What should I do if a tooth is knocked out?
Losing a tooth is can be a scary time. You face the prospect of going to school, work, or seeing your friends with a gaping hole in your smile. Luckily, your tooth can be reattached in some cases if you act fast.
The first step is to locate the tooth and hold it only by the crown (which is the part you chew with). Don’t scrub it or use soap if the tooth is a bit dirty. Instead, rinse it with water and put it in a glass of whole milk.
If you don’t have milk, holding the tooth between your gum and jaw should do the trick. You can also try sticking the tooth back into the lost socket. Then, schedule an appointment with Dr. Brusky straight away.
Ideally, you’ll want to visit your emergency dentist within 30 minutes if you want the best chances for saving your lost tooth.
When are sealants recommended?
Although thorough brushing and flossing remove most food particles and bacteria from easy to reach tooth surfaces, they do not reach the deep grooves and pits on chewing surfaces of back teeth. More than 75 percent of dental decay begins in these deep grooves (called pits and fissures). Toothbrush bristles are too large to possibly fit and clean most of these areas. This is where sealants play an important role.
A sealant is a thin plastic coating that covers and protects the chewing surfaces of molars, premolars, and any deep grooves or pits on teeth. They are generally done only on permanent teeth, although some children at higher risk for tooth decay will have baby teeth with deep grooves sealed as well. Sealant material forms a protective, smooth barrier covering natural depressions and grooves in the teeth, making it much easier to clean and help keep these areas free of decay.
Who may need sealants?
Children and teenagers – As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.
Infants – Baby teeth are sealed if the teeth have deep grooves and the child is cavity prone.
Adults – Tooth surfaces without decay that have deep grooves or depressions that are difficult to clean.
Sealants are easily applied by your dentist or dental hygienist and the process only takes minutes per tooth. After the chewing surfaces are roughened with a microetcher, a type of mini sandblaster, acid is applied to etch and clean the tooth. This helps the sealant adhere to the tooth. The sealant material is very precisely placed into the grooves of the tooth surface, where it is hardened with a special light, allowing for immediate function.
After sealant treatment, sealants will be checked for wear and chipping at your regular dental check-ups, and will be touched up or redone no charge, if portions have chipped out.
Combined with good home care, a proper diet, and regular dental check-ups, sealants are very effective in helping prevent tooth decay.
What do heart disease and other medical conditions have to do with periodontal (gum) disease?
Periodontal disease is one of the most common infections; often more prevalent than the common cold. Periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) is not only the number one reason people lose teeth; it can also affect the health of your body.
Periodontal disease is a bacterial infection, and in its earliest stages, is called gingivitis. It starts when an accumulation of plaque (a colony of bacteria, food debris, and saliva) is NOT regularly removed from the gums and teeth. The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jaw bone that supports the teeth. When periodontal disease is not treated it can eventually lead to tooth loss.
Numerous studies have investigated the correlation between gum disease and major medical conditions, and suggest people with periodontal disease are at a greater risk of systemic disease. This is because periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs or vessels and begin new infections.
Research suggests that periodontal bacteria in the blood stream may:
- Contribute to the development of heart disease
- Increase the risk of stroke
- Compromise the health of those that have diabetes or respiratory diseases
- Increase a woman’s risk of having a preterm, low-birth weight baby
There is still much research to be done to properly understand the link between periodontal disease and systemic diseases, but enough research has shown that infections in the mouth can play havoc elsewhere in the body.
To ensure a healthy, disease-free mouth, we recommend regular dental check-ups and cleanings, which include a periodontal evaluation. Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.
Remember the mouth-body connection. Taking care of your oral health may contribute to your overall medical health.
What can be done about old, unattractive, or discolored fillings?
Most of us have fillings in our mouths that date back many years and some may have even been placed during our childhood. These fillings may now be old, dark, and unattractive, making us feel self-conscious when we smile, laugh, and talk. In addition to being unattractive, old fillings may also be defective. When a filling is old, the margins (space between the tooth and filling) may eventually open, allowing bacteria and food debris to enter, which can cause additional dental decay. Fractures in the natural tooth underneath old silver fillings is epidemic, and can lead to much more aggressive and costlier treatment if not treated proactively.
Your dentist can check your fillings to determine if they need replacement. If you simply want to replace fillings that are unattractive, you and your dentist can decide which ones should be replaced first and what replacement options would best suit you. There are many state-of-the-art dental filling materials and procedures available today that are quick, painless, and cost effective for replacing old, unattractive or defective fillings.
Options for replacing old, unattractive, or discolored fillings:
Composite (bonding) fillings – These are tooth-colored fillings that can be closely matched to the color of your existing teeth. They are particularly well suited for use in front teeth or other visible parts of the teeth and are one of the best ways to improve the health and beauty of your smile. In our office, these are used in most cases to avoid doing crowns, which are a more aggressive and costly way to fix a tooth.
Crowns (Caps) – These types of restoration are used when a tooth is too damaged and cannot be repaired with a filling or other type of restoration. A crown is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens the remaining tooth structure and can be made of gold, porcelain, zirconia, and other materials.
Onlays – These restorations are laboratory made, rather large custom fit fillings that are glued into the hole where the tooth structure is missing. They can be made of composite resin, porcelain or gold. Onlays are usually best for the posterior chewing surfaces of teeth and are utilized to conservatively repair teeth that have large defective/unattractive fillings or have been damaged by decay or trauma.
Porcelain veneers – Used primarily in the front teeth and premolars that show during smiling, veneers are very thin shells of tooth-shaped porcelain that are individually crafted and permanently bonded to the front surface of teeth to correct discolored, pitted, chipped, malformed, or slightly crooked teeth. Veneers can also be used if you have unwanted spaces. Veneers are very durable, natural looking, and do not stain. This makes veneers a very popular solution for restoring an unattractive smile with old, discolored fillings.
As you can see, there are various options for replacing old, unattractive fillings and reshaping worn,teeth. These treatments will provide strong, natural, and long-lasting replacement solutions to enhance the health and beauty of your smile.
Do I have options if I’m missing one or more teeth?
Dr. Brusky will do his best to save your natural teeth in most cases, In those instances where one or more teeth cannot be saved, teeth replacements may be necessary.
Removable Bridge (Partial Denture): These tooth-colored artificial teeth hook onto adjacent teeth using a series of metal clasps. While considered one of the most economical options, partial dentures do have their drawbacks. They’re not as aesthetically pleasing as other dental restorations, and they tend to make the adjacent “anchoring teeth” more susceptible to decay.
Fixed Bridges: This type of bridge is comprised of porcelain or composite material and is glued to adjacent teeth. Fixed bridges are sturdy and permanent, but two healthy teeth will have to be fitted with crowns in order to hold the restoration in place.
Dentures: When all of your natural teeth are missing in one dental arch, dentures can provide you with a more complete smile. Dentures are removable and are designed to closely resemble your original teeth.
Implants: A dental implant is an artificial tooth root that is implanted into your jaw bone to replace a missing tooth. The artificial tooth is placed onto the implant, giving the appearance of a healthy tooth. Implants are permanent and the most aesthetically pleasing dental restoration currently available.
What can I do about stained or discolored teeth?
Whiter teeth have now become the number one aesthetic concern of many patients, so there are many products and methods available to achieve a brighter smile.
Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel. It is an easy and ideal way to enhance the beauty of your smile.
Over-the-counter products are widely available, but they tend to be less effective and induce more sensitivity than professional treatments and may not be approved by the American Dental Association (ADA).
As we age, the outer layer of tooth enamel wears away or oxidizes, revealing a darker or yellow shade. The color of our teeth comes from the inside of the tooth, which may become darker over time. Certain habits, such as smoking, drinking coffee or tea, or drinking red wine may also contribute to tooth discoloration, making our teeth yellow and dull. Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline or minocycline. Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.
It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching. Occasionally, tetracycline and fluorosis stains are difficult to bleach so your dentist may have you whiten for considerably longer to get the desired result. The other option would be to do veneers or crowns to cover up such stains. Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins. Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.
Since whitening is long-term, a touch-up may not be needed for many years to keep your smile looking bright. It is our belief that the results are stable indefinitely.
The most widely used professional teeth whitening systems:
Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouth guard (tray), created from a mold of your teeth. The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep. Depending on the degree of staining and the desired level of whitening it usually takes two-four weeks to achieve the desired results.
Some patients may experience tooth sensitivity after having their teeth whitened. It is always temporary and subsides shortly after completing the bleaching process.
Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile!
What are porcelain veneers and how can they improve my smile?
Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth. They are a popular solution to restore smiles because they are very durable, will not stain, and involve minimal tooth reduction. They also are the most lifelike of any dental restoration because they allow for underlying tooth color to show through, when desired. They are more fracture resistant than composite bonding as well.
Veneers may be used to restore or correct the following dental conditions:
Severely discolored or stained teeth
Unwanted or uneven spaces
Worn or chipped teeth
Slight tooth crowding
Teeth that are too small or large
Getting veneers usually requires two visits because they are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory. At the laboratory, each veneer is custom-made (for shape and color) for your individual smile.
Teeth are prepared by shaping the front surfaces of the teeth to allow for the .3 – 1 mm thickness of veneers. The veneers are carefully fitted and bonded to the tooth surface with resin cement. As with any bonded restoration, a specialized light is used to harden and set the bond, allowing you to eat right away.
Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.
How can cosmetic dentistry help improve the appearance of my smile?
If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.
More patients are turning to cosmetic dentistry procedures than ever before, due to the many advances in cosmetic dental procedures and materials available today, but also because patients want a healthier, whiter, more radiant smile.
There are many cosmetic dental procedures available to improve your teeth and enhance your smile. Cosmetic dental treatments can change your smile dramatically through a full mouth make-over, or it can be as simple as a single tooth replacement. Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.
Teeth Whitening: Over time, teeth can become stained from aging, food, drink and tobacco use. Bleaching is a great way to brighten up your smile. Your dentist can also help if your teeth have become discolored due to injury or certain medications. The effectiveness depends on the degree of staining present and the type of tooth structure.
Composite (tooth-colored) Fillings: Also known as bonding, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, or to replace old, defective fillings. Tooth-colored fillings can also be used to repair chipped, broken, or discolored teeth. It is also very useful to fill in gaps and protect sensitive, exposed root surfaces caused by gum recession.
Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells bonded to the fronts of teeth to create a beautiful smile. They are used to restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth. Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.
Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface, thereby restoring it to its original shape and size. Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations, and are ideal for teeth that have large, fractured or broken fillings or teeth that are badly decayed.
Dental Implants: Dental implants are artificial roots surgically placed into the jaw to replace one or more missing teeth. Porcelain crowns and bridges, as well as dentures can be made specifically to fit and attach to implants. The result is a strong, stable, and durable solution to removable dental appliances.
Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients. In some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces. Braces can also be done in some cases on the back (tongue) side of the teeth. Even when teeth are missing, braces can be done in conjunction with tiny temporary anchor devices (TAD’s) to allow for straightening of teeth.
Thanks to the advances in modern dentistry, cosmetic treatments can rehabilitate and revitalize your smile.
Why is dental floss so important for oral health?
Brushing your teeth may help to remove food, plaque, and bacteria from the surfaces of your teeth, but flossing can help to clean between your teeth where those tiny bristles can’t reach. Those nooks and crannies between your teeth are excellent places for bacteria to hide. Incidentally, those areas are also where periodontal disease tends to begin.
Daily flossing is also a great way of cleaning under the gumline. To floss properly, take 12-16 inches of dental floss and wrap it around two fingers, leaving about 2 inches of so of floss between your hands.
Use your thumbs and forefingers to guide the floss between each of your teeth by gently inserting the floss and using a sawing motion. Curve the floss into a “C” shape around your teeth and make sure to get under the gumline. Move the floss up and down very gently to clean the sides of each tooth.
If you have trouble flossing, use a floss holder, which can be found at most major drug stores.Flossing on a daily basis as part of your home oral care routine will help to keep your smile beautiful and healthy for a lifetime.
How can I tell if I have gingivitis or periodontitis (gum disease)?
Four out of five people have periodontal disease and don’t know it! Periodontal disease can be hard for you to detect because it is painless in its early stages. Unlike tooth decay, which may cause sensitivity to sugars or cold, it is possible to have periodontal disease without noticeable symptoms. Regular dental check-ups and periodontal examinations are very important and will help detect periodontal problems.
Periodontal disease begins when plaque is left on the teeth and gums. The bacteria in the plaque produce toxins (enzymes and acids) that inflame the gums and slowly destroy the bone. Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.
Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:
Smoking or chewing tobacco – Tobacco users are more likely than non-users to form plaque and tartar on their teeth, making them more susceptible to periodontal disease.
Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings may trap plaque and bacteria, allowing them to attack the teeth.
Many medications – Steroids, cancer therapy drugs, blood pressure medicines, oral contraceptives and other medications have side effects that reduce saliva, leaving the mouth dry, making it easier for plaque to adhere to the teeth and gums.
Pregnancy, oral contraceptives, and puberty – Changes in hormone levels can cause gum tissue to become more sensitive to bacterial toxins.
Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc. and other systemic diseases can alter the health of your mouth.
Genetics – Some patients may be predisposed to a more aggressive type of periodontitis. Patients with a family history of tooth loss should pay particular attention to their gums.
Signs and Symptoms of Periodontal Disease
Red and puffy gums – Gums should never be red or swollen.
Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
Persistent bad breath – Caused by bacteria or rotting food in the mouth.
New spacing between teeth – Caused by bone loss.
Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth in the bone).
Pus around the teeth and gums – Sign that there is an infection present.
Receding gums – Loss of gum around a tooth.
Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
How often should I have a dental exam and cleaning?
Dr. Brusky recommends that you get your teeth checked and cleaned at least twice yearly. If your oral health is poor, it may be necessary to schedule more frequent dental appointments.
Regular dental exams and cleaning visits will help to detect and prevent many common dental problems. Regular checkups are also the key to maintaining optimal oral health.
During your exams and cleanings, Dr. Brusky will review your medical history, he may or may not take diagnostic x-rays, he will conduct an oral cancer screening, gum disease evaluation and an exam to detect tooth decay.
Dr. Brusky will also thoroughly examine any existing dental restorations before all tartar and plaque are removed from the teeth’s surfaces. Dr. Brusky will finish your exams with teeth polishing, ensuring you leave the office with a sparkling smile and fresh breath.
Dr. Brusky will usually give you oral hygiene recommendations at each appointment. Consider these expert tips for keeping your smile healthy and looking its best for life.
How often should I brush and floss?
Brushing and flossing help control the plaque and bacteria that cause dental disease.
Plaque is a clear, sticky film made up of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert carbohydrates in the food particles into acids that attack the teeth, causing decay. If plaque is not removed, it turns into calculus (tartar) and can destroy the gums and bone, causing periodontal (gum) disease.
Plaque formation and growth is continuous, but is controlled by regular brushing, flossing, and the use of other dental aids.
Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste. Power/electric brushes have been shown to be more effective and less damaging to tooth roots.
Gently brush at a 45 degree angle to the gums, using a small, circular motion, ensuring that you always feel the bristles on the gums.
Brush the outer, inner, and biting surfaces of each tooth.
Use the tip of the brush head to clean the inside front teeth.
Scrape your tongue to remove bacteria and freshen your breath.
Electric toothbrushes are highly recommended. They are easy to use and are more efficient in removing plaque. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job. We recommend Sonicare or Braun Oral B brushes as the most effective.
Flossing – Daily flossing is the best way to clean between the teeth and under the gum line where your toothbrush cannot reach. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.
Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
Curve the floss into a “C” shape around each tooth and under the gum line, and gently move the floss up and down, cleaning the side of each tooth.
Floss holders are recommended if you have difficulty using conventional floss.
Rinsing – This is not necessary after brushing, as it rinses out the beneficial fluoride, calcium, and phosphate ions needed to keep teeth well mineralized. Many of our office-dispensed pastes and gels specifically state not to rinse after use. Enamelon Treatment Gel and Fluoridex toothpaste are our products of choice at present. Rinsing is appropriate after meals if you are unable to brush or if you wear dentures. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.
What should I do if I have bad breath?
Halitosis is unpleasant and embarrassing and can happen to everyone from time to time. The main causes of bad breath include the typical morning breath, certain foods, poor oral hygiene and periodontal disease.
Dr. Brusky recommends that you scrub your tongue well when brushing. Many times, bad breath is caused by microbial deposits on the back of the tongue. A tongue scraper can do an even better job. Dr. Brusky can also provide you with a syringe to flush debris from your tonsillar area. Ask about one of these dental tools at your next dental appointment.