You have only one chance to make a good first impression, and your smile is a big part of that initial impact.  Like it or not, your smile affects all aspects of your life: your own self-esteem, your relationship with family and friends, your career choices, your image.

A healthy and beautiful smile can improve your quality of life and even your job performance.  If you're not happy with your smile, it can affect your confidence, your personality and, likewise, your whole life. 

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask us how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening:  Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings:  Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers:  Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps):  A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Tooth Recontouring:  A process of changing the shape of teeth to improve their overall appearance.  When teeth are slightly crowded or uneven or appear too long, small adjustments can be made to correct these flaws.  Recontouring involves modifying the teeth by removing small amounts of enamel to create harmony and balance in the mouth.

The procedure is quick and painless (the enamel has no nerves), and is usually completed in just a few minutes.  This treatment has limitations and can only be used for minor changes.  Recontouring is often combined with bonding for more involved modifications of teeth.

Dental Implants:  Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics:  Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can gave you the Smile of a Lifetime!

Teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural teeth and is an ideal way to enhance the beauty of your smile.

What Makes Teeth Yellow or Stained?

The most common causes of yellow, grey or dull looking teeth are; normal aging, consumption of coffee, tea, colas, tobacco, the use of antibiotics such as tetracycline, excessive fluoride, trauma and nerve degeneration.

Safe, Effective and Inexpensive

Teeth whitening has been around for many years.  However, earlier versions often included overly strong chemicals that were difficult to handle.  In addition, the at-home treatment was often uncomfortable, cumbersome and only partially effective.

Because having whiter teeth has now become the number one esthetic concern of most patients, there are now a number of ways to whiten teeth.  Our office currently offers a true laser whitening treatment as well as an improved at-home whitening system.  In just one short visit, you can now enjoy the benefits of a whiter and more confident smile with “true” laser tooth whitening.

Diode Laser Tooth Whitening

The Diode Dental Laser is a device at the cutting edge of technology, designed for a wide variety of procedures, including whitening.  Diode Laser Tooth Whitening is achieved with a proprietary photo-activated whitening gel that is activated by the selective absorption characteristics of a specific true-laser wavelength of light.

This is one of the most advanced, widely-accepted and effective tooth whitening methods in current use.  It has transformed the appearance of thousands of patients.  Even for those whose teeth are deeply stained, yellowed or gray in color, Diode Laser Tooth Whitening offers outstanding results.

Best of all, the Diode Laser Whitening procedure is completed in just four (4) 30-second sessions, performed in one short visit.

Since teeth whitening only works on natural tooth enamel, it is important to evaluate the status of any old fillings, crowns, or other esthetic restorations prior to treatment.  Replacement of any inadequate restorations will be done after whitening, so they will match the newly whitened teeth.

Diode Laser Whitening vs. Traditional Non-Laser Whitening

Most dental offices and all spas and salons that offer “laser teeth whitening” do not, in fact, use an actual diode laser in the procedure.  The term “laser” has been loosely used to refer to bleaching systems that use a light as an activator.  These lights are actually non-laser plasma lights.  There is a significant difference in both the effectiveness and safety of these plasma lights, versus true diode laser activation.

Diode Laser

The wavelength output of the diode laser is synchronized to the proprietary whitening gel, which increases efficiency and minimizes the amount of energy required to produce maximum whitening.  This results in shortened treatment time and increases effectiveness, while eliminating the heating of teeth that can result in post-operative sensitivity.
 
Non-Laser Plasma Light  (Inaccurately referred to as a “laser” light)

Ordinary non-laser whitening systems require longer treatment times and higher energy output because of their inefficiencies.  Non-laser whitening devices use just a tiny percentage of the broad-spectrum light's energy.  The rest of the energy is wasted as heat and light, which is absorbed by the teeth and adjacent tissues, often resulting in intra-operative and post-operative sensitivity.

Is Teeth Whitening Effective for Everyone?

Everyone’s teeth respond differently to teeth whitening, but in almost all cases the results are dramatic.  An examination by Dr. Kenward or Dr. Mayoral will determine if you are a good candidate for whitening at the time of your free consultation.  The long-term results depend primarily on the individual.  Certain habits, such as the use of tobacco products, drinking a lot of coffee, tea and colas can work against the results.  Regular professional care can help maintain your natural whiteness for up to 2 years or more.

Post Operative Care Instruction

• Regular checks-ups and cleanings will help you to maintain your beautiful new smile, as well as keep your teeth and gums in healthy condition.
• Brush at least twice a day and floss regularly.  This drastically reduces plaque and tartar buildup and keeps surface staining to a minimum.
• To keep your smile bright and beautiful, avoid the consumption of products that cause staining.  Chewing tobacco and smoking are also major causes of staining.  To keep stains at a minimum, develop healthy oral habits.
• You may have a small degree of sensitivity.  This will disappear usually within a 24 hour period.  Avoid foods and beverages that are too hot or cold, and try to stay away from acidic foods like oranges, grapefruit, tomatoes and foods that contain these things.
• If you want to extend the period of your new whiter teeth, a “touch up” program by either laser whitening or home bleaching can be done once a year.

Ever wonder how those Hollywood movie stars get such dazzling smiles?  Porcelain veneers are the answer.

Porcelain veneers are thin (0.5mm), hand-sculpted facings of super hard dental porcelain that bond directly to the front surfaces of the teeth.  They are molded and shaped on a model made from an impression of the patient’s mouth.  Veneers are an ideal choice for improving your smile and have become increasingly popular due to their simplicity and versatility.

Veneers can be used to improve a wide variety of cosmetic dental problems.  They can whiten stained or discolored teeth, close gaps between teeth, "correct" a crooked smile without the need for braces, repair chips and imperfections and create a more attractive or youthful looking smile.

When bonded to the teeth, the ultra-thin porcelain veneers are virtually undetectable and highly resistant to coffee, tea, or even tobacco stains.  For strength and appearance, their resemblance to healthy, white tooth enamel is unsurpassed by other restorative options.

With proper care, porcelain veneers will brighten your smile for well over a decade.

Cosmetic bonding is an alternative to veneers, and can be used as a restorative procedure for teeth that are chipped, cracked, discolored or misarranged.

The tooth is prepared for the procedure by lightly etching the surface and applying a bonding liquid.  Once the liquid sets, a plastic resin is applied and sculpted into the desired shape by the dentist.  Once set, the resin is trimmed, smoothed and polished to a natural appearance.

Using resin instead of porcelain veneers for cosmetic dentistry saves time and money, however there are disadvantages with bonding.  Since the plastic resin used is not as strong as porcelain or your natural tooth enamel, it is more likely to stain, chip or break during normal use.  Resin can discolor over time, and does not have as much natural beauty as porcelain veneers.

Bonding typically lasts three to five years before need of repair.

Surprising but true: the major cause of tooth loss in adults is not decay – it’s periodontal (gum) disease.  And it’s completely painless right up to an advanced stage.

More than half of all people over age 18 have at least the early stage of periodontal disease.  After age 35 about three out of four adults are affected.

Some people seem to be more susceptible to gum disease than others.   Anything from pregnancy, systemic disease (like diabetes) and certain medications can contribute to its development.  Smoking increases the likelihood dramatically (and renders treatment less effective). 

Some unlucky folks are inherently more susceptible because of unique bacterial and chemical mixes in the mouth that encourage plaque.

Danger Signs of Gum Disease

• Do your gums bleed – at all – when you brush?
• Are your gums swollen, red and tender?
• Have any permanent teeth loosened?
• Are you distressed by persistent bad breath?
• Are your gums pulling away from your teeth?
• Do your teeth fit together differently when you bite?

The results of gum disease aren’t pretty.  Early stages show up as persistent bad breath and red, swollen gums.  Eventually tooth loss is inevitable.

But there is good news.  Once you’ve been diagnosed, your dentist can start you on a treatment program that involves mechanical removal of plaque and smoothing the root surface of teeth so gum tissue has a chance to reattach.  As co-therapist, your dentist will depend on you to continue the work at home.  It’s critical to the success of your treatment that you:

1) Brush and floss twice a day.

2) Come in regularly.  Only a hygienist can get your teeth their cleanest.

3) Maintain a healthy diet.

Periodontal disease can be treated at every stage.  If you notice any signs of gum problems, call our office for a periodontal exam.  Together you can beat the statistics and have a good chance of never having to wear dentures.

We often see patients, who for various reasons, haven’t been to the dentist for a cleaning and check-up in a while.  Many of these patients have built up a larger than usual accumulation of plaque and tartar on the teeth since their last professional cleaning.  These bacterial deposits on the teeth almost always result in puffy, inflamed and bleeding gums; a condition we call gingival inflammation.  Gum pockets may also begin to form next to the teeth as a result of this inflammation.

When this condition occurs, the American Dental Association recommends that the patient receive as treatment a Deep Cleaning or Gross Scaling, also sometimes referred to as a Full-Mouth Debridement.

During the debridement procedure, large deposits of tartar are removed, gum pockets are measured and recorded, and home care is reviewed with the patient.  The hygienist may use special medicines to lower the bacterial population in your mouth.  This is the first step in diagnosing and treating gum disease and bringing your gums back to a healthy state.

Following the gross scaling appointment, the patient is seen again by the hygienist in two weeks to evaluate the response of the gums and gum pockets to the treatment.  During this visit, the gum pockets are measured and recorded again, and the overall health of the gums is evaluated.  If at this point the pockets have returned to normal and the inflammation has improved, a regular cleaning or Prophylaxis may be performed.  Any small remaining deposits on the teeth will then be removed and the teeth will be polished.

If any gum pockets greater than 3mm remain, your hygienist and your dentist will decide the best course of action to take in order to restore the health of your gums.

The keys to success of healthy gums are regular dental hygiene appointments and of course, regular brushing and flossing at home.

If you have any questions, please feel free to call us.  We’re here to help.

The number one cause of mortality in the United States since 1900 continues to be heart disease. Nearly 6 million people are hospitalized with cardiovascular disease in this country and 250,000 people die of heart attacks before they reach a hospital every year. Contributing factors such as excessive stress and pre-disposition due to genetics are familiar to most people. Another factor that has gotten more attention from the media in the last decade due to numerous studies is the link between cardiovascular disease and gum or periodontal disease.

Research has increasingly suggested that gum disease can be seen as a reliable indicator of pre-disposition to heart problems and disease. There is clear evidence that people with gum disease are more likely to suffer from coronary artery disease than those without gum disease. The media has alerted the public to this fact, since the early warning signs of heart disease maybe less obvious than those of gums problems. Periodontal disease is is also easier to prevent in the early stages.

Gums that are red and puffy and bleed upon brushing and flossing signal inflammation. This is an indication that the immune system is releasing white blood cells to resist the build up of bacteria. Proteolytic enzymes meant for the break-down of bacteria are released into the gums. As immune cells die off the bacteria tend to survive relatively unaffected and though these enzymes are targeting the bacteria, gum tissue breaks down instead. The gums then pull away from the teeth, creating open pockets that breed more bacteria. As this process continues, bone around the teeth will be re-absorbed until an advanced stage where tooth loss may occur. All this may actually happen without any symptoms at all including pain, which is why periodontal disease has been called "The Silent Epidemic."

During the stages of gum disease, bacteria and toxins from infected gums may access our bloodstream and travel to the heart. According to one theory, when the bacteria travels into the blood stream it attaches to fatty plaque in the coronary arteries, which are the blood vessels of the heart. In disease of the coronary arteries, the arterial walls thicken with the buildup of fatty proteins and clot formation results. When the normal blood flow is restricted by clotting, normal function of the heart is impaired, such as the intake of oxygen and nutrients. As heart function gradually diminishes, this may result in a diseased condition and eventually in heart attacks.

Another theory suggests that there is a relationship between the buildup of plaque on the arteries and the buildup of plaque on the teeth. While there are different types of plaque and the plaque on the arteries may not be the same as the plaque on the teeth, the latter may signal a pre-disposition to the former. The link here is inflammation, which causes both gum disease and an increased build up of arterial plaque.

Periodontal disease can also cause an aggravation of existing heart conditions. A well established link between the gums and heart disease has to do with endocarditis, a serious infection of the lining of the heart. There is a clear connection between bleeding in the mouth that creates an opportunity for bacteria to travel into the bloodstream. Normally this bacteria is eliminated from the blood stream promptly by the white blood cells. However some people have a predisposition for the bacteria to cause serious infection by latching on to the damaged heart tissue. It is therefore common practice to make certain that patients with this type of heart condition are medicated with antibiotics before dental procedures that may result in bleeding.

Since important factors that create a condition of gum disease are stress, diet and home hygiene practices, it is usually necessary to assess preventive care of both gum and heart disease in the context of other lifestyle factors. When someone doesn't brush and floss regularly, eats largely acidic foods like soda and refined pasta and may smoke and rarely exercise, the implications for heart disease are present as well. Patients who smoke are at risk for gum disease as well as heart disease, as are patients with diabetes. So apart from these related factors, how clear is the connection between periodontal disease and heart disease? Evidence from the many studies involved have factored in these various components so that the data has not been obscured by them and the conclusions have been straightforward as to a definite link in that gum disease alone is a powerful predictor of heart disease and stroke.

For this reason a dentist who find advanced stages of gum disease in patients who are over 45 and particularly those who smoke, may recommend a cardiovascular check-up, particularly if the patient is male. There is an index developed by researchers based on the presence of oral bacteria associated with gum disease as well as the amount of bone loss and pocketing and the number of missing, decayed or restored teeth. In studies that compared the dental-disease index to the history of cardiovascular disease, it was found that there was a significant link between the dental disease index and heart disease, unrelated to lifestyle and background factors such as smoking, age or education.

It may then be fair to say that the gums are a foundation for health and well being in your whole body and not just your mouth. Given the clear indicators present and the additional benefit of a lifetime of happy smiles and healthy teeth, the advantage of regular check-ups and other preventive care for teeth and gums is clear.

Pregnant women who have gum disease run a higher risk of developing gestational diabetes than pregnant women who have healthy gums, says a study from the New York University College of Dentistry.

In gestational diabetes, pregnant women lose the ability to transport glucose. Although the condition usually goes away once the pregnancy ends, women who have suffered from gestational diabetes run an increased risk of developing type 2 diabetes later in life.

Ethnic groups most at risk for gestational diabetes are Asians, Hispanics, and Native Americans.

The year-long study, which NYU conducted in conjunction with the Faculty of Dental Sciences at the University of Peradeniya in Sri Lanka, followed on the heels of a 2008 study that concluded that pregnant women with periodontal (gum) disease were more likely to develop gestational diabetes than pregnant women with healthy gums.

In that study of 256 women at Bellevue Hospital Center in New York, the 22 women who developed gestational diabetes had notably higher levels of gum bacteria and inflammation than the others.

Affiliating the study with Sri Lankan scientists had the built-in advantage of tracking 190 pregnant women whose poverty and cultural taboos forbade smoking and alcohol consumption, two factors commonly thought to increase the chance of developing gestational diabetes.

One-third of the Sri Lankan women in the study said that their gums bled when they brushed their teeth, a telltale sign of gum disease. Dr. Ananda P. Dasanayake, Professor of Epidemiology and Health Promotion at NYU, reported that women with the highest incidences of gum bleeding also had the highest blood glucose levels.

Dr. Dasanayake, who published the study's findings in the April 2008 issue of Journal of Dental Research, said he expected the final data to show that the 20 to 30 Sri Lankan women who reported the heaviest gum bleeding went on to develop gestational diabetes.

The findings confirm what other research has shown: namely, that gum disease and heightened levels of bacteria in the mouth are strong predictors of the development of diabetes-gestational in some cases and type 2 in many others. The thinking is that because diabetes is an inflammatory condition, inflammation in the mouth could be a predictor of or contributory factor to its eventual onset.

Not yet convinced about keeping your healthy teeth?  Here's another reason.

People, who suffer from gum disease and also have a severe form of rheumatoid arthritis, reduced their arthritic pain, number of swollen joints and the degree of morning stiffness when they cured their dental problems.  Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland reported on this new intervention for arthritis in the Journal of Periodontology.

"It was exciting to find that if we eliminated the infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement on the signs and symptoms of that disease," said Nabil Bissada, D.D.S., chair of the department of periodontics at the dental school.

"It gives us a new intervention," adds Bissada.

This is not the first time that gum disease and rheumatoid arthritis have been linked.  According to another researcher in the study, Ali Askari, M.D., chair of the department of rheumatology at University Hospitals, "From way back, rheumatologists and other clinicians have been perplexed by the myth that gum disease may have a big role in causing systematic disease."

He added that historically teeth were pulled or antibiotics given for treatment of rheumatoid arthritis, which actually treated the periodontitis.  The patients got better.

Askari and Bissada are part of a team of researchers that studied 40 patients with moderate to severe periodontal disease and a severe form of rheumatoid arthritis.

The study results should prompt rheumatologists to encourage their patients to be aware of the link between periodontal disease and rheumatoid arthritis, says Askari.

Bissada notes that gum disease tends to be prevalent in rheumatoid arthritis patients.

Both inflammatory diseases share similarities in the progression of the disease over time.  In both diseases, the soft and hard tissues are destroyed from inflammation caused by toxins from bacterial infection.

One toxin from the inflamed areas called tumor neurosis factor-alpha (TNF-α) is a marker present in the blood when inflammation is present in the body.  TNF-α can initiate new infections or aggravate sites where inflammation already exists.

The study's participants were divided into four groups.  Two groups of patients were receiving a new group of anti-TNF-α drugs that block the production of TNF-α at inflamed rheumatoid arthritis sites. Two groups were not on this new medication.  Half of group of the participant on the medication and half not receiving the new drug received a standard nonsurgical form of periodontal treatment to clean and remove the infection from the bones and tissues in the gum areas.  The other half of those studied did not receive the treatment until after completion of the study.

After receiving treatment for the gum disease, improvement in rheumatoid arthritis symptoms was seen in patients who did and did not receive the anti-TNF-α medications, which block the production of TNF-α that aggravate or can cause inflammation.  Patients on the TNF- α inhibitors showed even greater improvements over those not receiving the drugs.

"I'm optimistic that someday the biologic agents that we use successfully in treatment of rheumatoid arthritis will lead to improvement of periodontitis and would be available for use and treatment of this perplexing problem," says Askari.

"Again we are seeing another link where good oral health improves the overall health of an individual," says Bissada, who adds that studies have linked gum disease to premature births, heart disease and diabetes.

Source: Case Western Reserve University

An important step in maintaining a healthy smile is to replace missing teeth.  When teeth are missing, the remaining ones can change position, drifting into the surrounding space.  Teeth that are out of position can damage soft tissues in the mouth, as well as cause chipping, fracturing and accelerated wear of the remaining teeth.

The change in bite that occurs when teeth are missing or have shifted position is often the cause of TemporoMandibular Joint (TMJ) disorder.  Chewing can become difficult or even painful.  Clenching, grinding and headaches are common symptoms.

The loss of front teeth can severely affect a person’s ability to speak clearly.  Even the shape of one’s face can change dramatically with the loss of even one tooth.

Fortunately, advancements in dental science and technology offer us several wonderful options for correcting tooth loss.  Dentists can now replace missing teeth with restorations that look and feel like your own natural teeth.

Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.

Dental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. In addition, implants can help preserve facial structure, preventing the bone deterioration which occurs when teeth are missing.

The implants themselves are tiny titanium posts that are placed into the jawbone where teeth are missing. The bone actually grows onto and fuses with the titanium, creating a strong foundation for artificial teeth.

Procedure

For most patients, the placement of dental implants involves two minor surgical procedures. First, the titanium implants are placed within your jawbone. The implants are completely beneath the surface of the gums, gradually bonding with the jawbone for three to six months following surgery. You should be able to wear temporary dentures, if necessary, and eat a moderately soft diet during this time.

After the implants have bonded to the jawbone, the second phase begins. The surgeon will uncover the tops of the implants and attach small healing collars to them, at gum surface level. After a few days, special impressions will be taken so that your dentist will be able to start making your new teeth.

The healing collars will then be replaced with posts or attachments, connected to the implants. The teeth replacements are then fitted to these posts or attachments. The entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life.

If, like many others, you feel implant dentistry is the choice for you, we ask our patients to undergo a dental/radiographic examination and health history. During these consultation visits, your specific needs and considerations will be addressed by your dentist, or by an Oral and Maxillofacial Surgeon referred by the practice. Your dental team will be happy to address any questions and concerns that you may have and will work with you very closely to help make your procedure a success.

It is estimated that between 40 and 90 million Americans feel they suffer at least some degree of halitosis, commonly known as bad breath.  Because our sense of smell has an incredible ability to adjust to odors, many people with halitosis aren’t even aware of their problem breath.  Up until recently even your dentist couldn’t do a whole lot about it other than tell you to, “floss and brush more.”

But now, thanks to a new technology (recently featured on the ABC News program 20/20), the real causes of bad breath can be identified and treated.  And the good news is that the treatment is simple, quick and relatively inexpensive.

Types of Bad Breath

Transitory, or short-term bad breath is caused by foods like garlic and onions and generally only lasts from 1 to 3 days.  No treatment is necessary.

About 10% of the time, persistent or chronic bad breath is actually caused by underlying medical conditions like diabetes, sinusitis or emphysema.  If the patient has an internal problem, he or she is referred to the proper specialist.

Many people assume that their bad breath is the result of severe periodontal problems and sometimes they are right.  But most of the time this isn’t true.  The pungent, “rotten egg” odor of chronic bad breath usually results when bacteria in the mouth and on the tongue cause the formation of what are called volatile sulphur compounds, or VSCs.

What About Mouthwash?

VSCs are the real cause of over 90% of bad breath cases and most over-the-counter mouthwashes will effectively mask these compounds for only a few hours, at best.  What gets rid of them is a series of carefully administered chlorine dioxide treatments.  Chlorine dioxide is a safe but very powerful agent that destroys the sulphur compounds in the mouth and eliminates bad breath in almost every case.

Although there is no permanent cure for most cases, long-term treatment for halitosis can be easy, convenient and effective.  Successful treatment can occur in as little as 3 or 4 visits.

Ask us how we can help you attain the fresh, clean breath you want and deserve.

Many people suffer from teeth grinding, headaches and tenderness of the jaw muscles and joints.  Although stress is often a factor, these symptoms are usually related to problems with the jaw muscles and the jaw, or TM (TemporoMandibular) Joint.

TM Joint disorders are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.   No one treatment can resolve TMJ disorders completely and treatment takes time to be effective.  Your dentist can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons.  You might clench or grind your teeth, tightening your jaw muscles and stressing your TM Joint.  Or, you may have a damaged jaw joint due to injury or disease.   Whatever the cause, the results may include excessive tooth wear, clicking or grinding noises in the TM Joint, as well as pain or difficulty in opening or closing one’s mouth.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch, or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat or yawn?
• Have you ever injured your neck, head or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken or worn?

The more times you answered "yes", the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they're treated.

Treatment

There are various treatment options that dentists can utilize to improve the harmony and function of your jaw.  Once an evaluation confirms a diagnosis of TM Joint disorder, your doctor will determine the proper course of treatment.  It is important to note that treatment always works best with a team approach of self-care as well as professional care.

Only a generation ago, it was routine for dentists to diagnose as many as a half dozen cavities or more in a single check-up visit for children and young adults.  Nowadays, perfect checkups are a common occurrence.  What happened?

Certainly dentistry is doing a better job of educating patients on how to better take care of their teeth and gums.  Protective treatments such as sealants have greatly contributed to the prevention of tooth decay.  But of all the marvelous advancements in the field of dentistry in the last 50 years, none have matched the impact of a gift from Mother Nature – Fluoride.

What is Fluoride and How Does It Reduce Tooth Decay?

Fluoride is a naturally occurring element that prevents tooth decay from within (systemically) when ingested during tooth development and on the surface (topically) when applied to erupted teeth.

Systemic fluorides taken regularly during the time when teeth are developing (6 months to 16+ years of age) are deposited throughout the entire tooth surface and provide longer-lasting protection than those applied topically.  Sources of systemic fluorides include water, dietary fluoride supplements in the forms of tablets, drops or lozenges, and fluoride present in food and beverages.

Topical fluorides strengthen teeth already present in the mouth.  In this method of delivery, fluoride is absorbed into the surface of the teeth, making them more decay-resistant.  Topical fluorides include toothpastes, mouth rinses and professionally applied fluoride gels, foams and rinses.

Researchers have observed fluoride's decay preventive effects in three specific ways:

1) Fluoride makes tooth enamel harder and more resistant to the acid that causes tooth decay.

2) It reduces the ability of dental plaque organisms to produce acid.

3) Fluoride promotes the remineralization (repair) of tooth enamel in the early stages of tooth decay.

Is Water Fluoridation Safe?

Since the 1930s, hundreds of carefully conducted scientific studies have shown that water fluoridation, at the concentrations recommended for decay prevention, has no harmful effects.  Fluoridation of community water supplies is a valuable public health measure supported by the American Dental Association, the World Health Organization, the U.S. Public Health Service, the American Medical Association and the American Cancer Society.

Did You Know?

• Research shows that fluoride reduces cavities by up to 50 percent in children.

• As a direct result of water fluoridation and over-the-counter fluoride products, half of the children entering the first grade today have never had a single cavity, compared with 36 percent in 1980 and 28 percent in the early 1970s.

• People who drink optimally fluoridated water from birth have up to 40 percent fewer cavities over their lifetimes.

Do Adults Benefit From Fluoridation?

Fluoride benefits people of all ages in two ways.  Studies have clearly shown that topical fluoride can not only stop early decay, but can also make the enamel tooth surface more resistant to future acid attacks.  Additionally, systemic fluoride in saliva provides a supply of fluoride ions that can be absorbed into the tooth surface to prevent decay.

Does Bottled Water or Well Water Provide Fluoride Protection Against Decay?

The vast majority of bottled waters on the market do not contain optimal levels (0.7-1.2 ppm) of fluoride.  Additionally, reverse osmosis home treatment systems remove significant amounts of fluoride from the water supply.  Consumers on well water, or who use home water treatment systems should have their water tested to establish the fluoride level of the treated water.  Testing is available through local and state public health departments.  Private laboratories may also offer testing for fluoride levels in water.

What Types of Fluoride Products Are Available?

Dietary fluoride supplements are available only by prescription.  They are available in three forms: drops for infants aged six months and up, fruit-flavored lozenges or chewable tablets for children and adolescents.

There are a variety of topical fluoride rinses, gels and foams that are available either as office treatments, or by prescription.  Many over-the-counter products are useful, as well.  Your dentist or hygienist will be happy to discuss which of these products may be of benefit to you.

Used for well over a century, dental amalgam is a compound of silver, mercury and other metals mixed together in precise amounts.  While dental amalgam continues to be a commonly used restorative material, some have raised concerns because of its mercury content.  Although mercury by itself is classified as a toxic material, the mercury in amalgam chemically combines with other metals to render it stable and safe for use in filling and restoring teeth.

Extensive long-term research in the United States as well as internationally, has shown time and time again that amalgam fillings are safe.  Although allergies to dental amalgam are possible, fewer than 100 cases have ever been reported.  Patients should feel very secure that the many organizations responsible for protecting the public's health have confirmed the safety of silver fillings. Those organizations include the World Health Organization, the United States Public Health Service, the National Institutes of Health and the Food and Drug Administration.

Despite its safety and reliability, there are nevertheless some drawbacks to the use of amalgam fillings.  Metal conducts temperature very well and short-term sensitivity to hot and cold temperatures after the filling is placed is common.  The mechanical properties of silver fillings usually require that more tooth structure be removed to allow placement of the filling than for composites.  In some cases, this can eventually result in stress fractures of the supporting tooth, necessitating a more extensive restoration such as an onlay or crown.  And lastly, the silver-colored filling is not as esthetically pleasing as one that is tooth-colored, especially when the restored tooth is near the front of the mouth, visible when the patient laughs or speaks.

Only a generation ago, the dental profession focused most of its attention on the restoration and replacement of broken, decayed or missing teeth.  While this is still an important aspect of dental practice, much more time and effort is now spent on the prevention of these maladies.  One of modern dentistry’s strongest weapons in the fight against tooth decay is occlusal sealants.

What Are Sealants?

Sealants are a safe and painless way of protecting your children's teeth from dental decay.  A sealant is a protective plastic coating, which is applied to the biting surfaces of the back teeth.  The sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves of the teeth and causing decay.

Sealants are usually applied to the back teeth - the molars and premolars - as these are the teeth that have the pits and fissures on their biting surfaces.  Your dentist will advise you which teeth should be sealed after they have been examined.  Some teeth naturally form with deep grooves, which will need to be sealed, others with shallow ones, which will not need sealing.

What Is Involved?

The process is usually quick and straightforward, taking only a few minutes per tooth.  The tooth is thoroughly cleaned, prepared with a special solution, and dried.  The liquid sealant is then applied and allowed to set hard by shining an activating light onto it.  The procedure is totally pain free, and the teeth do not feel any different afterwards.

When Should This Be Done?

Sealants are often applied as soon as the permanent teeth start to come through.  This is usually between 6 and 7 years of age.  The rest are usually sealed as soon as they appear which can be any time between 11 and 21 years of age.  Sealants last for many years, but your dentist will want to check them regularly to make sure that the seal is still intact.  They can wear over time, and sometimes it is necessary to add or replace some sealant to be sure that no decay can start underneath them.

How Much Does It Cost?

At less than one-fourth the cost of a single small filling, sealants are an excellent value in preventive care.  Combined with good oral hygiene, dental fluorides and regular professional cleanings, sealants can help to insure that no-cavity check-up.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

How to Brush Your Teeth

Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath.

Rotarty electric toothbrushes like the Rotadent are also recommended.  They are easy to use and can remove plaque extremely well.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, moving slowly over all surfaces of all teeth.

How to Floss

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Don't Forget to Rinse

It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  There are several fine products such as Tooth and Gum Tonic and Listerine that reduce bacteria in the mouth, condition soft tissues and freshen the breath.

If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Murphy’s Law of Dentistry states that the likelihood of a dental emergency increases dramatically on weekends, holidays and while away on vacation.  But with a little knowledge and a bit of preparation, most dental patients can manage these little disasters with minimum panic and maximum chance for a successful outcome.

Avulsed Teeth

When a tooth is knocked out you should immediately call your dentist for an emergency appointment and attempt to find the tooth.  If it’s a permanent tooth, gently rinse it with plain water, but do not scrub the tooth to remove dirt or debris.  Don’t attempt to replace the tooth into the socket.  This could cause further damage.

The best place to keep the tooth is in the mouth, between the cheek and gum, to keep it moist.  But if that's not possible, wrap the tooth in a clean cloth or gauze and immerse in milk.  Most importantly, get to the dentist as soon as possible.  If it is within 30 minutes of the injury, it may be possible to save the tooth.

Extruded Teeth

If the tooth is pushed out of place (inward or outward), it should be gently pushed back to its normal position with very light finger pressure.  Do not force the tooth into the socket. Hold the tooth in place with a moist tissue or gauze.  Again, it is vital that a dentist see the injured individual within 30 minutes.

If You Lose a Filling

The main concern here is pain.  Often there is none, but you can generally expect some mild to moderate temperature sensitivity as long as the tooth remains open.  If you aren't in any pain, simply keep the area clean and see your dentist as soon as you can.

If it hurts, an over-the-counter temporary filling/pain reliever such as Dentemp O.S. may be applied into the cavity.  Use the enclosed applicator and follow the directions carefully.  This should minimize the pain until you can get to a dentist.

Never put an aspirin on your tooth or gum.  Aspirin is an acid and can burn the tissue.

If a Cap or a Crown Falls Off

Coat the inside of the cap or crown with petroleum jelly or Dentemp O.S. and gently place it back on the tooth.  See your dentist as soon as you can.

If Wires on Braces Break

Ideally, cover the sharp end of the broken wire with a small piece of soft dental wax.  Your dentist or orthodontist can provide this material for you.  If you don't have any dental wax, try a little ball of warm candle wax.  In a pinch, you can use a little chunk of pre-chewed sugarless gum.  Any port in a storm.

Injuries to the Soft Tissues of the Mouth

Tears, puncture wounds and lacerations to the cheek, lips or tongue should be cleaned right away and the injured person taken to the emergency room for the necessary suturing and wound repair.  Bleeding from a tongue laceration can be reduced by pulling the tongue forward and using gauze to place pressure on the wound area until the bleeding stops.

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your over all health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any sings of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

You lost a filling, but it doesn’t hurt right now.  Or you brush your teeth and your gums bleed a little.  You tell yourself, “It’s no big deal.  Besides, I’ll get around to seeing a dentist…next week…after the car is fixed.”

If this sounds a little like you or someone you know, then we would like to give you a little free advice: prevention is the key to health and happiness when it comes to safeguarding one of your most unique personal assets – your smile.

We know when times are tough and dollars are scarce that dental problems often windup on the back burner.  But we cling to the idea of preventive dentistry not just because we value your dental health, but because any way you look at it, preventive dentistry is less expensive.

Stop and think about these facts for a moment:

•  It costs the average dental patient less money to have his or her teeth checked and cleaned than it does for the same patient to have his or her hair cut each year.

•  The real cost of even an expensive and elaborate dental procedure such as a crown is only 20 cents per day over the average lifetime of the crown (15 years).

•  By age 65 most Americans have lost some or all of their teeth and have to wear dentures.  Yet by age 65 most dental hygienists have all of their teeth.  Do they know something the rest of us don’t?

It will always cost you less to fix a problem now than it will later.  Of course you can gamble and possibly make the problem irreparable.

In our practice the patients with the best track records are always the ones who take an active aggressive interest in their own dental health.  On our side we instruct patients in the best home preventive techniques, encourage regular professional cleanings and check-ups and restore and repair problems with the best materials and techniques so that any dental work will be a long term valuable investment to our patients.

If you have current problems or concerns we hope to be of service to you in the near future.  Whether you come to us or not, make sure to treat any dental problems as they occur while they are still small.  In that way you can prevent unnecessary pain and inconvenience.

And in the long run your pocketbook will be healthier too!

We’ve been asked that question occasionally when a patient’s company switches to an HMO/PPO plan.  We could give you a wishy-washy, sugarcoated answer – some dentists do.  But we think our patients deserve the real answer.

Every dentist is solicited by three or four insurance companies each month to join their plan.  Contrary to popular belief there is no quality control or screening process, even though it sounds like you will be joining an elite family of dentists.  The “elite” are simply – whoever signs up.  “Preferred Provider” is an insurance industry term; it has nothing to do with a dentist’s skills, knowledge or experience.

The Free Lunch

The promotional material we get from these multi-billion dollar insurance companies is very appealing.  It appears everyone wins in this deal: the patients now get FREE (or greatly reduced) cleanings, x-rays, exams and perhaps fillings.  Even the major treatment is much cheaper.  They’re ecstatic!  Your employer has much cheaper dental insurance premiums to pay each month, they’re ecstatic!  If you have been following the profits of the HMO/PPO industry you know they are making money hand over fist.  The insurance executives are the most highly paid in the business world.  So we know they’re ecstatic too.

This must be the mystical free lunch at last.  Unfortunately, someone has to absorb the costs of all this free or cheap treatment.  You guessed it – it’s the HMO/PPO dentist.

Now, you ask, “why would anyone work harder for less money?”

Well my friends, that’s the $64 question.  Let’s look at why anyone would do this.  The insurance industry dazzles dentists with promises of wealth, endless patients and busy practices.  Then they add, “Oh, did we forget to mention that you have to give away many services for free and cut the rest of your fees by 30- 40%?  But don’t worry about that,” they point out, “because you will have two to four times as many patients to try and see in order to make up for the lost revenue.  You’ll just have to work faster.”

OK, so that’s the dentist’s complaint.  What about you, the patient?  How does this affect you?  Here’s how:

Understand that an HMO/PPO dentist is paid 6 – 10 dollars per month per family or patient weather or not that patient ever shows up in your office.   Now if that patient does want to come in and get their teeth cleaned or a filling done (which the dentist is by contract required to do for FREE) do you think that the dentist (or anyone else in the practice) actually wants that patient to come in?  Of course not.  He doesn’t make any money when the patient comes in.  Does it make any sense to pay someone not to perform their craft or practice their profession?

Now do you see why it might be difficult for you to be seen for a routine visit or in an emergency in one of these practices?  The biggest complaint from patients about HMO/PPO practices is they can’t get an appointment and they never see the same dentist twice.  Is there any mystery now as to why?

Too Many Cut Corners

In our opinion, to be an HMO/PPO dentist we would have to sacrifice quality, service and the personal attention we give to our patients.  In short, we would have to give up our ethical and clinical standards.  We won’t do that and it’s an easy choice to make.  We won’t practice on roller skates, sacrificing quality for the sake of quantity.  As an HMO practice we would have to use cheap labs, cheap materials, work faster and cut corners.  Some of the corner cutting would come in the area of sterilization, by not providing as many disposables as we do now.  Our patients are too important for us to do that to them.

The medical profession has all but lost the war to the insurance industry.  The story has been well documented in a recent TIME magazine cover story.  The dental profession still offers you the freedom to choose your own dentist and level of care.  As long as that continues we will endeavor to provide you with the best that dentistry has to offer.  You deserve nothing less.

Sincerely,

Scott F. Kenward, DMD
Osvaldo Z. Mayoral, DMD

“Your fee for this is over what my insurance company calls ‘usual and customary’, does that mean you’re overcharging me?

That’s a good question, one we’re happy to answer.

Each separate insurance company has its own “usual and customary” fees for all dental procedures for a certain geographical region.  When our state dental association asks these companies for data to see how the numbers were arrived at and which dentists (if any) were surveyed, they are told categorically by every insurance company that this is confidential, internal information and they will not reveal it.

Our answer is, “If this survey was done fairly and truly represents the fees in a given area, then why can’t we see how it was done?”

The fact is that different companies have different usual and customary fees for the same area.  If the calculations were done correctly they should all have the same fees.  But they don’t.

Because the insurance companies establish artificially low fees in an effort to avoid paying out, animosity can be created between the dentist and patient.  Any time an insurance company says they want to be your friend, grab your wallet to see if it’s still there!

What is Dental Insurance?

Dental insurance is nothing more than a contract between the employer and the insurance company to partially pay for certain services.  It exists to help in covering the costs; it was never intended to cover all costs.

There are deductibles, some services get paid at 50% or 85% and some aren’t covered at all.

The type of insurance coverage your employer is willing to buy is determined by how much the employer is willing to pay for.  The employer selects as many or as few benefits as they want.  The higher the premium paid by the employer – the higher is your usual and customary fee.

How Are Our Fees Set?

Our fees are set by the actual cost of doing business in this particular office.  Costs vary from office to office depending on the quality of service, quality of materials used, lab costs and many other factors.

The truth is that you would be surprised at the lengths we go to in order to keep costs down while maintaining a high level of service.  We have never tried to be a dental office for everyone.  We also have never tried to be the cheapest, because there is a standard of quality we will not go below.

For example, we will not compromise on sterilization because it’s just too important for our patients.  Likewise, we will not use inferior materials for our dental restorations just to “save money”.  The truth is, you never save money this way, because the cheaper materials don’t last as long and the patient ends up back in your chair in a few years complaining that his or her crown has failed.

We won’t go that route.  And we wanted you to know why.

Sincerely,

Scott F. Kenward, DMD
Osvaldo Z. Mayoral, DMD