Tooth Care

Tooth ChartAt birth people usually have 20 primary (baby) teeth, which often erupt through the gums as early as six months of age.

These teeth are then shed at various times throughout childhood. By age 21, all 32 of the permanent teeth have usually erupted.

A Child’s First Visit

A child’s first visit to the dentist should be pleasant, positive, and informative. The more you and your child know about the first visit, the better you will feel. Our office makes a practice of using pleasant, non-frightening, simple words to describe your child’s first dental visit. We want you to feel at ease from the moment your family arrives at our office.

New Teeth

Your child’s first tooth erupt’s between ages 6-12 months and the remainder of their 20 primary or “baby” teeth typically erupts by age 3. During this time, gums may feel tender and sore, causing your child to feel irritable. To help alleviate this discomfort, we recommend that you soothe the gums by rubbing a clean finger or a cool, wet cloth across them. You may also choose to make use of a teething ring.

Your child’s primary teeth are shed at various times throughout childhood, and their permanent teeth begin erupting at age 6 and continue until age 21. Adults have 28 permanent teeth, or 32 including wisdom teeth.

Healthy Oral Hygiene

As new teeth erupt, examine them every two weeks for lines and discoloration caused by decay. Remember that sugary foods and liquids can attack a new tooth, so take care that your child brushes their teeth after feeding or eating. We recommend brushing four times a day for optimal oral hygiene: after breakfast, after lunch, after dinner, and at bedtime. Brushing can be fun, and your child should brush as soon as the first tooth arrives. When a baby’s tooth erupts, parents should brush the tooth with a soft-bristled toothbrush and a pea-sized amount of fluoridated toothpaste. We suggest reviewing proper tooth brushing procedures with your child.

Flossing is also a part of good oral hygiene habits, and your doctor will discuss with you the right time to start flossing.

If you notice signs of decay, contact your dentist immediately.

Preventing Tooth Decay

Tooth decay is preventable. Tooth decay is caused by sugars left in your mouth that turn into an acid which can break down your teeth. Children are at high risk for tooth decay for a simple reason – many children and adolescents tend to be lax in their oral hygiene habits. Proper brushing and flossing routines combined with regular dental visits help keep tooth decay away. A low-sugar diet also helps keep tooth decay at bay. Your child should visit the dentist every 6 months for regular dental cleanings and checkups. We recommend fluoride treatments twice a year along with cleanings to keep teeth their strongest. Tooth sealants are also recommended because they “seal” the deep grooves in your child’s teeth, preventing decay from forming in these hard-to-reach areas. Sealants last for several years, but will be monitored at your regular checkups.

Brushing and Flossing

It is recommended to spend 2 minutes brushing your teeth twice a day. Here are some tips on how to brush properly:
Hold your brush at a 45-degree angle against
your gumline. Gently brush from where the
tooth and gum meet to the chewing surface in
short (about half-a- tooth-wide) strokes.
Brushing too hard can cause receding gums,
tooth sensitivity.

Use the same method to brush all outside and inside surfaces of your teeth.
To clean the chewing surfaces of your teeth, use short sweeping strokes, tipping the bristles into the pits and crevices.
To clean the inside surfaces of your top and bottom front teeth and gums, hold the brush almost vertical. With back and forth motions, bring the front part of the brush over the teeth and gums.
Using a forward-sweeping motion, gently brush your tongue and the roof of your mouth to remove the decay-causing bacteria that exist in these places.

Facts on Flossing

Brushing is important but it won’t remove the plaque and particles of food between your teeth, and under the gumline. You’ll need to floss these spaces at least once a day.

The type of floss you choose depends on how much space you have between your teeth. Dentists usually recommend unwaxed floss because it’s thinner and easier to slide through small spaces. However, studies have shown that there is no major difference in the effectiveness based on the type of floss used.

With any floss, you should be careful to avoid injuring your gums. Follow these instructions:
Carefully insert the floss between two teeth, using a back and forth motion. Gently bring the floss to the gumline, but don’t force it under the gums. Curve the floss around the edge of your tooth in the shape of the letter “C” and slide it up and down the side of each tooth.
Repeat this process between all your teeth, and remember to floss the back sides of your back teeth.

Gum Disease

Gum disease (also called periodontal disease) is an infection of the tissues that support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. At each regular checkup the dentist will measure the depth of the shallow v-shaped crevice (called a sulcus) between your tooth and gums to identify whether you have gum disease.

Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. These bacteria create toxins that can damage the gums.

Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and supporting tissues to break down. As the tissues are damaged, the sulcus develops into a pocket; generally, the more severe the disease, the greater the depth of the pocket. Periodontal diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis.

Gingivitis

In the early stage of gum disease, called gingivitis, the gums become red, swollen, and bleed easily. At this stage, the disease is still reversible and can usually be eliminated by daily brushing and flossing.

Periodontitis

In the more advanced stages of gum disease, called periodontitis, the gums and bone that support the teeth become seriously damaged. Whereas healthy gums and bone anchor teeth firmly in place, infected gums can cause teeth to become loose, fall out, or have to be removed by a dentist.

Some factors increase the risk of developing periodontal disease:

  • Tobacco smoking or chewing
  • System-wide diseases such as diabetes
  • Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives
  • Bridges that no longer fit properly
  • Crooked teeth
  • Fillings that have become defective
  • Pregnancy
  • If you notice any of the following signs of gum disease, see the doctor immediately:
  • Gums that bleed easily
  • Red, swollen, tender gums
  • Gums that have pulled away from the teeth
  • Persistent bad breath or bad taste
  • Pus between your teeth and gums
  • Permanent teeth that are loose or separating
  • Any change in the way your teeth fit together when you bite
  • Any change in the fit of partial dentures
  • It is possible to have periodontal disease and have no warning signs.

That is one reason why regular dental checkups and periodontal examinations are very important. Treatment methods depend on the type of disease and how far the condition has progressed.

Good oral hygiene at home is essential to keep periodontal disease from becoming more serious or recurring. You don’t have to lose teeth to periodontal disease. Brush regularly, clean between your teeth, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.
Extractions

There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk of decay, so your doctor may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.

When it is determined that a tooth needs to be removed, your dentist may extract the tooth during a regular checkup or may request another visit for this procedure. The root of each tooth is encased within your jawbone in a “tooth socket,” and your tooth is held in that socket by a ligament. In order to extract a tooth, your dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with your doctor any concerns.

Once a tooth has been removed, neighboring teeth may shift causing problems with chewing or with your jaw joint function. To avoid these complications, your dentist may recommend that you replace the extracted tooth.

Root Canals

In the past, if you had a tooth with a diseased nerve, you’d probably lose that tooth. Today, with a special dental procedure called root canal treatment, you may save that tooth.

Inside each tooth are both the pulp and the nerve. The nerve is the vestige of the tissue that originally formed the tooth. Once the tooth has been in the mouth for a time, the functioning of the nerve is no longer necessary.

When a tooth is cracked or has a deep cavity, bacteria can enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the root tip in the jawbone, forming a “pus-pocket” called an abscess. An abscess can cause the pulp tissue to die. When the infected pulp is not removed, pain and swelling can result. Certain byproducts of the infection can injure your jawbones and your overall health. Without treatment, your tooth may have to be removed.

Treatment often involves from one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. Next the pulp chamber and root canal(s) of the tooth are cleaned and sealed. Often posterior teeth that have endodontic treatment should have a cast crown placed in order to strengthen the remaining structure. Then, as long as you to continue to care for your teeth and gums with regular brushing, flossing, and checkups so that the root(s) of the restored tooth are nourished by the surrounding tissues, your restored tooth can last a lifetime.

Most of the time a root canal is a relatively simple procedure with little or no discomfort, involving one to three visits. Best of all, it can save your tooth and your smile!

Wisdom Teeth

The removal of wisdom teeth has become so commonplace that it is almost a rite of passage for young adults. Wisdom teeth are a type of molar that is found in the very back of your mouth. There are four wisdom teeth: upper left, upper right, lower left, and lower right. These teeth usually appear in late teens or early twenties but may become impacted (fail to erupt) due to lack of room in the jaw or angle of entry. The most common type of impacted wisdom tooth is “mesial,” meaning that the tooth is angled forward toward the front of your mouth.

When a tooth is impacted, it may need to be removed. If it is not removed, you may develop gum tenderness, swelling, or even severe pain. Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections, and even gum disease.

Each patient’s situation is unique, and your dentist will take x-rays and discuss your particular needs with you. If your dentist recommends removal of your wisdom teeth, it is best to have them removed sooner than later. As a general rule, wisdom teeth are removed in the late teens or early twenties because there is a greater chance that the teeth’s roots have not fully formed and the bone surrounding the teeth is less dense. These two factors can make extraction easier.
In order to remove a wisdom tooth, your dentist first needs access to it. To make this process most comfortable, your dentist will numb the area with a local anesthetic. Because the impacted tooth is frequently under the gums and still encased in your jaw bone, your dentist will need to remove a portion of the covering bone to extract the tooth. To minimize the amount of bone that must be removed, your dentist will often “section” your wisdom tooth so that each section can be removed through a small opening in the bone.

Once the teeth have been extracted, the healing process begins. Healing time varies depending on the degree of difficulty related to the extraction. Your dentist will share with you what to expect and provide instructions for an efficient healing.

Dental Sealants

Sometimes brushing is not enough. Everyone has hard-to-reach spots in their mouth and brushing doesn’t always fully clean those difficult places. When that happens, you are at risk of tooth decay. Using dental sealants on your teeth gives you an extra line of defense against tooth decay.

A dental sealant is a plastic resin that bonds to the deep grooves in your tooth’s chewing surface. When sealing a tooth, the grooves of your teeth are filled and the tooth surface becomes smoother — and less likely to harbor plaque. With sealants, tooth brushing becomes easier and more effective against tooth decay.

Sealants are usually applied to children’s teeth as a preventative measure during the years of most likely tooth decay. However, adults’ teeth can also be sealed. It is more common to seal “permanent” teeth rather than “baby” teeth, but every person has unique needs. Your dentist will recommend sealants on a case by case basis.

Sealants generally last from 3 to 5 years. However, it is fairly common to see adults with sealants still intact from their childhood. A dental sealant only provides protection when it is fully intact so if your sealant comes off you must let your dentist know.