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Dental Decay
Tooth decay is caused by bacteria. The bacteria streptococcus mutans is the primary agent responsible for caries (cavity) formation. The bacteria first colonize the tooth and multiply until they form a thick plaque on the tooth. This plaque is a sticky glue designed to hold the bacterial colony in place. The thickness of the plaque then holds metabolic acids the bacteria produce as a waste product, and this acid demineralizes, or eats away, the tooth structure.

There are three factors necessary for decay to progress. First, bacteria must attach to the teeth and produce a thick plaque to hold the acid in proximity to the tooth. Second, a source of food for the bacteria must be available. Third, there must be time enough for the acid to be produced and held in place for the demineralization to occur. If any one of these factors is disrupted decay can not occur.

Brushing and flossing mechanically disrupt the bacterial colony, preventing plaque formation, which in turn prevents the acid waste product production that causes the decay. Brushing and flossing also help remove the sugary residue from food that the bacteria feed on.

Avoiding sugary foods deprive the bacteria of their food source. Bacteria prefer easily fermentable simple sugars. Sugary foods that stick to the teeth provide a sustained sugar supply for the bacteria, and simple starchy foods such as crackers are easily changed to simple sugars by saliva in the mouth.

If brushing and flossing occur at regular intervals each day, there will not be enough time for the bacteria to colonize, form plaque, and produce acid. Also, if sugar exposures are kept to a minimum, the food needed for bacterial reproduction is not as readily available, which breaks the cycle.

Some people wonder how they get cavities if they take care of their teeth. The answer to this is that is sometimes hard to clean all plaque out from all areas of the mouth, and it is sometimes hard to keep ahead of the cycle if your diet is high in the sugar that fuels the bacteria. At the dental office, we can advise how to brush and floss properly for your individual situation, showing how to give extra attention to problem areas. We can also review your diet habits to help you make practical changes in your sugar intake. (Click on ?nutrition? in dental departments for more information.) We can also provide fluoride treatments to remineralize teeth that have shown some decalcification from the acid waste of the bacteria.

Periodontal Disease
As described in the explanation of dental decay, bacteria are continually reproducing in your mouth, forming plaque, which is a biofilm of the bacteria. This plaque is thick and keeps oxygen from reaching many areas within your mouth, such as under the gumline. While many different types of bacteria may cause the plaque film to form initially, the dangerous periodontal bacteria (which are anaerobic, or oxygen hating) take advantage of the oxygen deprived conditions provided them by these other bacteria, and proliferate wherever there is a pocket without oxygen.

Whereas sugar is the food culprit in dental decay formation, the diet aspect that affects periodontal disease is not carbohydrate, but rotting food particles of any type. Anytime food particles remain caught in the tight spaces between teeth, they can physically block oxygen from getting into the areas and cause proliferation of anaerobic bacteria. This is in addition to contributing to plaque biofilm formation.

The bacteria plaque that forms from the above processes can become hardened when minerals in saliva come in contact with it. This hardened, calcified plaque is called calculus, and it coats the roots of the teeth where periodontal bacteria have colonized. When the tooth roots become covered with this hardened substance, the body starts to think of the tooth as a foreign object, and it reacts much the same way as it would to a splinter. Inflammation occurs, white blood cells are drawn to the area, and an increased blood supply is provided, and the result is reddened, puffy gums that bleed on pressure.

As bacteria levels increase and calculus becomes more entrenched, the infection processes of inflammation and toxin release affects collagen formation, and this causes gum tissue to loosen, moving it away from the tooth (like a turtleneck that is stretched out). This allows the bacterial toxins to attack the space between teeth and gum, causing a destruction of the bone supporting the teeth. If the bone level is reduced to the point that there is not enough bone level to hold the teeth, the teeth may be lost.

The infection process continues as the disease progresses to bone loss, and at this stage it becomes serious because the bacteria can enter the bloodstream. It is believed that these bacteria may contribute to many serious illnesses as the process that occurs in the mouth spreads to other parts of the body, causing inflammation, plaque development, and blood clotting. Periodontal bacteria have been implicated as a factor in heart disease, stroke, premature birth, pneumonia, diabetes complications, and increased mortality from other diseases.

What is the solution to preventing these diseases?
The obvious prevention to disease is to brush and floss regularly, which works to mechanically break up the bacteria in the mouth. In the case of dental decay, brushing the sugar from food off the teeth robs the bacteria of their food source, so they can not proliferate and produce the acid waste products that cause decay. As for periodontal disease, flossing get rids of food particles and plaque biofilm that cause the oxygen deprived environment that the anaerobic bacteria need. In short, scrubbing all surfaces, especially the crevices between the teeth, keep bacteria from doing their dirty work.

There are so many products available for home use that I felt it was a good idea to go over which products make sense and which are a waste of money.  I have also briefly described the basic processes of caring for your teeth and gums, but it is always a good idea to have these methods demonstrated for you personally by a dental professional.

Toothbrushing - Use a soft toothbrush and brush at a 45 degree angle to your teeth, wiggling the brush as you go up and down.  Avoid scrubbing the gum line area too hard, as it can cause erosion, or wearing away, of the gums.

Flossing - Use either waxed or unwaxed floss, depending on your preference. One brand of floss that I particularly like is Glide floss.  To floss, work the floss between the teeth and bend the floss to make a "C" each way - forward and backward - to access the hard to reach area near the gum line.

Orthodontic Home Care - Teeth require special care when orthodontic braces are in place. Toothbrushes made especially for orthodontic use are shaped to have the best effect around braces.  In addition, floss threaders must be used to clean where floss can not go because of orthodontic wire.  A fluoride rinse or gel is also strongly recommended for use while brackets are in place. It is very important to have this special oral hygiene demonstrated by a dentist or hygienist when you begin orthodontic treatment.

Care of night guards or other appliances -  Nightguards and other plastic appliances should be brushed with a toothbrush and toothpaste after use and kept in a case.  Cleaning the appliance occasionally with an antimicrobial rinse such as Listerine can be effective for disinfection.  Keep the appliance away from heat or direct sun to prevent any warping of the plastic, and never leave appliances on a counter or wrapped in a paper towel since they can easily be discarded by someone else.

Fixed Bridge Care - Since bridges are connected, regular floss can not be used. Floss threaders, which are thin yet firm plastic loop holders for floss, allow you to access the hard to reach area with floss.  Another product, called a Proxi brush, which has a small bristle area at the tip, also allows you to get into the area under the false tooth area of the bridge to clean.  It is important to have proper care of a bridge demonstrated for you by a dentist or hygienist.

Care of Partial or Full Dentures - The use of a commercially available product is usually the safest way to keep partials and full dentures clean and disinfected.  Home recipes for cleaners or use of household cleaners can cause corrosion of  the metal parts of a partial denture. We also recommend removing partial or full dentures at night to give the supporting tissues a rest.

Care of  Implants - Implants should be brushed and flossed like normal teeth, but caution should be used because the titanium in them is a soft metal that is easily scratched or abraded.  Take special care to use gentle products when cleaning implants, as advised by the dentist or hygienist for your particular case..

Products Available for Home Care
Toothbrushes - There are many different gimmicks with toothbrushes today, but the only important point to note is to choose a soft toothbrush to avoid too much abrasion when brushing.  Buy the right size toothbrush for your mouth; a rounded tip may be more comfortable. Other factors such as bent tips, special alignments of bristles, and other unique qualities are all just a matter of your personal preference. Some very inexpensive toothbrushes may not have smoothly finished bristles and can be uncomfortable.

Electric Toothbrushes - These toothbrushes can be very helpful for people with braces, or with people who have limited dexterity. Recommendations for the best brand for your individual problems can be made by a hygienist.

Toothpaste - Any fluoride toothpaste with the American Dental Association seal has been proven to be effective at preventing cavities and is recommended.  Some extra whitening toothpastes are abrasive and are not recommended.  Some tartar control toothpastes may increase cold sensitivity in teeth.  The hygienist can help you determine the correct toothpaste to use for any specifice problems.

Rinses and Gels Available From the Pharmacist
Phosflor is a strong fluoride rinse prescribed at the dental office. It is designed for patients who have poor resistance to decay and can also be used  to alleviate the problem of sensitive teeth.
Gel-Kam is a gel form of fluoride, used to treat tooth sensitivity or for patients with excessive decay.
Peridex is chlorhexidine gluconate, an antimicrobial rinse that is used in periodontal therapy or for treatment of soft tissue infections.

Rinses Available Over the Counter for Home Use
Fluoride rinses such as Act or Fluoriguard are fluoride rinses with a lower concentration of fluoride than Phosflor, as described above. They may be helpful in preventing cavities.
Listerine is an antimicrobial rinse that does have some effect on the bacteria that cause gingivitis.
Mouthwashes that advertise to help bad breath may help in some cases, but if bad breath is a continual problem it is best to have an evaluation made at the dental office since bad breath is often an indicator of other serious problems such as periodontal disease
Plax is a rinse that is advertised to reduce plaque, but studies have shown that this is not true and this product  is not recommended.

Tooth Whitening or Bleaching Products - These can be unpredictable and can affect soft tissue, and are often not as effective as the products prescribed by the dentist.  It is advised that tooth whitening take place under a dentist's care with individually molded trays and prescribed product in the appropriate strength.

Toothpicks, Interdental Stimulators - Floss is superior to these other products for removing plaque from between teeth; toothpicks are not effective at preventing periodontal disease.

Floss Holders - These are handles that allow floss to be used in back teeth areas where it can be hard to reach otherwise. These can be helpful for people with very large hands or for those with arthritis who have trouble reaching their back teeth.

Floss Threaders - As described in bridge care and orthodontic care, this product allows flossing access to clean around orthodontic wires or bridge pontics (the false tooth part of the bridge). Threaders are a requirement for anyone with either full orthodontic brackets or a fixed bridge.

Electric Periodontal Products - Periodontal irrigators are recommended to help deliver antibacterial solutions to the periodontal area.  Specific recommendations as to the best product for your individual problems can be made by a hygienist.

Tongue Scrapers - These are used to clean plaque from the tongue area and have been advised for some people who have bad breath.  There is no problem in using one, but they are not generally necessary for oral care.

Mouthguards - Purchased mouthguards to be used for sports can be appropriate to prevent injury.  We strongly recommend the use of mouthguards for any contact sport, as we are constantly repairing chipped teeth in young people who were not wearing these appliances.

Denture Cleansers - There are many good commercial products available.  Always check for the American Dental Association seal of approval.

Denture Adhesives - The need for denture adhesives is usually a sign of an improper fitting denture, and it should probably be remade.  There are some cases where the dentist may recommend an adhesive but professional evaluation of the denture is the best way to decide the proper course of action.

Toothache Drops or Gels - Some products that contain the active ingredient oil of cloves may give temporary relief form some toothaches but are not a substitute for dental care.  Products containing oil of cloves should not be used for infant teething.

When most people consider nutrition as it relates to dental disease, they think of sugar and avoiding candy and other treats. While sugar consumption is a component in the nutrition discussion, it certainly isn't the only factor involved in diet and dental health. Many nutrients contribute to healthy teeth and gums and help people resist the destruction of dental disease, and appropriate food choices help people avoid the cravings for less healthy alternatives. In this section, I will explain the effects of sugars and other carbohydrates, review some of the nutrients that affect oral health, and discuss tips for obtaining a nutritious diet.

If you have any questions about nutrition, we are happy to discuss them at the office. Maureen, our office manager, has a master's degree in nutrition and has many practical ideas to help patients improve their diet habits.

Carbohydrate Consumption

Carbohydrates consist of sugars and starches. Sugar is the food that the decay causing bacteria strep mutans prefers, so limiting sugary foods will lessen decay. However, since we can not eliminate all carbohydrates from our diet, it is helpful to understand certain facts about carbohydrate consumption that are most likely to accelerate the decay process

Three factors of sugar consumption are particularly influential in the decay process. The amount of time the teeth are exposed to sugar, the stickiness of the sugar containing food, and the combining of sugar with other foods all affect how the bacteria react and cause decay. Below are more detailed explanations of the mechanisms involved.

Timing

Each time you consume a sugary food, there is a response by bacteria in your mouth as they utilize the sugar and produce the acid waste that causes cavities. The more time you spend each day snacking on carbohydrate foods, the more exposure your teeth have to the decay process. Limiting your snacking or sugary beverage consumption goes a long way in preventing cavities. Almost every time I see someone with extensive decay, upon questioning I find either a problem with continuous sugary beverage consumption (soda or sweetened coffee or tea are the worst culprits), or poor snacking habits.

Parents are often surprised when we explain that offering children one piece of candy each day is far worse for the teeth than an occasional binge with the same foods. We advise for Halloween and other holidays to allow children to consume as much candy as they want within a three day period, then to get rid of what remains. (We have never had to throw anything away with our own children - they have always been incredibly efficient at consuming all candy within a short period of time.)

In terms of shopping, avoiding purchase of candy and cookies at the grocery store also helps limit exposure times. If you don't have the foods around the house, there is obviously less consumption, and it also makes it more fun when it is available. Candy should be considered a special treat, not expected as a routine part of a diet. A trip to the store to pick out a piece of candy for a reward can be a meaningful event for a child, and adults can follow this bit of advice for themselves as well.

Stickiness of the sugary food

Not all sugary treats are equally bad for your teeth. Some foods are notorious for causing cavities because they cling to the tooth. Below we have listed some foods that appear repeatedly in diet recollections of patients with severe decay.

Beverages - soda (including diet sodas), fruit drinks, powdered drinks, fruit juices (especially apple juice), iced tea, sweetened hot coffee or tea - Beverages are some of the worst offenders in tooth decay for several reasons. They are heavily sweetened, with some sodas or powdered fruit drinks having as much as three tablespoons of sugar in a glass of beverage. They are also fluid and sticky and can easily seep between the teeth. Finally, they are often acidic, which can cause a chemical erosion of the teeth similar to the acid from decay causing bacteria. (It should be noted that even sugar free diet soda can be bad for teeth. Because of the high phosphoric acid levels in the drink, it can cause demineralization of tooth enamel.)

People are often surprised to find out that juice is not a wonderful food. While any juice can cause decay, apple juice is often drunk in greater quantities throughout the day by young children and shows up more often as a problem than citrus juices such as orange or grapefruit. We mentioned in the family page that this also creates a problem of causing fullness in children, preventing them from obtaining enough milk or other protein rich foods necessary for growth.

If you do have a habit of drinking sugary beverages, there are many suggestions for change or ideas to help reduce the contact with teeth. Try to switch to water or fruit flavored bottled water instead of sugary drinks. (Make sure you check the label; some flavored water has sugar added.) If you drink coffee or tea with sugar, at least cut back the sugar to reduce the syrupy consistency, and keep floss handy (preferably in a readily accessible pocket) to periodically remove the syrup that does build up between your teeth. Using a straw will also help minimize the contact of the sugar with your teeth.

Fruit roll ups, hard candy, lollipops, sugared cough drops, breath mints - These are all sticky foods that adhere to teeth, or are foods that tend to be consumed repeatedly, causing excessive exposure.

Fruit roll ups are not the same as a piece of fruit. They are sticky, sugary candies deceptively marketed as wholesome. They have no place in a child's diet and are probably one of the most expensive foods you can buy when you factor in the cost of fillings for decayed teeth caused by this product.

Hard candy or lollipops that stay in the mouth a long time and dissolve slowly are notorious for causing decay. If you want to offer a candy that is less likely to cause decay, gummy candies or plain dark chocolate are better options.

Cough drops, breath mints, and occasionally some liquid medicines that are administered for a long period can cause decay. If you have a cough, buy sugar free cough drops, and do not get into the habit of popping breath mints. Some of the worst decay we have seen in my practice has been from breath mints. The decay from foods that dissolve slowly tends to pool around the base of the tooth, and we have seen teeth just snap off from being weakened by decay in this way. (You should also note that if you have bad breath, you need to discuss it at the dental office to determine the cause.)

Crackers - Although we do not usually see this as a problem as much as the foods listed above, you should be aware that starchy foods that stick to the teeth can cause problems because enzymes in your mouth can quickly convert the starch to sugar. Use of whole grain products slows this process and these foods would be a better choice than foods made with white flour, as would any carbohydrate food that does not stick to the teeth.

Combining of sugar with other foods

More complex sugary foods, foods combined with fats, or sugary foods consumed as part of a meal are all less likely to contribute to decay. Anything that helps reduce stickiness or reduce concentration of sugar will lessen the decay causing ability of a food. For example, a piece of custard pie eaten with a meal is probably going to be less of a problem for your teeth than a sticky candy bar or caramel covered cookie eaten alone as a snack.

Nutrients important for dental health

Since nutrients interact to form strong bones and maintain healthy tissue, we could write a book about the interactions of all of the important nutrients. There are two nutrients that are particularly important, however, and they can be neglected in the diet, so we will concentrate on them. We have also included a discussion of vitamin and mineral supplements and their value in the diet.

Calcium - This mineral, as most people know, is important for development of strong bones and teeth. Calcium combines with phosphorus in the body to form calcium phosphate, which is deposited in crystals around a protein framework in bones. For children, calcium is obviously a significant factor in tooth development, but calcium continues to be important for adults. Calcium is necessary for maintaining dense bone in the jaw to provide resistance to the destruction caused by periodontal disease.

Calcium is found primarily in dairy products - milk, cheese, yogurt, and ice cream. (Low fat dairy products are recommended.) It can also be obtained in smaller amounts in green vegetables such as spinach or broccoli, or in calcium fortified orange juice. Children in the pre-teen years, (ages ten to twelve), teen-agers, and adult women need 1200 mg of calcium per day, which can be obtained in four glasses of milk. Adult men need about two glasses of milk or two servings of dairy products to meet their calcium needs.

Although calcium can be obtained from supplements, only limited amounts of calcium can be absorbed at one time, so it is advisable to split up the supplements into two or more dosages per day, with no more than 500 mg administered at one time. It is strongly recommended to try to obtain at least some calcium from dairy products because they are healthful foods that provide protein and other nutrients as well. Also, vitamin D is provided in milk, which is necessary for utilization of the calcium by the body.

Vitamin C - Vitamin C, also known as ascorbic acid, is known to aid in healing and tissue repair, and is particularly helpful in resisting periodontal disease. Vitamin C plays a role in forming and maintaining collagen. The breakdown of collagen by bacteria is a major factor in the development of periodontal disease, so it follows that adequate vitamin C is necessary for a healthy oral condition. It should be noted, however, that while vitamin C is involved in the maintenance of tissue health, periodontal disease should not be considered to be a vitamin deficiency disease.

Vitamin and mineral supplementation - People often assume that if vitamins are important, then they should be taking pills for optimum health. For most purposes, including prevention or control of periodontal disease, taking vitamins in amounts above that found in a normal healthy diet generally does not add any benefit.

Although there is no harm in taking one multivitamin, it is important to try to obtain your vitamins and minerals as much as possible from dietary sources. Studies have repeatedly shown that advantages found from eating fruits and vegetables can not be duplicated when the vitamin or mineral in question is obtained from supplements alone. The interactions of nutrients and phytochemicals in various foods play a big part in how the body is able to utilize them.

Tips for Obtaining a Healthy Diet

The most important idea in consuming a healthful diet involves changing how you obtain your calories during the day, with more calories allocated to breakfast and lunch, and less to your evening meal. Adding fiber and redistributing protein consumption throughout the day also add to give a feeling of fullness, which helps prevent the uncontrolled nervous snacking that leads to dental and other health problems.

Breakfast - Most people know that eating breakfast is important for health but skip it because they are in a rush. The easiest way to get breakfast is to make it a routine that doesn't require any thinking. If you can manage to make coffee or tea in the morning, you can just as easily make some hot cereal or pour some cold whole grain cereal into a bowl. Adding thawed frozen berries to the cereal and pouring a glass of milk makes it a complete nutritious breakfast.

A nutritious breakfast that will keep you satisfied until lunch should include about four hundred calories (even if you are dieting), fifteen grams of protein, and ten or more grams of fiber. You should include at least one fruit or vegetable serving that is high in vitamin C.

Four hundred calories sounds like a lot, but you need to consume enough calories in the morning to keep you going until lunch, and to avoid that feeling of starvation in the evening that leads you to munch on junk foods. Even if you are dieting you should be obtaining one third of your calories at breakfast, and four hundred calories is one third of 1200 calories, which would be a very low calorie diet. You probably need to use a double serving size of cereal to get enough calories, or add a piece of toast or other bread serving (use whole grains) to a serving of cereal.

The recommended protein and fiber help slow the metabolism of the meal. If you have ever felt that breakfast goes right through you and makes you hungrier, it is probably because you are consuming a high carbohydrate, low protein, low fiber meal that is metabolized too fast and can end up causing a drop in blood sugar. Try changing to a cereal with a higher protein level and add 8 - 12 ounces of skim milk. (Hot cocoa is fine if you really hate the taste of plain milk.) The hot whole grain cereals generally provide more protein and fiber, but if you prefer cold cereal there are several that provide high levels of fiber and protein - just check nutrition labels.

Since you need at least five servings of fruits and vegetables every day, you need to get in the habit of having one or two servings at breakfast. This is one time when orange or grapefruit juice is appropriate. You might also consider tomato or vegetable juice, which provides high levels of vitamin A as well as vitamin C. You can add thawed frozen fruit or a banana to your cereal, or if you really can't eat fruit with your meal, grab an orange to take to work to eat at your first break.

Lunch - Many people eat at fast food restaurants for lunch, and it is possible to obtain a healthy meal at most restaurants if you choose wisely. It is important to have adequate calories, protein, and fiber to get through the afternoon without cravings for sweets. Below are some good choices from popular restaurants.

Subway has many low fat choices for sandwiches. Make sure you add all the vegetables offered to get a full vegetable serving.

At McDonald's, you will manage well with fat and calories if you order a small hamburger or a grilled chicken sandwich. For a drink, order an orange juice instead of a soda. It is difficult to obtain enough fiber from this restaurant, so it's always a good idea to keep fruit around the office to fill in any deficiencies.

Taco Bell offers healthy lunch choices with the bean burrito (high in fiber) or the chicken gordita surpreme.

Roy Rogers roast beef sandwich is a good low fat choice.

If you end up at a grocery store, the best salad bar choices include spinach or romaine lettuce (instead of iceberg lettuce), olives, chickpeas, and cottage cheese. Add a piece of fresh fruit or a fruit plate and a roll or bagel. At the bakery, a foccacia (an Italian round bread with added cheese or tomatoes) is also a good choice. If you do select a salad for lunch, the most important thing to remember is to add enough protein foods to make it a complete meal. Too often people think that eating a low calorie vegetable salad is the best choice, but unless there is protein and fiber, you will end up hungry too soon and may make poor snacking choices.

If you eating at home or if you have access to a microwave, vegetable, tomato, or minestrone soups are some of the best choices for providing a filling nutritious meal. A recent study found that a serving of soup helped dieters consume less total calories throughout the day.

Dinner - If you have followed the advice here and have had enough calories, protein, and fiber at breakfast and lunch, you should not feel ravenous in the evening and will not feel the need to eat everything in sight. Experiment with your diet until you reach the right balance to avoid this feeling in the evening.

It is important to not overeat in the evening. Do not increase calorie consumption earlier in the day and keep up old habits of a big dinner. Light dinners of spaghetti or pasta, fish, or main dish salads with grains along with two vegetable side dishes make good dinner choices. It's a good idea to have a few meatless dinners each week - it saves a lot on calories and saturated fat.

Snacking - Treats are important and can be part of a healthful diet. As mentioned at the beginning of this section, the biggest problem with sugar comes from repeated use throughout the day, so having one treat should not cause problems with your teeth. Below are some good suggestions that are also low calorie and low fat.

Frozen fruit bars are great because they are portion controlled - you just eat one. If you do want a scoop of a frozen dessert, frozen yogurt is a good choice and is a good source of calcium.

Surprisingly, chocolate syrup or fudge ice cream topping can be a dieter's best friend. A tablespoon of topping provides intense chocolate flavor, yet is generally low fat or fat free(check the label) and contains only fifty calories. Served over fruit such as strawberries or pears, it provides a great solution for chocolate cravings and the fruit adds nutritional value.

Another easy fruit dessert is a microwaved baked apple. Slice the apple in a bowl, (you don't even need to peel it) sprinkle with cinnamon, sugar, and a dash of vanilla, and cook in the microwave for about two minutes, or until the apple is soft.

Cinnamon toast is also a nutritious and easy snack choice, especially if you use whole grain bread.

For non-sweet snack foods, the best choices are popcorn, pretzels, or tortilla chips. Salsa counts as a vegetable serving and adds some fiber to the snack. Cheese is also a good choice if you select a lower fat cheese such as part skim mozzarella or provolone.

Types of Teeth - You have thirty two permanent teeth; children have twenty baby teeth. The types of teeth are described below.
primary or deciduous teeth - baby teeth
anterior teeth - the six front teeth, composed of four incisors and two canines per arch, twelve in all
posterior teeth - your back teeth, composed of three molars and two premolars (also known as bicuspids)for each quadrant - twenty posterior teeth in all
maxillary teeth or arch - your upper teeth
mandibular teeth or arch - your lower teeth
incisors - the front squared teeth - two central incisors and two lateral incisors per arch, one lateral on each side of the centerals
canines - the pointed teeth, two per arch
premolars - two rooted teeth designed for chewing
molars - three rooted teeth designed for chewing

Surfaces of Teeth
incisal - biting edge of front tooth
lingual - tongue side of tooth
buccal - cheek side of tooth (called facial in front teeth)
occlusal - chewing surface of tooth
mesial - side surface of tooth, towards front of mouth
distal - side surface of tooth, towards back of mouth

Dental Specialists
endodontist - specializes in root canal therapy
oral surgeon - surgical specialist, handles extractions, jaw fractures, implants, other oral surgery
orthodontist - specializes in tooth straightening and braces
pedodontist - specializes in children's dentistry
periodontist - specializes in gum care and surgery
prosthodontist - specializes in replacing missing teeth, dentures, implants

Dental Procedures
amalgam - silver filling
biteguard - a plastic plate fabricated to fit over teeth to break a bruxism, or clenching habit.
bitewings - x-rays of between teeth
bridge - a fixed prosthesis consisting of a pontic (the replacement for the missing tooth) with an abutment (crown for adjacent tooth to attach to the pontic) on either side
ceramic or porcelain jacket crown - used for front teeth primarily, this is a "cap" made of all ceramic material, with no metal base
composite - tooth colored filling
panorex, or panoramic x-ray - x-ray of entire mouth area
periapical - x-ray of single tooth and root.
periodontal scaling and root planing - scraping of bone under gum to remove built up calculus
porcelain to metal crown - a "cap" of porcelain bonded to precious metal, used to restore a broken down tooth
prophylaxis - tooth cleaning
prosthesis - an appliance used to replace missing teeth, can be either fixed (bridge) or removable (partial or full denture or overdenture)
root canal or endodontics - treating an abscess by removing the nerve from the tooth, disinfecting, and filling with an inert substance
sealant - a plastic coating placed on chewing surface of molars to prevent decay

Numbering of Teeth
Permanent teeth are numbered from 1 - 32, starting at the upper right back, going to the upper left (#1-16). #17 starts at the lower left back, going back to the lower right, #32.

Primary, or baby teeth, are described by letters, going from upper right back to upper left (A-J), then lower left back to lower right (K-T).

Other Terms
bruxism - habit of clenching teeth
endodontal - pertaining to the nerve of the tooth
occlusion - how teeth mesh together for chewing
palliative treatment - minor treatment to relieve pain
periodontal - pertaining to gums
TMJ - temperomandibular joint (jaw joint)

Many patients are surprised to find out how important a medical history is for dental care. There are many interrelationships between your general health and your oral health, and there are also many interactions of drugs that affect your care. Below are some explanations of why we need to know about your health conditions.

Keep in mind, however, that this is by no means a complete list of health conditions or medications that affect your dental care. You should always tell us about any medical treatment you are receiving and about all medicines you are taking. It is also a good idea to use the same pharmacy (with a computer record system) to keep track of possible drug interactions.

Bacterial Endocarditis - When you have dental work performed that could involve bleeding, such as teeth cleaning, periodontal treatment, extractions, or fillings around the gum area, bacteria that is present in your mouth may be introduced into the bloodstream. This is not a problem for most people, but if you have certain conditions, it can cause serious problems if precautions are not taken.

Conditions that require antibiotics before dental care include a history of rheumatic fever, articial joints, organ transplants, or mitrovalve prolapse with regurgitation.

Heart Disease - Periodontal disease is a risk factor in heart disease. With heart conditions, extra care must be taken to monitor periodontal conditions. Some heart conditions may also affect the type of anesthetic used, and some medicines taken for heart conditions affect dental treatment.

Cancer - Radiation therapy can cause reduced saliva flow, which in turn can cause rampant decay. If a patient is undergoing radiation therapy, a prescription for artificial saliva and a fluoride rinse may be necessary, along with close monitoring at the dentist's office.

Nutrition concerns while undergoing cancer treatment may also affect oral hygiene, and vomiting from chemotherapy can cause erosion of teeth.

Glaucoma - This condition would cause concern about the type of anesthetic to use for local anesthesia. We would need to use an anesthetic without epinephrine.

High blood pressure - Epinephrine, added to dental anesthetics to provide a longer lasting effect, causes a rise in blood pressure. If you have high blood pressure, we would need to use a different kind of anesthetic, without epinephrine.

Diabetes - Diabetics have a much higher risk of developing periodontal disease, and periodontal disease aggravates diabetic problems. Diabetics also have a harder time healing from oral surgery, so special precautions may be needed. Close monitoring of gum problems, with more frequent cleanings and check ups may also be indicated.

Eating Disorders - Bulimia can cause severe erosion of teeth. Acid regurgitated from the stomach repeatedly eats away at tooth enamel. Anorexia or overall poor nutrition can cause gum or soft tissue problems.

Head or jaw injury, Arthritis, Chronic Headaches - Injuries to head or jaw can cause TMJ (jaw joint) problems and should be monitored. Arthritis can also affect the jaw joint, and chronic headaches may be caused by dental problems such as bruxism (clenching of teeth).

Anemia or blood clotting problems - These can both cause complications with periodontal treatment or other dental surgery.

Chronic sinus problems - Pressure from this condition can cause tooth pain, and can mimic an abscessed tooth.

Medicines and Dental Care

Blood thinners and aspirin - These drugs can affect clotting times and cause complications from dental surgery. A patient may need to discontinue these medicines temporarily when dental surgery is scheduled.

Birth control pills - These can aggravate some periodontal problems, and some antibiotics should not be prescribed for a patient on birth control pills since they can reduce the effectiveness of the contraceptives.

Over the past few years there has been an explosion of technology in dental equipment.  In this section we have detailed some of the equipment we have adopted for use in our office, along with explanations of some other advances that we have chosen not to incorporate into our practice.

Diagnodent - a small laser instument which scans your teeth with harmless laser light searching for hidden decay. Locating hidden decay before it destroys tooth structure is a major goal for modern dentistry. It is a completely safe and pain free instrument which provides instint feedback on the health of the tooth.

Velscope - This practice is dedicated to providing the most optimum level of patient care. We are especially concerned about the growing problem of oral cancer. A new technology called Velscope can help in earlier detection of cancer and we have incorporated it into our standard of care for our patients. We will be offering it on an annual basis for all of our adult patients.

Invisalign - Is a clear alternative that makes it easy to straighten your teeth with out bands, brackets, or wires.

Periodontal LASER Therapy - Periodontal LASER Therapy is less invasive and the LASER light reduces inflammation in the tissue, there is usually very little discomfort with this form of therapy compared to traditional surgical methods. The amount of tissue affected by the LASER is much less and the healing is gentler due to the reduced amount of trauma to the body.

Stereoscopic Loops - These are magnifying glasses that are worn to view the dental field in 2.5x magnification, enabling the dentist to see details in dental work that are not discernible with the naked eye.  We have found that these can greatly assist our ability to check crown margins, extent of decay and periodontal health.

Air Abrasion Technology - This technology replaces a dental drill to remove decay in many instances.  It uses a stream of aluminum oxide to sandblast the decayed area.  Its advantages include being able to remove a smaller amount of tooth structure than a drill can because it is such a fine diameter stream, and not having to use anesthesia in many cases because this equipment does not generate the heat or vibration of a dental drill.

Computerized Radiography - This technology uses digital images to generate dental x-rays.  It uses only one tenth the radiation of normal x-rays.  It is also kinder to the environment because there are no chemicals used to develop the radiographs.

Computerized Dental Charting - This is simply utilizing laptop computers to keep track of all patient records.  With one entry, the treatment can be recorded and the patient account posted.  With the digital x-rays, the record keeping by computer is almost complete.  These records are also safer, since we utilize a laptop computers to keep a copies of all records with us even after we leave the office.  We also backup onto a disc daily, which our office staff can access from a home computer to handle after hours scheduling.

Dental Imaging - Another part of the computerized records utilizes a digital camera to produce intraoral photographs.  We can use this to show before and after cosmetic cases, to demonstrate healthy gums to periodontal patients before and after treatment, and even to record a patient's face or inside the mouth photograph.

How to reach us after hours

If you call our office number after hours (703-754-2300), you will hear emergency numbers for that day.  The numbers given are usually the docotor's home number and cell phone as a second number backup.  While we are lmost always quickly accessible through one of these numbers, there may be times (such as when we are in a car in an out of range area) when you might have to call again. 

Dental First Aid

Tooth Knocked Out - Do not try to clean the tooth.  Place it in liquid if possible (milk is best) or hold it in the person's mouth in contact with some saliva and get to the dentist or emergency room within thirty minutes.  If you can not make it to a health care facility in that time, you can try to place the tooth back in the socket gently.

Tooth Broken - If you have the broken piece available, save it to bring to the office.  Sometimes it is possible to use the fragment to bond back to the remaining tooth, and if not, it can be useful for us to evaluate the overall damage by examining the pattern of fracture.  If only a small portion of tooth fractured off, generally the visit can wait until the next day.  If, however, you can see pink where the tooth has broken, the nerve is likely exposed and you should obtain care as soon as possible.  If you can not get to the dentist and the area is sensitive or sharp, covering the area with a "band-aid" of orthodontic wax (usually available at drug stores) can help relieve sensitivity and keep the area clean.

Gum or Lip Injury - If the cut is not severe, applying cold will reduce swelling.  We usually recommend a popsicle for children with this type of injury.   If the cut is severe enough to cause an open gash, sutures may be needed for proper healing.  If you do go to an emergency room, you may want to ask if an oral surgeon is on call to suture the area and to examine for other possible injury to the mouth.

Knocked in Mouth, no Apparent Injury - If you have taken a blow to the mouth but nothing appears broken, it is still a good idea to see a dentist within twenty four hours, particularly if there are loose teeth or if sensitivity is present. Sometimes when an accident occurs and teeth are not broken, force from the trauma is absorbed by the roots of the teeth, and damage to the pulp may occur. We may want to evaluate with an x-ray, and then follow up with another x-ray in a few months to determine if nerve damage occurred.

Fall by a Child, Baby Teeth Jammed - The most important thing to remember when this happens is to not move the teeth any more after the accident.  When baby teeth are jammed up, any further manipulation can damage the developing permanent teeth, so even if the baby tooth has changed position the best course of action is to leave it alone.  You will want to schedule an office visit within twenty-four hours for a dental evaluation.

Toothaches - When you have a toothache, it is important to figure out exactly what makes it hurt so we can obtain a proper diagnosis at the dental office.  While some aches are very clear as to the cause, some toothaches can be vague, making it difficult to pinpoint the reason for the pain.  Below is a guide we use to help in diagnosis of those vague aches, along with an explanation of what different types of aches may indicate.  None of this information is meant to replace a proper diagnosis by the dentist, and any toothache should be evaluated at the dental office.

Toothache Symptoms

Throbbing, intense pain, may come and go, touching the offending tooth makes pain worse - This is generally an indication of an abscessed tooth and care is needed as soon as possible to clear up the infection.

Soreness in upper arch, can not pinpoint one tooth, feels worse when you bend over - This could be from sinus pressure.  If you have a cold, or if you have been working in a dusty area, this could be the problem.  Taking an antihistamine or decongestant should alleviate pain, although if you have a severe infection (and it is possible to have a sinus infection and not realize it) you may need antibiotics. Evaluation at the dentist or physician's office can confirm a diagnosis.

Pain in several teeth, no pattern, may be accompanied by headache or jaw soreness - This pain could be caused by clenching or grinding of  teeth to the point that the periodontal ligaments have been stressed.  The dentist can evaluate your teeth for wear and examine the jaw joint for signs of stress to make a diagnosis.  If you have been under stress this could be the problem.  It should be noted, however, that it is possible for an abscess to cause referred pain to other teeth, and that option should not be ruled out.  In either case, it is important to visit to the dentist as soon as possible for diagnosis.

Pain in one tooth while chewing or applying pressure - This could be the sign of a cracked tooth, although it could also be the beginning symptoms of an abscess. A cracked tooth can be difficult to diagnose properly since it may not show up on x-ray and may be hidden from view.  Treatment for a cracked tooth generally involves crowning the tooth.