If you have ever had tooth decay, you should know:

1. Tooth decay is one of the most common of all diseases, second only to the common cold.
2. Tooth decay affects more than one-fourth of U.S. children ages 2 to 5, half of those ages 12 to 15, and more than 90 percent of U.S. adults over age 40.
3. Tooth decay causes pain, suffering and disability for millions of Americans each year — even more disturbing, tooth decay is preventable.
4. If it is not treated, in extreme and rare cases tooth decay can be deadly. Infection in an upper back tooth can spread to the sinus behind the eye, from which it can enter the brain and cause death.
5. Tooth decay is an infectious process caused by acid-producing bacteria. Your risk for decay can be assessed in our office with a simple test for specific bacterial activity.
6. Three factors are necessary for tooth decay to occur: susceptible teeth, acid-producing bacteria and a diet rich in sugars and refined carbohydrates.
7. Babies are not born with decay-causing bacteria in their mouths; the bacteria are transmitted through saliva from mothers, caregivers, or family members.
8. Fluoride incorporated into the tooth structure protects teeth against decay by making the enamel more resistant to acid attack.
9. Sealants, which close up the nooks and crannies in newly erupted teeth, stop bacterial collection where a toothbrush can't reach. Teeth with sealants have been shown to remain 99 percent cavity-free over six years.
10. Restricting sugar intake is important in preventing tooth decay. Your total sugar intake should be less than 50 grams a day (about ten teaspoons) including sugars in other foods. A can of soda may have six teaspoons of sugar — or more!

Contact us today to schedule an appointment to discuss your questions about tooth decay. You can learn more by reading the Dear Doctor magazine article “Tooth Decay – The World's Oldest & Most Widespread Disease.”

Finally: Your braces are off! Break out the taffy, bubble gum, corn on the cob... and... whoa!!... the retainer?

Yes, the retainer. As the name implies, this simple device will ensure that your pearly whites remain in the new, desired position you've worked so diligently to achieve. Here's why:

The same physiological properties that allow your teeth to move when you're wearing braces are always at work — braces simply direct that movability in controlled ways. Teeth are not set into your jaw bone like posts fixed in concrete; rather, the root portion is attached to the bone by elastic periodontal (peri – around; odont – tooth) ligaments that permit micromovement of teeth all the time. The periodontal tissues are living; therefore, they are always changing and “remodeling” (just as hair grows, skin peels, etc.) When a light orthodontic force is placed on a tooth the following processes occur:

• on the pulling or tension side, the periodontal ligament will activate bone-forming cells (osteoblasts) to deposit new bone to fill in the area from where the tooth was previously, and
• on the pressure side, the periodontal ligament will activate bone-resorbing cells (osteoclasts) to remove bone allowing the tooth to move in that direction.

Visualize drawing your hand forward through water: The water parts in front of your hand and fills in behind it.

Once your teeth are in their desired position and your braces are removed, your teeth will tend to return to their old position if they are not stabilized or “retained” in their new one long enough for the bone and ligament to re-form and mature around them. This can take several months. In addition, orthodontic treatment stretches collagen fibers in gum tissues to some extent, contributing to the forces that tend to shift teeth back in the direction from which they came. The gum tissues will continue to exert this pressure until these tissues remodel. This can take longer than the bone and ligament stabilization, as collagen cells reorganize at a much slower rate.

Types of Retainers

The type of retainer you will use, how frequently and for how long will depend on your unique situation. The most familiar type of retainer is removable and one you may not have to wear all the time, at least after the first couple of months. In cases where the retainer is going to be needed for a long-term period, a common alternative is to have thin retainer wires bonded to the inside surfaces of the front teeth so they don't show.

Considering how much time, effort, and sometimes expense is required in improving your smile, the retainer is your assurance that it was all well spent. Even people getting a comparatively simple pedicure/manicure don't leave the salon without letting the polish dry!

If you would like more information about orthodontics and retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.”

Have you heard of palatal expanders? If your child needs orthodontic work, then you ought to hear about them! These small appliances offer plenty of advantages to kids whose smiles, due to a variety of problems, may need some help. Here are five things you should know:

1. Palatal expanders are small orthodontic appliances that fit inside the mouth.

Custom-fabricated for each child, these devices are placed near the roof of the mouth, in between the two rows of upper teeth. They consist of two small metal brackets with a tensioning system that can be adjusted by a tiny key. Not everyone needs one, but they can really benefit kids with certain orthodontic conditions.

2. Palatal expanders take advantage of a child's natural growth processes.

That's part of the reason they work so well. Since the bones of a child's upper jaw don't fuse together until sometime after puberty, it's relatively easy to move them apart before that time. The palatal expander applies gentle pressure to gradually move the left and right halves of the upper jaw apart, over a period of a few months. Then it's left on several weeks longer, allowing new bone to fill in and stabilize the expansion.

3. Palatal expanders are helpful in treating a variety of orthodontic problems.

Crowding — that is, not having enough space in the jaw to accommodate all of the teeth — is one major issue. A related issue is impacted teeth: These are teeth that are blocked from coming in (erupting) by other teeth or jaw structures. A third issue is crossbite: That's when the back top teeth come down to bite inside, rather than outside, the bottom teeth. Gaining additional space in the upper jaw can help relieve all of these problems.

4. Palatal expanders can eliminate the need for tooth extraction.

Once upon a time, extraction was the only way to solve these problems. However it's an invasive (and potentially complex) procedure. A palatal expander can often provide the same — or better — results, via a noninvasive method.

5. Palatal expanders typically shorten overall orthodontic treatment time.

They're generally worn for a total of three to six months, but they can considerably shorten a child's overall orthodontic treatment time. Plus, they're invisible — a big plus to image-conscious teens. Could they benefit your child?

If you have questions about palatal expanders, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Palatal Expanders” and “The Magic of Orthodontics.”

Perhaps you've heard about dental implant surgery — or maybe you've been told you are a candidate for the procedure. You may already know that today, implants are the “gold standard” of tooth replacement options. It's no wonder why: They have a documented success rate of over 95%, and can last a lifetime. But if you're put off by the thought of implant surgery, then it may be reassuring to learn the following five facts.

1. The entire implant process is planned before surgery is done.

This usually involves taking radiographs (X-rays), and sometimes CT scans, as precision guides to implant placement. Before the minor surgical procedure begins, we have already examined the bite and the bone structure, and determined exactly where the implant will fit in. There should be no surprises during the surgery — which is only one phase of the implant process.

2. Implant surgery uses the highest-quality materials and state-of-the-art techniques.

The implant itself is fabricated of commercially pure titanium, or a titanium alloy. This metal has a unique property — it's capable of osseo-integration, which means it can actually fuse with bone. During the implant procedure, the bone is handled with utmost care: it's gently prepared to receive the implant, and cooled with water to prevent tissue damage. If you don't have enough of your own bone tissue to support an implant, it has even become routine to restore bone with grafting techniques.

3. The surgical procedure itself is generally painless.

Almost all implants are placed using local anesthesia — typically, a numbing shot. If you're especially anxious about the procedure, it's possible to be given sedatives or anti-anxiety medications beforehand. Of course, we will make sure you don't feel any pain before we begin! Some mild vibration is generally all that you may experience during the procedure, but it's very rarely a cause for concern.

4. There is little discomfort following the procedure.

On the day of surgery and perhaps the day after, a non-steroidal anti-inflammatory medication (NSAID) of the aspirin or ibuprofen family is usually all that's needed to control minor discomfort. You may also be given a prescription for antibiotics and/or a mouth rinse to aid healing.

5. The result: Natural-looking teeth that can last a lifetime.

Implants have become dentistry's premier option for replacing missing teeth. Their placement involves minimally-invasive techniques, and has a success rate higher than any other tooth replacement system. And, given proper care, they can last for the rest of your life. Could you ask for more?

If you have questions about dental implant surgery, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Dental Implants.”

If you have noticed that one or more of your teeth have lost some of the surrounding pink gum tissue so that part of the root surface is now uncovered, you are experiencing gum recession. It's a very common problem — in fact millions of Americans have some degree of gum recession. Fortunately, there are very effective methods of treating it.

Gum recession can be unsightly, but there are more serious concerns. Tooth root surfaces exposed by gum recession can become sensitive to temperature and pressure changes and can decay or wear away. In very severe cases, teeth can actually be lost. That's because gum or “gingival” tissue as it is medically known is supposed to encircle and firmly attach to the necks of the teeth and the underlying bone. This forms a protective barrier that is resistant to the abrasive action of foods during eating, biting and chewing.

Gum tissue is largely made of a fibrous protein called collagen, covered by a layer of another very resilient protein called keratin (nails and hair are also made of it). Yet it is still possible for this tough tissue to lose its grip on the teeth it protects. Here are some of the ways this can happen:

• Ineffective oral hygiene — inadequate removal of dental bacterial plaque (biofilm) with daily brushing and flossing.
• Excessive brushing (and flossing) — too hard, or for too long.
• Habits — holding foreign objects between the teeth, such as bobby-pins, nails etc that press on the gum tissues.
• Oral appliances and ornaments — badly fitting removable partial dentures and orthodontic appliances (braces), or tongue bolts and oral piercings can apply pressure to the gums.

Treatment will depend in part on whether the recession is stable or progressive. For example, an older person might have a few areas of gum recession but there are still adequate zones of attached protective gum tissue and the exposed tooth root surfaces are healthy. In this case, there may not be reason to do anything but monitor the situation. On the other hand, a teenager with a history of fairly rapid gum recession (over a period of months) usually requires immediate treatment. The dental specialty of periodontics (“peri” – around; “odont” – tooth) has developed predictable surgical techniques to deal with recession.

Free Gingival Grafting, for example, involves taking a very thin layer of skin from the palate, where the tissue is identical to gum tissue, and transplanting it to the area where gum has been lost. Both sites will heal in a very predictable and uneventful manner. The free gingival graft is so-called because it is “freed” from the donor (original) site completely. It is crucial to make sure individuals with gum recession correct faulty hygiene habits prior to this (or any) treatment so that they will not jeopardize their future results.

If you are concerned about gum recession, please contact us or schedule an appointment for a consultation. You can also learn more about gum recession and gingival grafting by reading the Dear Doctor magazine article “Periodontal Plastic Surgery.”

Years ago, if you hadn't received braces by the time you finished high school odds are you would never pursue orthodontic treatment. Most adults wouldn't have even dreamed of wearing braces! Thankfully, today, clear aligners have quickly become a popular alternative for adults who have mild to moderate crowding or spacing of teeth.

Unlike traditional orthodontic “braces” in which small (metal) brackets are attached to the teeth, clear aligners use a sequence of individual, clear, removable “trays” to straighten teeth. These trays completely cover each tooth and gradually move the teeth into new improved positions. Clear aligners can be used to realign mildly crowded or tipped teeth, to close small spaces between teeth and even treat elongated teeth.

Your clear aligners will be computer-generated based on current dental records. If you would like to find out if you are a candidate for orthodontic treatment using clear aligners, we will need a full set of records to properly assess your case starting with a thorough examination, taking radiographs (x-rays) of your teeth, jaws and skull, as well as photos and impressions of your teeth that can be used to create models. If you have a good bite, which means that your back teeth fit together properly, clear aligners should be a viable treatment option for you. However, if your upper and lower jaws don't align properly, resulting in a severe overbite or underbite, you will more likely need traditional orthodontic braces to straighten your teeth and improve your bite.

Each patient presents unique dental challenges. Cases vary, but you can expect to have to wear the aligners all day except when eating, for an average of anywhere from six months to two years. But don't worry about what others might think — clear aligners are barely noticeable at all.

If you are ready to improve your smile with this state-of-the-art orthodontic treatment, call our office today. To read more about clear orthodontic aligners, and to view photos that compare traditional orthodontics to clear alternatives, please read the article “Clear Orthodontic Aligners: An Alternative For Adult Orthodontics” in Dear Doctor magazine.

Oral cancer accounts for approximately 3% of cancers in men and 2% in women. That may not sound like a lot, but the disease often isn't detected until it has progressed to its later stages when it's harder to treat and the outlook for survival is significantly diminished.

The main areas where oral carcinomas (cancers) occur are:

• the tongue (most common location, particularly the sides and underneath)
• the lip (especially the lower one),
• the oral cavity (the mouth), and
• the pharynx (back of mouth and throat).

Risk Factors You Can't Control

Even if you can't change these risks, awareness helps raise your vigilance in order to catch potential problems early when treatment options and positive outcomes are greatest.

• Heredity
• Aging — More than 90% of all oral cancers occur in individuals over 40. However, the incidence among younger people has been on the uptick recently, perhaps related to lifestyle behaviors.
• Race — African Americans have a higher incidence of oral cancer than Caucasians.

Risk Factors You Can Address

• Smoking and chewing tobacco — Smokers are at five to nine times greater risk and snuff and tobacco chewers at about four times greater risk
• Alcohol — Moderate to heavy drinkers are at three to nine times greater risk; the higher the alcohol content, the greater the risk
• Chronic sun exposure — Often connected with lip cancers.
• Viral infections — Namely the human papilloma virus “HPV 16,” which has been linked to sexual transmission (oral sex) and cervical cancer in women.

One way you can address these risk factors is to have a diet rich in fruits/vegetables, which are high in antioxidants because they been found to have a protective effect against a variety of cancers, including oral.

As part of your routine oral hygiene, you should be closely monitoring any non-healing changes in your mouth (e.g., ulcers or sores, white or red patches on the tongue). And rest assured that as part of your regular check-ups, our office performs a comprehensive visual screening for signs of oral cancer.

If you would like more information about oral cancer prevention and detection, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Oral Cancer” and “Diet and Prevention of Oral Cancer.”

Sleeping disorders impact people in different ways. For some people, they may feel they do not have a problem — except for the fact that their sleeping partner complains about their snoring. For others, they may know they have a snoring issue because they constantly wake themselves up gasping for air. This is a dangerous condition known as Obstructive Sleep Apnea OSA (“a” – without; “pnea” – breath). If any of these scenarios sound like your experience, then you may have OSA or another type of Sleep Related Breathing Disorder (SRBD). However, before jumping to conclusions, you need to obtain a thorough examination from a primary-care physician who is trained in sleep medicine in conjunction with our office. We have received training in the diagnosis and treatment of sleep disorders. But the good news is that sleep apnea is a treatable condition.

As for your question, yes, there are many things we can do to treat your snoring after the cause of your problem is properly established. One helpful approach is through the use of a specially designed oral appliance that we custom make and fit to your mouth. It is easy to use during sleep. Once in place, it will keep your lower jaw in a forward position so that your tongue is held forward to stop blocking your upper airway (i.e. the back of your throat and area causing your snoring and hindering your breathing while you sleep). Another option is to use a Continuous Positive Airway Pressure (CPAP) machine. This specialized machine requires you to sleep with a mask that covers your mouth and/or nose. While you sleep, it delivers continuous pressure to your windpipe so that your tongue is forced away from your airway.

If your snoring is keeping you or your loved ones awake, we are a good place to start. Contact us today to discuss your questions about snoring or to schedule an appointment. You can also learn more about snoring and sleep disorders when you continue reading the Dear Doctor magazine article “Sleep Disorders & Dentistry.”