FAQs- Questions for Dr. Nash
Q. Why is it important to floss?
A: Just brushing does not remove the food, plaque and debris from your teeth. You must clean between your teeth to maintain your oral health. 90% of periodontal (gum) disease starts between the molar and premolar (back) teeth. Periodontal disease is prevented and treated by removing bacteria (in the form of plaque, a sticky, bacteria-laden substance) from the tooth surfaces. Flossing is the single most effective home care procedure for prevention of periodontal disease. It is also helpful in preventing cavities between the teeth. Again, your brush does not clean there.
Medical research has shown other reasons why flossing is good for you. Periodontal disease has been linked to heart disease. The nature of this connection is not completely understood but if you floss regularly, you will have a lesser chance of developing heart disease. Periodontal disease has also been related to poor blood sugar control in diabetics, increased throat infections, and low birth weight.
Q. What is the correct way to floss?
A: Take 12-18” of floss and wrap it gently around your two middle fingers. Using your thumbs and forefingers to manipulate the floss, ease the floss through the tight contact area between the teeth with a sawing motion so as not to snap the floss through, damaging the gums.
Next, wrap the floss around each tooth with a “C” shape and move it up and down the tooth, reaching beyond the gum line. Start with the same teeth each time and it will be easier to make sure you have flossed every one.
There are several devices on the market to ease the process. The single-use floss holder is very popular now. We often recommend the Access Flosser, an elegant solution for those who do not like to put your hands in your mouth. Interproximal brushes are just as effective as floss. Instructions for these devices generally come with the product.
Q. How can esthetic dentistry help my appearance?
There are many ways to improve a smile. Teeth can be whitened, straightened, lengthened, covered, covered partially, and even uncovered. Hopefully, you won’t need all these procedures, but we will be glad to analyze your mouth and give you the best options available. Here is an explanation of the various procedures:
Whitening: Commonly known as bleaching, this procedure removes stain caused by age, food, drink, and tobacco. Drug-discolored teeth can be treated but with a less predictable result.
Whitening can be accomplished two ways, either at home or the one-visit, in-office treatment. The at-home treatment consists of custom fitted trays loaded with a whitening gel. You place them in your mouth and wear them for the prescribed period. The treatment is done after anywhere from four to fourteen sessions or when you are satisfied with the result. When you choose in-office treatment, we apply a higher concentration gel multiple times, while protecting the gums. The appointment takes a little over an hour and gives instant results. The main drawback to whitening is occasional cold sensitivity, more likely to occur with higher concentrations of the gel.
Composite (tooth colored) fillings: Often used in place of amalgam or silver fillings, these restorations are bonded to the teeth. Composites are much more durable than in the past but may not hold up very well in molar teeth, depending on the patient.
Porcelain Veneers: Veneers are thin slivers of porcelain custom made for your teeth. They can “correct” the color, length, and shape of your teeth. They can also close gaps between the teeth and improve the appearance of crowded teeth. They usually require removal of tooth structure, despite what you see on television.
Esthetic Crowns (caps): These crowns can be all ceramic or metal with a ceramic covering. They require substantial reduction of the tooth involved and are used on teeth with large fillings, cavities, and/or fractures. Crowns are often placed to prevent catastrophic fracture of a tooth. Crowns can also change the shape, length and color of the teeth, even more effectively than veneers.
Implants: Dental implants are metal prostheses installed in the jawbone that can support an individual crown (cap), some of your teeth (partial denture or bridge), or all of them (full denture). Implants are the greatest advancement in dental practice in my thirty-plus years in the field. The single tooth replacement implant that supports a single crown is a great substitute for a bridge and can be used where a fixed bridge can’t be placed. Multiple implants can take the place of a removable partial. And when implants are used to improve retention of a denture, the improvement in function is dramatic.
Orthodontics: Orthodontics is often the best way to improve crowded or crooked teeth. The new method involving a series of removable appliances works very nicely in selected cases.
Gingival recontouring: Sometimes a patient’s teeth are partially covered by the gingiva (gum). This gives the appearance of short teeth and a “gummy” smile. With a simple procedure done with local anesthesia the excess gum is removed, exposing the entire tooth. The result can be dramatic.
Q. Do I have gum disease?
Gum disease comes in two forms, known as gingivitis or periodontal disease. Both are characterized by red, swollen gums that bleed upon brushing or flossing. You might have persistent bad breath. Even without these signs you may have a periodontal problem. A thorough exam should determine if you have this condition. In more advanced cases, the teeth can move, creating spaces where there were none. Finally
Periodontal disease is caused by microorganisms (mostly bacteria) that adhere to the tooth in the form of a sticky film called plaque. If the plaque is not effectively removed, the gums become infected. The body reacts with the above symptoms. In periodontitis, the bone around the teeth actually disappears. When most of the bone around the tooth is lost these teeth need to be extracted
Many factors increase the risk of developing periodontal disease. Smoking and other tobacco products coat the mouth with toxins that weaken the gums’ defenses. Genetics can be a factor. Also, the type of bacteria in your mouth can be more or less virulent. Your bacteria is passed to you by your primary caregiver when you were an infant. Oral bacteria can also be passed between family members, including spouses.
Systemic diseases such as diabetes, AIDs, and blood cell disorders weaken the immune system and let the bacteria in your mouth run amok. Many medications dry the mouth, increasing the risk of both periodontal disease and cavities. Certain types of prescription drugs, such as anti-seizure medicines and beta-blockers (a type of heart medication) can cause the gums to swell markedly. Pregnancy, oral contraceptives or puberty alter hormone levels which makes the tissue more sensitive to plaque. Stress can contribute to the progression of the disease. Finally, ill-fitting dental work becomes a trap that harbors plaque, making it very difficult to clean your teeth properly.
Q. What about amalgam (silver) fillings?
Amalgam fillings are a mixture of silver, mercury, copper, zinc, and tin that is mixed and placed immediately into the prepared cavity. There is a long standing concern regarding the safety of amalgam. The claim is that the small amount of mercury vapor that escapes from these fillings enters the bloodstream and is responsible for a multitude of conditions. The best study I’ve seen on the toxicity of mercury in the bloodstream was done years ago at Harvard where they looked at the incidence of the various diseases ascribed to mercury in the blood by comparing a group of people with a significantly higher mercury level than the rest of the population- dentists. After correcting for the various demographic factors, no difference was found in the incidence of these diseases between dentists and the general population.
Recent studies have confirmed the safety of amalgam. The ADA, FDA, CDC, the World Health Organization, and the U. S. Public Health all agree that amalgam is safe for human use. The only exception to this is those few individuals who are hypersensitive to mercury. You should see your Allergist to determine if you are hypersensitive.
However, some people are uncomfortable with amalgam and we will accommodate any request to avoid this material in you or your family. Alternatives to amalgam include bonded composites, ceramic crowns or onlays, gold restorations, or porcelain bonded to gold crowns. Feel free to ask about any material we use in your mouth.
Q. How often should I have my teeth cleaned?
Most people should have their teeth cleaned and examined twice a year. Depending on the amount of decay and/or the health of your gums, you may need more frequent appointments.
Q. What do you do when you clean my teeth?
Formally known as a prophylaxis and exam, this procedure is very important to your dental health. The exam is much more than looking for cavities. Your medical history is reviewed. We do an oral cancer screening, check for periodontal (gum) problems, and infections or irregularities in the teeth and soft tissue. Your home care is checked and reviewed if needed. The calculus (tartar) is removed and any stain is gently polished off. Any required x-rays are taken.
Q. My friend went to a dentist in another country and got all this work done for a fraction of what you charge. Why such a big difference in price?
Over the years, I’ve seen a lot of dentistry done in other countries. Some good, most was awful. There are a lot of very good dentists outside the country, but, like in the U.S., you get what you pay for. Often the problem is more than poor esthetics. Poorly fitting crowns, bridges, partials, etc. will damage your teeth. I suspect that fees for a good overseas dentist is no different than fees charged in the U.S.