1. How safe are dental x-rays?

With digital x-rays, radiation from exposure to x-ray has been reduced by 80-90%. We receive more radiation from our environment in one day than from regular check up x-rays done about once a year. Washington State does not require the use of a lead apron, but to further protect our patients, we use one that even covers the thyroid. In addition, with traditional film x-rays, harmful chemicals are needed to process them, but with all digital we’ve been able to eliminate exposure to that as well. For our patients who are very sensitive to having x-rays taken, we even have a Green Tea ND supplement where 1 teaspoon mixed in water is equal to 20 cups of green tea and protects DNA from radiation damage.

2. Are amalgam fillings safe?

The American Dental Association says yes.  Based on what science says about mercury I question its use in dentistry. Amalgam (or silver) fillings have a mixture of different metals that make up this material. One of the metals used in amalgam is mercury, a harmful and toxic substance. Like lead it is a heavy metal. Lead was taken out of gasoline and paint. Mercury thermometers have been discontinued. We have to dispose of scrap amalgam as a toxic waste or risk being fined. There are many opinions on the safety of the mercury being used in the mouth. Small amounts of mercury vapor (the most harmful form of mercury) are released into the body every time amalgam fillings are chewed on. Over time, mercury could build up in your body and possibly be damaging. Not only that, but placing amalgam can also put patients and ourselves at risk for mercury exposure. In my practice, I do not use amalgam fillings and we practice a safe removal technique designed to protect the dental team and patient.  To learn more about how we are practicing mercury and metal-free dentistry please read here.

3. How does your mouth affect your overall health?

I get this question a lot. Your mouth is the main gateway into the body and has a very direct relationship with overall health. Gum disease is associated with other diseases such as heart disease, Alzheimer’s disease, diabetes, stroke, some cancers, and low birth weight in babies. Gum disease is the most common chronic inflammatory condition. Inflammation of the gums results in bleeding which allows bad bacteria to enter the bloodstream and be absorbed into the body, causing more inflammation in other parts. Inflammation is the root cause of nearly every disease. Likewise an infected tooth can cause problems beyond the oral cavity. To learn more about how we practice whole person dentistry please read here.

4. What is an abscessed tooth?

An abscess is an infection at the root of the tooth or in the gum. This can be caused by severe and untreated tooth decay or trauma that has occurred to the tooth and/or a gum infection. Some symptoms may include throbbing and constant pain, fever, a sore or “pimple” on the gum, swollen gums or face, and/or lingering sensitivity to hot and cold. Even if the tooth becomes non-vital or dead and the pain goes away, the infection will remain active. Antibiotics may be needed to fight the infection and reduce pain symptoms temporarily. To treat an abscessed tooth, a root canal may be recommended, but at times an extraction is necessary.

5. Why are my teeth sensitive?

Sensitivity can occur when the root surface of the tooth becomes exposed as a result of receding gums. The roots of the teeth are not covered by enamel and contain microscopic little tubules that lead to the pulp of the tooth which contains nerves. These exposed tubules allow the hot, cold or sweet feelings to reach that nerve and cause sensitivity. A few things can cause sensitivity including tooth decay, recession, brushing too hard, clenching and grinding, acidic foods and beverages, cracked or broken teeth and/or tooth whitening products.

6. What causes tooth decay?

Tooth decay is caused by a few different things including certain oral bacteria and the sugars in the food we eat. Biofilm, or plaque, containing bacteria forms a barrier over the gums and teeth where the bacteria can feed on the natural or artificial sugars in our food and turns it to acid. Over time that process breaks down the tooth enamel which results in a cavity. Decay can easily be prevented with good oral hygiene such as brushing twice a day to disrupt that biofilm and flossing once a day to remove food and saliva from between the teeth.

7. What is gingivitis and gum disease?

Gingivitis is inflammation of the gums. This is usually caused by plaque build up on the teeth. Plaque that remains in the mouth can harden under the gum line and turns into calculus (tartar). The gum then becomes irritated and swollen and more likely to bleed. Gingivitis is easily treated with a professional cleaning by a dentist or hygienist and with better oral hygiene routines such as brushing and flossing. But left untreated, gingivitis can progress into periodontal or gum disease. Periodontal disease is a serious gum infection that damages the gum tissue as well as the bone supporting the tooth. Untreated, periodontal disease can increase the risk of other diseases and inflammatory issues in the body such as heart disease, stroke, diabetes, and some forms of cancer. Treatments include scaling the root of the tooth to remove the hardened plaque called tartar along with the bacteria using hand instruments and/or laser treatment. The laser is very effective at removing diseased tissue as well as tartar build up, encouraging tissue reattachment and reduced pocket depths. Maintenance usually includes more frequent checkups and cleanings. To learn more about how we are helping patients with periodontal disease, please read here.

8. How is laser used in dentistry?

Lasers have been used in the dentistry since the early 90s and has many different purposes in the dental field. Some the them are for the treatment and removal of decay, treatment of diseased gum tissue and pain therapy. We use the Waterlase MD and Biolase Epic in our office. The Waterlase is the only laser designed specifically for dentistry and uses light energy and water to remove tooth decay usually without even using the drill. The drill can cause microscopic fractures in the tooth and the friction the drill causes heats up to tooth resulting in sensitivity. The laser can often be used without anesthetic and usually results in no post-operative sensitivity or discomfort. We use laser energy to remove diseased gum tissue and calculus for patients with periodontal disease, resulting in tissue reattachment and reduced pocket depths. The laser can also be used during root canals to kill bacteria up to 1mm into the tooth structure and sterilizes the canals. The laser not only disinfects but also biostimulates, bringing needed blood and oxygen to stimulate healing. The Biolase Epic is used for pain and tissue therapy, using diode energy followed by pulses of “down” time for comfort. This laser can be used for soft tissue surgery, whitening and the temporary relief of minor pain from restorative dental treatment, gum disease treatment and TMJ. To learn more about our lasers read here.

9. What is a Dental Implant?

An implant is an artificial tooth root made traditionally from titanium, but also more recently from zirconia, a non metal substitute. Implants are surgically placed into the bone as an anchor for a crown to replace a missing tooth and acts as the “root”. For implants to be successful a patient needs to have a healthy amount of bone and healthy gum tissue. Smokers or patients who have conditions or disorders such as diabetes or heart disease need a proper evaluation done for them individually to see if they would qualify for implants.

10. What causes bad breath?

Bad breath (halitosis) can be caused by a number of different factors. If you don’t brush and floss your teeth daily, then plaque is allowed to sit on your teeth and gums and allows bacteria to grow, this can attribute to bad breath. Smoking cigarettes and chewing tobacco can also cause bad breath. When a patient has periodontal disease, which is the build up and calcification of plaque and bacteria, they are also prone to having bad breath. Patients who either naturally or because of certain medications experience dry mouth often experience bad breath because of the lack of saliva. Saliva cleanses away food and debris, as well as washes away dead skin cells from the gums, cheeks and tongue that would otherwise begin to decompose in the mouth. Some foods such as garlic and onions also usually contribute to bad breath as well. Some stomach conditions as well as acid reflux are also to be considered when determining why a patient is experiencing bad breath.

Dental Questions You Should Be Asking:

1.What should I do if I break a tooth?

If you chip or break a tooth or a crown, you need to see your dentist as soon as possible. If you put off seeing a dental professional, you risk further damage to the tooth either by decay or infection. If the break causes a sharp edge that is bothersome to the tongue or cheek you can cover it with a piece of wax that you can purchase from the drug store until you can be seen by your dentist. If possible, avoid chewing or biting down on that tooth to prevent further pain or damage. Treatment of a broken tooth or crown depends on how much damage has occurred. If the chip or break is small enough then a simple filling can be down to repair it. If more significant damage has been done then a crown may be necessary. When a chip or break has hit the nerve or pulp of the tooth then a root canal or extraction will be recommended.

2. Why do I need my crown replaced?

Crowns do not last forever. Although many crowns have lasted upwards of 25-30 years, most crowns have a life expectancy of 15-20 years. A crown may need to be replaced for a number of different reasons, the most common being that decay has crept in under the crown around the margin where the crown meets the tooth. Other reasons include ill-fitting crown or the cement may be wearing out and causing microleakage. If you have a crown or crowns in your mouth, it is good to have regular checkups and cleanings by a dentist or hygienist to make sure your crowns are in good condition.

3. Do I really have to floss every day?

Behind brushing, flossing is the most important thing you can do to maintain good oral health. Flossing removes small pieces of food and disrupts bacteria and plaque. If plaque (or biofilm) is not removed by brushing and flossing, it hardens and turns into tartar or calculus. When tartar builds up under the gums, it causes them to become inflamed and irritated and eventually leads to gum disease. Flossing removes the bacteria that the brush misses in between the teeth, so it is a very important part of your oral health routine.

4. Why do my gums bleed and hurt?

Gums bleed and can hurt when plaque has been allowed to sit on your teeth and near your gums long enough for it to harden and turn into tartar or calculus. At this point, brushing and flossing will not remove this. The tartar causes the gums to become irritated and inflamed; this is called gingivitis. In some cases, you may already have the more advanced stage called gum disease. If a patient is not a regular flosser, the gums bleed easier and are more painful when they do floss. Other health reasons that cause bleeding gums include: Leukemia, blood disorders, and hormonal changes such as pregnancy.

5. Are there any ways to test my susceptibility to periodontal disease?

The answer to this question is yes, you can test for susceptibility to periodontal disease. This test identifies a person’s genetic susceptibility to gum disease with a saliva sample. The test itself is easy and requires that a patient swishes a saline solution in their mouth for 30 seconds. Afterwards, the test is sent to a lab and the results are sent back as to whether you have the gene that puts you at greater risk for periodontal disease. This genetic test only needs to be done once in a person’s life.

6. What should I know about teeth whitening?

First of all, there are two different ways you can whiten your teeth effectively, in-office whitening and at home whitening. In office whitening’s are a little more expensive up front, but give an immediate result. With just one in office session a person’s teeth can become 3-7 shades whiter than when they walked in depending on the patient. At this appointment, a protective gel is put around your gums and a bleaching gel is put on the teeth to be whitened. A curing light or laser is then shined onto the gel which enhances the whitening process. The other option is an at home whitening method. This system is a little less expensive, but is more time consuming and requires diligence and dedication from the patient to reach the same results. This method requires impressions of the teeth so that custom fit bleaching trays can be fabricated. With these, you will receive a few syringes of whitening gel, usually a hydrogen peroxide solution, and you put it into the trays. You wear the trays for 1-2 hours a day until you reach the desired shade. There are many brands of over the counter whitening products that are less expensive. These products contain more chemicals than professional whitening gels, but are relatively safe. Over the counter methods are less effective and usually only whiten 1-2 shades. Whitening can cause sensitivity to the tooth and gums for a few days, especially if you have gum recession. And bleaching is not permanent; you may need touch ups every few years. Whitening has no effect on crowns, veneers, or fillings so this also needs to be taken into consideration when you want to whiten your teeth. If you are thinking of having your teeth whitened, speak with your dentist about whether you are a good candidate because whitening may not be for everyone. Your dentists will be able to talk to you about what options are best for you personally.

7. Why do I need x-rays every year?

Dental x-rays are a very important part of diagnosis. Without x-rays, many cavities and other dental problems would go undetected and worsen. Decay can at times progress rapidly, and sometimes without symptoms, such as pain. X-rays reveal decay that is not visible to the naked eye, especially between the teeth, as well as abscesses at the end of the roots. It is recommended to have a series of 4 Bitewing x-rays every 12-18 months and a full mouth series of x-rays every 5-8 years.  This gives us a good picture of the health of your teeth, as well as the health of the bone supporting your teeth.

8. What is dental photography?

Dental photography is just what it sounds like…pictures of our mouth. This is a very key aspect in patient education because as they say, a picture is worth a thousand words. A picture allows the patient to see exactly what the dentist sees and thus is able to then understand why certain treatment may be recommended or see a problem and how it affects them. Dental photography also captures changes that can occur in the mouth over time, such as before and after treatment. The invention of dental photography also has its place in schools and continuing education seminars. Instructors are able to use real life examples of people’s mouths and teeth for teaching and educational purposes, instead of just diagrams. Photographs are also used to communicate with insurance companies and dental laboratories, as well as between referring doctors. A standard series of photographs are usually taken on a patient’s first appointment and then updated every few years.

9. Is fluoride bad for you?

This is a hotly debated topic amongst scientists and dentists alike. Her are some of the facts about fluoride: Fluoride is a chemical byproduct of copper, iron and aluminum, but is also a synthetic chemical that can be recreated in a laboratory. Fluoride is typically found in toothpastes, mouthwashes, and tap water. Many cities in the US put fluoride in their water supplies, but some are stopping the practice because it is not federally regulated. The most recognizable benefit of using fluoride is that it helps prevent tooth decay and can at times reverse early decay by rematerializing the enamel. There are some significant dangers to using fluoride though. Again, fluoride is a chemical ion and so if a person (specifically children) are exposed or swallow too much fluoride, they are at risk for poisoning. Studies have shown that the use of fluoride in children is linked with lowered IQ, thyroid dysfunction and lower bone density.  New research is also proving that any possible fluoride benefits are only topical, so there is no valid reason to swallow it. Before fluoride was used in dentistry, it was used as a rat poison and insecticide. Fluoride is considered a toxic substance and once ingested the kidneys can only eliminate about 50% of daily intake. This toxin has also been shown to enhance the brain’s absorption of aluminum, a contributor to Alzheimer’s disease.

10. What is Cavitation?

Cavitation, also called residual infection, can occur after a person has a root canal or extraction due to an abscessed tooth. A residual infection can occur following tooth removal, and sometimes there is incomplete healing of the bone. This area of jawbone contains bacteria and other toxins. Slowly over time this hole in the bone will begin to leak its bacteria and can at times impact the health. Cavitations can develop as a result of a bacterium that has remained after a root canal or extraction and/or incomplete healing. It is very difficult to diagnose cavitation without doing explorative surgery on a past extraction site. Even x-rays are limited in being able to diagnose cavitations. Cone-beam CT scans are helpful when diagnosing cavitations, as they are 3 dimensional images. To prevent cavitiation, we use our dental laser to disinfect extraction sites and root canals. This kills bacteria up to 1mm into the tooth and tissue.

11. Why should I get a lower night guard?

We believe lower night guards are better for your dental and overall well being. I took training with a local Osteopathic physician in Cranial Sacral therapy (which is the gentle manipulation of the bones of the skull and back). When I trained with this Osteopath she taught that if the bones didn’t move correctly, it could cause problems with wellness. There are 29 bones in the head and only one in the lower jaw that is not hooked to the other bones. The lower jawbone (mandible) is a single bone and is suspended from the skull by ligaments, tendons and muscles. The rest of the bones in the skull have sutures and subtle movement. Putting a night guard on the upper teeth has the side effect of binding the skull bones in place, preventing their natural movements. This can affect the normal cranial sacral rhythm. Making a night guard on the lower arch still protects the teeth the same as an upper but prevents those bones from binding up and actually stimulates cranial sacral movement. At times, a lower night guard is not the best option, so an upper is still better than none at all if a patient is a clencher or grinder, but when possible we will recommend a lower night guard.

12.  What is TMJ disorder?

One out of every 10 Americans suffers from chronic headaches. Many never know that their headaches may be caused by TMJ, and that their pain is the result of a bad bite. Symptoms can include headaches, ear ringing, earaches, jaw clicking, and stiffness of the jaw, neck, shoulders or back. TMJ stands for Temporomandibular Joint and it is the joint that connects the mandible (lower jaw) to the temporal bone of the skull. It is unclear at this time what causes this disorder, but some factors like an improper bite, injury, severe stress, clenching, grinding and arthritis as well as some sleeping disorders can tire the muscles of the TMJ and create painful spasms. A cycle of pain can continue as the repeated muscle problems affect the joints causing muscle tenderness and more spasms. There are a few treatments available for TMJ disorder including: applying moist heat or ice, getting a custom bite or night guard, stress management, bite adjustments, laser therapy, relaxation therapy, and restorative work to relieve the joint of stress.