Maybe you had braces as a child, or you are thinking of having your own (it's never too late) or your child's teeth straightened through orthodontia. But how much do you really know about this branch of dentistry? Here are six questions people often ask about orthodontia.

Q. How did the word “orthodontia” originate?
A. From Latin roots meaning “straight” and “teeth”

Q. Teeth are anchored in bone. How is it possible to move them?
A. Living bone is not unchanging. The bone, ligament, and the outer layer of a tooth's root (called cementum) react to the stresses of biting and chewing. Due to this stimulation the bone is constantly being resorbed (broken down) and rebuilt as it is pushed from one side of a tooth and pulled from the other. Under normal conditions, there is a balance resulting in a steady state. Orthodontia takes advantage of this process to slowly change the teeth's position in the desired way.

Q. My dentist talks about the periodontal ligament. What does this mean?
A. The ligament is a fibrous tissue that connects the teeth to their bone and takes part in the dynamic process of resorption and rebuilding of the bone.

Q. What kinds of conditions can orthodontia correct?
A. Treatment can improve the teeth's position and relations to each other (being too crowded or badly spaced) and the way the upper and lower jaws relate. It can enhance the appearance of a person's teeth and face, and can also improve the teeth's function in biting and chewing.

Q. What is the best first step to orthodontic treatment?
A. Talk to your general dentist about your concerns. If you are referred to an orthodontist, the next step is to assess your situation using molds of your teeth that show the way the upper and lower teeth meet (your bite). Special x-rays will be taken to show the locations of your teeth and relation of your upper and lower jaw. Your dental team may also use photographs of your smile and computer imaging to get a clear view of how your teeth are now and how they may be moved.

Q. What are some of the methods of treatment?
A. In the traditional method, small metal brackets are attached to the crowns of the teeth. Thin wires, called arch wires, are strung through attachments on the brackets. These wires are used to apply controlled force to direct the teeth in the desired direction. Another method is to use removable clear plastic aligners. A series of aligners is designed by a computer, to be changed from one to the next as the positions of the teeth slowly change.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about braces and orthodontia. You can also learn more by reading the Dear Doctor magazine articles “Moving Teeth with Orthodontics” and “The Magic of Orthodontics.”

Until recently anyone who needed to repair cavities in his or her teeth ended up with a mouth full of “silver” fillings. Dental amalgam, which has a silver appearance, was the tooth restoration material of choice. Amalgam, a combination of metals including silver, mercury, and other metals, is still used — but today there are other options that mimic the original teeth they are restoring.

You may have read about some people's concerns about the mercury used in dental amalgam. According to the American Dental Association (ADA), scientific studies have found no ill effects arising from using dental amalgam in fillings for adults or children: “While questions have arisen about the safety of dental amalgam relating to its mercury content, the major US and international scientific and health bodies, including the National Institutes of Health, the US Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Dental amalgam is still used for molars (back teeth) that must withstand heavy pressure from chewing.

For teeth that are more visible, materials that look and perform more like the original teeth — and are thus more pleasing in appearance — are now available. Dentistry is now taking a “biomimetic approach” (from words meaning “life mimicking”). The new materials — composite resins and porcelains — look like teeth because in many ways their structure imitates the biologic structure of teeth.

Composite resins are made of a plastic material (methacrylate) combined with fillers made of silica, a form of glass. They are able to bond to natural tooth structure and resemble the dentin, the inner layer of the tooth, which has a porous structure similar to bone.

Dental porcelains are a form of ceramic. They are non-metallic materials formed by the action of heat, like the ceramics used in porcelain cups and bowls. They come in a powder form that is mixed with water, shaped, and then placed in an oven until they reach the proper hardness. The end product is translucent and very hard, resembling the densely packed crystals of calcium that make up a tooth's normal outer layer, the enamel.

The old amalgam fillings required removal of tooth material to prepare a site in which they could be placed. Composite resins and porcelains can be used to treat teeth that have small or large amounts of damage to their natural substance because the materials bond directly to the remaining dentin and enamel. Thus they end up stabilizing and strengthening the restored tooth, as well as providing a natural-looking appearance.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about tooth colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

Gum disease (gingivitis) and tooth decay are primarily caused by dental plaque. Dental plaque is a whitish, sticky film that accumulates daily along the gumline and on the surfaces of your teeth. Composed of bacteria, it is controllable through good oral hygiene habits — most importantly, effective brushing.

Controlling plaque and preventing gingivitis and tooth decay will make it more likely that you keep your teeth through your lifetime and will also improve your general health. Scientific studies have linked gum disease and diseases of the heart and circulatory system.

“I know how to brush my teeth. I've been doing it since I was a toddler,” you may be saying. But you may not be performing this daily ritual in the most effective way.

Let's take another look at tooth brushing. First, your grip: Hold the brush in your fingertips with a light pressure. Position the brush so the bristles are at a 45 degree angle to your gumline, and then brush with a gentle scrubbing motion. Don't scrub too hard, or you may damage your sensitive gum tissue.

Some electric brushes can remove plaque more quickly than a regular hand-held brush, but if you brush well any kind of brush works. A brush will last several months. Get a new one when the bristles become worn or splayed out.

Use a toothpaste that contains fluoride. When used consistently, fluoride toothpastes make your teeth more resistant to decay. Spit out the toothpaste after brushing, but don't rinse or you will wash the fluoride away.

After brushing, complete your cleaning job by using floss to clean between your teeth where the brush does not reach. Wrap it in a “C” shape around each tooth and move it vertically up and down, removing plaque from the tooth surfaces where your teeth meet. You can also use an antibacterial mouth rinse.

Thoroughly clean your teeth at least once a day, brushing and flossing. A plaque film takes 12 to 24 hours to form itself again.

To be certain you are brushing correctly, ask our office or one of our hygienists to demonstrate brushing techniques for you in your own mouth. You can also assess the quality of your brushing technique by checking with your tongue after brushing to make sure your tooth surfaces feel smooth and slick. Your gums should not bleed after brushing. Bleeding is a sign of infection. If you have a habit of consistent brushing but your gums continue to bleed, it's time for a visit to our office.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Oral Hygiene Behavior.”

Your self-image has a lot to do with how you feel about your appearance — and particularly your smile. If you are unhappy with the way you look, cosmetic dentistry may be the answer to your problems.

1. What do we mean by cosmetic dentistry? The word “cosmetic” refers to beneficial changes in appearance. Thus cosmetic dentistry is all dental work that restores or improves a person's appearance.
2. What is a cosmetic dentist? Every dentist learns to do procedures in a way that conserves or improves a patient's appearance. Some dentists continue to study and specialize in procedures that are done specifically for the purpose of enhancing a person's appearance.
3. What is a smile analysis? The first step to improving your smile, this analysis involves a study of all the elements of your smile — teeth appearance and alignment, gums, jaws — and also your facial features and how they all fit together.
4. How can I choose the right cosmetic dentist? Ask your dentist about his or her training and experience. Ask for photos of previous work. You may need to select more than one person, working as a team to take best advantage of each one's experience, skills, and training.
5. What can be done to improve a smile using 21st century techniques? We are fortunate to live in times in which numerous options are available. These include making teeth whiter; altering their size, shape, balance, color, and alignment; filling in parts of teeth that are missing because of decay or injury; and even replacing teeth that are missing entirely.
6. How can chipped or discolored front teeth be restored? This can often be done by bonding with composite resin.
7. How can damaged back teeth be restored? Back teeth with cavities or traumatic injuries can now be repaired with non-metallic tooth-colored material that bonds to the tooth substance.
8. What techniques can be used to correct more severe problems? Porcelain veneers, thin layers of porcelain material, can be used to change the appearance of misshapen or undersized teeth. Porcelain crowns can be used to replace the part of the tooth that rises above the gums.
9. How can we change the position of teeth that do not meet together well? Orthodontists are dentists who specialize in correcting malocclusions (bad bites). They use traditional braces or clear aligners to move teeth into more attractive and functional positions.
10. What if some teeth are missing? A dental implant replaces the root of a missing tooth. A porcelain crown that looks just like a natural tooth can then be connected to the implant.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”

Periodontal (gum) disease can lead to serious infection and even loss of teeth; but it can easily be prevented. Here are seven things you can do to prevent gum disease — or stop it in its tracks if you already have it.

1. Understand the causes of gum disease. Diseases of periodontal (from the root words meaning “around” and “tooth”) or gum tissues start with bacteria collecting on your teeth, in the areas where the teeth and gums meet. The bacteria, called plaque or biofilm, irritate the surrounding tissues and cause them to become inflamed and swollen, and to bleed easily on contact. This condition is called gingivitis.
2. Brush correctly and effectively. Brushing twice a day is not just to polish your teeth to pearly whiteness. An important reason to brush is to remove the daily coating of plaque from your teeth. At your next dental appointment, ask me or our staff to show you the most effective way to brush.
3. Floss every day. Daily flossing removes the plaque that settles in between your teeth, in places where your brush can't reach.
4. Have regular professional cleanings. Our hygienist will remove plaque that you missed by brushing and flossing. This plaque hardens into a material called calculus or tartar. In a professional cleaning your hygienist uses special tools to scrape these materials away. The hygienist also measures the distances between your gums and teeth to make sure that inflamed gums have not separated from the teeth, forming pockets in which the bacteria continue to grow.
5. Recognize the signs of developing gum disease. These signs include any of the following: gums that bleed easily when you brush or floss; bad breath; red or swollen gums; and sensitive teeth.
6. Stop smoking. If you haven't stopped smoking for your heart or lungs, here is another reason to quit. Smokers are more likely to develop periodontal disease than nonsmokers. Smoking masks the effects of gum disease, so smokers are less likely to notice the symptoms, allowing the disease to progress to a greater degree before they seek help.
7. See our office right away if your teeth become loose or your gums become red and swollen. If inflamed gum tissues do not heal, the disease continues to progress. The tissues that attach your teeth to your bone, called ligaments, are lost as pockets deepen as the infection advances. Your gums may also become red, swollen, and painful. As the infection gets worse it eats away the bone around your teeth, causing the teeth to loosen and fall out.

So start with prevention and stop periodontal disease in its early stages.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about gum disease. You can also learn more by reading the Dear Doctor magazine article “Warning Signs of Periodontal (Gum) Disease.”

A pregnant woman has a lot to think about while preparing to welcome a new member of her family. It's important to think about her oral health as well. She is sharing her body with the developing infant, so problems with her health — including her dental health — can affect the baby. The following facts will help you understand the relationship between oral health and pregnancy.

1. A baby's primary (baby) teeth begin to form during the sixth week of pregnancy. They begin to form their enamel (the hard outer layer of the teeth) and dentin layer (just under the enamel) at about the third or fourth month. The calcium, phosphorous, and protein that are needed for these structures must all be provided by the mother's diet.
2. A good diet for a pregnant mother, in order to provide for both her needs and those of the fetus (the developing baby), includes whole grains, fruits, vegetables — including green leafy vegetables — proteins and dairy products. A doctor may also recommend iron and/or folic acid supplements.
3. If the mother's diet does not provide enough calcium for the baby's bones and teeth, it will come from calcium stored in her bones — not from her teeth. The old idea that a mother's teeth lose calcium during pregnancy has been found to be a myth.
4. Progesterone, a normal female hormone, is elevated during pregnancy. This hormone stimulates production of prostaglandins, substances that cause inflammation in gum tissues if the bacteria that cause periodontal (gum) disease are present. The resulting swelling, redness, and sensitive gum tissues, called pregnancy gingivitis, are common during the second to eighth months of pregnancy.
5. The bacteria involved in periodontal disease can affect whole body conditions such as heart disease and strokes, diabetes, and respiratory diseases. The inflammation resulting from such bacteria can also cause premature delivery (birth before 37 weeks of pregnancy) or low birth weight in the baby.
6. Periodontal disease is also related to pre-eclampsia, or high blood pressure, during pregnancy.
7. Dental x-rays do not expose the mother to very high radiation, but in any case every precaution is taken to minimize exposure to the fetus. These include a leaded apron that shields the baby from exposure.
8. Most drugs commonly used in dentistry, including local anesthetics, can safely be given to pregnant women without affecting the fetus. However, it is important to let your dentist know you are pregnant before embarking on any treatment to make sure anything that is done will be safe for the fetus and its developing teeth.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about pregnancy and your oral health. You can also learn more by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”

As the Boy Scouts say, it's best to be prepared. You may never have a traumatic injury to your teeth. But what if you do? Here are four questions and answers about such injuries and their treatment that may be helpful some day.

What are traumatic injuries?
We are talking about physical damage caused by a fall, an accident, or a blow to the face. The word trauma comes from the Greek root meaning “wound.”

A traumatic injury can also cause broken, cracked, or split teeth, or a fracture to the root of the tooth. A tooth may be dislodged from its proper position, pushed sideways, out of or deeper into its socket. It may even be completely knocked out of your mouth.

What should you do if your tooth is knocked out?
With proper treatment, the tooth can be restored to its original place. You must handle the tooth gently and seek professional help as soon as possible. Rinse the tooth in cold water if it is dirty, but do not use any cleaning agent. Avoid touching the root. While hurrying to your dentist, keep the tooth from drying out by keeping it in a container of milk or of your saliva, or by holding it in your mouth between gum and cheek. It is vital to keep the tooth's living tissues moist until it can be professionally assessed and replanted in its socket. If a tooth has been dislodged but not knocked out, it must be repositioned in its socket and may be stabilized with a splint.

Who can treat a tooth that is damaged by a traumatic injury?
A general dentist, an oral surgeon or an endodontist is trained to treat such injuries. An endodontist is trained to treat the root canal(s) inside a tooth. The word comes from “endo” the Greek word for “inside,” and “odont,” the word for “tooth.” After a tooth is replaced in its socket and stabilized, root canal treatment is often needed.

What is root canal treatment?
A tooth is composed mostly of dentin, a living tissue. The top part or crown is covered by hard mineralized enamel. The soft tissue inside the tooth, the pulp, contains blood vessels, nerves and connective tissues. It extends from the crown to the tip of the roots. Treatment of dental pulp injuries is called root canal or endodontic treatment and is usually needed to treat teeth that have been dislodged or fractured.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about injuries to teeth and related nerve damage. You can also learn more by reading the Dear Doctor magazine article “Trauma & Nerve Damage to Teeth.”

Most people think of bone as rock-solid, but it's actually a living tissue that's constantly changing. This has significant implications for your oral health, general health, and appearance — if you are one of the 70% of Americans missing at least one tooth.

Throughout the day, your top and bottom teeth make hundreds of fleeting contacts with each other. These small stresses are transmitted though the periodontal ligament (“peri” – around; “odont” – tooth) that supports each tooth in its socket like a hammock. Think of it as a gentle push on the hammock, which causes the tooth to gently bump the underlying bone. The bone then builds up in the spot that's receiving stress to counteract it. This constant remodeling of bone is what allows bone to stay healthy and strong.

When a tooth is lost, the bone does not receive that gentle stress. It reacts by literally melting away. Sometimes this happens fairly quickly — in a matter of months. After the tooth-supporting bone is lost, the jawbone itself begins the same process of deterioration. This could eventually change the shape of the face, as the distance from nose to chin can decrease — even if only a few back teeth are missing. The results aren't pretty. But the good news is, there's a way to prevent all this.

Dental implants, which function as substitute tooth roots, actually save underlying bone when teeth are lost. They do this because they are made of titanium, which fuses to the bone in which it's set, stabilizing it. The implant is topped by a realistic-looking crown, which replaces the part of the missing tooth that was visible in the mouth. Together, they look and function just as your natural tooth did.

If you are missing a lot of teeth, implants can also be used to anchor bridges or even removable dentures while providing that same bone-saving benefit. And when you consider that they are so durable they should never need replacement, implants are a great investment.

If you have any questions about dental implants, please contact us today at (888) 851-8083, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

If an adult has lost his or her teeth (a condition called “edentulism”), full removable dentures (false teeth) can restore the person's appearance and ability to bite, chew, and talk properly. Even with our current extensive knowledge about tooth care and restoration, over 25 percent of Americans have lost all their teeth by the time they are 65.

How much do you know about dentures? Test yourself below.

How does tooth loss affect your bones?
Bone is a living substance that is constantly changing and rebuilding itself, depending on signals it receives from surrounding tissues. The bone that surrounds your teeth is called alveolar bone (from “alveolus,” meaning sac-like). To keep healthy, alveolar bone needs stimulation or function such as chewing and your teeth touching your opposing teeth. If you lose your teeth, bone begins to melt away (resorb).

How can we minimize bone loss during tooth extraction?
We can maintain bone volume by using bone grafting techniques. While this sounds scary, it is a relatively easy procedure. The principle of bone grafting is to build a sort of scaffolding on which your body begins to build and maintain its own bone. Bone loss can be prevented by the placement of a few dental implants.

How are dentures designed and created?
The dentures that look best and work best for you are based on your original teeth. We often utilize photographs of how you looked with your natural teeth, along with your input about possible changes you would like to see. First we take detailed impressions (molds) of the residual ridges in which your teeth once rested. From these we make denture bases of a light cured plastic resin. We attach horseshoe-shaped rims made of wax to the bases, to simulate the position of the teeth as we work out their design and spacing, based on both appearance and function. The prosthetic teeth are then tried out in your mouth, adjustments are made, and the dentures are processed in a dental laboratory. The final product substitutes a pink colored plastic (methyl methacrylate) to represent the gums and white plastic material as the teeth, created to make them look as natural as possible.

What is your part in the denture fitting process?
As a patient with new dentures, you must learn to use your jaw joints, ligaments, nerves, and muscles in new ways to help stabilize your dentures and to relearn to speak, bite, chew, smile, and laugh with these new structures. It takes a little practice, but with your removable dentures you can once again enjoy a complete and normal life.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about full removable dentures. You can also learn more by reading the Dear Doctor magazine article “Removable Full Dentures.”

On the day when braces come off, most people feel that their orthodontic treatment is over. When they are then asked to wear retainers, they may wonder what this additional requirement will accomplish. Wasn't the work of moving their teeth to desired positions already completed? To understand the answer to this question, you need to understand how orthodontics works.

How does orthodontic treatment remodel your smile?

Although they give the appearance of being stable and unmoving, teeth and their surrounding structures (gums, jawbones, and ligaments) are living tissues and are actually in a constant state of change.

Teeth are rooted in bone and are attached by a fibrous tissue called the periodontal ligament (from peri meaning around and odont meaning tooth). One side of the ligament attaches to the cementum (part of the tooth's root) and the other side is attached to the bone, with the tooth suspended in between.

These tissues are constantly remodeling themselves, but pressure from the lips and cheeks on one side and from the tongue on the other create a balance that keeps the teeth suspended in the same location. When mild forces are placed on the teeth, such as the forces from the wires used in orthodontic treatment, the tissues slowly adapt and rebuild, resulting in a new position for the teeth.

What are retainers?

Orthodontic retainers are devices usually made of a clear plastic section that is fitted to the roof of the mouth, with thin wires that fit over the teeth.

What is the purpose of retainers?

The remodeling process keeps going after the orthodontic treatment stops, so time is needed for the teeth to reach a new balanced state. The retainer stabilizes them in their new position so that bone and ligament can reform around the teeth and hold them there. This works well for adolescents, whose jaws are in a state of growth, but adults may need outside assistance to stabilize their teeth for a longer time. They may be asked to wear retainers indefinitely to make sure their teeth do not move from their new positions.

What happens if you don't wear your retainers?

If you don't wear your retainers, your teeth are likely to return to the positions they had prior to your orthodontic treatment. This can happen fairly rapidly, underscoring the importance of wearing retainers as instructed.

What are the different types of retainers?

Most retainers are removable devices as described above. For people who require long-term use of retainers, thin retainer wires can be bonded to the inside surfaces of their front teeth. Such wires are usually left in place for several years, relieving them of the need to remove and replace their retainers.

Contact us today at (888) 851-8083 to schedule an appointment to discuss your questions about orthodontics and retainers. You can also learn more by reading the Dear Doctor magazine article “Why Orthodontic Retainers?”