Generally, whitening is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth whitening if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the colour of yellow, brown or orange respond better to whitening. Gray stains caused by fluorosis, smoking or tetracycline use can be lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal (gum) disease or teeth with worn enamel, your dentist may discourage whitening.

What's involved?

First, the dentist will determine whether you are a candidate for tooth whitening and what type of whitening system would provide the best results. Most patients choose dentist-supervised at-home whitening, which is more economical and provides very good results.

To start, we will make impressions of your teeth to create a mouthguard-type appliance, called whitening trays. The trays are custom-made for your mouth and are lightweight so that it can be worn comfortably while you are awake or sleeping. The trays are so thin that you should even be able to talk and work while wearing it. Along with the trays, you'll receive the whitening materials. You'll be given instructions on how to wear the trays.

Some whitening systems recommend whitening your teeth for up to several hours a day. Generally this type of system requires two to four weeks to complete. Other systems recommend whitening at night while you sleep. This type of system usually requires only 10 to 14 days to complete. At Como Lake Dental, we use Pola White, and for most people, whitening result is visible in as little as one week of daily application of 60 minutes.

Over-the-counter whitening systems are also available and are generally safe and effective, although it is best to check with your dentist before using these products. These systems, which come in the form of strips and gels, usually contain a lower strength of whitening agent than products used in the dentist’s office. For this reason, they must be used longer to achieve a desired effect.

How long does it last?

Lightness should last from a few months up to a year, depending on your personal habits such as smoking and drinking coffee and tea. At this point you may choose to get a touch-up. The retreatment time is much shorter than the original treatment time.

How does it work?

The active ingredient in most of whitening agents is carbamide peroxide; when water comes into contact with this white crystal, the release of hydrogen peroxide lightens the teeth.

Is it safe? Any side effects?

Several studies have proven whitening to be safe and effective. The American Dental Association has granted its seal of approval to some tooth whitening products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

What are realistic expectations?

No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement as seen on a dentist's shade guide. The success rate depends upon the type of stain involved, the type of whitening procedure and your compliance. Whitening can only provide a shift in colour from gray to a lighter shade of gray, for example. Whitening does not lighten artificial materials such as bonding or veneers.

Grinding and clenching of the teeth, or Bruxism as in dental terminology, may cause facial pain. People who grind and clench their teeth, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren't diagnosed with bruxism until it is too late, as many people don't realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.

Can bruxism cause harm?

People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

What are the signs?

When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth, which is called dentin. When exposed, dentin may cause the tooth to become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ), which may manifest as popping and clicking of the jaw. Tongue indentations are another sign of clenching.

Stress and certain personality types are at the root of bruxism. Anger, pain, nervousness and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.

What can be done about it?

During regular dental visits, the dentist automatically checks for physical signs of bruxism. If the dentist or patient notices signs of bruxism, the condition may be observed over several visits to be sure of the problem before recomending and starting therapy.

The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard, that's worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient's destructive behavior. It can also reposition the jaw so to relax the muscles involved in jaw movement, when they are not in function.

Cold sores, also known as fever blisters, are tiny, clear, fluid-filled blisters that form around the mouth and are caused by the herpes simplex virus (usually type 1, or HSV-1) living inside your nerve tissue. Cold sores usually do not last longer than two weeks. However, the sores are highly contagious and tend to recur when the virus is reactivated by a trigger such as stress, sunlight, fever or illness.

What is the difference between a cold sore and a canker sore?

Like cold sores, canker sores – also known as aphthous ulcers – can be quite painful and often recur. While cold sores are caused by a virus, the formation of a canker sore may be triggered by multiple factors such as stress, food allergies or a weakened immune system. A canker sore forms in the soft tissues of your mouth and is not contagious, whereas a cold sore usually appears around the lip area outside the mouth and is highly contagious. If a cold sore appears inside the mouth, usually it appears on the non-movable parts such as the roof, rather than the tongue or soft palate.

What happens when you are first exposed to HSV-1?

Most people get HSV-1 infections during infancy or childhood and usually catch the virus from an infected family member or friend. Only an estimated 30 percent of those infected actually develop the characteristic blisters. If sores do develop, they can appear anywhere from two to 12 days after exposure to an infected person. Other persons with a primary infection may have flu-like symptoms such as a high fever, sore throat, swollen neck glands and mouth soreness.

What are the stages of a cold sore?

Day 1: Prodrome (tingle) stage - Before a cold sore has formed, you may feel a tingling, itching or burning sensation beneath the skin, usually around the mouth or the base of the nose. Applying antiviral medications during this stage can help alleviate cold-sore symptoms.

Days 2 to 3: Blister stage - An outbreak of fluid-filled blisters is the first visible sign of cold-sore formation.

Day 4: Ulcer or weeping stage - Typically, the most contagious and painful stage of cold sores is when blisters rupture, leaving a shallow, reddish, open sore.

Days 5 to 8: Crusting stage - After a few days, the blisters dry up and form a yellow or brownish crust, which eventually falls off. During this stage, it is important to care for the scab, which can crack or break.

Days 9 to 12: Healing stage - Usually a series of scabs will form on the lesion, which eventually flake off. Each new scab will be smaller than the previous one, until the cold sore heals completely, usually without scarring.

What triggers a cold sore outbreak?

There may be long periods when the herpes virus remains inactive. The following factors can trigger cold sores:

• Illness, such as cold or flu
• Dental treatment
• Physical stress or fatigue
• Menstruation or pregnancy
• Mouth trauma
• An immune-system deficiency
• Sunlight exposure or ultraviolet lamps
• Food allergies

How are cold sores treated?

Most cold sores are mild and do not require treatment. Antiviral medications can reduce the frequency, duration and severity of outbreaks. Medications with a numbing agent, such as benzyl alcohol, can help alleviate a cold sore's burning, itching and pain. Emollients can reduce cracking and soften scabs. Applying aloe vera balm three times a day to the cold sore also can help fight the infection and enhance healing.

If over-the-counter remedies don't help, ask your dentist for a prescription. A dentist also can accurately diagnose cold sores and base treatment on important factors such as your age, overall health, medical history and tolerance for specific medications.

What precautions should be taken?

To prevent transmission of the virus to another person, avoid:

• Intimate physical contact with others
• Sharing eating utensils, toothbrushes, towels and razors
• Touching the blisters (always wash your hands after applying medication)

What can I do to minimize recurrent outbreaks?

• Eat foods high in lysine (an amino acid found in red meats, fish and dairy products) or take supplements
• Apply sunscreen to the face and lips before going outdoors
• Shave with a disposable razor during an outbreak
• Replace your toothbrush
• Engage in relaxing activities to reduce stress

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and food. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible. Two forms of fluoride protect the teeth: systemic fluoride and topical fluoride.

What is systemic fluoride?

Systemic fluoride is ingested into the body when added to public and private water supplies, soft drinks and teas and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

What's topical fluoride, and when should I use it?

Topical fluoride is applied directly to the teeth. It is found in products containing strong concentrations of fluoride to fight tooth decay, such as toothpastes and mouth rinses. These products are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.

Professionally administered topical fluorides such as gels or varnishes are applied by a dentist and left on for about one to four minutes, usually during a cleaning treatment. For patients with a high risk of cavities, the dentist may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Why is most of the water we drink fluoridated?

Fluoridated water protects against cavities and root caries – a progressive erosion of adult root surfaces caused by gum recession – and helps remineralize early carious lesions. Thanks to these preventive benefits, public water fluoridation is considered the most efficient and cost-effective cavity prevention measure available. More than 144 million United States residents in more than 10,000 communities drink fluoridated water, most from public water supplies with artificially added fluoride. A small percentage get water from private wells with naturally fluoridated water.

The Environmental Protection Agency (EPA) in U.S. has determined that the accepted "optimal" range of fluoride in water lies between 0.7 and 1.2 parts per million (ppm) or milligram per liter. The limit allowed by the EPA in public water is 4 ppm. Backed by results from more than 140 documented studies undertaken in 20 different countries over the past several decades, fluoridated water adhering to these standards has been scientifically established as safe for drinking. Water fluoridation is endorsed by nearly every major health and safety-related organization. Fluoridation of community water supplies is the single most effective public-health measure to prevent tooth decay and to improve oral health for a lifetime.

In Great Vancouver Region, the public water system is not fluoridated.

Are children more sensitive to fluoride?

In young children, excess fluoride intake can cause dental fluorosis, a harmless cosmetic discolouring or mottling of the enamel, visible as chalky white specks and lines or pitted and brown stained enamel on developing teeth. They are at greater risk if they swallow or use too much toothpaste and fluoride supplements. Parents should monitor the use of toothpaste, mouth rinses or other topical fluoride supplements in young children, checking with a dentist on proper dosage.

From subtle changes to major repairs, as your dentist, we can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discoloured, chipped, misshapen or missing. We can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include whitening, bonding, crowns, veneers and reshaping and contouring.

These improvements are not always just cosmetic. Many of these treatments can improve oral problems, such as your bite.

Whitening

Whitening is a common and popular chemical process used to whiten teeth. Some people get their teeth bleached to make stains disappear, while other just want a whiter shade.

Discolouration occurs in the enamel and can be caused by medication, coffee, tea and cigarettes. Discolouration also can be hereditary or due simply to getting older.

Whitening can be performed by your dentist in the office or, under dental supervision, at home. Many patients enjoy whitening at home because it is more convenient. Treatment begins when your dentist creates a custom mouthpiece to ensure the correct amount of whitening solution is used and that your teeth are properly exposed. Typically, whitening at home takes two to four weeks, depending on the desired shade you wish to achieve. Whitening in the office may call for one or more 45-minute to one-hour visits to your dentist's office.

Bonding

Bonding is tooth-coloured material used to fill in gaps or change the colour of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-coloured filling for small cavities. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its colour and shape.

Crowns

Crowns, also known as caps, cover a tooth to restore it to its normal shape and appearance. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time-consuming.

Veneers

Veneers are thin pieces of porcelain or plastic placed over the front teeth to change the colour or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discoloured, oddly shaped, unevenly spaced or crooked. Veneers are used to treat some of the same problems as bonding.

This treatment is an alternative to crowns, which are more expensive. The procedure requires your dentist to take an impression of your tooth. Before the custom-made veneer is cemented directly onto the tooth, your dentist will lightly buff the tooth to compensate for the added thickness of the veneer. Once the cement is between the veneer and your tooth, a light beam is used to harden it. Porcelain veneers require more than one visit because they are fabricated in a laboratory. Veneers have a longer life expectancy and colour stability than bonding.

Contouring and reshaping

Tooth reshaping and contouring, is a procedure to correct crooked teeth, chipped or irregularly shaped teeth or even overlapping teeth in a single session. Tooth reshaping and contouring, is commonly used to alter the length, shape or position of your teeth. Contouring teeth may also help correct small problems with bite. It is common for bonding to be combined with tooth reshaping.

This procedure is ideal for candidates with normal, healthy teeth but who want subtle changes to their smile. Your dentist will take X-rays to evaluate the size and location of the pulp of each tooth to ensure that there's enough bone between the teeth to support them.

A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Crowns are necessary when a tooth is generally broken down and fillings won't solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn't get worse. Crowns are also used to restore a tooth when there isn't enough of the tooth remaining to provide support for a large filling, attach a bridge, protect weak teeth from fracturing, restore fractured teeth or cover badly shaped or discoloured teeth.

How is a crown placed?

To prepare the tooth for a crown, it is reduced so the crown can fit over it. An impression of the teeth and gums is made and sent to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown is made. On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.

Will it look natural?

Yes. The dentist's main goal is to create a crown that looks like a natural tooth. That is why your dentist takes an impression. To achieve a certain look, a number of factors are considered, such as the colour, bite, shape and length of your natural teeth. Any one of these factors alone can affect your appearance.

If you have a certain cosmetic look in mind for your crown, discuss it with your dentist at your initial visit. When the procedure is complete, your teeth will not only be stronger, but they may be more attractive.

Why crowns and not veneers?

Crowns require more tooth structure removal, hence they cover more of the tooth than veneers. Crowns are customarily indicated for teeth that have sustained significant loss of structure or to replace missing teeth. Crowns may be placed on natural teeth or dental implants.

How long do crowns last?

Crowns should last approximately five to eight years. However, with good oral hygiene and supervision, most crowns will last for a much longer period of time. Some damaging habits like grinding your teeth, chewing ice or fingernail biting may cause this period of time to decrease significantly.

How should I take care of my crown?

To prevent damaging or fracturing the crown, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting your dentist and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.

Veneers are ultra-thin shells of ceramic (porcelain) or a composite resin material, which are bonded to the front of teeth. This procedure requires little or no anesthesia and can be the ideal choice for improving the appearance of the front teeth. Veneers are placed to mask discolourations, to brighten teeth and to improve a smile.

Why a veneer?

Veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth's colour, size or shape. Veneers can mask undesirable defects, such as teeth stained by tetracycline and damage due to an injury or as a result of a root-canal procedure. They are ideal for masking discoloured fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.

What happens during the procedure?

Patients may need up to three appointments for the entire procedure: diagnosis and treatment planning, preparation and bonding.

It's critical that you take an active role in the smile design. Spend time in the planning of the smile. Understand the corrective limitations of the procedure. Have more than one consultation, if necessary, to feel comfortable that your dentist understands your objectives.

To prepare the teeth for the veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about half a millimeter of the tooth is removed, which may require a local anesthetic. Composite resin veneers are generally done in one appointment. After the tooth is prepared, the dentist carefully bonds and sculpts the composite material onto your teeth. For ceramic veneers, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This may take several days. If the teeth are too unsightly, a temporary veneer can be placed.

When your ceramic veneers are ready, the dentist places each veneer on the teeth to check their fit and get a sense of the shade or colour. While the veneers are resting on your teeth, view the results, and pay particular attention to the colour. At this point, the colour of the veneers can still be adjusted with the shade of the cement to be used. The colour cannot be altered after veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a light beam hardens the cement.

How about maintenance?

For about a week or two, you will go through a period of adjustment as you get used to your "new" teeth that have changed in size and shape. Brush and floss daily. After one or two weeks, your dentist will ask you to return for a follow-up appointment.

What are realistic expectations?

Veneers are reasonable facsimiles of natural teeth, not perfect replacements. It's not uncommon to see slight variations in the colour of veneers upon close inspection, as this occurs even in natural teeth. Nevertheless, this procedure can greatly enhance your smile and can heighten self-esteem.

There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since tooth position and gum condition vary. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth.

Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue, the chewing surfaces and between teeth. Using a back-and-forth motion causes the gum surface to recede, can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

Soft or hard bristles?

In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp and soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?

It might be a good idea to brush with the radio on, since dentists generally recommend brushing three to four minutes, the average length of a song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing.

To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full three to four minutes twice a day, instead of brushing quickly five or more times through the day.

Should I brush at work?

Definitely, but most people don't brush during the workday. Yet a survey by Oral-B Laboratories and the Academy of General Dentistry shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent. 

Getting the debris off teeth right away stops sugary snacks from turning to damaging acids and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to your desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

Tips to improve your office brushing habits:

• Post a sticky note on your desk or computer as a reminder to brush teeth after lunch.
• Brush teeth right after lunch, before you become absorbed in work.
• Store your toothbrush and toothpaste at work in a convenient and handy place.
• Make brushing your teeth part of your freshening-up routine at work.
•  When brushing at the office or away from home, it's important to make an extra effort to keep your toothbrush germ-free.

Tips on how to properly store and care for your toothbrush at work:

• Always store your toothbrush in a travel container.
• Dry your toothbrush after use and before returning to its container.
• Change the toothbrush you take to work more often than your toothbrush at home to avoid bacteria build-up.

Plaque is a sticky layer of material containing bacteria that accumulates on teeth, including places where toothbrushes can't reach. This can lead to gum disease. The best way to get rid of plaque is to brush and floss your teeth carefully every day. A toothbrush cleans the tops and sides of your teeth. Dental floss cleans between them. Some people use waterpicks, but floss is the best choice.

Why should I floss?

Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces and controls bad breath. By flossing your teeth daily, you increase the chances of keeping your teeth a lifetime and decrease your chance of having periodontal (gum) disease and tooth decay.

Flossing is the single most important weapon against plaque, perhaps more important than the toothbrush. Many people just don't spend enough time flossing and many have never been taught to floss properly. When you visit your dentist or hygienist, ask to be shown.

Which type of floss should I use?

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridge work. Tapes are usually recommended when the spaces between teeth are wide. They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss makes a squeaking sound to let you know your teeth are clean. Bonded unwaxed floss does not fray as easily as regular unwaxed floss but does tear more than waxed floss.

How should I floss?

There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity. Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger. (Don't cut off your finger's circulation!) Wind the rest of the floss similarly around the same finger of the opposite hand. This finger takes up the floss as it becomes soiled or frayed. Maneuver the floss between teeth with your index fingers and thumbs. Don't pull it down hard against your gums or you will hurt them. Don't rub it side to side as if you're shining shoes. Bring the floss up and down several times, forming a "C" shape around the tooth and being sure to go below the gumline.

The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis. Take an 18-inch piece of floss and make it into a circle. Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop. Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gumline and forming a "C" on the side of the tooth.

How often should I floss?

At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

What are floss holders?

You may prefer a prethreaded flosser or floss holder, which often looks like a little hacksaw. Flossers are handy for people with limited dexterity, for those who are just beginning to floss or for caretakers who are flossing someone else's teeth.

Is it safe to use toothpicks?

In a pinch, toothpicks are effective at removing food between teeth, but for daily cleaning of plaque between teeth, floss is recommended. When you use a toothpick, don't press too hard, as you can break off the end and lodge it in your gums.

Do I need a waterpick (irrigating device)?

Don't use waterpicks as a substitute for brushing and flossing. But they are effective around orthodontic braces, which retain food in areas where a toothbrush cannot reach. However, they do not remove plaque. Waterpicks are frequently recommended by dentists for persons with gum disease; solutions containing antibacterial agents like chlorhexidine or tetracycline, available through a dentist's prescription, can be added to the reservoir in these cases.

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either "conventional" or "immediate." A conventional denture is placed in the mouth about a few weeks after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. Many people prefer an immediate denture as they don’t have to worry about the missing teeth; however, it may require more adjustments after the healing has taken place.

Who needs a denture?

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech and provides support for facial muscles. It will greatly enhance the facial appearance, smile, and self-esteem.

What happens when you get a denture?

A dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper colour, shape and fit; and the patient's final denture is placed, following any minor adjustments.

New denture wearers need time to get accustomed to their new "teeth," because even the best-fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days to a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers often notice a slight change in facial appearance, increased salivary flow or minor irritation or discomfort.

How do you care for a denture?

A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpaste. Never use harsh, abrasive cleansers, including abrasive toothpastes, because they may scratch the surface of the denture. Don't soak your denture in boiling water because it will cause it to become warped. If you wear a partial denture, be sure to remove it before brushing your natural teeth. When not in use, leave it in a container to dry, or soak it in a cleanser solution once a whileor. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.

Should a denture be worn at night?

While you may be advised to wear your denture almost constantly during the first two weeks – even while you sleep – under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of the gums.

Continue seeing your dentist regularly

It is important to continue having regular dental checkups so that your dentist can examine oral tissues for signs of disease or cancer. With age, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself, and do not use denture adhesives for a prolonged period because this can contribute to bone loss. When in doubt, consult your dentist.

Are there any alternatives to dentures?

Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed support, or implants, can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. Dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. Speak with your dentist for advice.

A composite filling is a tooth-coloured plastic and glass mixture used to restore decayed teeth. Composites are also used for cosmetic improvements of the smile by changing the colour of the teeth or reshaping disfigured teeth.

How is a composite placed?

Following preparation, the dentist places the composite in layers, typically using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.
  
What are the advantages of composites?

Aesthetics are the main advantage of composites, since dentists can blend shades to create a colour nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

What are the disadvantages?

After receiving a composite, a patient may experience postoperative sensitivity. Also, the shade of the composite can change slightly if the patient drinks tea, coffee or other staining foods. Composites tend to wear out sooner than metal or ceramic restorations in larger cavities, although they hold up as well in small cavities.

Gum disease, or periodontal disease is a chronic inflammation and infection of the gums and surrounding tissue. It is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life. Periodontal diseases include gingivitis and periodontitis.

What causes gum disease?

Bacterial plaque – a sticky, colourless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar). Toxins produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets that fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper, and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control. Pregnant women experience elevated levels of hormones that cause the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as “pregnancy gingivitis.”

What are the warning signs of gum disease?

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, pus between the gum and tooth, persistent bad breath, a change in the way teeth fit together when the patient bites and a change in the fit of dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages of gum disease, most treatment involves a special cleaning called scaling and root planing, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums – sometimes with the assistance of a laser – and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

Is maintenance important?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit the dentist every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don't reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners are the best way to clean between the recesses in the teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist.

More than 80 million people suffer from chronic halitosis, or bad breath. In most cases it originates from the gums and tongue. The odor is caused by wastes from bacteria in the mouth, the decay of food particles, other debris in your mouth and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

What causes bad breath?

Bad breath is primarily caused by poor oral hygiene but can also be caused by retained food particles or gum disease.

Does bad breath come from other sources than the mouth?

Bad breath also may occur in people who have a medical infection, diabetes, kidney failure or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate postnasal drip. This is where mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor.

Why is saliva so important in the fight against bad breath?

Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva, allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware, because the odor may reappear even if you've brushed your teeth.

Do certain foods cause bad breath?

Very spicy foods, such as onions and garlic, and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach, and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.

How do I control bad breath?

It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. Proper brushing, including brushing the tongue, cheeks and the roof of the mouth, will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. To alleviate odors, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control odor. If you have dentures or a removable appliance, such as a retainer or mouthguard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouthrinses, deodorizing sprays or tablets, talk with your dentist, because these products only mask the odor temporarily and some products work better than others.

What is my dentist's role?

Visit your dentist regularly, because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, your dentist can help determine its source. He or she may ask you to schedule a separate appointment to find the source of the odor. Or, if your dentist believes that the problem is caused from a systemic (internal) source, such as an infection, he or she may refer you to your family physician or a specialist to help remedy the cause of the problem.

A dental implant is an artificial tooth root that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support and they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth.

Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

How do they work?

Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

Can anyone receive dental implants?

Talk with your dentist about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

What can I expect during this procedure?

The dentist must perform surgery to anchor the "artificial root" into or on your jaw bone. The procedure is done in the dental office with local anesthesia. The gum is then secured over the implant, which will remain covered until it fuses with the bone. The dentist then uncovers the implant and attaches an extension, or post, to the implant. With some implants, the implant and post are a single unit placed in the mouth during the initial surgery. Finally, the dentist makes an artificial tooth, or crown, that is attached to the implant post.

How long does the process take?

The process can take up to nine months to complete. Each patient heals differently, so times will vary. After the implant and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months. Sometimes, if a patient has good bone quality, posts can be placed and replacement teeth fitted in one appointment.

What is the success rate of implants?

The success rate for implants depends on the tooth's purpose and location in the mouth, as well as a patient’s overall health.

How do I care for implants?

Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

What is the cost of implants?

Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental insurance policies. Your dentist can help you with this process.

Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, blood vessels and connective tissue. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.

Why do I feel pain?

When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

Why do I need root canal therapy?

Root canal therapy is necessary because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it's always best to keep your original teeth.

What is a root canal procedure?

A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with a rubberlike substance called gutta–percha or another material to prevent recontamination of the tooth. The tooth is then permanently sealed, with possibly a post and/or a crown made of porcelain or metal alloy. This enables patients to keep the original tooth.

What is involved in root canal therapy?

Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an endodontist (a root canal specialist). Treatment usually involves one to three appointments.

First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, an opening is drilled from the crown into the pulp chamber, which, along with the root canal, is cleaned of all diseased pulp and reshaped.

Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, the tooth may be left open to drain or the dentist may go right ahead and fill the canals.

If you're given a temporary filling, usually on the next visit it's removed and the pulp chamber and canal(s) are filled with gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.

What are the risks and complications?

More than 95 percent of root canal treatments are successful. However, sometimes a procedure needs to be redone due to diseased canal offshoots that went unnoticed or the fracture of a filing instrument, both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

What happens after treatment?

Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods with the treated tooth, and see your dentist regularly.

A dental sealant is a thin plastic film painted on the chewing surfaces of teeth to prevent cavities.

How effective are sealants?

Studies have proven that properly applied sealants are 100-percent effective in protecting the tooth surfaces from cavities. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

How are sealants applied?

A cleaning solution is applied to the surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden, sometimes by using a special curing light. Sealant treatment is painless and takes anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

How long will a sealant last?

Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental checkups are necessary to monitor the sealants' bond to the tooth.

Who should receive sealant treatment?

Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities. Surveys show that the majority of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95-percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

Are sealants covered by insurance?

Insurance benefits for sealant procedures have increased considerably, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

Temporomandibular joint disorder (TMD) describes a variety of conditions that affect jaw muscles, temporomandibular joints and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men.

What is the temporomandibular joint?

The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side of the skull) and the mandible (lower jaw). Chewing muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways and open and close.

The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. TMD may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

What causes TMD?

Trauma to the jaw or jaw joint sometimes plays a role in TMD, but in most cases the cause of the disorder is unknown. Most experts suggest that certain tasks, either mental or physical, may cause or aggravate TMD, such as stressful situations. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth (bruxism). These excessive habits tire the jaw muscles and lead to discomfort, such as headaches or neck pain.

What TMD symptoms can I experience?

• Jaw pain or soreness that is more prevalent in the morning or late afternoon
• Jaw pain when you chew, bite or yawn
• Clicking when opening and closing your mouth
• Difficulty opening and closing your mouth
• Locked or stiff jaw when you talk, yawn or eat
• Sensitive teeth when no dental problems can be found
• An earache without an infection

 

What can I do to treat TMD?

The majority of cases can be treated by unloading (resting) the joint, taking a non-aspirin pain reliever and practicing stress management and relaxation techniques. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. Eating soft foods and avoiding chewing gum also help relax the muscles.

Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint, or bite guard). When necessary, stronger pain or anti-inflammatory medications, muscle relaxants or antidepressants may help ease symptoms.

Is TMD permanent?

The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis.

The average person swallows 2,000 times per day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related health problems, such as frequent headaches or sleep disorders, because their jaw muscles must work harder to bring the teeth together, straining the surrounding jaw muscles.

This strain, know as orofacial pain, is defined as any pain in or around the face. Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while other experience clicking when moving the jaw.

Orofacial pain can also be caused by temporomandibular disorder (TMD), stress, nerve disorders or muscle spasms. Serious causes of orofacial pain are tumors in the jaw bone area, oral cancer or referred pain from cardiac disease.

Sometimes orofacial pain may be difficult to diagnose if its origin is not localized in one area.

Orofacial pain that lasts longer than 10 days to two weeks or is not related to a specific stressful event, such as a car accident, may signal a more serious problem requiring additional tests.

Common symptoms of orofacial pain:

• Pain behind the eyes
• Sore jaw muscles
• Teeth grinding
• Clicking or popping of joints
• Head/scalp painful to the touch
• Earaches or ringing
• Neck, shoulder or back pain
• Dizziness

Radiographic, or X-ray, examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine th presence or degree of periodontal (gum) disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

How often do I need to have X-rays taken?

Your radiographic schedule is based on your dentist's assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease, and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

What kind of X-rays does my dentist usually take?

Typically, most X-rays require patients to hold or bite down on a piece of plastic with X-ray film in the center.

Some dentists are now using digital X-rays. To take a digital X-ray, your dentist will place a sensor on the tooth that looks like a piece of film. Once the picture is taken, your dentist can adjust the contrast and brightness of the image to find even the smallest area of decay. Other benefits of digital X-rays are decreased exposure to radiation and reduced time to develop photos, which helps eliminate treatment disruptions.

My dentist has prescribed a panoramic radiograph. What is that?

A panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

Why do I need both types of X-rays?

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which other X-rays cannot show. On the other hand, you might need close-up X-rays to show a highly detailed image of a smaller area, making it easier for your dentist to see decay between your teeth. X-rays are not prescribed indiscriminately. Your dentist has a need for the different information that each X-ray can provide to formulate a diagnosis.

Should I be concerned about exposure to radiation?

Dental X-rays require exposure to very low levels of radiation, which makes the risk of potentially harmful effects very small. All health care providers are sensitive to patients' concerns about exposure to radiation. Your dentist has been trained to prescribe X-rays when they are appropriate and to tailor radiographic schedules to each patient's individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, your dentist knows which techniques, procedures and X-ray films can minimize your exposure to radiation.

Sedation allows dentists to create a state of relaxation and thus manage the fear and pain patients may experience during dental procedures. There are several different types of sedation in dentistry.

Local anesthesia is administered by injecting medication into tissue or by applying a medication topically to an area to eliminate sensation.

Minimal sedation is used most frequently in dentistry and usually involves taking medications orally. All bodily functions remain normal and the person is able to breathe on his or her own. The patient may respond normally to verbal commands and may experience some degree of amnesia about what happened during their dental appointment.

Moderate sedation is achieved by using medications that can be taken orally or intravenously (IV). Patients who undergo moderate sedation are awake and respond to touch and/or verbal commands. All bodily functions remain normal, and the patient does not need assistance breathing.

Deep sedation can be achieved by injecting medication, giving oral medications, and in combination with gases. Patients who are deeply sedated are not easily awakened but may respond to some stimulation. Patients may need some breathing assistance at deeper levels. 

Patients who are minimally sedated may take a recommended dosage of a single oral sedative medication prior to their dental appointment. Moderately sedated patients generally have taken a medication or a combination of medications while in the dental office. The medication causes the patient to become sleepy and feel relaxed. The dentist will give the patient specific instructions and you will be asked to avoid driving while you are on the medications.

Minimal and moderate sedation reduce anxiety that is typically associated with dentistry and allow the patient to relax. The amnesia usually associated with these methods also is a plus for many patients. However, sedation in dentistry does have disadvantages. Minimal sedation usually cannot be administered to patients with respiratory problems like emphysema or asthma or those who are sensitive to the class of drugs used for minimal sedation. 

With moderate sedation, the level of sedation cannot be adjusted without administering additional medications and sensitivity to certain medications can be a factor. Also, the patient should be prepared for supervision after the dental visit until the effects of the medications have passed. This applies to sedation administered both orally and intravenously.

With intravenous deep sedation, a needle has to be put in the arm or hand, so it may not be the most relaxing method if you are afraid of needles. It is possible to experience complications, such as hematoma (a localized swelling filled with blood) at the site where the needle entered. In addition, recovery from IV-administered or oral medications may not be complete at the end of dental treatment, so the patient should be prepared to be escorted home by a responsible adult.

Sedation is safe although you should talk to your dentist and/or the specialist and gain a thorough understanding of how it works and what is expected of you before the procedure. Your medical history will be examined comprehensively to ensure safe sedation and your vital signs will be monitored throughout the entire procedure to confirm that your blood pressure, pulse rate, and blood oxygen levels are normal.

Dry mouth (xerostomia) is caused by a decrease in the amount of saliva in the mouth when the salivary glands do not work properly. The salivary glands help keep your mouth moist, which helps prevent tooth decay and other oral health problems.

Prescription and over-the-counter medications are the most common cause of dry mouth. In fact, more than 400 medications can contribute to mouth dryness. The most common troublemakers are antihypertensives, antidepressants, painkillers, tranquilizers, diuretics and antihistamines.

Dry mouth may be a sign of a serious health condition or may occur when a person is upset or experiences stress. It also can be caused by radiation therapy, chemotherapy, hormonal alterations, or diseases such as AIDS, diabetes or Sjögren's syndrome. Patients with Alzheimer's disease or those who suffer a stroke may experience dry mouth. Approximately 30 percent of persons over the age of 65 are affected by dry mouth.

Dry mouth can cause difficulty in tasting, chewing or swallowing. It also allows plaque to build up on your teeth faster, leading to a higher risk of cavities. In certain cases, a lack of moisture can make your tongue become very sensitive, causing a condition called burning mouth syndrome. Dry mouth can also lead to bad breath, ulceration or soreness of the mouth, gum disease and difficulty in wearing dentures.

Saliva helps wash away cavity-causing bacteria, provides enzymes to help digest food, protects teeth from decay by neutralizing harmful acids and keeps oral tissues healthy. Without saliva, you would lose your teeth much faster.

Your dentist can help find the causes of your dry mouth and treat the symptoms. Ask your dentist if you have difficulty swallowing or speaking, oral soreness or a dry throat.

Invisalign is a series of clear, removable teeth aligners that dentists use as an alternative to traditional metal dental braces. 

The most obvious advantage of the treatment is cosmetic: the aligners are completely transparent, therefore far more difficult to detect than traditional wire and bracket braces. This makes the method particularly popular among adults who want to straighten their teeth without the look of traditional metal braces. Due to the removable nature of the device, food can be consumed without the encumbrance of metallic braces.

Clinically, aligners avoid many of the side effects of traditional fixed appliances, for example the effects on the gums and supporting tissues. Patients "graduate" to a new set of aligners in their treatment series approximately every two weeks. The aligners give less force per week and less pain than do traditional metal braces.
 
Aligners should be removed to eat, drink, to clean the teeth, or to have them checked by the clinician. Because you remove the aligners, you are not limited to what you eat. Computerized treatment planning is compulsory as part of the Invisalign protocol. As with other forms of orthodontic treatments that incorporate a computerized plan, this allows the prospective patient to review the projected smile design, learn how long the treatment is likely to take, compare different plans, and make a more educated decision about whether or not to use Invisalign.

However, the product also has potential disadvantages: the very fact that the aligners are removable means they are not continually correcting the teeth. Unlike traditional fixed braces, they are largely dependent on a patient's habits and their consistency in wearing the aligners. The success of the Invisalign aligners is based on a patient's commitment to wear the aligners for a minimum of 20–22 hours per day, only removing them when they are eating, drinking, or brushing their teeth .  The aligners must be removed before eating, an advantage and disadvantage depending upon the person. They and the teeth should be cleaned before re-inserting them afterwards. Also, similar to traditional metal braces, aligners may cause a slight lisp at the beginning of treatment. This usually disappears as the patient becomes used to the treatment.

The treatment begins by taking dental impressions, x-rays and photographs of the patient's teeth. The impressions are put through a CT scan from which a computer creates a three-dimensional model. Technicians then individualize the teeth in the computer model and move them to their final position as prescribed by dentist. Custom software then simulates the movement of the teeth in stages. The dentist reviews the simulation, modifies or approves the treatment. Once approved, a plastic resin aligner is manufactured for each stage of the computer simulation and shipped to the dentist.

Average treatment time is about one year, again depending on the complexity of the treatment. Simple treatments (minor crowding, minor spacing) may be as short as twenty weeks. Although the aligners are removable, they must be worn at least 20 to 22 hours per day to avoid delaying the treatment process. If they are not worn consistently, treatment time will increase.

After the regular aligner or braces treatment is complete, retainers composed of a similar plastic material are usually required to be worn, at least at night.