correct position and function as a valuable asset or they may remain unerupted and cause no problems. However, this is usually not the case.

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