Frequently Asked Questions
- What should I do if I have a dental emergency while on vacation?
- How can I keep a youthful smile?
- What is a cap?
- How can I be sure that my caps/crowns/veneers look natural?
- What can I do about sensitive teeth?
- What can I do about bleeding gums?
- How does fluoride work?
- How can I avoid tooth decay caused by sugar intake?
- How can I avoid enamel damage caused by citrus intake?
- How do I protect my teeth while playing sports?
- How do I ensure my dentures look natural?
- What is dental insurance?
Most dental emergencies involve broken fillings, toothaches and/or abscesses, lost caps (crowns), broken/chipped teeth, and broken dentures.
Here's what you should do in a dental emergency:
- When staying with friends, have them call their own dentist as soon as possible. Your friends will have more clout than if you, "a perfect stranger," called the office.
- If you don't have a dentist, but are in the U.S.,
- Call the local dental society in town.
- Ask the hotel for a referral.
- Call the local pharmacy for a referral.
- Use the Yellow Pages as a last resort.
- If you are out of the country,
- Ask your hotel for a referral.
- Call the American Embassy or armed forces base. Most government officials will only used qualified foreign personnel.
If you cannot reach a dentist after exhausting all of the above possibilities, use these common sense dental emergency aids:
- Rinse mouth with lukewarm water to remove food or debris.
- Avoid any very hot or very cold substances.
- Avoid eating on that side (and avoid eating anything sticky, like caramels or gum)
- If your tooth is sensitive to the air, cover the tooth with a wad of sugarless gum, beeswax, or sticky denture adhesive cream.
- Buy some oil of cloves at a pharmacy. Dip some cotton into the clove oil and then cover up the hole in the tooth with the cotton.
- By all means, do not put an aspirin tablet near the tooth. The aspirin can burn the gum tissues or the cheeks.
Toothache and/or Swelling
- Use some ice packs to reduce the swelling.
- Get to a dentist or a hospital as soon as possible.
- Try to get a prescription for some pain pills from a dentist or a physician so you can get some sleep.
- Do not place an aspirin tablet near the swollen tooth. It can burn the inside of your mouth.
Lost Cap (Crown)
- Try to put the cap back on to the tooth. Use denture adhesive if it won't stick by itself.
- If you can't cover the tooth with the cap, use a wad of gum, beeswax, or even tissue paper to help protect the tooth from the air.
- Rinse mouth with warm water.
- If your lips are swollen, use ice packs.
- Avoid really hot or cold substances, like ice cream, ice cubes, or hot espresso coffee.
- Get to a dentist as soon as possible.
- Bring a second set with you before you go on the trip.
- Either bring an old set or have a duplicate set of teeth made at the same time you are having your dentures made.
- Remember, good dentures should not require any adhesive. However, if you should drop and crack them, they may no longer fit. When traveling, always bring some denture adhesive.
At the most, you should only have to wait 24-48 hours for dental care. Do not wait more than two days if you have one of the above emergencies.
The best way to avoid vacation emergencies is to have regular dental check-ups (three month, four month, or six month). Never leave the country before having your teeth checked. Foreign dentistry is years behind California dentistry, but it is often three times more expensive.
Vigorous healthy smiles have several characteristics. First of all, your two front teeth should be slightly longer than the other teeth by about ½ millimeter. Teeth that are the same length indicate excessive wear (a hard life) and they age a person considerably. The aging process can be reversed by lengthening the front teeth. Special plastic (Cosmetic Bonding) can be applied to the edges of the teeth or the teeth can be capped or crowned.
Make your teeth look whiter and brighter by closing all spaces. Dark spaces or chipped teeth make the teeth look darker and dirtier. Spaces may be closed three ways: braces (orthodontics), caps (crown), or plastic fillings (Cosmetic Bonding)
Did you know that a tooth has six sides, just like a box? The sixth side at the top of the root is not visible in the mouth, so for all intents and purposes, only five sides are fillable inside the mouth. One, two or three sides of decay can be filled on any tooth. But four or five-sided fillings are usually very weak and a cap (crown) or "complete tooth covering" would be a better solution.
A cap replaces lost or broken enamel. The shape of the tooth under the cap is very important in determining how well the cap will stay on. The tooth should be shaped like a box instead of a pointed "tepee." Teeth average 7-10 millimeters in width. Your dentist can shape the tooth under the cap so the cap is only 1½ millimeters thick instead of 3 millimeters.
Caps or crowns help protect the rest of the tooth from decay and nerve damage. Caps can be made of aluminum, plastic, stainless steel, gold, porcelain or a combination of gold and porcelain. Remember, no cap lasts forever and no cap is as strong as enamel ... and even enamel wears out. Aluminum lasts 6 weeks; plastic, 6 months; stainless steel, 1 year; gold, porcelain or gold and porcelain, 5-7 years.
Keep three words in mind: color, contour, and texture.
- Color. Does the color blend with the other teeth? Just like dyeing your hair, a more natural result can be achieved with a combination of colors. Teeth are not white! They have combinations of colors — orange, brown, yellow. gray, pink.
- Contour. Is the shape or contour in keeping with the surrounding teeth? Teeth can be square, squatty, pointed, bulbous or flat. Just think of placing a straight hairpiece on top of an Afro...and you can get the idea about the importance of properly contoured teeth.
- Texture. Does the porcelain/plastic crown or cap duplicate the existing surface texture? Tooth enamel can be peach-like or covered with ripples, vertical grooves, or maybe even horizontal grooves. Teeth are never as smooth as glass!
In some adult mouths, the bone around the front of the tooth is very thin and the gum tissue can recede (or lower) exposing the root which is not covered by a hard material-like enamel, but a very thin coating called cementum. This layer (cementum) has very fine nerve connections to the tooth's pulp (nerve) and if exposed to air, hot, cold or sweet sensations, may result in some pain or sensitivity.
There are some over-the-counter toothpastes (Sensodyne, Denquel) that can be purchased that can help reduce the sensitivity. I usually suggest that my patients utilize these over-the-counter desensitizing toothpastes before I prescribe fluoride gels from the pharmacy. Special fluoride gels can be applied directly to the exposed roots with a cotton swab at least once a day, preferably two times a day.
Fluoride gels should also be used on all the teeth if the patient is undergoing chemotherapy. Chemotherapy to arrest cancer not only affects one's hair and skin, but also causes the saliva glands to stop functioning. Without saliva, decay becomes rampant throughout all the existing teeth). The use of fluoride gels three times a day helps stop extensive root decay due to chemotherapy.
Not all sensitive teeth are treatable with fluoride gels. Sensitive teeth might indicate bite problems, night grinding, or cracked or decayed teeth, so please consult your own dentist if any of your teeth are sensitive.
Healthy gum tissue is firm and pink and does not bleed. In most cases, bleeding gums are caused by infrequent brushing and flossing, poor diet (high in sugars, starches, carbohydrates or alcohol), and blood sugar imbalances. If it has been one year since your last cleaning, very often there will be calcified deposits attached to the teeth and the gums will be irritated. Similar to having a splinter in your finger, it is sore until you get the splinter out.
You can avoid getting sensitive, bleeding gums by:
- Having a regular check-up exam and cleaning. Based on your individual needs, this may need to occur every three months, four months, or six months.
- Taking care of your own mouth between cleanings. Use a soft toothbrush at least twice a day (ideally after every meal)
- Remembering to buy a new toothbrush every month. Brushes do wear out!
- Flossing. Your toothbrush can only clean the front and back of your teeth. The best way to clean the side of your teeth that touches another tooth is with dental floss.
Your mouth is a mirror of your body's health. If you do see your dentist regularly, and you do take care of your teeth between check-ups, bleeding gums could indicate other problems, including diet deficiencies, vitamin deficiencies, pregnancy, menstrual cycles, or even diabetes or leukemia. Blood tests at a laboratory can quickly determine if you have any other diseases. Select a dentist who is interested in prevention and has a plaque control program. If your gums still bleed after finishing this plaque program, your dentist may consult with your physician about the need for some medical tests.
Fluoride is a natural compound that is found in practically all soils, plants, animals and even teeth! Since the 1940s it has been used in drinking water, topical gels, solutions and tooth pastes.
Fluoride can drastically reduce tooth decay by 25 to 50%. The most common use for fluoride is in drinking water. (Over 100 million Americans currently drink fluoridated water.) The best dosage is one part fluoride to one million parts water. Fluoride drinking water is most effective during the years when a child's teeth are forming (birth to age 6)
Remember, the adult teeth (front incisors as well as back molars) begin to form buds at age 9 months, even though they don't appear in the mouth until ages 6 or 7. Fluoride becomes part of the calcifying tooth bud and helps make the adult teeth stronger and more resistant to decay. Fluoride can also strengthen the first set of teeth (baby teeth) while they are forming in utero, and during the first 6 months after birth.
On the negative side, the adult tooth buds (forming from birth to age 6) are very susceptible to high temperatures and also stains from medication. Therefore, fevers and viruses can cause pits or chalky areas in the enamels, while the antibiotic tetracycline can stain the forming teeth blue and/or gray.
Excess fluoride 5-6 times the ideal (or 5-6 parts fluoride to one million parts water) can cause brown or yellow stains in the teeth. Don't be afraid; Los Angeles doesn't have water like that. Los Angeles has fluoride in the water naturally, one half part fluoride to one million parts water. The states of Colorado and Texas have high concentrations of natural fluoride (56 parts per million)
Today, many children's vitamins contain fluoride, so it is important to talk with your pediatrician and dentist about the proper dosage of fluoride vitamins and fluoride drinking water to avoid increasing the optimum dosage of one part fluoride to one million parts water.
And as for the "quack doctor" claims that fluoride is a poison: At the level of one part fluoride to one million parts water, you would have to drink 200-300 gallons of water at one sitting to get a lethal dose. The water alone would kill you first!
Dentistry is one of the few professions dedicated towards eliminating the very basis for its existence (decay and periodontal disease). Fluoride drinking water works well!
Don't be misled by labels! Sucrose, fructose, dextrose, honey, corn starch, corn syrup, natural sweetener, all are "high falootin" names for SUGAR. Honey is sugar in a syrupy form. Alcohol is quickly digested to become sugar in a liquid form. Most packaged foods today contain sugar: your creamer is loaded with corn starch, that little 8 oz fruit yogurt has about eight cubes of sugar in it...even table salt has sugar in it. The average person today eats more than 120 lbs of sugar a year, as compared to 10 lbs a year in 1920.
The signs of heavy sugar diets include:
- Decay around the necks of two or more teeth
- Decay around the edges of your dental fillings
- Swollen, bloody gums
- Loss of bone around your teeth
If you do eat sweets, limit them to mealtimes, or maybe limit them to one treat a day a week. Be sure to brush within thirty minutes. It only takes thirty minutes for the bacteria in your mouth to turn sugar into an acid which can destroy tooth enamel.
Here are some ways to limit your sugar intake:
- Be an informed consumer by reading nutrition labels
- Purchase foods packed in water instead of syrup
- Snack on fruit and nuts instead of cookies or candy
- Buy plain yogurt and add your own fresh fruit
- Avoid sugary cough medicines
- Watch those candy throat lozenges
Many people are dissolving their teeth with citric acid (the liquid that is present in lemons, oranges and grapefruits). Just like too much bleach can eat holes in your clothes, too much citric acid can dissolve your tooth enamel.
The signs of damage caused by citrus include:
- Rough, brown patches on the enamel near the gumline. As the acid dissolves the outer layer (the enamel), the next layer of the tooth (dentin) begins to show through. Dentin is usually orange or brown in color.
- Sensitivity to hot or cold or sweet things around the gumline of the tooth. The outer layer (enamel) does not have any nerves in it, but the inner layer (dentin) does. As the enamel wears off, more and more of the dentin can be exposed, resulting in sensitive teeth.
The damage from citrus juice overdose can be corrected with bonding (tooth-colored material that sticks to the tooth). Or, if the damage is too deep, the affected teeth may have to be covered with caps (sealed under the gum tissues). Remember to drink orange, lemon or grapefruit juice in moderation.
Rinse your mouth with water to stop the citric acid. Also, the same enamel damage can occur with a heavy diet of sugary carbonated drinks or even olives pickled in vinegar.
Mouth protectors should be worn while playing sports. Mouth guards reduce the probability of concussion and help absorb trauma to your mouth and jaw. Torn and traumatized cartilage in your TMJ (Temporomandibular joint) can result in a permanently stiff joint, limiting your ability to open your mouth. Other injuries to your mouth that can occur while playing sports include:
- Lip lacerations
- Cracks or chips in teeth
- Fracture of tooth enamel or root
- Avulsion (complete knocking out) of tooth
- Fracture of jaw and/or the jaw joint
- Fracture of the skull bone (the maxilla, the bone that covers your front teeth)
The shape of your jaw can be very critical in sports injuries. The jaw (mandible) is one continuous U-shaped bone that inserts into a socket near the ear on either side of your face. The jaw joint (Temporomandibular joint) is just like any other joint. There is a ball and a socket, a pad of cartilage, and ligaments that hold the jawbone into the socket. If your jaw (ball) or condyle is larger than the socket, you will have a higher risk of jaw fracture if you are hit in the face. Such a jaw is labeled "glass jaw".
Before you begin any sporting activity, you should get a dental checkup and be sure that:
- All cracked and missing fillings should be replaced.
- All abscessed teeth should be removed or saved with root canals.
- All mouth pathology, such as gum disease or tooth infections, should be treated before you resume playing.
- Individuals with a cleft palate or other malformations need specially fitted mouth protectors.
The key to mouth protectors is to make them comfortable. There are 3 types and in all cases a dentist should fit all three. Don't rely on coaches, trainers or yourself. The types of mouth protectors are:
- Stock - as the name implies, this type or mouth protector is bought "off the shelf." They come in different sizes, but the fit and retention is minimal and the jaws must be kept tightly together in order to keep it in place.
Mouth-Formed - it has an inner and outer layer. The outer layer is firm and supports a softer, initially
moldable inner material. Mouth-formed protectors come in two varieties:
- Type 1 - Thermostat - the inner material is softened by heat (usually hot water) to the surface. The entire appliance is then placed in the mouth, where it sets to the desired form.
- Type 2 - Chemoset - the inner material is mixed and placed into the firm outer shell. The dentist then holds it in its proper position in the mouth until the desired chemical reaction occurs and the setting is complete.
Custom-Formed - is the best and the most comfortable. It is formed over a cast (plaster model). The materials
most frequently used are plastic resin, vinyl plastics, polyurethane, self-caring latex and resilient vulcanized
rubber. There are two methods to prepare custom protection:
- Method 1 - Vacuum-Adaptation - a sheet of heat-softened material is adapted over the cast (plaster model), drawn to fit and formed by a vacuum force.
- Method 2 - Processed Protector - a resilient material is mixed and processed directly on a plaster model.
Mouth guards attempt to protect the mouth from trauma. The "bite" or the relationship of the upper and lower teeth determines on which dental arch the protector is actually worn. There are 3 general "bite" classifications:
- Class I - for most people the upper teeth slightly overlap the lower teeth.
Class II - 2 divisions
- Division I - overbite - the upper teeth grossly overlap the lower teeth and may even bite the lower lip.
- Division II - overjet - the upper teeth stick out, leaving a big space between the upper and the lower teeth ("bucktooth" or "horseface" appearance).
- Class III - those individuals with a prominent lower jaw. Sometimes the teeth are end to end, or the lower front teeth may even overlap the upper front teeth ("bulldog look)
Mouth-guards for Class I and II would cover the upper teeth, while with Class III (prominent lower jaw), the mouth-guard may be used on the lower teeth. For the most protection, cushioning and retention, the mouth protector should cover all of the remaining teeth of one arch.
Just like there is an art and a science to matching hairpieces and eyelashes, there is an art and a science to matching dentures. Here is the criteria for natural looking dentures:
- Have the color of your denture teeth correspond to the color of your eyes, skin and hair. Just as one's hair color changes with age, your teeth also age with you to show more color. Allow your dentist to blend the color of your denture teeth. The two front teeth should be the lightest in color (but never white). The two side front teeth (laterals) should be one shade darker, and the two eyeteeth (cuspids) two shades darker than the two front teeth.
- Select the shape of tooth best suited for the structure of your face. Did you know that teeth can be different shapes: round, oval, square, and/or tapered?
- Have the denture teeth arranged so that they are visible when speaking and so that they support the musculature of your mouth. Proper support prevents a caved-in looking mouth. Vary the position of the front teeth for a more natural looking result. Avoid teeth arranged in a perfectly straight line. The two front teeth should be slightly longer depending on one's age; the teeth of an 18-year-old look out of place on a 60-year-old. Over the years, teeth are worn down on the chewing edges, so allow your dentist to reshape the edge of your denture teeth in order to make them look like they belong in your mouth.
- Have a collapsed bite corrected by restoring the proper jaw relation of the top teeth to the bottom teeth. See your dentist regularly every six months to check for any sores or lesions and to check for possible collapsed bite, which can increase facial wrinkles and bags.
- Dentures don't last forever. Many denture wearers incorrectly assume that their dentures are good for life...until they get loose or they begin to hurt. Dentures usually have to be remade every five years to make up for the loss of redye (bone).
Over 70 million Americans are covered by prepaid dental care programs. While each plan is unique, there are some general points to remember:
- Benefits can run from basic coverage to full coverage.
- Dental insurance plans do not pay for the entire cost of dental care. They are designed to help lower the patient's share of the bill.
- Every program includes guidelines to limit the payment of the insurance company. These include:
- Deductibles - Deductibles require the patient pay a specific dollar amount toward the bill before the insurance coverage begins.
- Co-Payment - An insurance company will pay a certain percentage of the bill for covered dental services, leaving the remainder of the cost to be paid by the patient. The two key phrases here are "certain percentage" and "covered dental services". These will vary based on your individual insurance plan.
- Set Dollar Limits - Insurance companies can place set dollar limits on covered services.
- Dental services your plan may include are:
- Diagnostic (x-rays, dental exams)
- Preventative (cleanings)
- Restorative (fillings)
- Oral and maxiofacial surgery
- Endodontics (pulp/root canal therapy)
- Periodontics (gum specialties)
- Prosthodontics (cemented or removable bridges, full dentures)
Check with your insurance provider to see what your plan offers.