Over my years working as a dentist, I have found that many people have very similar questions, but generally do not want to ask.

Here, I will cover topics about dental health in general. With further knowledge, it is my hope that the community as a whole will lead happier, healthier lives.

Why Do I Need to Have a Professional Cleaning?
As you may already know, the recommendation is to brush teeth for two minutes twice a day, once in the morning and once at night. Unfortunately, some studies have suggested that on average, people do brush twice a day, but only for approximately 30 seconds each time.


Even if that were not the case, there are many little grooves and spaces on top of and between teeth that are hard to clean completely. As that bacteria sits, it begins to gather materials from the food to build. On average it takes about four days for the bacteria to harden, but once it does, that bacteria is extremely hard to remove with something soft like a toothbrush, especially because it likely built up somewhere the toothbrush already had a hard time reaching. That hardened bacteria is what is generally removed during a cleaning, as well as ensuring that everything is as healthy as can be.

What is a Good Way to Keep Teeth Clean?
Generally, I recommend using an electric toothbrush that has 2 key features. First, a timer that will signal when 30 seconds of brushing have passed. This will let you know to move from one side to another or from top to bottom. Spending 30 seconds in each quarter of the mouth will make ensure that brushing is evenly done, and done for the recommended 2 minutes. The other feature that I personally find important is a toothbrush that will shut off or light up when too much pressure is applied. It is very easy to push the brush into the teeth to try and scrub and get teeth cleaner. The problem is that over years of brushing this can cause the teeth to wear away. Similar to how old stone steps will wear down where people walk, teeth will begin to wear away near the gums if they are scrubbed too hard.

Aside from good brushing technique, I highly recommend flossing daily. When flossing, take a long segment of floss and wrap the majority around one finger then just hold the other end. Everytime you use the floss to clean between the teeth, unwind the floss once from the side that is holding all the floss and take up the excess with the other hand. This is done to make sure you never put the same piece of floss between teeth twice. Although the plastic floss holders are convenient and easy to use, reusing the same floss may clean the first few times, but eventually the bacteria is just being moved from one area to the next.

The last recommendation is the use of a water flosser. There are many brands and models, but the important part is that it can clean the front and back of the teeth by the gums where floss has a hard time reaching. If the other two steps are done well, the water flosser will have a minimal impact, but I always recommend it as a failsafe to make sure that all the bacteria has been taken off the teeth.

What is a Deep Cleaning? When is it Required?
Normally on a healthy tooth, there is very little space between a tooth, the gum surrounding it, and the bone supporting it. As bacteria builds up, the body’s immune system attacks the bacteria. However, in doing so, the immune system is not perfect and the bone is damage slightly. If this process continues, over time, the bone supporting a tooth will begin to drop down. The deeper this area becomes, the harder it gets to keep the area completely clean, usually leading to the process progressing faster and faster. Without any intervention, the bone can come so far away that the tooth becomes loose and hurts to chew on.

Once the bone is about 5 millimeters below the level of the gum we begin looking into deep cleaning. When we do a deep cleaning, we clean the areas below the gums. Because the outer protective layer on the tooth stops at the gums, these areas can often be very sensitive and thus, it may be required to numb the area to fully clean it out. Once the area is cleaned, we will have a follow up appointment to ensure that the gums are healing well and bacteria is not continuing to collect between the gums and the tooth.

After a deep cleaning, it is recommended to have regular cleanings every 3 months to ensure that the gum disease is under control.

What Actually Happens During a Dental Filling and When Do I Need One?
A dental filling is done when bacteria have gotten through the outer protective layer of a tooth. Some bacteria can be more aggressive than others, but ultimately, as they eat the sugars in the mouth, they produce acid that slowly break the tooth down. As the tooth starts to break down, it becomes darker and softer, and will show up on an x-ray as a dark spot. Once that dark spot gets completely through the protective layer of the tooth, it will no longer heal by keeping the area clean, and a dental filling is recommended.

When a filling is done, all the softened areas of tooth need to be removed. Those soft areas house bacteria , and so we need to ensure all bacteria have been removed and are not trapped underneath the filling. This is the part of the filling that people often visualize. A bur is used to cut away all infected and softened tooth, as water is sprayed over the area to keep the tooth from heating up. Much like cutting porcelain tiles, if there is not enough water used, the area can heat and it can cause the object being cut to break.

Once the tooth is cleaned out, the area is rinsed and lightly dried. If a white filling is placed, any amount of moisture can weaken the whole filling, so keeping the area dry is of utmost importance. With the area dry, a thin layer of a chemical is put down and activated. This chemical is designed to join the white filling material to the tooth. Next the filling is put into the tooth in layers. Each layer is packed and hardened before the next layer is placed to reduce the chances of an air pocket being trapped inside of the filling. Once the filling is nearing completion, the material is sculpted to have all the lumps and bumps that a normal tooth would have. After the last portion is hardened, the filling is polished to make sure there are no rough areas that could trap any bacteria, and to endure that it feels just like the tooth did originally.

What is the Difference Between White and Silver Fillings? Are Silver Fillings Dangerous?
There are a few traits that are important when looking at fillings. Generally, when discussing options with a patient, I look at the lifespan of the filling, how much force a filling can take, and how the filling looks.

On average a silver filling will last for about twelve years, and a white filling will last around seven years. This means that when people have a long history of having fillings fail, or have several very large fillings, the silver fillings have some merits.

With respect to force, it is not too surprising that the silver fillings are less likely to break from direct force. This means that in areas where people chew heavily, and on people who tend to chew on hard things (like cracking almonds or crab claws) the silver fillings again have some merits.

As for how a filling looks, it goes without saying that the white fillings look better by far. Anywhere that is easily seen calls for a white filling, and in circumstances where white fillings are not advised, other treatments aside from fillings are advised.

All this together means that in most cases for shallow fillings, and anywhere that is in the front teeth, white fillings will almost exclusively be used. However in some cases on back teeth, on the chewing surface, there are still conditions where a silver filling may be considered.

In recent years there has been growing concern about the mercury in silver fillings. It is true there is mercury in silver fillings. That mercury has been noted to slowly leak out of silver fillings, but most studies have stated that when it does leak out, it does so in a form that the body can not and will not absorb.

When do I need a root canal? What is a root canal? Do they hurt?

A root canal is a way to save a tooth that has been damaged badly by cavities. Often times, as the bacteria grows, it will eat away more and more of the tooth. This causes sensitivity as more of the tooth is damaged. Eventually that bacteria can eat so much of the tooth that it gets to the nerve in the center. Once the bacteria hits the nerve inside the tooth, there is often (but not always) constant pain. This is when we need to remove the infected nerve and clean out the tooth of bacteria by doing a root canal.

Sometimes, if the infection is bad, an antibiotic may be needed to stop the bacteria from spreading further, but generally this is not needed. The area does however need to be numbed to make sure there is no aches or pains during the work. Once the tooth is numb, every area that was damaged by bacteria needs to be removed, exposing a path to the nerve. Then using a small rough file, the nerve is removed, and the inside of the tooth is scraped clean. Often times an x-ray is taken to prove the tooth was completely cleaned out and that none of the nerve remains. Once the area is clean, it is rinsed with an antibiotic, and dried well. Then the tooth is sealed up with a sap like rubber that should prevent any liquid or bacteria from getting into the area.

This process generally is not painful. The worst is usually the needle at the start to get the tooth nice and numb. After that there should only be a feeling of vibration. On occasions where there is infection, there may be a slight pinch when the nerve is first removed, but after that all feeling should be gone.

What happens after a root canal? Is it bad to have a dead tooth?

It is true that when we remove the nerve from the tooth in a root canal, the tooth dies. Because of this the tooth can become weaker and is more likely to chip crack or break. To prevent the chipping cracking or breaking, we place a crown (also called a cap) over the tooth. This is made from metal and porcelain so it looks like a tooth but is strong enough not to break when used to chew.

In some cases, if there is not a lot of tooth left above the gums, we may need to build the whole tooth up even before we can put a cap over it. In this case we use a titanium post, and place it in the root of the tooth to act as an anchor. Once the titanium post is secured, we can then build the tooth up with a material similar to (but stronger than) white filling material.

Done properly, and kept clean, this can last for many years acting like any other tooth in the mouth.

What is a crown (or cap)? Why do I need one?

A crown can refer to a whole host of materials, but generally it is something that is built to go over a tooth when that tooth has been root canal treated or has had such large cavities that very little of the tooth remains. Dentists will often refer to it as a fixed prosthetic, but that simply means that it is not something that can be taken out easily like a denture. A crown can be made of several materials from zirconia to ceramic, but generally we tend to uses porcelain fused to metal.

What are the types of crown? What are the advantages and disadvantages to each?

Generally, we tend to recommend the porcelain fused to metal. The reasoning behind that is it is strong and can be thinner than the ceramic crowns. The downside to these crowns is that there is a little metal collar that sits just underneath the gums. As time goes on, if the teeth are not kept clean, or the teeth are brushed too forcefully, the gums can pull away from the teeth and that little metal rim may show.

In some cases all ceramic crowns can be made, these need to be somewhat thicker, and can be difficult on the lower front teeth that are already quite thin to begin with. The other issues is that the ceramic shrinks becomes very hard when it is baked fully, so, to avoid that the ceramic is baked part way, then the ceramic block is cut into a larger version of the crown, then baked to completion. Theoretically, if the ceramic is made perfectly, the shrinking should be uniform and make the crown fit exactly. Unfortunately, it is not always the case, and to make a successful crown the space between the tooth an the crown must be less than 100th of a millimeter to prevent water and bacteria from leaking in. This process can be used with great success, but it is very important to be extremely thorough to ensure there are no defects in these crowns.


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