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Fillings

To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material once lived.
Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).

What Steps Are Involved in Filling a Tooth?

First, the dentist will numb the area around the tooth to be worked on with a local anesthetic. Next, a drill, air abrasion instrument or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.

Next, your dentist will probe or test the area during the decay removal process to determine if all the decay has been removed. Once the decay has been removed, your dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.

Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, your dentist will shape the composite material to the desired result, trim off any excess material and polish the final restoration.

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What Types of Filling Materials Are Available?

Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic and glass materials called composite resin fillings. The location and extent of the decay, cost of filling material, patients' insurance coverage and your dentist's recommendation assist in determining the type of filling that will best address your needs.

Cast Gold

Advantages:

1. Durability – lasts at least 10 to 15 years, usually longer; doesn't corrode
   
   
2. Strength – can withstand chewing forces
   
   
3. Aesthetics – some patients find gold more pleasing to the eye than silver, amalgam fillings

Disadvantages:

1. Expense – more than other materials; up to 10 times higher than cost of amalgam filings
   
   
2. Additional office visits – requires at least two office visits to place
   
   
3. Galvanic shock – a gold filling placed immediately next to a silver, amalgam filling can cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur – it's a rare occurrence, however

Aesthetics

Most patients don't find any "colored" fillings to be an "eye-pleasing" advantage

Silver-fillings (Amalgams)

Advantages:

1. Durability – lasts at least 10 to 15 years and usually outlasts composite fillings
   
   
2. Strength – can withstand chewing forces
   
   
3. Expense – is less expensive than composite fillings

Disadvantages:

1. Poor aesthetics – fillings don't match the color of your natural teeth
   
   
2. Destruction of more tooth structure – healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling
   
   
3. Discoloration – amalgam fillings can create a grayish hue to the surrounding tooth structure
   
   
4. Cracks and fractures – although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material – in comparison with other filling materials–may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures
   
   
5. Allergic reactions – a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations

Tooth-colored composite fillings

Advantages:

1. Aesthetics – the shade/color of the composites can be closely matched to the color of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth
   
   
2. Bonding to tooth structure – composite fillings actually chemically bond to tooth structure, providing further support to the tooth
   
   
3. Versatility in uses – in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken or worn teeth
   
   
4. Tooth-sparing preparation – sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling

Disadvantages:

1. Lack of durability – composite fillings wear out sooner than amalgams (lasting at least 5 years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgams under the pressure of chewing and particularly if used as the filling material for large cavities
   
   
2. Increased chair time – because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgams to place
   
   
3. Additional visits – if composites are used for inlays or onlays, more than one office visit may be required
   
   
4. Chipping – depending on location, composite materials can chip off the tooth
   
   
5. Expense – composite fillings can cost up to twice the cost of amalgams

In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist–ceramics and glass ionomer.

Other

1. Ceramics, which are made most often of porcelain, are more resistant to staining than composite resin material but are also more abrasive. This material generally lasts more than 15 years and can cost as much as gold.
   
   
2. Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts 5 years or less with costs comparable to composite resin.

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Does Dental Insurance Cover the Cost of Composites?

Most dental insurance plans cover the cost of the composites up to the price of the silver filling, then the patient must pay the difference.


What Are Indirect Fillings?

Indirect fillings are similar to composite or tooth-colored fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.

During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.

There are two types of indirect fillings – inlays and onlays.

• Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
  
  
• Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.

Inlays and onlays are more durable and last much longer than traditional fillings – up to 30 years. They can be made of tooth-colored composite resin, porcelain or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.

Another type of inlay and onlay - direct inlays and onlays - follow the same processes and procedures as the indirect, the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.


What's a Temporary Filling and Why Would I Need One?

Temporary fillings are used under the following circumstances:

1. For fillings that require more than one appointment – for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
   
   
2. Following a root canal
   
   
3. To allow a tooth's nerve to "settle down" if the pulp became irritated
   
   
4. If emergency dental treatment is needed (such as to address a toothache)

Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within 1 month. Be sure to contact your dentist to have your temporary filling replaced with a permanent one. If you don't, your tooth could become infected or you could have other complications.

Are Amalgam-Type Fillings Safe?

Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that amalgams are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.

The American Dental Association (ADA), the FDA, and numerous public health agencies say amalgams are safe, and that any link between mercury-based fillings and disease is unfounded. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.

As recently as March of 2002, the FDA reconfirmed the safety of amalgams. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. The National Institutes of Health has several large-scale studies currently under way to ultimately answer many of the questions raised about silver-colored amalgams. Results of these studies are expected to be released in 2006.

In addition, there has been concern over the release of a small amount of mercury vapor from these fillings, but according to the ADA, there is no scientific evidence that this small amount results in adverse health effects.


How Should I Care for My Teeth With Fillings?

To maintain your fillings, you should follow good oral hygiene practices – visiting your dentist regularly for cleanings, brushing with a fluoride-containing toothpaste, and flossing at least once daily. If your dentist suspects that a filling might be cracked or is "leaking" (when the sides of the filling don't fit tightly against the tooth, this allows debris and saliva to seep down between the filling and the tooth, which can lead to decay), he or she will take X-rays to assess the situation. If your tooth is extremely sensitive, if you feel a sharp edge, if you notice a crack in the filling, or if a piece of the filling is missing, call your dentist for an appointment.

Problems With Dental Fillings

Pain and Sensitivity

Tooth sensitivity following placement of a filling is fairly common. A tooth may be sensitive to pressure, air, sweet foods, or temperature. Usually, the sensitivity resolves on its own within a few weeks. During this time, avoid those things that are causing the sensitivity. Pain relievers are generally not required.

Contact your dentist if the sensitivity does not subside within 2 to 4 weeks or if your tooth is extremely sensitive. He or she may recommend you use a desensitizing toothpaste, may apply a desensitizing agent to the tooth, or possibly suggest a root canal procedure.

Pain around the fillings can also occur. If you experience pain when you bite, the filling is interfering with your bite. You will need to return to your dentist and have the filling reshaped. If you experience pain when your teeth touch, the pain The pain is likely caused by the touching of two different metal surfaces (for example, the silver amalgam in a newly filled tooth and a gold crown on another tooth with which it touches). This pain should resolve on its own within a short period of time.

If the decay was very deep to the pulp of the tooth, you may experience a "toothache-type" pain. This "toothache" response may indicate this tissue is no longer healthy. If this is the case, "root canal" treatment will be required.

Sometimes people experience what is known as referred pain -- pain or sensitivity in other teeth besides the one that received the filling. With this particular pain, there is likely nothing wrong with your teeth. The filled tooth is simply passing along "pain signals" it's receiving to other teeth. This pain should decrease on its own over 1 to 2 weeks.


Allergies

Allergic reactions to silver fillings are rare. Fewer than 100 cases have ever been reported, according to the ADA. In these rare circumstances, mercury or one of the metals used in an amalgam restoration is thought to trigger the allergic response. Symptoms of amalgam allergy are similar to those experienced in a typical skin allergy and include skin rashes and itching. Patients who suffer amalgam allergies typically have a medical or family history of allergies to metals. Once an allergy is confirmed, another restorative material can be used.


Deteriorating Fillings

Constant pressure from chewing, grinding or clenching can cause dental fillings to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up.

If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp .

If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.

New fillings that fall out are probably the result of improper cavity preparation, contamination of the preparation prior to placement of the restoration or a fracture of the restoration from bite or chewing trauma. Older restorations will generally be lost due to decay or fracturing of the remaining tooth.

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Dental Crowns

A dental crown is a tooth-shaped "cap" that is placed over a tooth – covering the tooth to restore its shape and size, strength, and/or to improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Why Is a Dental Crown Needed?

A dental crown may be needed in the following situations:

1. To protect a weak tooth (for instance, from decay) from breaking or to hold
   together parts of a cracked tooth
   
   
2. To restore an already broken tooth or a tooth that has been severely worn down
   
   
3. To cover and support a tooth with a large filling when there isn't a lot of tooth left
   
   
4. To hold a dental bridge in place


5. To cover misshaped or severely discolored teeth
   
   
6. To cover a dentakl implant

What Types of Crown Materials Are Available?

Permanent crowns can be made from all metal, porcelain-fused-to-metal, all resin, or all ceramic.

• Metals...
  
  used in crowns include gold alloy, other alloys (for example, palladium) or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.

• Porcelain-fused-to-metal...
  
  dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.

• All-resin...
  
  dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.

• All-ceramic or all-porcelain...
  
  dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.

• Temporary versus permanent.
  
  Temporary crowns can be made in your dentist's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.

What Steps Are Involved in Preparing a Tooth for a Crown?

Preparing a tooth for a crown usually requires two dentist visits, the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.


First Visit: Examining and preparing the tooth.

At the first visit, your dentist may take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.

Before the process of making your crown is begun, your dentist will anesthetize (numb) your tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used (for instance, all-metal crowns are thinner, requiring less tooth structure removal than all-porcelain or porcelain-fused-to-metal ones). If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to "build up" the tooth to support the crown.

After reshaping the tooth, your dentist will use impression paste or putty to make an impression of the tooth to receive the crown. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions are sent to a dental laboratory where the crown will be manufactured. The crown is usually returned to your dentist's office in 2 to 3 weeks. If your crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using a temporary cement.


Second Visit: Receiving the permanent dental crown.

At your second visit, your dentist will remove your temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.


How Should I Care for My Temporary Dental Crown?

Because temporary dental crowns are just that – a temporary fix until a permanent crown is ready, most dentists suggest that a few precautions be taken with your temporary crown. These include:

• Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
  
  
• Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of your mouth.
  
  
• Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
  
  
• Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.
  
  

What Problems Could Develop With a Dental Crown?

• Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush your teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix this problem.

• Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.

• Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact your dentist's office.

• Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit or a lack of cement. If this happens, clean the crown and the front of your tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for your tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement your crown in place; if not, a new crown will need to be made.

• Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.

• Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.

What Are "Onlays" and "3/4 Crowns?"

These are variations on the technique of dental crowns. The difference between these crowns and the crowns discussed previously is their coverage of the underlying tooth - The "traditional" crown covers the entire tooth; onlays and 3/4 crowns cover the underlying tooth to a lesser extent.


How Long Do Dental Crowns Last?

On average, dental crowns last between 5 and 15 years. The life span of a crown depends on the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting your fingernails and using your teeth to open packaging).


Does a Crowned Tooth Require any Special Care?

While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the underlying tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day-especially around the crown area where the gum meets the tooth.


How Much Do Crowns Cost?

Costs vary depending on what part of the country you live in and on the type of crown selected (for example, porcelain crowns are typically more expensive than gold crowns, which are typically more expensive than porcelain-fused-to-metal crowns). Generally, crowns can range in cost from $500 to $900 or more per crown. A portion of the cost of crowns is generally covered by insurance. To be certain, check with your dental insurance company.

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Bridges

Dental bridges literally bridge the gap created by one or more missing teeth.
A bridge is made up of two crowns for the teeth on either side of the gap – these two anchoring teeth are called abutment teeth – and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by natural teeth or implants.

What Are the Benefits of Dental Bridges?

Bridges:

• Restore your smile
  
  
• Restore your ability to properly chew and speak
  
  
• Maintain the shape of your face
  
  
• Distribute the forces in your bite properly by replacing missing teeth
  
  
• Prevent remaining teeth from drifting out of position
  

What Types of Dental Bridges Are Available?

There are three main types of bridges:

• Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.


• Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.


• Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.
  

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Veneers

Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size or length.
Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement. You will need to discuss the best choice of veneer material for you with your dentist.

What Types of Problems Do Dental Veneers Fix?
Veneers are routinely used to fix:

• Teeth that are discolored – either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
  
  
• Teeth that are worn down
  
  
• Teeth that are chipped or broken
  
  
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
  
  
• Teeth with gaps between them (to close the space between these teeth)

What's the Procedure for Getting a Dental Veneer?
The procedure usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.

• Diagnosis and treatment planning.
  This first step involves active participation between you and your dentist. Explain to your dentist the result that you are trying to achieve. During this appointment your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth.
  
  
• Preparation.
  To prepare a tooth for a veneer, your dentist will remove about ½ millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1 to 2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.
  
  
•  Bonding.
  Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished and etched – which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.

What Are the Advantages of Dental Veneers?

Veneers offer the following advantages:

• They provide a natural tooth appearance.
  
  
• Gum tissue tolerates porcelain well.
  
  
• Porcelain veneers are stain resistant.
  
  
• The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
  
  
• Veneers offer a conservative approach to changing a tooth's color and shape-veneers generally don't require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative to bonding.

What Are the Disadvantages of Dental Veneers?

The downside to dental veneers include:

• The process is not reversible.
  
  
• Veneers are more costly than composite resin bonding.
  
  
• Veneers are usually not repairable should they chip or crack.
  
  
• Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
  
  
• Veneers may not exactly match the color of your other teeth. Also, the veneer's color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
  
  
• Though not likely, veneers can dislodge and fall off. To minimize the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise put pressure on your teeth.
  
  
• Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
  
  
• Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active periodontal disease), weakened teeth (as a result of decay, fracture, large dental fillings) or for those who have an inadequate amount of existing enamel on the tooth surface.
  
  
• Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.

How Long Do Dental Veneers Last?

Veneers generally last between 5 and 10 years. After this time, the veneers would need to be replaced.

Do Dental Veneers Require Special Care?

No. Continue to follow good oral hygiene practices including brushing and flossing as you normally would.

Even though porcelain veneers resist stains, your dentist may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea or red wine).

Are There Alternatives to Dental Veneers?

Yes, bondigs and crowns. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit-as is done with bonding-but not enough to require a crown.

How Much Do Veneers Cost?

Costs vary depending on what part of the country you live in and on the extent of your procedure. Generally, veneers range in cost from $500 to $1300 per tooth. The cost of veneers is not generally covered by insurance. To be certain, check with your specific dental insurance company.

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Gum Disease

What is gum disease?

Gum disease is a bacterial infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease.
Gingivitis is mild gum disease that only affects the gingiva, or gums, the tissue surrounding the teeth. Gum disease that progresses and spreads below the gum line to damage the tooth-supporting tissues and bone is called periodontitis

• Gingivitis causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
• Periodontitis develops if gum disease progresses. The gums pull away from the teeth, leaving deep pockets where bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back, or recede. This can make the teeth look longer. Teeth may become loose, fall out, or have to be removed.

What causes gum disease?

Your mouth constantly produces a clear, sticky substance called plaque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gum line and damage the bone that supports the teeth. With time, plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygenist
You are more likely to get gum disease if you:

• Do not clean your teeth well.
• Smoke or use spit tobacco.
• Have gum disease in your family.
• Have a condition that makes it harder for your body to fight infection, such as:
• Uncontrolled diabetes, AIDS orleukemia
• A high level of stress.
• A diet low in nutrients.

What are the symptoms?

Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. Early-stage gum disease (gingivitis) causes:

• Gums that are red, swollen, and tender.
• Gums that bleed easily during brushing or flossing.

As gum disease advances, it causes more noticeable symptoms, such as:

• Gums that pull away or recede from the teeth.
• Persistent bad breath.
• Pus coming from the gums.
• A change in how your teeth fit together when you bite.
• Loose teeth.

How is gum disease diagnosed?

To diagnose gum disease, your dentist will do an exam to look for:

• Bleeding gums.
• Hard deposits (calculus or tartar) above and below the gum line.
• Areas where your gums are pulling away or receding from your teeth.
• Pockets that have formed between your teeth and gums.

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.


How is it treated?

If you have gingivitis, you will probably be able to reverse it with daily brushing and flossing and regular cleanings at your dentist's office.

If your gum disease has advanced to periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.

How can I prevent gum disease?

While gum disease is most common in adults, it can affect anyone, even children, so good dental habits are important throughout your life:

• Brush your teeth two times a day, in the morning and before bedtime, with a fluoride toothpaste.
• Floss one time a day.
• Visit your dentist for regular checkups and teeth cleaning.
• Don't use tobacco products.

Having gum disease may increase a pregnant woman's risk of having a premature, low-birth-weight baby.1 Also, studies have found a direct link between heart disease and the bacteria that cause gum disease.2, 3 So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

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Brushing and Flossing

Teeth and Gum Care

With proper care, your teeth and gums can stay healthy throughout your life. The healthier your teeth and gums are, the less risk you have for tooth decay and gum disease.

How Should I Care for My Teeth and Gums?

There are four basic steps to caring for teeth and gums:

1. Brushing
2. Flossing
3. Eating right
4. Visiting the dentist

Tips for Brushing

• Brush at least twice a day. If you can, brush after every meal. Brushing removes plaque, a film of bacteria that clings to teeth. When bacteria in plaque come into contact with food, they produce acids. These acids lead to cavities. To brush:
• Place a pea-sized dab of fluoride toothpaste on the head of the toothbrush. (Use a soft toothbrush.)
• Place the toothbrush against the teeth at a 45-degree angle to the gum line.
• Move the brush across the teeth using a small circular motion. Continue with this motion cleaning one tooth at a time. Keep the tips of the bristles against the gum line. Avoid pressing so hard that the bristles lie flat against the teeth. (Only the tips of the toothbrush clean the teeth.) Let the bristles reach into spaces between teeth.
• Brush across the top of the chewing surfaces of the teeth. Make sure the bristles get into the groves and crevices.
• Use the same small circular motion to clean the backside of the upper and lower teeth – the side that faces the tongue.
• To clean the inside of the bottom front teeth, angle the head in an up-and-down position toward the bottom inside of the mouth and move the toothbrush in a small circle.
• For the inside of the top front teeth, angle the brush in an up-and-down position with the tip of the head pointing towards the roof of the mouth. Move the toothbrush in a small circle.
• Give your tongue a few gentle brush strokes, brushing from the back of your tongue forward. Do not scrub. This helps remove bacteria and freshens your breath.
• After brushing your teeth for two to three minutes, rinse your mouth with water.
• Replace your toothbrush with a new one every 3 to 4 months.

Tips for Flossing

Floss once a day. Flossing gets rid of food and plaque between the teeth, where your toothbrush cannot reach. If plaque stays between teeth, it can harden into tartar, which must be removed by a dentist. To floss:

• Remove about an 18-inch strip of floss from the dispenser.
• Wind the floss around the middle fingers of each hand, leaving a 1-inch section open for flossing. Floss the top teeth first, then the bottom.
• Place the floss in your mouth and use your index fingers to push the floss between the teeth. Be careful not to push too hard and injure the gums.
• Move the floss up and down against the tooth and up and around the gum line. The floss should form a C-shape around the tooth as you floss.
• Floss between each tooth as well as behind the back teeth.
• Use a clean section of floss as needed and take up used floss by winding it

Tips for Eating Right

Eat a variety of foods but eat fewer foods that contain sugars and starches. These foods produce the most acids in the mouth and the longer they stay in the mouth, the more they can damage the teeth. Hard "sucking candies" are especially harmful because they stay in the mouth a long time.
Snacking on sugary foods can lead to tooth decay because most people don't brush after snacks. Starchy snack foods, like potato chips, stick to the teeth. Avoid snacking on:

• Candies, cookies, cakes and pie
• Sugary gum
• Crackers, breadsticks and chips
• Dried fruits and raisins

Dental Check-Ups

Visit your dentist at least once every six months. To maintain healthy teeth and gums, it's important to have regular check-ups and professional cleanings. You should also see your dentist if you have pain in your teeth or mouth or bleeding, swollen gums.

You can also ask your dentist about denta sealants. Sealant is a material used to coat the top, chewing surfaces of the teeth. This coating protects the tooth from decay and usually lasts a long time.

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Mouth Guards

Mouth guards are coverings worn over teeth, and often used to protect teeth from injury from teeth grinding and during sports.
There are three types of mouth guards:

• Stock mouth protectors are preformed and come ready to wear. They are inexpensive and can be bought at most sporting good stores and department stores. However, little can be done to adjust their fit, they are bulky and make breathing and talking difficult and they provide little or no protection. Dentists do not recommend their use.
  
  
• Boil and bite mouth protectors also can be bought at many sporting goods stores and may offer a better fit than stock mouth protectors. The "boil and bite" mouth guard is made from thermoplastic material. It is placed in hot water to soften, then placed in the mouth and shaped around the teeth using finger and tongue pressure.
  
  
• Custom-fitted mouth protectors are individually designed and made in a dental office or a professional laboratory based on your dentist's instructions. First, your dentist will make an impression of your teeth and a mouth guard is then molded over the model using a special material. Due to the use of the special material and because of the extra time and work involved, this custom-made mouth guard is more expensive than the other types, but it provides the most comfort and best fit and protection.

Generally, mouth guards cover your upper teeth only, but in some instances (such as if you wear braces or another fixed dental appliance on your lower jaw), your dentist will make a mouth guard for the lower teeth as well. Your dentist can suggest the best mouth guard for you. An effective mouth guard should be comfortable, resist tears, be durable and easy to clean, and should not restrict your breathing or speech.
If you grind your teeth at night, a special mouth guard-type of dental appliance – called a nocturnal bite plate or bite splint -- may be created to prevent tooth damage.

Who Needs a Mouth Guard?

Mouth guards should be used by anyone – both children and adults – who play contact sports such as football, boxing, soccer, ice hockey, basketball, lacrosse, and field hockey. However, even those participating in noncontact sports (for example, gymnastics) and any recreational activity (for example, skateboarding, mountain biking) that might pose a risk of injury to the mouth would benefit from wearing a protective mouth guard.

Adults and children who grind their teeth at night should have a nocturnal bite plate or bite splint made to prevent tooth damage.

Why Use a Mouth Guard When Playing Sports?

Because accidents can happen during any physical activity, the advantage of using a mouth guard is that it can help limit the risk of mouth-related injuries to your lips, tongue, and soft tissues of your mouth. Mouth guards also help you avoid chipped or broken teeth, nerve damage to a tooth or even tooth loss.

Can I Wear a Mouth Guard if I Wear Braces?

Yes. Since an injury to the face could damage orthodontic brackets or other fixed appliances, a properly fitted mouth guard may be particularly important for people who wear braces or have fixed bridge work. Your dentist or orthodontist can determine the mouth guard that will provide the best protection for your unique mouth work. An important reminder: do not wear any retainers or other removable appliance during any contact sports or during any recreational activities that put your mouth at risk for injury.

How Do I Care for My Mouth Guard?

To care for your mouth guard:

• Rinse your mouth guard with cold water or with a mouth rinse before and after each use and/or clean it with toothpaste and a toothbrush.
• Occasionally clean the mouthguard in cool, soapy water and rinse it thoroughly.
• Place the mouth guard in a firm, perforated container to store or transport it. This permits air circulation and helps to prevent damage.
• Protect the mouth guard from high temperatures – such as hot water, hot surfaces, or direct sunlight – to minimize distorting its shape.
• Occasionally check the mouth guard for general wear. If you find holes or tears in it or if it becomes loose or causes discomfort, replace it.

Bring the mouth guard to each regularly scheduled dental visit to have your dentist exam it.

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Dental Implants

Despite improvements in dental care, millions of Americans suffer tooth loss – mostly due to tooth decay, gingivitis (gum disease), or injury. For many years, the only treatment options available for people with missing teeth were bridges and dentures. But, today, dental implants are available.

What Are Dental Implants?

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.


What Are the Advantages of Dental Implants?

There are many advantages to dental implants, including:

• Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
  
  
• Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.
  
  
• Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
  
  
• Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
  
  
• Improved self-esteem. Dental implants can give you back your smile, and help you feel better about yourself.
  
  
• Improved oral health. Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
  
  
• Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.
  
  
• Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing your dentures, as well as the need for messy adhesives to keep your dentures in place.

How Successful Are Dental Implants?

Success rates vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.


Can Anyone Get Dental Implants?

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for an implant procedure. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders – such as diabetes or heart disease – or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. If you are considering implants, talk to your dentist to see if they are right for you.


Does Insurance Cover the Cost of Dental Implants?

In general, implants are not covered by dental insurance at this time. Coverage under your medical plan may be possible, depending on the insurance plan and/or cause of tooth loss. Detailed questions about your individual needs and how they relate to insurance should be discussed with your dentist and your insurance provider.


What Is Involved in Getting a Dental Implant?

The first step in the process is the development of an individualized treatment plan. The plan addresses your specific needs and is prepared by a team of professionals who are specially trained and experienced in oral surgery and restorative dentistry. This team approach provides coordinated care based on the implant option that is best for you.
Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take from 6 to 12 weeks.

Once the implant has bonded to the jawbone, a small connector post – called an abutment – is attached to the post to securely hold the new tooth. To make your new tooth or teeth, your dentist makes impressions of your teeth, and creates a model of your bite (which captures all of your teeth, their type, and arrangement). Your new tooth or teeth are based on this model. A replacement tooth, called a crown, is then attached to the abutment.

Instead of one or more individual crowns, some patients may have attachments placed on the implant that retain and support a removable denture.
Your dentist also will match the color of your new teeth to your natural teeth. Because the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth.

How Painful Are Dental Implants?

Most people who have received dental implants say that there is very little discomfort involved in the procedure. Local anesthesia can be used during the procedure, and most patients report that implants involve less pain than a tooth extraction.
After the dental implant, mild soreness can be treated with over-the-counter pain medications, such as Tylenol or Motrin.

How Do I Care for My Implant?
Dental implants require the same care as real teeth, including brushing, flossing, and regular dental check-ups.

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