Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned. Often, however, problems develop that require their removal. When the jaw isn't large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned). Wisdom teeth may grow sideways, emerge only part way from the gum or remain trapped beneath the gum and bone.

Extraction of wisdom teeth is generally recommended when:

Wisdom teeth only partially erupt. This leaves an opening for bacteria to enter around the tooth and cause an infection. Pain, swelling, jaw stiffness and general illness can result.

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There is a chance that poorly aligned wisdom teeth will damage adjacent teeth.

A cyst (fluid-filled sac) forms, destroying surrounding structures such as bone or tooth roots.

Patients should ask the dentist about the health and positioning of their wisdom teeth. The dentist may make a recommendation for removal or send the patient to an oral surgeon for further evaluation.

What Is Plaque?

Many of the foods you eat cause the bacteria in your mouth to produce acids. Sugared foods, such as candy and cookies, are not the only culprits. Starches, such as bread, crackers, and cereal, also cause acids to form. If you snack often, you could be having acid attacks all day long. After many acid attacks, your teeth may decay.

Plaque also produces substances that irritate the gums, making them red, tender or bleed easily. After a while, gums may pull away from the teeth. Pockets form and fill with more bacteria and pus. If the gums are not treated, the bone around the teeth can be destroyed. The teeth may become loose or have to be removed. In fact, gum disease is a main cause of tooth loss in adults.

One way to prevent tooth decay and gum disease is by eating a balanced diet and limiting the number of between-meal snacks. If you need a snack, choose nutritious foods such as raw vegetables, plain yogurt, cheese or a piece of fruit.

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What causes bad breath?

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash will only mask the odor temporarily. Odors continue until the body eliminates the food. Dieters may develop unpleasant breath from infrequent eating.

If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor. Dentures that are not cleaned properly can also harbor odor-causing bacteria and food particles.

One of the warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Periodontal disease is caused by plaque, the sticky, colorless film of bacteria that constantly forms on teeth. The bacteria create toxins that irritate the gums. In the advanced stage of the disease, the gums, bone and other structures that support the teeth become damaged. With regular dental checkups, your dentist can detect and treat periodontal disease early.

Bad Breath (Halitosis)

Bad breath is also caused by dry mouth (xerostomia), which occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. If you suffer from dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing your fluid intake.

Tobacco products cause bad breath, stain teeth, reduce one's ability to taste foods and irritate gum tissues. Tobacco users are more likely to suffer from periodontal disease and are at greater risk for developing oral cancer. If you use tobacco, ask your dentist for tips on kicking the habit.

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Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract (nose throat, windpipe, lungs), chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment. If your dentist determines that your mouth is healthy, you may be referred to your family doctor or a specialist to determine the cause of bad breath.

Eliminating periodontal disease and maintaining good oral health is essential to reducing bad breath. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odors. Let your dentist know if you've had any surgery or illness since your last appointment.

Brush twice a day with a fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an interdental cleaner to clean between teeth. If you wear removable dentures, take them out at night. Clean them thoroughly before replacing them the next morning.

Mouthwashes are generally cosmetic and do not have a long-lasting effect on bad breath. If you must constantly use a breath freshener to hide unpleasant mouth odor, see your dentist. If you need extra help in controlling plaque, your dentist may recommend using a special antimicrobial mouthrinse. A fluoride mouthrinse, used along with brushing and flossing, can help prevent tooth decay.

Look for products that carry the American Dental Association Seal of Acceptance. Products that display the seal have undergone strict testing for safety and effectiveness.

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What can I do about bad breath?

Regular checkups will allow your dentist to detect any problems such as gum disease, a dry mouth or other disorders that may be the cause. Maintaining good oral hygiene, eliminating gum disease and scheduling regular professional cleanings are essential to reducing bad breath.

Regardless of what may be the cause, good oral hygiene is essential. Brush twice a day and clean between your teeth daily with floss or interdental cleaners. Brush your tongue, too. If you wear dentures, be sure to remove them at night and clean them thoroughly before replacing them the next morning.

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What is the treatment for bad breath?

If your dentist determines that your mouth is healthy and that the odor is not of oral origin, you may be referred to your family physician or to a specialist to determine the cause of the odor and for treatment. Of course, if the odor is of oral origin, as it is in the majority of cases, your dentist can treat the cause of the problem.

If the odor is due to gum disease, your general dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate. Sometimes more extensive treatment is necessary. If you have extensive build-up of plaque, an invisible layer of bacteria, your dentist may recommend using a special antimicrobial mouthrinse. Your dentist may also recommend that when you brush your teeth, you also brush your tongue to remove excess plaque.

Gum Disease (Periodontal Disease)

Gum disease (also called periodontal disease) is an infection of the tissues surrounding and supporting the teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, however, you may not know you have it.

Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. These bacteria create toxins that can damage the gums.

In the early stage of gum disease, called gingivitis, the gums can become red, swollen and bleed easily. At this stage, the disease is still reversible and can usually be eliminated by daily brushing and flossing.

In the more advanced stages of gum disease, called periodontitis, the gums and bone that support the teeth can become seriously damaged. The teeth can become loose, fall out or have to be removed by a dentist.

What are the signs of gum disease?

If you notice any of the following signs of gum disease, see your dentist immediately:

gums that bleed when you brush your teeth
red, swollen or tender gums
gums that have pulled away from the teeth
bad breath that doesn't go away
pus between your teeth and gums
loose teeth
a change in the way your teeth fit together when you bite
a change in the fit of partial dentures
Normal, healthy gums
Healthy gums and bone anchor teeth firmly in place.

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Periodontitis
Unremoved, plaque hardens into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums.

Advanced periodontitis
The gums recede farther, destroying more bone and the periodontal ligament. Teeth — even healthy teeth — may become loose and need to be extracted.

How can I prevent gum disease?

The good news is that you can help prevent gum disease by taking good care of your teeth every day and having regular dental checkups. Here's how to keep your teeth and gums healthy:

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Brush your teeth well twice a day.
This removes the film of bacteria from the teeth. Be sure to use a soft-bristled toothbrush that is in good condition. Toothpastes and mouth rinses containing fluoride strengthen the teeth and help prevent decay. Choose products that bear the American Dental Association Seal of Acceptance, your assurance that they have met the ADA's standards for safety and effectiveness. The ADA reviews all advertising claims for any product bearing the Seal. The Seal on a product is an assurance for consumers and dentists against misleading or untrue statements concerning a product's safety and effectiveness.

Clean between your teeth every day.
Cleaning between your teeth with floss or interdental cleaners removes bacteria and food particles from between the teeth, where a toothbrush can't reach. Early gum disease can often be reversed by daily brushing and flossing. If you use interdental cleaners, ask your dentist how to use them properly, to avoid injuring your gums.

Eat a balanced diet.
Choose a variety of foods from the basic food groups, such as breads, cereals and other grain products; fruits; vegetables; meat, poultry and fish; and dairy products, such as milk, cheese and yogurt. Limit between-meal snacks.

Visit your dentist regularly.
It is important to have regular dental checkups, and professional cleaning is essential to prevent periodontal diseases.

Your Oral Health And Overall Health

Do you tell your dentist as much about your overall health as you do your primary doctor? Your dentist may be the first to see signs of a more serious health problem.

Based on information gathered during the 2001 American Dental Association (ADA) annual session, dentists report that oral bacteria, in some studies, have been associated with heart disease, stroke, diabetes and the birth of pre-term, low- birth- weight babies.

ADA News Release - Oral Bacteria

KANSAS CITY, MO--Oral bacteria, in some studies, have been associated with heart disease, stroke, diabetes and the birth of pre-term, low- birth- weight babies, according to Connie Hastings Drisko, D.D.S, assistant dean for research at the University of Louisville, KY, School of Dentistry, in a presentation at the American Dental Association’s Annual Session on Oct. 15.

For example, according to Dr. Drisko, the presence of antibodies to certain oral bacteria identified in the amniotic fluid and fetal cord blood suggests that mothers with periodontal disease may be six to seven times more likely to have a pre-term, low- birth- weight baby.

Other associations between oral and overall health:

Heart Disease and Stroke
Dr. Drisko cautions that no causal effect to date has been established between stroke, cardiovascular (heart) disease and gum disease; however, data are emerging to support an association. Longitudinal and case-control studies have indicated such an association, and medical studies point to the involvement of pathogens Chlamydia pneumoniae and Heliocobacter pylori.

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Diabetes
Diabetics are at significantly higher risk for severe gum disease. When exposed to the same type of bacteria as non-diabetics, the gum tissue of diabetics becomes much more inflamed. Dr. Drisko says there are two potential pathways for severe gum disease and diabetes mellitus to co-exist. It is known that the treatment of diabetes will slow down the progression of gum disease and that diabetes is more easily controlled if the periodontal disease is treated.

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Pre-term, Low- Birth- Weight Babies
In addition to the antibodies in amniotic fluid, Dr. Drisko reports that microbes in the female lower genital tract may ascend to produce a pelvic infection or inflammation that may result in a portion of pre-term births. Numerous studies are currently being conducted to determine if treating the periodontitis in pregnant women will decrease the number of pre-term, low- birth- weight babies.

"Dentists are well-versed in handling oral health conditions, and currently help screen patients with diabetes,"; Dr. Drisko states. “In the future, dentists may have an even more important role in screening for other conditions such as heart disease and stroke as the link is strengthened between oral and overall health."

Please note: The presentation described in this news release does not necessarily reflect the policies or opinions of the American Dental Association.

ADA News Releases
October 1999

Does Your Oral Health Affect Your Overall Health?

HONOLULU -- "Oral health isn't just about your teeth anymore," states Marjorie Jeffcoat, DMD, one member of a panel of experts who will gather at the American Dental Association's (ADA) 140th Annual Session in Honolulu this October to discuss emerging issues in dentistry.

Dr. Jeffcoat, who is also one of the ADA's expert spokespersons on periodontics (gum diseases), says researchers are discovering that certain systemic diseases can affect your oral health. "Some medicines used to control high blood pressure, for example, can affect your gums by making them swollen or more likely to bleed when you brush or floss," Dr. Jeffcoat explains.

Researchers are also finding that the infections that cause oral disease, especially chronic periodontal (gum) diseases, may make patients more prone to cardiovascular disease and stroke, according to Dr. Jeffcoat. "We're learning more about these associations, and we're turning the equation around. When we treat the periodontal diseases and keep the mouth clear of infections, we may also be reducing the risk for other systemic ailments."

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Dr. Jeffcoat, a researcher at the University of Alabama at Birmingham, says there are two important clinical studies taking place at her school. Researchers are trying to determine if women with periodontal (gum) disease are more likely to deliver low-birth-weight babies and, in another study, if dental x-rays can be used to correlate density in the bone around the jaw with the density of the bone in the hip for women at risk of osteoporosis, a bone-thinning condition. "We have to do clinical trials to see if these theories can be translated into facts that provide us with more knowledge to improve patients' oral health as well as their overall health," Dr. Jeffcoat adds.

Dr. Jeffcoat's advice is to see your dentist regularly and follow the dentist's recommendations on ways to maintain your oral health.

For more information on oral health and periodontal diseases, visit the ADA's website at http://www.ada.org.

Oral Health And Your Heart

What should I Be Concerned About?
Researchers are finding possible links between periodontal infections and other diseases throughout the body. Current studies suggest that there may be a link between periodontal (gum) disease, heart disease and other health conditions. In fact, research suggests that gum disease may be a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender and age. New studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works. Your oral health affects your overall health, but the studies that will find exactly why these problems are linked are still underway.

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How can gum disease affect my overall health?
The current theory is that bacteria present in infected gums can come loose and move throughout the body. The same bacteria that cause gum disease and irritate your gums might travel to your arteries. Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing or even chewing.

Research shows that risk varies according to the level of gum infection. The worse the infection, the more likely the bacteria are to become blood-borne. Infected gums bleed, making it easier for bacteria to enter your bloodstream. If bacteria become dislodged, the bacteria enter through cuts or sores in your mouth and travel to other parts of the body through your bloodstream. Once bacteria reaches the arteries, they can irritate them in the same way that they irritate gum tissue. This could cause arterial plaque to accumulate in the arteries, which can cause hardening and block blood-flow. Compromised blood-flow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If blockage occurs in the brain, it can cause a stroke. Your dentist may use a special rinse immediately after dental procedures to neutralize these bacteria, but your best protection is to maintain a healthy mouth.

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What should I do?
Keep your mouth healthy! See your dentist at least twice a year for periodic maintenance. Gum disease is a serious gum infection that should always be taken seriously. Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated, or gums that bleed easily. There are many new treatments available to control and help reverse gum disease.

Always remember that gum disease is caused by plaque buildup. Brush and floss regularly to remove plaque that you can't see below the gumline and remember to schedule regular check-ups. If you remove the plaque, you minimize the chance for getting gum disease. If you have any questions about your oral health, ask your dentist.

This information was compiled for you by the Academy of General Dentistry. Your dentist cares about long-term dental health for you and your family and demonstrates that concern by belonging to the Academy of General Dentistry. As one of the 37,000 general dentists in the United States and Canada who are members of the Academy, your dentist participates in an ongoing program of professional development and continuing education to remain current with advances in the profession and to provide quality patient treatment. Visit the AGD's website at www.agd.org. To find a dentist, please call 877/2X-A-YEAR (877/292-9327). You have permission to photocopy this page and distribute it to your patients

Use of any tobacco product can increase your risk of developing oral cancer and gum disease (periodontal disease).

Tobacco products damage your gum tissue by affecting the attachment of bone and soft tissue to your teeth. An example of the effect is receding gums. A receding gum line exposes the tooth roots and increases your risk of developing a sensitivity to hot and cold, or tooth decay in these unprotected areas.

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Smoking can delay healing after a tooth extraction or other oral surgery.

Smoking also can contribute to bad breath, stains on your teeth and tongue, and a build-up of tartar on your teeth.

Are cigars a safe alternative to cigarettes?

Cigars are not a safe alternative to cigarettes. Even if you do not inhale cigar smoke, you are still at risk for oral and pharyngeal (throat) cancers.

Like cigarette smokers, cigar smokers are at increased risk for periodontal (gum) disease, a leading cause of tooth loss.

In addition to the health risks, cigar smoke (and cigarette smoke) can cause staining of the teeth and tongue as well as bad breath.

Are smokeless tobacco products safe?

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Like cigars and cigarettes, smokeless tobacco products contain a variety of toxins associated with cancer. At least 28 cancer-causing chemicals have been identified in smokeless tobacco products.

Smokeless tobacco can irritate your gum tissue, causing it to recede or pull away from your teeth. Once this gum tissue recedes, the roots of your teeth are exposed, increasing your risk for tooth decay. The roots of your teeth also may become sensitive to hot and cold or other irritants, which means you could experience some discomfort when eating or drinking.

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Sugars, often added to enhance the flavor of smokeless tobacco, can increase your risk for tooth decay. Smokeless tobacco also typically contains sand and grit, which can wear down your teeth.

What are some signs of oral cancer?

Signs and symptoms that could indicate oral cancer include:

any sign of irritation, like tenderness, burning or a sore that will not heal;
pain, tenderness or numbness anywhere in the mouth or lips;
development of a lump, or a leathery, wrinkled or bumpy patch inside your mouth;
color changes to your oral soft tissues (gray, red or white spots or patches), rather than a healthy pink color.
difficulty chewing, swallowing, speaking or moving the jaw or tongue;
any change in the way your teeth fit together.

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Bruxism (Teeth Grinding)

"Keep a stiff upper lip" or "get a grip!" That's often the advice we get -- and give -- on how to cope with stress. If you take it literally, the result could be grinding your teeth or clenching your jaws. It's called bruxism, and often it happens as we sleep, caused not just by stress and anxiety but by sleep disorders, an abnormal bite or teeth that are missing or crooked.

Symptoms include a dull headache or a sore jaw.

You could have teeth that are painful or loose from severe grinding. This can lead to fractures in your teeth.

Your dentist can fit you with a mouth guard to protect your teeth during sleep.

If stress is the cause you need to find a way to relax! Physical therapy, muscle relaxants, counseling and even exercise may help reduce tension.

Don't make your teeth the brunt of your stress.

TMJ (TMD)

(TMJ) TMD (Temporomandibular disorders)

More than fifteen percent of American adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or even headaches and neck aches.

A dentist can help identify the source of the pain with a thorough exam and appropriate x-rays. Often, it's a sinus, toothache or an early stage of periodontal disease. But for some pain, the cause is not so easily diagnosed. The pain could be related to the facial muscles, the jaw or temporomandibular joint, located in the front of the ear. Treatments for this pain may include stress reducing exercises, muscle relaxants, or wearing a mouth protector to prevent teeth grinding.

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Facial Pain

Almost everyone gets facial pain on occasion. But more than fifteen percent of Americans suffer from facial pain that's chronic. That includes headaches, neckaches, earaches, tenderness around your jaw, and clicking or popping noises when you open your mouth.

To determine the cause of the pain, ask your dentist for a thorough exam and x-rays. It could be a toothache or gum disease.

Possibly it's related to your facial muscles or your jaw - what's called the temporomandibular joint or T.M. joint located in front of your ear.

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If so, muscle relaxants may give you relief. Your dentist may prescribe a mouth protector to keep you from grinding your teeth. And there are exercises to reduce stress. To find out what treatment is best for you be sure to see your dentist.

The Temporomandibular Joints are the points of attachment of the lower jaw (the Mandible) to the skull. They are among the most complex joints in the human anatomy. If you place your fingers on the sides of your face just in front of your ears, and open and close your mouth, you can feel the movement of the Mandible in the TM Joints. That's where they are. Most people think that the lower jaw moves as if its on a hinge, similar to the way a door opens and closes. In fact, there are two different movements associated with jaw opening and closing. The first phase of opening is indeed hinge-like, but only for about the first third of the opening range. But then in the last, two thirds of the opening range the Mandible slides forward, and down to full open. Closing movement is in reverse order. Now, think of the joint as a kind of ball and socket, with the TM Joint being the socket, and the top of the Mandibular bone (the Condyle Head) as the ball. There is a " cartilage", called the Articular Disk, which lies between the Condyle Head and the roof of the Joint, and the movement of that Artiular Disk is controlled by two elements, a rubber band-like ligament on the back end called the Retrodiskal Ligament, and on the front end the Articular Disk is controlled by a muscle, called the Lateral Pterygoid muscle. End of anatomy lesson.

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PRIMARY SYMPTOMS ASSOCIATED WITH TM JOINT DISORDERS:
Pain in the TM Joints associated with Jaw movements

Intermittent ;Locking; episodes

Limited range of vertical opening

Facial pain a sense of facial muscle fatigue

Noises in the TM Joints associated with Jaw movements (clicking, snapping, crunching, etc.)

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SECONDARY SYMPTOMS ASSOCIATED WITH TM JOINT DISORDERS
Ear aches not associated with an infection

A sense of fullness in one or both ears

Frequent headaches

Ringing in the ears

Neck Shoulder pain

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DIAGNOSIS & TREATMENT OF TMJ DISORDERS

"TMJ Disorders"; and "TMD" are generic terms which like any other joint in the anatomy, encompasses a whole spectrum of diseases, derangements of the articulating elements in the Joint, and injured or damaged tissues affecting the function of the Joint. Obviously, in order to treat a patient effectively, it is necessary to first find out EXACTLY what the specific problems are.

There are two elements to diagnosis. The first is a comprehensive history and clinical examination. The second is a series of diagnostic studies. Each practitioner has his or her own favorites which they rely on, and which may be used either singly or in any combination. In general, the diagnostic studies available for TM Joint diagnosis and evaluation are:

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X-rays of the TM Joints & Skull
MRI (Magnetic Resonance Imaging)
Electromyography (studies of muscle function)
Motion Performance Studies
Joint Vibration Analysis (a form of ultra-sound sonography)
Diagnostic Study Casts of the Mandible & Maxilla
X-rays of the Dentition

TREATMENT
The diseases which affect the TM Joints are no different, really, than the diseases which affect other joints in the human anatomy. Rheumatoid, and Osteoarthritis; Inflammation of the Joint capsule; inflammation of the Synovium; torn Ligaments; perforation, or tears in the Articular Disks; internal derangement of the Condyle Head, and or Disk, in the Joint space, and etc.

There are two basic types of treatment for TM Joint disorders: surgical and non-surgical, but it is generally agreed that in most cases the non-surgical approach should be taken first in an effort to restore comfort, and improve jaw function to an acceptable level.

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NON-SURGICAL TREATMENT MAY INCLUDE THE FOLLOWING IN ANY COMBINATION DEPENDING ON THE CASE:

Fabrication and insertion of an Intra-oral Orthotic (sometimes referred to as a Splint)
The purpose of these Orthotics, which may be fitted to either the upper or lower jaws, and in some cases to both, is to re-position the Condyle Head in the Joint space to a more normal position, thereby relieving the stresses, and pressures, being placed on the tissues of the Joints, and their related supporting structures allowing them to heal.

Physical Therapy Treatments.
These treatments might include Ultra-sound, and an exercise rehabilitation program.
Adjuntive Medication.
These would include anti-inflammatory, and muscle relaxants, and such other prescription medications as may be applicable to the case.
Stress Management.
The treating TMJ practitioner may refer the patient for stress management which can include any number of modalities from bio-feedback training to counseling.

Edward K. Reiman, D.D.S.(ekrei@tmjoint.com)
Copyright © Edward K. Reiman, D.D.S. Rutland, VT

Why Do Teeth Darken?

A patient of mine asked me recently, why are my teeth getting darker? I told her there are several reasons. First, you may be taking medications that could discolor your teeth. If so, talk to your physician.

Second, you can get stains on your teeth from smoking. Tobacco also has lots of other side effects, many of them downright dangerous to your health.

Another reason is that coffee, tea and certain fruits can stain your teeth. Still another possible cause is that, as you age, the outer layer of enamel on your teeth gets worn away. Eventually it reveals the darker tissue underneath, at the center of your tooth around the nerves and blood vessels.

If you're concerned, ask your dentist about the possibilities of bleaching, bonding and whitening treatments.

You may want to start by speaking with your dentist. He or she can tell you whether whitening procedures would be effective for you. Whiteners may not correct all types of discoloration. For example, yellow-ish hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all. Likewise, bleaching may not enhance your smile if you have had bonding or tooth-colored fillings placed in your front teeth. The whitener will not effect the color of these materials, and they will stand out in your newly whitened smile. In these cases, you may want to investigate other options, like porcelain veneers or dental bonding.

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In-Office Bleaching

If you are a candidate for bleaching, your dentist may suggest a procedure that can be done in his or her office. This procedure is called chairside bleaching and may require more than one office visit. Each visit may take from 30 minutes to one hour.

During chairside bleaching, the dentist will apply either a protective gel to your gums or a rubber shield to protect the oral soft tissues. A bleaching agent is then applied to the teeth, and a special light may be used to enhance the action of the agent.

A number of in-office bleaching agents have the ADA Seal of Acceptance, your assurance that they have met ADA standards of safety and effectiveness.

Bleaching solutions. These products contain peroxide(s), which actually bleach the tooth enamel. These products typically rely on percent carbamide peroxide as the bleaching agent, carbamide peroxide comes in several different concentrations (10%, 16%, 22%).

Peroxide-containing whiteners typically come in a gel and are placed in a mouthguard. Usage regimens vary. Some products are used for about twice a day for 2 weeks, and others are intended for overnight use for 1-2 weeks. If you obtain the bleaching solution from your dentist, he or she can make a custom-fitted mouthguard for you that will fit your teeth precisely. Currently, only dentist-dispensed home-use 10% carbamide peroxide tray-applied gels carry the ADA Seal.

You also may want to speak with your dentist should any side effects become bothersome. For example, teeth can become sensitive during the period when you are using the bleaching solution. In many cases, this sensitivity is temporary and should lessen once the treatment is finished. Some people also experience soft tissue irritation—either from a tray that doesn’t fit properly or from solution that may come in contact with the tissues. If you have concerns about such side effects, you should discuss them with your dentist.

Toothpastes. All toothpastes help remove surface stain through the action of mild abrasives. Some "whitening" toothpastes have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike bleaches, these products do not alter the intrinsic color of teeth.

Choosing A Toothpaste

You're standing there trying to pick out a toothpaste. But there are so many choices! What do you look for?

Go for a combination of ingredients, starting with fluoride still the best way to prevent tooth decay. Second is a mild abrasive to remove plaque that causes tooth decay and gum disease.

Optional ingredients include a whitening agent to help keep your smile bright. If your gums have receded and your teeth are sensitive, you might want to look for a toothpaste with a desensitizing ingredient -- to lessen the effect of heat and cold. Last is a pleasant flavor to encourage you to brush twice a day.

Toothpaste 101 means fluoride, plaque removal and tartar control. No matter what toothpaste you choose, look for the ADA seal of acceptance, as a sign that it meets the ADA standards for safety and effectiveness.

Toothbrushes should be replaced every three to four months or sooner if the bristles become frayed. Toothbrushes with frayed bristles may harm gums and generally do not clean teeth as effectively.

The ADA does not think it's necessary for consumers to change their toothbrushes after recovering from a cold or other infectious disease. The detergents found in almost all toothpastes kill the microorganisms that may linger on the toothbrush between brushings.

Choosing A Toothbrush

Look for toothbrushes with the American Dental Association's Seal of Acceptance. Before the Seal is awarded, a product must demonstrate that it meets ADA standards for safety and effectiveness. The ADA also scrutinizes all packaging and advertising for accepted products to determine that claims are scientifically supported and not misleading in fact or implication.

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American Dental Association Says Review What To Do In A Dental Emergency

"Being prepared for a dental emergency is no accident," explains Kimberly Harms, DDS, an ADA consumer advisor and general dentist from Farmington, Minn. "It takes a little time and thought, but knowing what to do before an accident occurs can mean the difference between saving or losing a tooth."

Dr. Harms said the ADA offers these tips on what to do for your child in case of the following:

Toothache: Rinse the mouth with warm water to clean it out. Floss to make sure that food or foreign objects aren't lodged around the tooth. Do not place aspirin on the aching tooth or gum tissues. Contact your dentist as soon as possible.

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Knocked-Out Tooth

It's important to retrieve the tooth, hold it by the crown, and rinse off the root of the tooth if it's dirty. Do not scrub it or remove any attached tissue fragments. If possible, put the tooth back in its socket. If that isn't possible put it in a container with milk or cool water. Immediately contact your dentist. Don’t forget to bring the tooth!

Broken Tooth: Rinse your mouth with warm water to keep the area clean. Use cold compresses on the area to keep the swelling down and contact your dentist's office quickly.

Bitten Tongue or Lip: Apply direct pressure to the bleeding area with a clean cloth. If bleeding does not stop, go to a hospital emergency room. If swelling is present, apply cold compresses.

Objects Caught Between the Teeth: Try to gently remove the object with dental floss and avoid cutting the gums. Do not use a sharp instrument. If you're not successful in removing the object, contact your dentist.

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Problems With Braces and Retainers

If a wire is causing irritation, cover the end with a small cotton ball, beeswax or a piece of gauze until you can get to the dentist. If a wire gets stuck in the cheek, tongue or gum tissue, do not attempt to remove it. Contact your dentist immediately. If an appliance becomes loose or a piece of it breaks off, take the appliance and the piece and contact your dentist.

"In the case of oral trauma, remember to try not to panic or delay treatment," Dr. Harms stressed, "or the result could be the actual loss of the tooth."

First, make sure that the tooth has been recovered. If it's dirty, rinse it gently under running water. Don't try to scrub it or remove any tissue fragments that might be attached. Try to insert the tooth gently in your child's mouth and hold it in its socket. If this is not possible place the tooth in a cup of milk or water. See your dentist as fast as you can within thirty minutes if possible. And don't forget to bring the tooth!

If you do this, there's a good chance the dentist can save your child's tooth.

Dental Anxiety

Do You Ever Get Nervous Just Thinking About Going To The Dentist?

Well you're not alone, because millions of people feel the same way.

It's often best to share your anxiety. If you're tense or anxious, tell your dentist and the dental staff. Getting your concerns out in the open will let your dentist adapt the treatment to your needs.

Try to choose a time for your dental visit when you're less likely to be rushed or under pressure. For some people, that means a Saturday or an early-morning appointment.

If the sound of the drill bothers you, bring a portable audio player and headset so you can listen to your favorite music. During the dental visit you might try visualizing yourself relaxing on a warm beach.

These positive techniques work wonders for many. Try them on your next dental visit.