White Teeth! Part 2: Two Available Techniques

Two Available Techniques
There are two types of whitening available.  One is done by the patient at home, and the other is done by us during an office visit.  They can be done separately or in conjunction with each other.  The at-home technique involves using a soft, thin, comfortable mouthguard-like tray.  An impression is made of your teeth, and custom whitening trays are fabricated.  Then at hom, you place the whitening solution in the trays and wear them for an hour or two each day or sleep with them in place all night.  With in-office whitening, you come to the office for 1 or 2 hours, and a stronger whitening solution is applied by us and activated for that time.  Usually only one visit is required.

The color change should last for 3 to 7 years in most people.  The color change you see immediately after whitening is completed will regress one shade over the course of 1 to 3 months, with most of the change taking place in the first week.  If you drink a lot of coffee, tea, cola beverages, red wine, or if you smoke, the teeth may begin to turn darker again.  When this happens, the whitening process can be repeated.

The possible side effects include temporary white discoloration of the gum tissue if the office whitening solution comes into contact with the gum.  This goes away quickly.  The teeth may become slightly sensitive to temperature changes for a short time.  This also goes away quickly.  There is no damage to the tooth enamel, dentin, or pulp from the whitening process.  Fillings and crowns do not whiten.  When your teeth change to a lighter color, you may need to have those fillings and/or crowns redone.  We will let you know whether this is a possibility before we whiten your teeth.  There are no other adverse effects known.

The teeth that show when you talk, smile, or eat are the teeth that would benefit your appearance most if whitened.  Usually the top teeth are whitened because they are much more visible than the bottom teeth, but both arches can be successfully whitened.  The lower teeth take about three times as long to reach the color change of the top teeth.

If you have any questions about whiter teeth, please feel free to ask us at (512)250-5012.
-Omni Dental Group

Whiter Teeth! Part 1: Why are They Yellow?

Why Do Teeth Get Yellow?
The intrinsic (normal) color of your teeth is related to the color and thickness of the enamel and dentin, as well as the types of foods and liquids you ingest.  The thinner the enamel, the darker the underlying dentin; the more coffee, tea, cola beverages, and red wine you drink, the darker your teeth will be.  Cracks that are commonly found in the enamel of your teeth may provide a pathway for discoloring fluids to reach the underlying dentin.



If you have a yellow, brown, or orange shade to your teeth, in most cases it can be made lighter by the whitening procedure.  Whitening works very well in removing age-related darkening of your teeth.  This age-related darkening is most likely due to years of drinking the beverages discussed above, or other environmental factors, rather than genetics.  No drilling or anesthesia is required for whitening.  Your teeth will not become weaker.  Because the mineralization of teeth varies so much from person to person, there is no way to determine how many office visits it will take to effect the color change change or how white the teeth will get.  The darker your teeth are, the more time required for the change and the more distinctive the color change will be.

The whitening procedure will also work to a lesser degree on teeth with tetracycline discoloration.  We have seen several fair to good results from both in-office and at-home whitening.  It does take more time to achieve good results on this type of stain, and unfortunately, sometimes the change is minor.

If you have any questions about stained teeth or whitening procedures, please don't hesitate to ask us at (512)250-5012. -Omni Dental Group

Are You Wise to the Ways of Wisdom Teeth?

Human beings have more teeth than they actually need: four more, to be exact.  The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth.  If we don't need them, why do we have them?  Hundreds of thousands of years ago, our ancestors didn't look a great deal like we do today.  They had smaller bodies but larger and more powerful jaws.  Their diet dictated this jaw structure and number of teeth.  Our ancestors ate a tougher and more abrasive type of food.  It wasn't cooked well, and it wasn't ground up well.  There are a lot of hard grains and foods that required lots of chewing.  Big jaws were capable of holding more teeth for this chewing.

Today, we don't need the heavy grinding capacity that early humans had.  Food is easier to eat, less abrasive, and much softer.  Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles.  The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total).  Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing.  The wisdom teeth often do not have enough room to grow properly.  Eventually, thousands of years from now, humans will not have wisdom teeth.  They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all.  They can be fully erupted, partially erupted, a soft tissue impaction, partial bony impaction, or full bony impaction.  If teeth come in well and you are able to keep them clean, we leave them alone.  If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen.  Decay and gum infection are likely to result.  These teeth are usually removed -- ideally before they begin to cause big problems with the second molars that are directly ahead of them.  Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin.  If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis).  The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist.  We will refer difficult extractions to an oral surgeon for treatment.  Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital.  This will be determined after viewing radiographs of the teeth.  Having all four wisdom teeth out at the same time is a common practice.  Postoperative discomfort can be minimal to extreme -- in the case of difficult full bony impactions.  Antiinflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well.  If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well.  If you need to have one wisdom tooth taken out , also have the opposing wisdom tooth removed.  When a tooth does not meet an opposing tooth, it "super erupts" or continues to grown out of the normal position.  When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it.

If you have questions about wisdom teeth, please feel free to ask us at (512)250-5012.  
-Omni Dental Group

Dry Mouth Syndrome: Xerostomia

Xerostomia (dry mouth) is not a condition everyone should expect.  You may notice it as you age due to a change in hormones, medication, and/or radiation therapy in the head and neck region.

Why Xerostomia Is a Problem
Saliva is important to oral health for several reasons.  The flow of saliva helps clear debris from the oral cavity.  It provides minerals neccessary to support the process of remineralization.  Tooth enamel daily undergoes acid attack that removes inorganic minerals from teeth.  This is called demineralization.  Remineralization is the opposite of demineralization.  It occurs when inorganic molecules flow into a region of weakened enamel and make it stronger.

When the salivary flow is reduced, a chain of events occurs.  The natural cleansing action is diminished, as are the buffering action and remineralization properties of saliva.  People with diminished salivary flow experience a very fast rate of decay, many times faster and over several teeth.  This type of decay is typically found along the gumline, around dental work that already exists, and on exposed root surfaces.

Prevention
You can help prevent dental decay that can result from xerostomia.

• Brushing and flossing correctly at least once each day becomes very important. (See This Post)
• Frequent sips of water during the day can help moisten the mouth and can help clear debris.
• Daily use of a mouthrinse containing fluoride can help remineralize the teeth.






• Use a toothpaste containing sodium fluoride.

• We recommend a daily brushing with a prescription, high-concentration sodium fluoride gel or paste.  We will either dispense this or give you a prescription for it.






• Chew sugarless gum or a rubber band to help stimulate salivary flow.
• In moderate to severe cases, special fluoride delivery trays can be made for you to use at home.  These will keep the high-concentration fluoride in a position to "soak" your teeth with fluoride for several minutes at a time.
• We recommend that you have your teeth cleaned, polished, and an office-applied topical fluoride treatment every 3 months while the condition persists.

Dry mouth can have serious dental consequences and must be treated accordingly.

If you have any questions regarding Dry Mouth Syndrome, don't hesitate to call us at (512)250-5012. -Omni Dental Group

A Child's First Visit to the Dentist

Getting Ready
A child's first visit to the dentist should be at a much earlier age than most parents think -- and for a different reason.  The first dental visit should occur in infancy, as teeth are beginning to erupt.  During this visit, we will let you know how to care for your child's teeth and what preventative measures you should be taking for your infant at this early stage.  Many dental problems can be intercepted when we have the opportunity to examine your child and visit with you in the early developmental stages.

The first cleaning for your child should be done at about 2 to 2.5 years of age, depending on the child's behavior.  Importantly, this should not be the first time the child visits our office.  Before this visit, we would like the child to come in with a parent who is getting a routine preventative cleaning and check-up.  In this visit with a parent, the child can learn that the dentist office is not a scary place and that the people there are very friendly.  This will allow your child to feel much more comfortable when the time comes for them to have an appointment.  Usually, children introduced to dentistry in this manner are very excited about having their own dental appointments.

It is important for parents to always talk positively about going to the dental appointment as well as after the appointment has occurred.  Children are quick learners.  They may not know what some of the words mean, but they can understand how you feel about it.  You should try not to use any words around them that might have an unpleasant connotation: toothache, drill, pull, hurt, pain, unhappy, etc.  Always talk about how happy you are to go to the dentist and what a great experience it was, so that your child is not afraid of being in the office.  It may even be helpful to mention ways that visiting the dentist has been helpful to you.

The Visit
The first time the child has a dental procedure performed, at the age of 2 to 2.5 years, it will usually be very simple, quick, and entirely painless.  Of course, we assume you have followed all the preventative suggestions we have given you: fluoride vitamins, if appropriate, brushing the child's teeth, nothing in a night bottle but water, and so forth.

First, we will spend a little bit of time with the child in a show-and-tell mode.  We will show the childs the various instruments: polishers, mirrors, the water gun (air/water syringe), and so on.  The dental hygienist will also begin to instruct the child in proper brushing techniques.  At this young age, children do not manipulate dental floss and a brush properly.  This is a project for the parent.  Since children admire and try to imitate their parents, your good example of brushing and flossing each day will help tremendously in this area.  Children will see that it is something you do, which they will then try to imitate.

Also during this visit, the dentist will "count" the child's teeth, while looking for decay or other problems.  Then the dental hygienist will "tickle" (clean and polish) the teeth.  Stains and plaque that might have accumulated will be easily removed.  It is very unusual for a child to have major periodontal problems.

If the child is prepared correctly, the first treatment visit at the dentist will be anticipated with no anxiety, proceed smoothly, and make the child excited about coming again.  What you do at home in preparation for this visit is most important to its success.  Good Luck!

If you have questions about your child's first visit to the dentist, please feel free to ask us at (512)250-5012.  -Omni Dental Group. 

Pocket Depth Measurement

When a dentist or physician is preparing a treatment agenda to heal a disease, test results are analyzed.  Treatment decisions regarding a potential cure depend on information gathered.  The more accurate the diagnostic information, the better the diagnosis and treatment.  In the realm of periodontal disease, diagnosis is based in part on the collection and analysis of many numbers, specifically, measurements of the depth of the sulcus (crevice) of gum tissue that surrounds each tooth.

A periodontal charting generally consists of taking at least six measurements around every tooth.  Areas of bleeding are also recorded.  The evidence of bleeding is significant.  Healthy gum tissue does not bleed when gently probed.  There are certain factors, such as found in smokers that restrict bleeding, so lack of bleeding alone does not signify a healthy site.

These measurements (in millimeters) are one of the diagnostic tools (along with tissue color, position, and shape) a dentist and dental hygienist use to determine the severity of periodontal (gum) disease.  Measurements generally range from 0 to 12 mm.  Probing of the sulcus around the tooth often shows normal depths of 1 to 2 mm with greater depths in between the teeth where they touch as opposed to the direct cheek side or tongue side.  The numbers will vary from position to position and tooth to tooth.  They are rarely uniform throughout the entire mouth.  The higher numbers indicate more severe soft and hard tissue involvement, and the greater the number of higher readings, the more likely surgical intervention is needed.

• 0 to 3 mm with no bleeding:  Great numbers.  No periodontal disease present.
• 1 to 3 mm with no bleeding:  Gingivitis (the mildest form of gum disease) present.  Probably no bone loss.  Usually treated with a good professional prophlaxis (cleaning) and improved oral self-care.
• 3 to 5 mm with no bleeding:  May or may not have gum disease present.  Smoking may be a factor in lack of bleeding.  Since a patient cannot reliably clean deeper than 3 mm on a routine basis, there is high potential for gum disease to begin.  Recommend professional recare visits 3 to 4 times a year.
• 3 to 5 mm with bleeding: Early to moderately advanced periodontal disease.  Treatment is professional prophylaxis consisting of scaling and root planning and possibly systemic and/or site-specific antibiotics and other medications.  Supporting bone may be involved.  More frequent and extensive recare appointments are required.  Some surgical intervention is possible.
• 5 to 7 mm with bleeding: Soft and hard tissue damage.  Bone loss likely.  Treatment will involve a more aggressive prophylaxis -- scaling and root planning.  Multiple appointments will be needed.  Localized surgical intervention probable.  Systemic and site-specific medications commonly used.  Teeth may have started to become loose.
• 7 mm and above with bleeding: Advanced periodontal disease.  Aggressive treatment required if teeth are to be saved.  Surgery almost always required.  Referral to periodontist is common.  Systemic and site-specific medications commonly used.

In short, low numbers are good and high numbers are bad.  The presence of deep periodontal (gum) pockets corresponds to more extensive gum disease and the need for more periodontal treatment.

If you are concerned about your periodontal health or have questions about pocket depth measurement, give us a call at (512)250-5012 and set up an appointment today!  
-Omni Dental Group

Smoking and Adult Periodontitis

If you are a smoker, you are at a higher risk for not only lung and circulatory problems but oral disease as well.  Smoking causes cell death and may be responsible for more than 50% of cases of adult periodontitis.  It has been reported that more than 85% or all periodontal cases are present in people who smoke.  And, more than 90% of gum infections that appear to be resistant to treatment (refractory gum disease) are found among smokers.  Smokers are 2.6 to 6 times more likely to have periodontal disease.  Former smokers are more likely to have periodontal disease.  A person who smokes will not heal as well and does not respond as well to periodontal therapy as does a nonsmoker.

Smoking Can Be a Cause of Oral Diseases

Thousands of chemicals are released during smoking, which causes a profound effect on the immune system that is responsible for helping us ward off infections.  And since we now know that periodontal disease is an infection, it is easy to make the connection.  Many smokers show few areas of bleeding during a periodontal charting because one of the effects of smoking is reduced circulation.

If you are reading this, you are most likely a smoker who has periodontal disease.  Many smokers would like to stop this habit.  Quitting is not as difficult as you may imagine.  The thought of it is probably the most difficult aspect.  There really are many aids today to help us to make that lead to a healthy decision about our dental and general well-being.  Our office can be a great source for some suggestions to help you stop smoking.  If you would like us to make suggestions for a healthier lifestyle, please feel free to call us.

We are available to discuss with you and answer questions about smoking and dental health.  You can contact us at (512)250-5012. -Omni Dental Group

Taking Care of Braces

It is very important to keep your teeth immaculately clean while you have braces, even though it is more difficult to do so.  The extra food that can be easily trapped around the band, brackets, and wires will decompose over time and can cause gum decay and possible gum disease.  It is pretty devastating to see braces removed from newly straightened teeth and find that the teeth are all decayed or disfigured.  It is even more depressing to have restorations placed in these nice straight teeth.  Fortunately, this can be avoided with proper self-care and maintenance.

We will spend as much time as you need in showing you how to keep your teeth clean and your gums healthy.  There are dental cleaning aids available to help maintain proper self-care while undergoing active orthodontic therapy.  We will demonstrate their use and either provide them for you or tell you where you can purchase them.

We advise that you return to the dentist office every three months while the braces are on in order to have your teeth cleaned by the dental hygienist and receive topical fluoride treatment.  We find that with this preventative recare interval, you have less chance of developing periodontal (gum) problems around the braces under and around the orthodontic appliances.

Keeping Braces Clean is Essential to Preventing Future Dental Problems.

Listed below are several additional tips for caring for your braces:

• Use a toothpaste containing fluoride when you brush your teeth.
• Use dental floss threader as instructed and demonstrated to clean under the arch wires every night.
• Rinse with a fluoride-containing mouthrinse at least once each day.  Follow the instructions included with the mouthrinse.  Use of the fluoride mouthrinse will help reduce the possibility of decay or decalcification (white or soft spots in the enamel) under the cemented or bonded bands and brackets.  We consider it to be a very important prevention aid.
• Use an oral irrigator as demonstrated to help remove debris from around the braces.  This is in no way a substitute for proper brushing and flossing.  It is an adjunct oral self-care aid.
• Use an electric toothbrush as instructed.

Take proper care of your teeth while your braces are on.  You will be glad you did.

If you have any questions about dental care while wearing braces, please feel free to contact us at (512)250-5012. -Omni Dental Group.

A Lifetime of Oral Health is Possible!

It is absolutely possible to have healthy teeth and gums for your entire life.  Cavities, periodontal disease, and other problems can be prevented.  Here are some ways to ensure that your mouth stays healthy:

• Brush, floss, and use recommended dental aids correctly, at least once a day.  Use a fluoride-containing mouthrinse daily.
• Come to the office for the recare hygiene appointments at the intervals we recommend to you specifically.  Let us provide a prescription-strength topical fluoride treatment at every recare appointment.
• Let us take radiographs when we believe they are necessary.
• Teeth age and wear, just like the rest of your body.  The outer covering of hard enamel can get thin, break off, or wear through and expose the softer dentin.  Dentin erodes very quickly.  When we see exposed dentin, let us get it covered and protected.
• Have sealants placed on all teeth that can benefit from them.
• Don't ask us to "patch" anything.  Patchwork dentistry is contrary to the concept of keeping your teeth trouble-free for a lifetime.  If small repairs are possible and appropriate, we will tell you.
• Choose the procedure or restorative material that will last you the longest.  All dental materials have a life expectancy, after which time they fail and must be replaced.  Each time a tooth is redrilled, it gets weaker.  Only solid, yellow gold could last for your entire life.  Tooth-colored ceramics and porcelain may last as long.  It is your choice.
• Bonded restorations require less drilling than silver fillings.  Less drilling is good.  The tooth retains more strength and the restoration lasts longer.  Let us use the good stuff.
• Gum disease can start at any time.  Genetics, diet, oral self-care, medications, and general health can all have an influence.  Gum disease is both site-specific (most often starts in a localized area) and episodic (can begin any time).  It is also painless in its early stages.  We will tell you as soon as we spot gum disease.  It will need to be treated properly and immediately.
• We have listened to what you want, examined your mouth, and know your dental needs.  Most patients can have all the best dentistry they want and deserve.  It just takes a little planning.  We can help with that, too.  If you want all of your teeth, all of your life, follow the above recommendations and do it right the first time.

Subgingival Irrigation

Subgingival irrigation (flushing) of the periodontal tissues is a nonsurgical, additional treatment for periodontal (gum) disease.

In a healthy mouth, there is a crevice or ditch-like space around every tooth called a sulcus.  We have an instrument called a periodontal probe to gently measure the sulcus space.  The sulcus should measure between 1 and 3 millimeters, and no bleeding or pain should occur during probing.  Gum tissue should be tightly attached to the bone surrounding each tooth.  When the gum tissue is infected and periodontal disease is present, the tissues become red and swollen.  When the sulcus is over 3 millimeters, it is difficult, if not impossible, to keep the bacteria levels under control with normal oral self-care.

 

Subgingival irrigation may aid in the removal of debris, bacteria, and toxins that cannot be routinely removed with normal oral self-care.  A stream of fluid under slight pressure is delivered under the gum tissue to the appropriate site(s).  The area is flushed out.  The irrigation in the office is usually done with an antimicrobial that has a substantive effect: the molecules of the antimicrobial cling to your teeth and tissues and keep working for hours after the subgingival irrigation is completed.  Water or other chemicals can also be used.  If you are told that subgingival irrigation should be part of your daily oral self-care routine, you will be instructed in the proper solution to use.

If the subgingival irrigation is properly accomplished, you can remove a high percentage of problem bacteria and toxins out of the sulcus that cannot be reached with normal care efforts.  The flushed and disturbed area should show a reduced level of bacteria.  It may take a while for the bacteria and debris to build up to a level where they can again cause further or continued problems.

 

Subgingival irrigation is not a substitute for excellent oral self-care or for periodontal surgery, but it is another modality we can use in the treatment or prevention of periodontal disease.  If you are in active initial periodontal therapy, the subgingival irrigation will be a part of your treatment.  If you are in maintenance, it may be part of the routine treatment rendered when you come in for your recare appointment.  If we recommend that you perform this procedure daily as part of your normal oral self-care, you will receive further instructions.

If you have any questions about subgingival irrigation, please feel free to ask us at (512)250-5012. -Omni Dental Group

What Exactly is Gingivitis?

Almost everyone knows what a cavity is.  Because of the far-reaching effects of advertising by toothpaste and oral rinse manufacturers, by 2004 almost everyone had heard of gingivitis.  What may not be quite clear to you, however, is exactly what gingivitis is.  You may recognize it as a problem but don't know why and how serious it might be.  You may even know that it is a type of gum (periodontal) disease.  You may also know that it is somehow related to plaque and tartar (calculus) on teeth.  But why should you be concerned about having it?

Gingivitis is an infection of the gum tissues surrounding the teeth.  it is a very common infection and affects almost 95% of the world's population. This infection can be characterized by redness, swelling, and bleeding of the gums around the teeth.  This gum infection absolutely needs to be treated as soon as possible.  Gum infections are almost always preventable with daily oral self-care.

Gingivitis is the mildest form of periodontal disease and it is reversible.  By definition, there is not loss of bone that supports the tooth.  If treated early, gingivitis can be completely eliminated.  If left untreated, it can progress into the more serious form of periodontal disease called periodontitis.  In its more serious form, the bone and gum tissues can be permanently affected.  Bleeding gums, one of the signs of gingivitis, are a sign of infection in the mouth.  Your gum tissues should never bleed.  It is not normal for blood to appear on your toothbrush when you have finished brushing (see previous post).  Gingivitis does not generally hurt, so you may not even know that you have it.  It can be localized (around a few teeth) or generalized (around most or all of the teeth).  Gingivitis is seen most often in patients who do not brush and floss well daily, but it can also be related to medication.  Bad breath can be another sign of gingivitis.  If you are using a mouthwash to get rid of bad breath, you may need dental attention.  While bad breath can be related to some medical problems, most often it is just debris that is not cleaned properly from your teeth, gums, and tongue that is decomposing in the dark, warm, and moist environment of your mouth --a perfect place to breed germs.

If you have bleeding gums, you should be concerned.  Healthy tissue anywhere in our bodies does not bleed.  So what can you do to stop the bleeding?

We can help you eliminate the gingivitis.  It involves a good professional cleaning and good oral self-care habits.  Plaque (soft debris made up of bacteria) and tartar (calculus or hardened debris) must be removed before the gum tissues can heal and the infection can be eliminated.  If it has been some time since your teeth cleaned properly, it may take more than one appointment to get you back into shape.

Get your teeth and gums cleaned on a regular basis.  Keep them clean with daily brushing and flossing.  The infection you have will be eliminated.  If you keep your teeth and gums clean, they can be healthy and trouble-free for your whole life.

If you have questions about gingivitis or want to set up an appointment for examination and cleaning, please give us a call at (512)250-5012. -Omni Dental Group.

Early Signs of Periodontal Disease

The early warning signs of every disease occur at a microscopic level.  The early warning signs cannot be seen, felt, touched, diagnosed, or discovered.  They cannot be noted by their symptoms.  The early changes might be able to be detected by sophisticated chemical or biologic analysis, but not by normal measures.

By the time you notice that your gums are bleeding (gingivitis), the disease has already been present for some time and it is not in its earliest stage.  It is not unusual to hear, "My gums have always bled like this," but treatment is not sought.  Yet if our eyes started to bleed when we washed our faces, we would generally rush to seek medical treatment!  Bleeding gums are not normal and healthy.  Luckily, at this stage the periodontal disease is fairly easy to treat and is reversible.  When the disease has progressed past the bleeding gum stage, you may notice some pain, gum recession, loosening of teeth, and bad breath.  If you have ignored your bleeding gums (possibly the earliest sign of gum disease) because you think it is normal to have a little "pink" on your toothbrush, you will likely have additional symptoms and conditions associated with disease progression.  At this point the bone and gum support for your teeth may be permanently altered and diminished.

It is recommended that you adhere to the suggested time intervals for your dental cleaning appointments.  We will examine your gums during the periodic dental cleaning appointments for early signs of periodontal disease.  While we clean your teeth, we will note areas where it is difficult for you to remove plaque or where calculus forms and areas of gum tissue inflammation and will record probing depths, which will measure your gum tissue for signs of periodontal disease.  We can then demonstrate effective oral self-care to prevent these areas from progressing into periodontal disease.

We want to stress prevention.  Don't wait for the warning signs of gum disease to occur before you schedule your dental hygiene appointment.  If you have very few fillings, have not lost any permanent teeth (other than wisdom teeth), and have very thorough oral self-care daily, a yearly cleaning and exam by the dental hygienist may be adequate.  If you have had a great deal of dental work performed (bridges, crowns, fillings) or if you have missing teeth that have not been replaced and you don't spend time with adequate oral self-care, visiting the dental office three or four times a year might be necessary.  We will let you know what is appropriate for your individual oral condition.

If you have questions about these symptoms of periodontal disease or would like to set up an appointment for examination and cleaning, please call us at (512)250-5012.  -Omni Dental Group.

How to Brush! How to Floss

An old expression says, "You don't have to brush all your teeth every day.  Only the ones you want to keep!"  And while this seems like a silly thing to say, it could not be more true.  To maintain good oral health, teeth must be thoroughly cleaned each and every day.  One good method of brushing is called the modified Bass technique.  It is easy and quite effective.  We can instruct you on how to brush properly.  It is certainly easier to see it done than to read and imagine.  But this will help you get started.

Use a multitufted, soft, nylon-bristled toothbrush.  Hard-bristled toothbrushes can easily damage your teeth and gums.  Soft-bristled toothbrushes last about 3 months before they need to be replaced.  Don't keep a toothbrush for an extended period of time.  When the toothbrush bristles become worn, they will not give you the best possible performance.  Medium and hard brushes will last longer, but almost everyone brushes too hard to use these brushes.  If you use medium and hard brushes or brush improperly with any toothbrush, you can cause permanent damage to your gum tissue, causing it to wear away.  This can also wear notches into the tooth itself, exposing the dentin.  In both cases, severe tooth sensitivity could develop.

Bass Method Brushing

The Bass Method

• The bristles of the brush should be angled toward the area where the tooth meets the gum, approximately a 45-degree angle.
• The bristles of the brush should be able to gently slide under the gum tissue.  Gently move the brush back and forth so that there is a vibrating motion, not a scrubbing motion.  The brush head should be able to cover and clean about two teeth at a time.
• Brush each area for about 10 seconds, then roll the bristles to the biting surface.  Move the brush head so that it overlaps a small portion of the tooth just brushed and the next teeth.  Repeat until all teeth are brushed.

Brush all teeth.  Start on the cheek side of the back teeth, at one corner of your mouth, brushing as you move across to the opposite corner.  Then switch to the inside (tongue or palate side) and again brush from one corner to the other.  Brush both upper and lower teeth using the vibrating back-and-forth motion.

Some areas will require you to switch the brush to a different angle such as the inside (tongue and palate side) of the top and bottom front teeth.  Using the tip or small end of the brush will help brush around this curved area.  Use the same type of vibrating motion with the brush, moving up and down against the tooth.

Brushing the biting surfaces of the teeth is easy.  Place the bristles on the biting surface of the teeth into the grooves and brush back and forth.  Be sure to brush the biting surfaces of left side and right side, upper and lower teeth.\

Use of Dental Floss
Start with a 14- to 16-inch piece of floss.  Any type of floss is okay to use.  Nonshredding is easiest to use.  It's thinner and most people find it easier to use.  Lightly wrap the floss around the forefingers of each hand until there is a length of about 1 to 1.5 inches available between the fingers.  Don't wrap it so tightly that you cut off circulation and your fingers turn blue!  Using your thumbs and forefingers, position the floss over the spot where two teeth meet.  With a gentle buffing motion, back and forth, move the floss between the teeth and slide it first under the gum around one of the teeth in a U shape.  Move the floss up and down a few times, then reverse the U and floss the other tooth.  The floss needs to get under the gum.  Then remove the floss and place it between the next two teeth.  Holding the floss taut between your fingers will give you more control, and flossing will be easier.

When you are able to perform these daily procedures effectively, you will significantly reduce your risk of gum disease and decay, and the associated expenses of treatment.  There are other flossing aids available if you have problems using your hands.  Let us know about these problems.  Electric or mechanical toothbrushes can also be used.  Again, talk to us about these devices.  Keeping your teeth healthy for the rest of your life can be accomplished -- one day at a time.

If you have any questions about how to brush or floss, please feel free to ask us at (512)250-5012. - Omni Dental Group

Headaches: The Dental Connection

You probably remember the old song "...the knee bone's connected to the leg bone; the leg bone's connected to the hip bone...etc." Your (lower) jaw bone actually is connected to your "head bone" -- and it is connected by muscles, ligaments, and tendons.  This area is known as the temporomandibular joint or the TMJ.  When the lower jaw lines up perfectly with the upper jaw and everything functions normally, everything is fine.  If the lower jaw does not line up properly or, perhaps more importantly, if there is abnormal stress present when the lower jaw contacts the upper jaw, problems can occur.  The abnormal stress is usually clenching or grinding of the teeth and it can occur any time, day or night, awake or asleep.  When this happens, a person can develop regular, chronic, or migraine headaches; muscle pain or tenderness in the jaw joint muscles; or the tempororomandibular joint dysfunction (TMD).  44 million Americans suffer from the chronic clenching and grinding, resulting in damage to teeth, and 23 million suffer from migraine headache pain.

While mouthguards have been used with some success to treat TMD patients, a new FDA-approved device seems to offer a higher success rate in eliminating TMJ problems.  This device has an additional advantage in that it was designed to reduce the clenching habits that often lead to chronic and migraine headaches.  This device prevents the upper and lower teeth from coming into contact.  By preventing high-intensity clenching (and the muscular irritation that leads to migraine pain, TMD, and chronic headaches), studies have shown that 82% of migraine and headache sufferers had a 77% reduction in the migraine incidents.  In short, the frequency and intensity of headache episodes and muscle tenderness can be reduced with the use of a mouthguard.

A tension suppression system is another effective form of mouthguard that can treat TMD.  This small removable device, made in the office, can be worn day and/or night and has been shown to reduce clenching intensity by 66%.  It takes advantage of a naturally protective reflex that suppresses the powerful chewing muscles active in clenching.  For those concerned about insurance coverage, the cost of this device is submitted first to medical insurance for evaluation of benefit coverage.  Most insurance carriers do consider this device a payable benefit.

How important is the reduction of the clenching stress?  Try this simple demonstration.  Put a pencil between the last top and bottom molars on one side and bite hard.  Remember how hard you were biting.  Then take the pencil and place it between the top and bottom front teeth and bite down hard again.  You will not be able to bite down as hard when just biting on the front teeth.  You should be able to detect a great difference between biting (clenching) on back teeth only and front teeth only.  Try another test: lightly place your fingertips on either side of your hand in the temporal area (above and in front of the ears).  Clench your teeth and feel the muscles on either side of the head bulge out.  Then take a pencil, place it between the top and bottom front teeth, and bite down again.  You will easily feel that the temporal muscles do not (cannot) bulge out as much, meaning that not as much clenching compression is possible.

If you have any questions about the connection between headaches and your teeth, please don't hesitate to ask us at (512)250-5012. - Omni Dental Group

Implants, Crowns, and Bridges vs. Natural Teeth

Nothing can replace the natural teeth you were born with for chewing and function.  However, very few people go through life without having teeth filled, crowns (caps) placed, or bridges and implants used to replace missing teeth.  Crowns, bridges, and implants are the best answer and closest to your natural teeth, but they are not the same as healthy, natural teeth.

Dental Crown

Crowns
Crowns are used to reconstruct a single tooth broken down as a result of dental decay.  Crowns are made of ceramic, resin, porcelain, porcelain plus metal, or resin plus metal materials.  They are bonded or cemented onto the prepared tooth and cannot easily be removed from the tooth once placed.  If the tooth was in good alignment before the crown was prepared, the crown will be in good alignment.  If the tooth was misaligned before the crown, sometimes the crown may be made to obtain a more ideal shape and position.  It is cleaned and flossed just like a natural tooth and is most like real teeth.

Bridges
Bridges are crowns that are attached together, suspending the crown portion of a false tooth in or over the space left by the missing tooth.  A bridge can be used to replace one or several teeth.  Sometimes a bridge is used to splint loose teeth together in order to make the teeth more stable.  Bridges are usually made of metal covered with either porcelain or resin.  Some of the newer bridges are made of all resin or all ceramic materials.  They are cemented or bonded onto the existing prepared teeth and are not easily removed once placed.  The bridge teeth can be brushed the same as natural teeth, but since they are attached together, must be flossed differently by using a floss threader or other device.

The teeth are generally the same shape as natural teeth.  However, if the existing teeth (abutments) that are used to anchor the bridge have moved from their original position because a tooth or teeth have been missing for years, the added tooth (pontic) may be longer or shorter than the tooth that it is replacing.  With a bridge, the false tooth will most often butt up against the soft tissue ridge where the removed tooth was.

The shape of the tongue side of the false tooth varies.  It is usually smaller on the tongue side and completely fills the space.  Food will have more of a tendency to collect in this area, so you must be prepared to clean it.  If the missing tooth has been gone a long time, the ridge may have shrunk considerably, and the pontic tooth will be longer than the teeth on either side.  If this is the case, there are several periodontal procedures that can be done prior to the construction of the bridge.  These procedures will build up the tissue to its former height.  The more your mouth has changed from its normal state, the harder it is to make new teeth look and feel natural.

Implant Crowns
Implant crowns are used to replace single or multiple teeth.  They are either cemented or screw-retained onto an implant fixture.  The crowns are made of porcelain or resin and metal.  But they have some significant differences from the natural teeth they replace.  Teeth are supported by a root or roots that are irregular in shape.  Implants are round.  The cross-sectional of the implant will never match that of the tooth it is replacing.  A multirooted tooth may be replaced by a single implant, so the manner in which an implant crown comes out of the soft tissue ridge will appear different from a natural tooth.  There will be more space between the implant root and the adjacent teeth.  Implant crowns are often cemented with temporary cement.  This allows the dentist to easily take off the crown and evaluate how the implant is doing.  Crowns on teeth are usually cemented with a final cement.  Implant-supported crowns are wonderful, but not the same as natural teeth with crowns.  Be prepared for some differences.  Expect more maintenance on your part and in the dental office with crowns, bridges, and implants.

Note to Smokers: Smoking can cause a more serious risk when it comes to implant failure, so be sure to discuss this with your dentist before moving forward with any procedure.

If you have any questions regarding implants, crowns, and bridges vs. natural teeth, please contact us at (512)250-5012.  -Omni Dental Group.

Extraction Site Defect

Teeth are removed for several reasons, including periodontal disease, extreme decay, and for orthodontic reasons.  Once a tooth is removed, the shape of the ridge (i.e., the supporting bone and gum in which the tooth was situated and retained) changes.  If there has been extensive bone loss, or if the tooth needed to be surgically removed (bone had to be cut away to gain access to the area), the change will b e more dramatic.  The ridge shrinks, collapses into itself, and over time decreases width and height.  As more time passes after the extraction, the more change occurs.  This is an extraction site defect.

The extraction site defect presents a problem when the area is to be restored with a bridge or an implant.  When the ridge architecture has significantly changed, the replacement tooth will have to deviate from the ideal shape.  This could easily make the area more difficult to keep clean, difficult for the dentist to restore, and cosmetically quite unsightly.  Perhaps the cosmetics may not matter to you when there is a back tooth being replaced -- one that is not visible when you speak or smile.  An extraction sit defect in an area visible when you speak or smile will create a severe esthetic problem.  The more the ridge has changed, the more the pontic will need to be either longer, wider, or fatter in order to fill up the extraction site.  If you have a smile line that shows the tooth or gumline, the replacement tooth will be very obviously misshaped.  It will never look right and will always be a cosmetic failure.

It is clear that for the replacement tooth to have a normal appearance, the extraction site must be rebuilt.  The closer it can be made to the ideal, the better the replacement tooth will appear.  The site (or ridge as it is called by dentists) will be restored through soft tissue or soft and hard tissue minor periodontal surgical procedures.  If the ridge needs only a small amount of augmentation, only soft tissue procedures will be needed.  If there is a large defect, the underlying supporting bone will have to be replaced as well.  If the site is especially visible or needs an extensive amount of rebuilding, more than one augmentation procedure may be necessary.  Our goal is to make the replacement tooth appear to be growing out of the extraction site, not merely lying against the soft tissue ridge.

If a dental implant is to be placed to act as an anchor for the replacement tooth,  the extraction site must have enough bone thickness and height to properly surround the implant.  These procedures almost always involve hard (bone) and soft tissue modification.  We will let you know what is appropriate for you.

If you have any questions, please feel free to ask us at (512)250-5012.

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.

Partial Coverage Restorations

One of our primary goals in providing you with the optimal oral care is to preserve as much of your natural dentition as possible.  Prevention of oral disease is the best way to accomplish this goal.  Unfortunately, dental decay is the most common disease known to the human body.  In the early stages the caries process can be reversed with the use of fluoride.  If, however, the decay progresses to the point when a filling is required, the decay can be removed and the tooth restored very conservatively with tooth-colored bonded direct restorations.  Direct restoration means that it is begun and completed in the office in one appointment.  Although tooth structure must be removed in this event, the amount removed is small and the strength of the tooth is not significantly compromised.  This should be reason enough to go to the dentist to have your teeth examined and cleaned on a regular basis.  Needs differ, but most adults should go two to four times each year.

If the tooth has a moderate to large amount of tooth structure to be replaced, a direct restoration will not be as successful.  For these teeth, a laboratory or externally processed restoration is more appropriate.  These are not the same as crown (cap).  A crown involves removing a maximum amount of tooth structure.  The cast restoration is then fitted over the prepared tooth, as a thimble fits over a fingertip.  No natural tooth can be seen.  While full cast crowns do have a proven track record of success, a great amount of tooth structure is sacrificed.

Partial coverage restorations can be made of gold, resin, porcelain, or ceramic materials.  The gold restorations are the least esthetic.  The color is similar to that of a gold wedding ring.  The other three materials are tooth-colored and provide a wonderful match to your natural tooth structure.

There are several advantages that you will realize with partial coverage restorations.  They require that less tooth structure be removed than for a crown so they are small in size.  This conservative preparation preserves much of the tooth adjacent to the gum tissue, providing much better opportunity for excellent periodontal health.  With the edges of the restoration above the gum, the restoration becomes easier to check for continued service.  New decay is more easily seen and treated at an early stage.  The chances of drilling of the tooth, the potential risk for future nerve damage, and a resulting root canal all decrease.

On the negative side, the partial coverage restorations are harder for the dentist to prepare and place.  They are very technique sensitive and time-consuming.  This contributes to a higher fee along with the necessary laboratory fees for processing the restoration.  But the result is well worth the extra effort and cost.  The maximum amount of sound, natural tooth is preserved.  There is nothing a dentist can put in your mouth that is as good as an undrilled, undamaged tooth.  The less the dentist must drill, the better off you will be, over both the short and long term.  We will always suggest to you the most appropriate treatment and material based on your individual oral needs.

If you have any questions about partial coverage restorations, please feel free to ask us at (512)250-5012.

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.