Frequently Asked Questions

Why is flossing so important?

The mouth plays host to millions of bacteria. These bugs feed on tiny particles of food and combine with food particles and proteins to produce plaque. The bacteria manfacture acid, which can erode the enamel of the tooth and eventually lead to decay. Another unwanted byproduct of bacterial presence is a compound which can cause bad breath. As important as brushing is, it cannot remove the plaque that hides between your teeth. Flossing removes the bacteria that hide in those tiny spaces and under the gum line. Brushing only cleans about 65% of the tooth surface. Flossing reaches what your toothbrush cannot, taking care of the other 35%. Choose a floss that will slip between your teeth and not fray or break. Interdental aids such as Soft Picks or a proxybrush can also be valuable tools in the battle against plaque. For information on flossing technique, check the American Dental Association's website,

What are plaque and tartar?

Plaque is a sticky film your body produces when it combines bacteria, food residue, and proteins found in the mouth. Plaque coats your teeth, especially the areas that are difficult to clean—such as in between the teeth, along the gum line and around fillings and crowns. If not dealt with, plaque forms acids that threaten the tooth structure and can lead to decay. Eventually plaque will harden into tartar (or dental calculus) which cannot be removed by brushing or flossing, but must be removed by a dental professional. Levels of more dangerous kinds of bacteria can build up within tartar, producing toxins that irritate and inflame the gum tissue.

Which is better to use, a manual or an electric toothbrush?

The answer is either, or both, and is individual to each patient. An electric toothbrush such as a Sonicare provides a healthy massage for the gum tissue. The advantage of a manual brush is the ability to angle and position it to get to hard-to-reach areas. If your hygienist notes that you are doing a great job with either brush, they will not likely suggest a change. For some patients who have difficult-to-clean areas, we may suggest alternating between the two. Your hygienist will help you evaluate which is the best choice for you.

What is periodontal disease?

Periodontal disease is an infection of the gum tissue and bone that supports the teeth. The gums and bone form a "pocket" around each tooth. When bacteria get under the gums it causes not only inflammation at the gumline but also a loss of attachment at the base of the pocket. Measurements of the pockets are taken routinely to determine the extent of the inflammation/attachment loss. When only the gums are affected the infection is classified as gingivitis, the reversible form of perio disease. Once the bone and surrounding tissues are involved it is classified as periodontitis. This condition is non-reversible, can vary from slight to advanced, and can lead to tooth loss if left untreated.

What is perio maintenance and how does it differ from a regular cleaning (oral prophylaxis)?

There are three levels of care your dental hygienist can provide for you: the preventive oral prophylaxis (what many patients refer to as a "regular cleaning"), scaling and root planing, and perio maintenance.

By definition, the oral prophylaxis is performed on patients with normal, healthy mouths to maintain oral health and prevent dental diseases. When periodontal disease is present, removal of deposits on the teeth is no longer a preventive service. Due to the increase of pocket depths around the teeth, the hygienist must scale further below the gum line to remove tartar and infection. When perio disease is diagnosed, a procedure known as scaling and root planing will probably be recommended. This is done with anesthetic to keep you comfortable. Your hygienist will remove plaque and tartar down to the bottom of each perio pocket, and follow by smoothing the surfaces of the affected tooth. This helps your gums to heal properly and makes it more difficult for plaque to hide out along the root surfaces.

Once you have had scaling and root planing, it is important that you return at recommended intervals for perio maintenance. The aim of this deeper cleaning of your perio pockets is to prevent the return of your teeth and gums to a disease state. According to the American Association of Periodontists, “Periodontal maintenance is started after completion of active periodontal therapy and continues at varying intervals for the life of the dentition.” .

How safe are digital x-rays?

Digital X-rays are the newest improvement is dental diagnostic imaging. Now you can have your dental x-rays done electronically, with up to 80% less radiation, and see them appear within seconds on our computer screen. You would need eight years of these new low dose digital x-rays to equal one year of the regular dental x-rays. We can optimize the brightness and contrast, as well as enlarge digital images for easier viewing. An article by Drs. Truhlar, Morris and Ochi in the Journal of Implant Dentistry Vol 2 No. 21993 emphasizes the safety of dental x-rays,. "The calculated risk of cancer to a patient from a Panoramic x-ray or series of cavity detecting x-rays is less than one in a million. To lend perspective on the relative risk of one in a million, compare to the following activities that are estimated to have a one in a million risk of causing your death:

(1) 20 minutes as a 60-year-old-man (natural death)

(2) 2 months in Denver (cosmic radiation), (3) 10 miles by bicycle (accident)

(4) 300 mile by car (accident)

(5) 10 days of typical factory work (accident) (6) 1 cigarette (chemical carcinogen), and

(7) 500 ml of wine (alcohol)."

Why are my teeth discolored, and is there anything I can do about it?

Most stains are caused by age, tobacco, coffee, or tea. Other types of stains can be caused by antibiotics, such as tetracycline; or too much fluoride. At-home procedures consist of placing a bleaching solution, usually a peroxide mixture, in a tray (nightguard) that has been custom fitted for your mouth by an oral health care professional. The bleaching solutions may vary in potency and may be worn for an hour, or throughout the night. Your oral health care professional can advise you on the appropriate type of application and the length of time needed to whiten your teeth, based on the severity of tooth discoloration and your specific needs.

Bleaching is effective in lightning most stains caused by age, tobacco, coffee, and tea. Based on clinical studies, 96 percent of patients with these kinds of stains experience some lightening effect. Other types of stains, such as those produced by tetracycline use or fluorosis (too much fluoride), respond to bleaching less reliably. Cosmetic dentists points out that bleaching systems are not fully predictable. If you have a tooth-color filling when your teeth are bleached, the filling will stay yellow—dental restorations do not change color when tooth whitener is applied.

Before using any whitening procedure, ADHA recommends that you first be evaluated by an oral health care professional to determine which application and program are best for you. (American Dental Hygienists' Association)

How can diabetes affect my oral health?

When diabetes is not controlled properly, high glucose levels in saliva may help bacteria thrive. Brushing twice a day with fluoride toothpaste and cleaning once a day between your teeth with floss or an interdental cleaner helps remove decay-causing plaque. Plaque that is not removed can eventually harden (calcify) into calculus, or tartar. When tartar collects above the gumline, it becomes more difficult to thoroughly brush and clean between teeth. This can create conditions that lead to chronic inflammation and infection in the mouth.

Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold your teeth in place. Patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than persons who have good control of their diabetes.

It is possible to have periodontal disease and not have all of the warning signs. If you notice any of the warning signs of gum disease, see your dentist immediately. Because of lowered resistance and a longer healing process, periodontal diseases often appear to be more frequent and more severe among persons with diabetes. That’s why good maintenance of blood sugar levels, a well-balanced diet that meets your needs, good oral care at home, regular dental checkups and periodontal examinations are important. (American Dental Association)

Why do I need a dental crown and what steps are involved in the treatment?

A crown or "cap" acts as a permanent restoration that covers the existing tooth structure. A crown may be needed for a variety of reasons which may be diagnosed by a dental professional:

  • if there is not enough tooth structure left to restore by placing a large filling.
  • to replace a missing tooth as part of a bridge.
  • if there are visible fracture lines throughout the tooth.
  •  to cover a dental implant.
  •  to cover a posterior tooth after endodontic treatment to prevent breakage.

A crown preparation involves many steps and two appointments are needed. The first appointment consists of the dentist removing damaged portions of the tooth and reducing the tooth structure for the fit of the crown. Impressions are also taken, which are sent to the dental laboratory for the making of your crown. A temporary crown is made and worn for about two weeks while waiting for your permanent crown to return from the laboratory. The second appointment consists of making all the needed adjustments to be sure your crown fits comfortably. After all adjustments are made and you and your dentist are satisfied with the results, the crown is then placed with a permanent cement.