Dental Check up
Dental Visit - Every Six Months
Have you ever wondered why the American Dental Association and your dentist recommend you come back every six months? It’s because regular dental visits are essential for the maintenance of healthy teeth and gums. And in between those examinations, it’s important that you work to keep your teeth and gums clean and healthy. If you need additional help, your dentist may even suggest more frequent visits.
What Goes On During A Regular Visit Checking your teeth for tooth decay is just one part of a thorough dental examination. During your checkup appointment, your dentist (or dental hygienist) will likely evaluate the health of your gums, perform a head and neck examination (to look for anything out of the ordinary) and examine your mouth for any indications of oral cancer, diabetes or vitamin deficiencies. Don’t be surprised if your dentist also examines your face, bite, saliva and movement of your lower jaw joints (TMJs). Your dentist or dental hygienist will then clean your teeth and stress the importance of you maintaining good oral hygiene at home between visits.
Many dentists will pay special attention to plaque and tartar. This is because plaque and tartar can build up in a very short time if good oral hygiene is not practiced between visits. Food, beverages and tobacco can stain teeth as well. If not removed, soft plaque can harden on the teeth and irritate the gum tissue. If not treated, plaque can lead to gum disease.
During your regularly scheduled dental appointments, your dentist will likely look at your gums, mouth, tongue and throat. There are several routine parts to a dental examination.
The Head And Neck Examination
Your dentist will start off by:
Examining your face
Examining your neck
Checking your lymph nodes
Checking your lower jaw joints (TMJs)
The Clinical Dental Examination
Next, your dentist assesses the state of your teeth and gums by:
Examining the gums
Looking for signs of gum disease
Checking for loose teeth
Root Canal Therapy
Root canal therapy is a treatment used to repair and save a tooththat is badly decayed or infected.
Root canal therapy is performed when the pulp which is composed of nerves and blood vessels in the tooth becomes infected or damaged. During root canal therapy, the pulp is removed, and the inside of thetooth is cleaned and sealed.
People fear root canals because they assume they are painful. Actually, most people report that the procedure itself is no more painful than having a filling placed. The discomfort experienced in the period leading up to seeking dental care is truly painful, not the procedure itself.
What Is Dental Pulp?
The pulp or pulp chamber is the soft area within the center of the tooth and contains the nerve, blood vessels, and connective tissue. The tooth's nerve is in the "root" or "legs" of the tooth. The root canals travel from the tip of the tooth's root into the pulp chamber.
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of heat or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
Why Does the Pulp Need to Be Removed?
When pulp is damaged, it breaks down, and bacteria begin to multiply within the pulp chamber. The bacteria and other dying pulp remnants can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of a tooth’s root. In addition to an abscess, an infection in the root canal of a tooth can cause:
Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage problems extending outward from the root. A hole can occur through the side of the tooth, with drainage into the gums or through the cheek into the skin.
What Damages a Tooth's Pulp in the First Place?
A tooth's pulp can become irritated, inflamed, and infected due to deep decay, repeated dental procedures on a tooth, large fillings, a crack or chip in the tooth, or trauma to the face.
What Are the Signs That Root Canal Therapy Is Needed? Signs you may need root canal therapy include:
Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity (pain) to hot or cold temperatures (after the heat or cold has been removed)
Discoloration (darkening) of the tooth
Swelling and tenderness in nearby gums
A persistent or recurring pimple on the gums
Sometimes no symptoms are present.
The Root Canal Procedure
Root canal therapy requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the teeth's dental pulp. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in the surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Actually, anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp, along with bacteria and related debris, is removed from the tooth. The cleaning-out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.
Tooth restorations are the various ways your dentist can replace missing teeth or repair missing parts of the tooth structure. Tooth structure can be missing due to decay, deterioration of a previously placed restoration, or fracture of a tooth. Examples of restorations include the following:
Fillings are the most common type of dental restoration. Teeth can be filled with gold, silver amalgam, or tooth-colored plastic materials called composite resin fillings.
Crowns are a tooth-shaped "cap" that is placed over a tooth to restore its shape and size, strength, appearance, to hold a bridge in place or cover a dental implant.
Bridges are false teeth that are designed to "bridge" the gap created by one or more missing teeth. Bridges can be anchored on either side by crowns and cemented permanently into place.
Implants are replacement tooth roots. Implants are actually a small post made of metal that are placed into the bone socket where teeth are missing. The implant is covered with a replacement tooth called a crown.
Dentures are a removable replacement for missing teeth and surrounding tissues. They are made of acrylic resin sometimes combined with metal attachments. Complete dentures replace all the teeth; partial dentures are considered when some natural teeth remain and are retained by metal clasps attached to the natural teeth.
Missing Teeth Replacement
There are several options for patients wishing to replace one or more missing teeth, depending on their condition.
This type of bridge is attached permanently to the adjacent teeth using a metal retainer covered with porcelain. It replaces one or more teeth.
A Maryland bridge is supported by metal bands cemented to the adjacent teeth.
Removable complete denture
Complete dentures replace all the teeth on the upper or lower jaw. They cover the residual gums and, for upper dentures, also the roof of the mouth. They consist of artificial teeth held in an acrylic retainer, which sits on top of the gums. They are held in place by suction, with the oral mucosa providing the seal. Complete dentures are a last resort.
Removable partial denture
This prosthesis is used to replace one or more missing teeth. It is made of acrylic on a metal base, and attached to the adjacent natural teeth with clasps to hold it in place.
Dental implants are artificial tooth roots made of titanium. They are surgically implanted in your jaw to replace natural teeth roots and serve as anchors for crowns, bridges or complete dentures.
Once in place, they progressively fuse to the bone, a process known as osseo-integration. The healing period varies depending on such factors as bone quality, the technique used and the type of restoration needed.
Getting an implant is usually considered minor surgery. Most patients who have had it say their post-operative experience was similar to recuperating from the extraction of a tooth.
A detailed examination is an essential prerequisite. The dentist who makes the restorations first examines your mouth to determine whether you are a candidate for an implant-supported prosthesis. You should then receive complete information on the advantages and drawbacks of the treatment under consideration along with the options available.
From subtle changes to major repairs, your dentist can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discolored, chipped, misshapen or missing. Your dentist can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include bleaching, bonding, crowns, veneers and reshaping and contouring.
These improvements are not always just cosmetic. Many of these treatments can improve oral problems, such as your bite.
Bleaching is a common and popular chemical process used to whiten teeth. Some people get their teeth bleached to make stains disappear, while other just want a whiter shade.
Discoloration occurs in the enamel and can be caused by medication, coffee, tea and cigarettes. Discoloration also can be hereditary or due simply to getting older.
Bleaching can be performed by your dentist in the office or, under dental supervision, at home. Many patients enjoy bleaching at home because it is more convenient. Treatment begins when your dentist creates a custom mouthpiece to ensure the correct amount of whitening solution is used and that your teeth are properly exposed. Typically, whitening at home takes two to four weeks, depending on the desired shade you wish to achieve. Whitening in the office may call for one or more 45-minute to one-hour visits to your dentist's office.
Bonding is tooth-colored material used to fill in gaps or change the color of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape.
There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health.
Treatments range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.
Non-surgical Treatments for Gum Disease
Treatments for gum disease that don't involve surgery include:
Professional dental cleaning. During a typical checkup your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed with professional cleaning) from above and below the gum line of allteeth. If you have some signs of gum disease, your dentist may recommend professional dental cleaning more than twice-a-year. Dental cleanings are not a treatment for active gum disease. They are, though, an important preventive measure that can help you stave off its development.
Scaling and root planing. This is a deep-cleaning, nonsurgical procedure, done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.
Surgical Treatments for Gum Disease
Some treatments for gum disease are surgical. Some examples are:
Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
If you have crooked teethand/or a misaligned bite (an underbite or overbite), there are a variety of treatments that can help straighten teeth, including braces and retainers.
Many general dentists are doing basic alignment and orthodontics, but orthodontists specialize in correcting irregularities of the teeth.
The dentist or orthodontist you choose will ask questions about your health, conduct a clinical exam, take impressions of yourteeth, take photos of your face and teeth, and order X-rays of the mouth and head. An appropriate treatment plan is made based on analysis of the gathered information.
In some cases, a removable retainer will be all that's necessary. In other rare cases (especially when there is an extreme overbite or underbite), surgery may be necessary. In most cases, however, braces will be needed.
What Types of Braces Are Available?
If braces are indeed the solution for you, the dentist or orthodontist will prescribe an appliance specific for your needs. The braces may consist of bands, wires, and other fixed or removable corrective appliances. No one method works for everyone.
How Do Braces Work?
In their entirety, braces work by applying continuous pressure over a period of time to slowly move teeth in a specific direction. As the teeth move, the bone changes shape as pressure is applied.
Braces are made up of the following components:
Brackets are the small squares that are bonded directly to the front of each tooth with a special dental bonding agent or are attached to orthodontic bands. Brackets act like handles, holding the arch wires that move the teeth. There are several types of brackets, including stainless steel and tooth-colored ceramic or plastic, which are often selected because they’re less obvious. Occasionally, brackets are cemented to the back of teeth, in order to hide them from view.
Orthodontic bands are stainless steel, clear, or tooth-colored materials that are cemented to the teeth with dental bonding agents. They wrap around each tooth to provide an anchor for the brackets. The clear or tooth-colored bands are more cosmetically appealing options but are more expensive than stainless steel. They are not used in all patients. Some people have only brackets and no bands.
Spacers are separators that fit between teeth to create a small space prior to placement of orthodontic bands.
Arch wires attach to the brackets and act as tracks to guide the movement of the teeth. Arch wires can be made of metal or be clear or tooth-colored.
Ties are small rubber rings or fine wires that fasten the arch wire to the brackets. They can be clear, metal, or colored.
A buccal tube on the band of the last tooth holds the end of the arch wire securely in place.
Tiny elastic rubber bands, called ligatures, hold the arch wires to the brackets.
Springs may be placed on the arch wires between brackets to push, pull, open, or close the spaces between teeth.
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes theseteeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
When wisdom teeth are misaligned, they may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.
Wisdom teeth also can be impacted -- they are enclosed within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum diseas,e because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.
How Do I Know if I Have Wisdom Teeth?
Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.
Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.
How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Youroral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
A number of conditions may require oral surgery, including:
Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or "impacted" between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.
It's not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.
Dental implants are an option for tooth loss due to an accident or infection or as an alternative to bridges and dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.
CHILD DENTAL CARE
A child's dental care really starts with his or her mother's healthypregnancy, because baby teethbegin to form before birth. If you are pregnant, make sure to eat a balanced, nutritious diet and get an adequate amount of vitaminsand minerals. It's important for pregnant women to have a complete dental exam and have any cavities or gum diseasetreated.
Your child's first teeth(primary teeth ) usually begin to break through the gums (erupt) at about 6 months of age, although the timing varies among children. All of the 20 primary teethshould come in between the ages of 6 months and 3 years. Your child will lose his or her primary teeth between the ages of 6 and 11. For more information, see the topic Teething.
Your child's first permanent teeth (molars) usually erupt behind the primary teeth at about age 6. The last permanent teeth usually erupt between the ages of 12 and 21.
See more information on your child's tooth development.
Starting to visit a dentist
By the time your child is 6 months of age, your doctor should assess the likelihood of your child having future dental problems. This may include a dental exam of the mother and her dental history, as the condition of her teeth can often predict her child's teeth. If the doctor thinks your child will have dental problems, be sure your child sees a dentist by his or her first birthday or 6 months after the first primary teeth appear , whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.
Experts recommend that your child see a dentist by your child's first birthday. Babies with dental problems caused by injury, disease, or a developmental problem should be seen by a children's (pediatric) dentist right away. If these dental problems are not limited to the surfaces of the teeth, your baby should also be seen by a children's doctor (pediatrician) or your family doctor.
To reduce sensitivity to heat, cold, or brushing, consider using a toothpaste specifically designed for sensitive teeth. Brush with it regularly or rub a small amount of the paste on the sensitive area with your finger 2 or 3 times a day. Floss gently between your teeth.
To reduce pain and swelling of a toothache, use an ice pack on the outside of your cheek; do not use heat. Avoid very hot, cold, or sweet foods and drinks if they increase your pain.
For short-term relief, adults can apply an over-the-counter benzocaine gel to the tooth. Be safe with medicine. Read and follow all instructions on the label . If your pain lasts longer than a few days or it gets worse, call a doctor.
If your gums are mildly swollen and red, use a tartar-control toothpaste that contains fluoride and also use a mouthwash that contains fluoride. Make sure you brush after meals and snacks and floss every day. If you cannot brush after eating, chew sugar-free gum, use a tooth pick, or rinse your mouth with warm salt water. You can make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (240 mL)] of warm water.
Tobacco can cause many gum problems, decreases your ability to fight infection of your gums, and delays healing. Do not smoke or use other tobacco products. For more information, see the topic Quitting Smoking.
Tooth decay is the destruction of tooth structure and can affect both the enamel (the outer coating of the tooth) and the dentin layer of the tooth.
Tooth decay occurs when foods containing carbohydrates (sugars and starches), such as breads, cereals, milk, soda, fruits, cakes, or candy are left on the teeth. Bacteria that live in the mouth digest these foods, turning them into acids. The bacteria, acid, food debris, and salivacombine to form plaque, which clings to the teeth. The acids in plaque dissolve the enamel surface of the teeth, creating holes in the teeth called cavities.
To prevent tooth decay:
Brush your teeth at least twice a day with a fluoride-containing toothpaste. Preferably, brush after each meal and especially before going to bed.
Clean between your teeth daily with dental floss or interdental cleaners, such as the Oral-B Interdental Brush, Reach Stim-U-Dent, or Sulcabrush.
Rinse daily with a fluoride-containing mouthwash. Some rinses also have antiseptic ingredients to help kill bacteria that cause plaque.
Eat nutritious and balanced meals and limit snacks. Avoid carbohydrates such as candy, pretzels and chips, which can remain on the tooth surface. If sticky foods are eaten, brush your teeth soon afterwards.
Check with your dentist about use of supplemental fluoride, which strengthens your teeth.
Ask your dentist about dental sealants (a plastic protective coating) applied to the chewing surfaces of your back teeth (molars) to protect them from decay.
Drink fluoridated water. At least a pint of fluoridated water each day is needed to protect children from tooth decay.
Visit your dentist regularly for professional cleanings and oral exam.
Researchers are developing new means to prevent tooth decay. One study found that a chewing gum that contains the sweetener xylitol temporarily retarded the growth of bacteria that cause tooth decay. In addition, several materials that slowly release fluoride over time, which will help prevent further decay, are being explored. These materials would be placed between teeth or in pits and fissures of teeth. Toothpastes andmouth rinses that can reverse and "heal" early cavities are also being studied.