If you have a dental implant, you have already discovered how lifelike and comfortable this type of tooth-replacement option can be. In fact, you may not even really be aware of your implant anymore; to you, it's simply a tooth like any other. Still, it's important to keep in mind a few things about implant care so the investment you have made in your smile will last as long as possible.

Once an implant is functioning properly in a person's mouth, the biggest enemy is infection — in particular a bacterial infection known as peri-implantitis (“peri” – around; implant “itis” – inflammation). This infection can cause the supporting bone around your implant to deteriorate, which will eventually cause loss of the implant. The good news is this infection is pretty easy to avoid.

Working as a team, you and our dental hygienist can make sure your mouth stays healthy and your implant retains its attachment to the bone for a lifetime. The key is to prevent biofilm (plaque) from building up in your mouth. Your job is to maintain a good oral hygiene routine at home with daily brushing and flossing, and to come in to our office regularly for professional cleanings. The hygienist's job is to remove any buildup of plaque and tartar (hardened deposits) beyond the reach of your brush and floss.

To do this, she will use special instruments that won't scratch the crown on top of the implant or the abutment (connector) between implant and crown. This is important because a scratched surface can harbor bacteria. The metal instruments used to clean natural teeth are not appropriate for the highly polished surfaces of the crown and abutment. Power instruments can be used on implants with nylon or plastic sheaths on the tip and lots of water irrigation to clean and flush debris.

In spite of these cleaning challenges, implants are highly successful and, in fact, the best option for replacing teeth today. Studies have shown the success rate of dental implants to be over 95% — far greater than any other tooth-replacement method.

If you would like more information about dental implants, please call us or schedule an appointment. You can also read more by reading the Dear Doctor magazine article “Dental Implant Maintenance.”

You're planning for one of the most important days in your life — your wedding — and you want everything to be perfect. You've chosen the outfits, the setting, the flowers... but there's one more thing to think about. Is your smile just as bright as your hopes for the future? Do you wish you could improve its appearance in time for the big date?

Here's good news: You can! Depending on how much advance notice you have — and what level of enhancement you need — your wedding day smile makeover can range from a thorough dental cleaning to a full-scale orthodontic treatment program. Let's look at a few options that can help you look and feel your best on this very special day.

Getting your teeth thoroughly, professionally cleaned can help remove some surface stains and tartar in just one appointment! Depending on the level of discoloration, and how long it's been since your last cleaning, more than one session may be needed. You have this basic and effective treatment done every three to six months anyway — right? So, be sure and schedule one before your wedding!

Sometimes your smile needs more than just routine maintenance. If that's the case, there are many other options to help it look its best. Tooth whitening is a safe, effective and economical way to lighten teeth by several shades. In-office treatments are quicker and more predictable, but dentist-supervised at-home bleaching kits are also an option if you have more time.

Porcelain veneers offer a more striking and more permanent solution for discolored teeth. To get the optimum “wow” effect from this treatment, figure from two to four office visits, and a total treatment time of at least three months.

Cosmetic bonding is a great way to hide those little chips in the front teeth, or discolored old fillings in back. Using the newest high-tech materials and a dose of old-fashioned artistry, we can restore the shiny, translucent look of your natural teeth — only with fewer imperfections. After a thorough evaluation, cosmetic bonding can often be performed as a one-visit procedure.

If your smile needs even more help, don't despair — there are still plenty of ways to improve it.

Teeth that are damaged or missing can be restored by crowns or bridgework. When the roots are intact, a crown replaces the visible part of the tooth above the gum line. If the tooth is missing, a bridge is used to secure a false tooth to two abutments on either side. Properly done, these restorations may last a decade or more, and generally require two or more visits.

Dental implants are a great way to restore missing teeth. They offer a permanent, natural-looking tooth replacement with numerous advantages over other restorative treatments. Achieving these results requires careful planning and takes a bit more time. If you need tooth restoration, be sure to ask us whether dental implants might be right for you.

If you would like more information about a wedding-day smile makeover, don't hesitate to contact us or schedule an appointment to discuss your treatment options. You can learn more in the Dear Doctor magazine article “Wedding Day Smiles.”

If you're looking to improve the appearance of your smile, tooth whitening treatments — whether done at home or in our office — are a popular option. Here are the answers to some questions that many people ask before they begin the process.

Q: Are commonly used tooth-whitening methods safe?

A: Yes — provided they are used as directed. A large body of research has shown that using the correct concentration of peroxide — the bleach that whitens teeth — for the proper amount of time is not known to cause any major health problems. However, there have been cases where poor-quality bleaching solutions and/or excessive usage have caused deterioration of tooth enamel and extreme gum sensitivity. Always follow our office's recommendation.

Q: Does this mean I have to have in-office treatments to whiten my teeth?

A: No. But you should come in for a thorough dental examination, with x-rays, before you begin whitening treatments. Why? Because if there is trouble with the underlying tooth structure, then whitening the tooth is like painting over rusty metal: It hides the symptom, but doesn't fix the problem. Abscesses and root-canal problems are just two of the underlying causes of tooth discoloration that should be treated before teeth are whitened.

Q: What are some different methods for whitening teeth, and how long do they take?

A: The fastest is in-office whitening treatments, using a strong bleaching solution and appropriate gum protection. Next comes the cost-effective method of at-home bleaching with custom-made flexible plastic trays (sometimes called nightguard vital bleaching.) If you're not in a hurry, over-the-counter (OTC) products can do the same thing — given enough time. One study comparing different whitening treatments found that a six-shade improvement in whitening was accomplished by three in-office treatments. A week was needed for custom-tray bleach applications, or 16 daily applications of OTC products, to achieve comparable results.

Q: Can any tooth be made bright white?

A: No. Every tooth has a maximum level of whiteness, beyond which it can't get any lighter. Furthermore, fillings, crowns and other dental restorations can't be lightened with bleach — another reason to talk to our office; we can help you achieve the best possible look for your particular smile.

Q: How long will my white teeth last?

A: It depends. No whitening method is permanent, but the typical result lasts for up to two years. To preserve that bright smile, you can take some positive steps: Avoid tobacco and beverages that stain, like red wine, tea and coffee; keep up with regular cleanings in our office; and, practice good oral hygiene at home. You can also have a touch-up treatment once or twice a year.

If you need more information about tooth whitening, or you're ready to start the process, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Important Teeth Whitening Questions Answered.”

Is it a root canal problem, a gum infection, or both?

Sometimes it's difficult to pinpoint the source of tooth pain; it can result from an infection of the tooth itself, or of the gum, or even spread from one to the other. Identifying the origin of a toothache is important, however, so we can choose the right treatment and do all that we can to save the tooth.

When a tooth becomes decayed, bacteria can infect the sensitive, living nerve tissue deep inside the tooth known as the root canal. This condition is called an endodontic (“endo” – inside; “dont” – tooth) problem. The infection inside the tooth can spread to the periodontal ligament (“peri” – around; “dont” – tooth) that encases the tooth and attaches it to the jawbone. Occasionally, infection of endodontic (root canal) origin can spread out from the end of the tooth root all the way up the periodontal ligament, and into the gum.

The reverse can also happen: dental pain can originate from periodontal (gum) tissues that have become diseased. Gum disease is caused by a buildup of bacterial biofilm (plaque) along the gum line. It results in detachment of the gums along the tooth surface. In advanced cases, this bacterial infection can travel into the nerve tissues of the dental pulp through accessory canals or at the end of a tooth.

To figure out where pain is coming from when the source is not obvious, we need to take a detailed history of the symptoms, test how the tooth reacts to temperature and pressure, and evaluate radiographs (x-ray pictures).

Unfortunately, once dental disease becomes a combined periodontal-endodontic problem, the long-term survival of the tooth is jeopardized. The chances for saving the tooth are better if the infection started in the root canal and then spread to the gums, rather than if it started as gum disease that spread into the root canal of the tooth. That's because in the latter case, there is usually a lot of bone loss from the gum disease. Effectively removing plaque from your teeth on a daily basis with routine brushing and flossing is your best defense against developing gum disease in the first place.

If you would like more information about tooth pain, gum disease or root canal problems, please contact us or schedule an appointment for a consultation. You can also learn more about this diagnostic dilemma by reading Dear Doctor magazine's article “Confusing Tooth Pain.”

If you think you'd rather wrestle a pack of porcupines than go to the dentist for a root canal treatment — then maybe it's time to think again! This common procedure has been the butt of jokes for a long time. Let's set the record straight by answering some common questions about the much-maligned procedure.

Q: What is a root canal?

A: Coursing through the central part of each root is a hollow space or canal, which contains the pulp tissue. The pulp tissue contains the nerves which respond to temperature changes transmitted through the tooth. When the temperatures are extreme the nerves signal sensitivity and pain. It's also shorthand for the dental procedure that is performed when the pulp tissue that fills these canals develops a disease.

Q: Why do I need to get a root canal?

A: Because an infection or inflammation has developed deep inside one or more of your teeth. When the living pulp tissue — which contains nerves and blood vessels — becomes inflamed or infected, it can cause intense pain. It also releases bacterial toxins, which can lead to further problems.

Q: What happens if I don't get a root canal?

A: Your acute pain may temporarily go away, but the infection won't. It will eventually travel through the tooth's roots into the surrounding tissues. If left untreated, it may result in an abscess or even a systemic infection. That's why you need to take care of it now.

Q: Will it be painful?

A: Generally, a root canal procedure is no more painful than getting a filling. In fact, it starts the same way: An anesthetic is given to numb the tooth and the surrounding area. Then a small hole is made through the tooth's chewing surface and down into the canal. Diseased pulp tissue is removed through the hole via a set of tiny instruments. Finally, the root canal is cleaned, disinfected, filled with inert biocompatible material and sealed up.

Q: What happens after that?

A: Your tooth may be sensitive for a few days after the treatment, but the acute pain will be gone. Over-the-counter pain relievers generally work well for pain relief at this point. To restore your tooth to its fully-functioning state, a crown or other restoration is usually needed after root canal treatment. Properly done, the restored tooth can last as long as any of your natural teeth.

Q: Is there an alternative?

A: Yes. You can relieve the pain by having the tooth removed. But you don't want to go there. Tooth loss can lead to unwanted side effects, like migration of teeth, bone loss and eventually the inability to chew properly. It's far better to save your natural teeth when you can.

If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”