What are Radiographs (X-Rays)

Dental X-ray examinations provide valuable information that your dentist could not collect otherwise. With the help of radiographs (X-rays), our Board Certified staff can look at what is happening beneath the visible oral tissues. X-rays pose a far smaller risk than many undetected and untreated dental problems.

If you are a new patient, we recommend a full set of radiographs to determine the present status of your mouth and to help analyze changes that may occur later. If you have had recent radiographs at your previous dentist, we may ask you to have the radiographs forwarded.

The schedule for needing radiographs at recall visits varies according to your age, risk for disease and signs and symptoms. Recent films may be needed to detect new cavities, or to determine the status of gum disease or for evaluation of growth and development. Children may need X-rays more often than adults. This is because their teeth and jaws are still developing, making them more likely to be affected by tooth decay than adults.

How the Test is Performed

The test is performed in the dentist’s office.

There are four types of x-rays:

Periapical: The periapical shows one or two complete teeth from crown to root.

Palatal (also called occlusal): A palatal or occlusal x-ray captures all the upper and lower teeth in one shot while the film rests on the biting surface of the teeth.

Bitewing: The bitewing is when the patient bites on a paper tab and shows the crown portions of the top and bottom teeth together.

Panoramic: A panoramic x-ray requires a special machine that rotates around the head. The x-ray captures the entire jaws and teeth in one shot. It is used to plan treatment for dental implants, check for impacted wisdom teeth, and detect jaw problems. A panoramic x-ray is not good for detecting cavities, unless the decay is very advanced and deep.

In addition, many dentists are taking x-rays using digital technology. The image runs through a computer. The amount of radiation transmitted during the procedure is less than traditional methods.

How to Prepare for the Test

There is no special preparation. Notify the dentist if you are pregnant.

How the Test Will Feel

The x-ray itself causes no discomfort. Some people find that biting on the piece of film makes them gag. Slow, deep breathing through the nose usually relieves this feeling.

Why the Test is Performed

Dental x-rays help diagnose disease and injury of the teeth and gums.

Normal Results

The x-rays show a normal number, structure, and position of the teeth and jaw bones. There are no cavities or other problems.

What Abnormal Results Mean

Dental x-rays may be used to identify the following:

Flossing Important to Dental Health

Plaque is a sticky film composed of food debris and germs that accumulate on teeth. The acid produced by bacteria is thought to cause tooth decay and periodontal (gum) disease. The best way to maintain dental health and prevent bad breath is to thoroughly remove the plaque at least once each day.

Tooth brushing effectively cleans the tops and sides of your teeth. However, most dental disease develops between the teeth, in areas where a toothbrush cannot reach. The solution and the key to dental health is floss. Oral irrigating devices such as waterpiks are suitable alternatives — particularly effective in cleaning under fixed bridges or orthodontic appliances. Research has clearly proven that the regular and proper use of floss is the best choice.

Dental floss is available in many forms: waxed, unwaxed, flavored, unflavored, wide, thin and regular. The type and brand is a matter of personal choice. Novices, or those with limited dexterity, may find floss threaders or other cleaning devices handy. When flossing is not convenient, the careful use of toothpicks may suffice. Please consult Ms. Manners about her thoughts on cleaning one’s teeth in the company of others.

Floss is the single most important weapon against dental disease, and, arguably, more important than the toothbrush. Its use should be a daily regimen. As with most of life’s experience, good technique is essential. Your dental health care professional can best assist you with perfecting your flossing skills.

Choosing the right Toothbrush

I’m a child-size toothbrush lover. I find the size of the child and youth-size brushes to be very efficient. Sure, you’ll cover more teeth in a single swipe with a large brush, but the quality of plaque removal isn’t as good with a large head. Plus, those last teeth in the row are difficult to reach with a brush head that’s big.

In order to do a proper job with a toothbrush, the bristles must go slightly under the gums and slightly around the tooth. You probably already noticed that teeth have rounded corners; unfortunately this anatomical feature makes it difficult to remove bacteria from your teeth. Without proper placement, a large brush can easily skip right over those spots. Newer brushes, with bristles going in all directions at different levels with different colors, are helpful, but you still have to know the principles of proper tooth brushing technique in order to make them work properly.

Around a tooth is a little moat. That moat and the rounded corners of your tooth at the gum line make a terrific habitat for bacteria. Bacteria love it there: there’s plenty of food, not much mechanical activity from biting and chewing, plus it’s moist and warm. The bristles need to get into the moat and around those curved corners. A large brush in the hands of the hurried person will fly right past those tricky areas. Using a small head brush will force the user to practically brush one tooth at a time, which is probably the best way to brush your teeth. If your hygienist keeps talking to you about properly brushing your teeth, you may want to consider a smaller or child-size toothbrush. Feel your teeth with your tongue when you’re done brushing; if they aren’t slippery, do them over. With enough time, brushing at home can achieve that slippery feeling you get from your dental hygienist polishing your teeth.

So when’s a good time to switch your child over to a larger size tooth brush? The answer is, as soon as the child is old enough to pay for their own brush. Bacteria cause decay and the longer decay is postponed, the greater the chance that the child will never have a “caries experience.” Better brushing is more likely with a smaller brush, so dont rush the big brush.

Another option for tooth brushing is an automatic, or power toothbrush. For the unmotivated brusher, a power toothbrush is a great tool. Choose one that you like. Choose one you’re going to use. When making the decision, highly consider the ones with the smallest heads. A lot has happened in the world of power brushes, most notably the cost. These days they range in cost from under $20 to over $100. The best one is one you use properly every day.

Which Type of Toothpaste Is Best?

Advertisements suggest that we need tartar control toothpaste for removing tartar, whitening toothpaste to brighten teeth, and even a gum-care toothpaste to prevent gum disease. Is this all true?

Many toothpastes share common ingredients. The average toothpaste is about 75 percent humectant and water, 20 percent abrasive (silica or powdered calcium), and 1-2 percent foaming and flavoring agents, buffers, coloring agents, opacifiers and fluoride. Most fluoride toothpastes contain stannous fluoride, sodium fluoride or monofluoride phosphate (MFP).

Tartar Control Toothpastes

Most studies suggest that tartar control toothpastes do not remove tartar. They do seem to prevent the accumulation of additional tartar, however. They do not reduce the tartar that forms below the gum line, which is the area where tartar can cause gum disease. This is why it is important for your dentist or hygienist to perform regular professional cleanings. Many companies, including Procter & Gamble, are currently working to formulate a tartar control dentifrice that also fights plaque and gingivitis

Toothpastes vs. Gels

While gels may seem less abrasive than pastes, this is not the case. Actually, gels can be more abrasive because of the silica (sand) used to make them. However, both are safe, effective cleaners — use whichever type you prefer.

Gum-Care Toothpastes

Gum-care toothpastes have questionable efficacy. This type of paste contains stannous fluoride as opposed to sodium fluoride found in other types of paste. While some studies show stannous fluoride may be helpful in reducing the incidence of gingivitis, it has also been suggested that stannous fluoride is not as effective in protecting against cavities as sodium fluoride. Any toothpaste containing fluoride is recommended over non-fluoridated pastes.

Baking Soda Toothpastes

Baking soda toothpastes have mounted an incredible comeback in recent years. I have not seen any conclusive studies that prove baking soda toothpastes significantly reduce cavities compared to other toothpastes. Some people enjoy the taste and feel of baking soda toothpastes. The flavor of baking soda may encourage people to brush longer. This is advantageous. However, many baking soda toothpastes may also contain peroxides which can irritate and damage gum tissue. These peroxide formulas can be dangerous. Advertisers have conditioned people to believe that the fizzing action of the combined baking soda and peroxide clean teeth. People think they are getting extra cleaning action from the bubbling activity but there is no scientifically proven therapeutic activity. The American Dental Association (ADA) believes that the current levels of peroxide in toothpaste are safe. Still, peroxide toothpastes are controversial. Peroxide toothpastes are not sold in Canada.

Abrasive “Smoker’s” Toothpastes

These toothpastes are not recommended as they can cause recession of the gums and abrasion of tooth structure. The best way to rid your teeth of smoking stains is to quit smoking and then have a professional cleaning by a dentist or dental hygienist.

Toothpastes for Sensitive Teeth

You should have any sensitivity checked by your dentist first to be sure it is not a symptom of a more serious problem. Sensitive toothpastes work for the 80-85 percent of the population that regularly brush with them. Generally, they are needed when a patient has had gum recession, thereby exposing the root of the tooth. Once this exposure occurs, a tooth can be sensitive to hot or cold temperatures or sweet and sour foods. Sensodyne, Denquel, Protect and Aquafresh for Sensitive Teeth are the major brands on the market. Some brands use different ingredients, including potassium nitrate, sodium citrate or strontium as their desensitizing agents. If one brand does not reduce sensitivity, try a different brand.

Whitening Toothpastes

Again, one must be careful when using these dentifrices due to their abrasivity. These should not be used exclusively but should be incorporated into a routine using a fluoride paste. Do not use a whitening paste every time you brush; use it only once every day or two. Certain brands can be more abrasive than others. Brands with sodium pyrophosphate are very abrasive. Rembrandt is one of the least abrasive whitening toothpastes. I question the effectiveness of whitening toothpastes. If you are serious about whitening your teeth, you should discuss this with your dentist.

Which Mouthwash Is Best for You?

Standing in a mouthwash isle the other day I couldn’t help but wonder who wouldn’t be bewildered by the variety of mouthwashes available to people today? On Internet newsgroups and in practice I’m often asked what mouthwash to use. Well, it depends on what you are after.

If you’re after fresh breath try a breath spray or breath drops. The alcohol in most mouthwashes is very drying to the oral tissue. This is of particular concern if youre taking medications that dry your mouth. If your only goal is to make your breath fresh you do not need to subject yourself to the alcohol.

If you find out from your dentist you have gingivitis, look for a mouthwash that contains essential oils. Essential oils have shown promise in killing the bacteria that cause gingivitis. The drawback is the presence of alcohol.

If you’re just one of those people that likes to use mouthwash, use one that contains fluoride. The mouthwashes that contain fluoride are very beneficial to re-building weakened enamel. It is very safe to use for anyone able to spit it out. Read the directions! It’s time sensitive.

The difference in costs between the generic and name brand mouthwashes can also be thought-provoking. When you look at the ingredients lists you will often find they are virtually identical. Even the bottle looks the same. The difference is in the amount of money the brand-name mouthwash company spends on research. Their findings often translate into your care in the dental office. So when you pay the extra money for the brand-name mouthwash you’re not just paying for some marketing manager in a fancy glass office. Before you pucker up make an educated decision in the mouthwash aisle.

How Fluoride Strengthens Teeth

Fluoride originates from a naturally occurring element called fluorine. Fluoride compounds are contained in rocks and soil, and form fluoride ions when water passes over them. Fluoride is present to some degree in all water sources, foods and beverages. Fluoride helps to prevent cavities when used in two ways: topically and systemically.

Topical (on the surface) application of fluoride occurs with the use of fluoride-containing toothpaste, mouth rinses, professionally applied gels, foams and rinses, and from our own saliva. Topical use of fluoride helps to prevent cavities by strengthening the surface of the teeth (the enamel), reducing the ability of bacteria contained in dental plaque to produce acid, and by re-mineralizing existing dental cavities. Fluoride can actually heal small cavities in some cases and prevent the need for dental fillings.

Systemically (throughout the body), fluoride is obtained when ingested via water and other beverages, foods, drops, tablets and other sources. A major function of fluoride taken systemically is the strengthening of developing teeth from infancy to adolescence.

Mass water fluoridation (addition of fluoride to community water supplies) is the most cost-effective measure available to reduce the incidence of tooth decay. The Environmental Protection Agency has determined that the acceptable tap water concentration for fluoride is 0.7 to 1.2 parts per million. Much higher levels have been associated with chalky white discolorations of the teeth known as fluorosis. Numerous studies in the United States and around the world have proven that fluoridated water at these levels reduces the incidence of cavities in children and adults from 25-60 percent or more.

Some people worry about the safety of fluoride in drinking water. Research has demonstrated that fluoridated water that occurs naturally, or is adjusted to optimal levels (0.7-1.2 ppm.) by adding it to the water supply, has no adverse health consequences. After fluoride is ingested, about half of it is removed through the kidneys, and nearly all of the remaining is deposited in the bones and teeth (from infancy to adolescence).

Fluoride is the one of the most significant ingredients to help prevent or reduce the incidence of dental cavities. The use of fluoride in conjunction with brushing, flossing and regular dental care is the most likely way to get your dentist to say what all patients love to hear, “No cavities, I’ll see you in six months!”


Brush with a fluoride toothpaste for two minutes at least twice a day using a soft bristled toothbrush. Most people only brush their teeth for about 20 seconds on average! Your toothpaste should also bear the ADA (American Dental Association) seal of approval on the container, which means that adequate evidence for safety and efficacy have been demonstrated in controlled, clinical trials. The mechanical action employed using the proper brushing technique is more important than the brand of toothpaste you purchase. Contrary to what toothpaste commercials show, the amount of toothpaste or gel needed on your brush for effective cleaning should only be pea-sized. Flossing at least once a day is also very important because it removes food and plaque from between teeth where even the best toothbrush and toothpaste are ineffective. Studies suggest that plaque (bacteria) regrow on clean teeth about four hours after brushing. Brush and floss regularly!