Questions & Answers
We want our patients to feel informed about dentistry and oral health, which is why we've complied answers to some of the questions we're most frequently asked. If you have a question that's not addressed below, please feel free to contact us. We're happy to help!
Should I replace my silver (amalgam) fillings with composite fillings?
Silver (amalgam) has been something of the "gold standard" of dental fillings for years, but recently, composite fillings have become a popular method. Dentists and patients have plenty of reasons to prefer composite fillings, but before you surrender your silver, consider some facts about fillings.
Silver fillings are durable, lasting on average at least 10 to 20 years, and they are very strong, making them ideal for use in the large back molars. They also tend to be less expensive than composite fillings, but usually require more invasive preparations. The biggest drawback to silver fillings is aesthetic, as they can cast a gray hue over the surface of a tooth. Silver fillings have gotten a bad reputation because of their mercury content, but the FDA and the ADA agree that there's no proof that the compound has any adverse side effects. In fact, the mercury in amalgam fillings is only one component of a chemically stable alloy. Silver fillings have been used in dentistry for hundreds of years, and allergic reactions are rare.
Composite fillings, made out of a mixture of glass and quartz materials, provide a tooth-colored restoration that looks more like your natural tooth. Composite materials are also versatile and can be bonded (held adhesively) to teeth, which calls for less invasive preparation and leaves more healthy tooth structure beneath the filling. Compared to amalgam, composite fillings are slightly less durable and are better suited for teeth with light or moderate bite pressure, and they can take longer to place. Composite fillings can cost a bit more than amalgam.
Unless Dr. Douglas notices cracks or damages in your current fillings or expresses other concerns regarding your dental health, replacing silver fillings is a matter of personal preference.
How can I tell if I'm at risk for gum disease?
According to the American Academy of Periodontology, half of U.S. adults have gum disease. The prevalence of gum disease increases with age, because as we age, our teeth wear down, our gums naturally recede, teeth can become more sensitive, and medications can affect some oral changes. If your gums feel tender or sore, or if they look red and swollen, you may be at risk for gum disease. Other signs include bleeding and/or receding gums, pain or sensitivity in your teeth (and even loose teeth, caused by weakening gum fibers and/or bone loss), and persistent bad breath. If left untreated, gum disease can lead to tooth loss as well as various other health problems. More and more life-threatening illnesses are being linked to the presence of dental diseases.
The first thing to do is get a thorough dental evaluation. If you have any degree of periodontal disease, Dr. Douglas can help. He strongly believes in and focuses on the importance of healthy gums for a healthy mouth and body. Gum disease used to require surgery more often than not. While surgery is still an option and sometimes needed, many cases are now treated with less invasive techniques first, such as deep cleanings, local antibiotics, and special rinses. Please come in and let Dr. Douglas help you achieve and maintain healthier gums for a healthier you.
How can cosmetic dentistry improve my life?
A more beautiful smile can make life more beautiful. Studies have shown that a healthy and attractive smile can raise self-esteem, increase confidence, improve your personal as well as your professional life, and help you make better first impressions on others. Sometimes it doesn’t take much treatment for you to feel better about your smile, and there are a variety of subtle, yet noticeable ways that smiles can be enhanced. There are also more significant and dramatic treatment procedures (and combinations of procedures), often called “smile makeovers,” that can totally change teeth and smile appearance, to give you the smile of your dreams.
While there is no true “specialist” association with cosmetic dentistry, there are a number of organizations with advanced training and awards associated with cosmetic dentistry. Some dentists place greater emphasis on cosmetic dentistry treatments, especially when they have an exceptionally artistic eye and/or particular enjoyment for cosmetic procedures.
Advancements in dental technology have made it possible for dentists to address a wide variety of issues affecting smile appearance. Some common cosmetic dentistry treatments include teeth whitening, cosmetic bonding and enamel shaping, porcelain veneers, bridges, and orthodontic solutions (including braces and aligner therapy). Replacing old, amalgam (silver) fillings with tooth-colored fillings can also be considered cosmetic in nature, as it is done to improve both the health and structure, and the appearance of teeth. Really, all dental treatment aimed to improve the appearance of your teeth, gum shape, and smile can be considered cosmetic in nature.
A couple of my teeth have been worn down and need to be replaced. Should I opt for crowns?
Crowns, often called "caps," cover teeth to restore them to their appropriate shape and size after large fillings, fractures, and/or weakening forces such as intense grinding. In all of these cases, crowns not only cover teeth but provide added support as well. Crowns can also be used to attach bridges, cover dental implants, restore seriously discolored or misshapen teeth, and even as a preventive measure to protect a tooth in danger of breaking.Crowns can be made of all-porcelain (ceramic) material, porcelain fused to metal (for added strength), gold alloys (high noble), or base metal alloys (non-noble). Each of these restorative materials has its advantages and disadvantages. All-porcelain restorations most closely mimic natural tooth appearance. Their strength depends on adequate porcelain thickness, thus this material requires more extensive preparation. Porcelain fused to metal alloy restorations are tooth-colored and stronger than all-porcelain crowns. Gold alloy crowns are very strong and wear resistant. They are well tolerated in terms of biocompatibility, but metal colors do not match natural teeth. Base metal alloy crowns are similar to gold for strength and durability. However, allergy to the non-noble base metals may be an issue with some patients.
Crowns can be placed in as few as two appointments. For porcelain crowns, properly matching the aesthetics of teeth can take more visits but the natural looking cosmetic results are worth it to most patients. Crowns in general are very strong restorations, and they help to protect teeth. If a crown is placed before the tooth is so badly decayed or so weak that it fractures, the necessity of a root canal can often be preempted. This can also help prevent a broken tooth from becoming so bad that it needs to be removed, which would require a bridge or implant for restoration.
In light of their excellent restorative capabilities, crowns have few disadvantages. As they are more extensive restorations than fillings, their relative cost is higher. However, if our doctors recommend a crown it is because we want to help you keep your teeth healthy and looking good for years to come. The problems crowns help to prevent and repair offset the cost.
Also, while crowns are highly resistant, due to normal wear they will eventually need to be re-cemented or replaced. Six to nine percent of teeth that are damaged enough to need a crown may someday need a root canal.
I've been told me I need root canal therapy. What should I know before my appointment?
Beneath the top layer of your tooth (the enamel) and the second layer (the dentin), there is a pulp, or nerve, which delivers sensations such as heat, cold, and pain to the brain. Whether from excessive decay or physical trauma, this nerve can become damaged, causing an abscess to form at the root of the tooth. Root canal therapy is a procedure in which the diseased pulp is removed from an infected tooth, to prevent further damage and tooth loss, and most importantly, to relieve your pain.
Symptoms of an infected root include severe toothaches, sensitivity, discoloration, and upraised lesions on your gums. X-rays and a thorough dental examination determines whether a root canal is your best option. Though root canal therapy has a reputation for being painful, the toothaches associated with an infected root are most likely causing you more pain than the treatment will. In addition, there are a number of ways to relieve pain and discomfort, including nitrous oxide and oral sedation.
The nerve is not vitally important for day-to-day function, so removing it will not affect your tooth—unless you count saving the tooth from total loss! In fact, allowing it to decay further can lead to more pain and bone loss. Usually, an over the counter pain medication takes care of immediate post-operative discomfort, and most patients return to normal activities the very next day. Root canal therapy is highly successful, and a tooth receiving the treatment can last you a lifetime. Especially when used in conjunction with a restoration (a crown or composite filling), no one will even notice a difference in your smile.
I experience severe anxiety during dental visits, and I've been hearing a lot about oral conscious sedation lately. Is it safe, and could it be right for me?
Oral conscious sedation medications are measured and evaluated by pharmacists and physicians on a safety scale called the therapeutic index, where the higher the number on the scale, the better the safety rating of the drug. The sedation medications commonly used by dentists have high numbers on this index, and you will probably recognize some of the names of the drugs (including Valium®, Halcion®, and Sonata®). When a dentist is working with you to choose a drug protocol (primary sedation agent) – because there are several – factors such as age, weight, and level of dental anxiety are taken into careful account. Health history, including medications (prescription, over-the-counter, vitamins and supplements), and habits such as alcohol consumption and smoking are critical to talk to your dentist about, as well. Even certain fruit juices can affect the reaction of sedation medications in the body. For example, patients should not drink grapefruit juice within 72 hours before or after dental treatment with sedation. Prior to your sedation visit, Dr. Douglas will go through the proper preparation steps, from diet adjustments and possibly taking a sleep agent the night before, to having a companion drive you to your appointment and what to expect after treatment.
When patients feel anxiety, their threshold of pain is lower and so dental treatments feel more uncomfortable, stressful, and panic-causing than they otherwise would. The most advantageous aspect of oral conscious sedation is that this can be eliminated. The object is to enable anxious patients, and patients with special needs, relax the body and mind to be able to receive the treatment they need. Getting the dental care you need is essential to maintaining your optimal overall health.
Taking medication or undergoing any type of anesthesia involves a certain level of inherent risk, so your dentist will consult with you about this. Also, patients' bodies metabolize pills differently, so the calming effect of sedation medications might take longer.
Most patients experience little to no discomfort or remaining effects from a sedation dentistry visit. Immediately after treatment, you might feel a little wobbly while the medication wears off, but Dr. Douglas will give you simple, helpful instructions for the rest of your day.
Am I candidate for dental implant restorations?
Dr. Douglas and our team work hard to stay on the leading-edge of restorative dentistry. If you or someone you love struggles with ill-fitting, uncomfortable dentures or a retainer with false teeth, we have a permanent solution. Quickly becoming the preferred method of dental replacement, implants can give your smile a second chance. They are useful in denture stabilization, but they can also be used in conjunction with crowns, bridges, and in single-tooth replacements.
Permanent implants are not only more durable and long-lasting than traditional tooth replacements, they also look and feel more like natural teeth. Most importantly, they function like natural teeth, so you can chew, talk, and smile with confidence again. Because the implant procedure allows for more of your healthy tooth structure to be saved, fixed implants can even prevent bone loss.
Many patients suffering from advanced tooth decay, root canal failure, trauma to the mouth, or just extreme natural wear and tear on teeth are benefiting from this revolutionary option in restorative dentistry. However, there are still some things to consider before you decide on dental implants. For example, they are best performed after adolescence, when the teeth and jaw bone are fully developed. Additionally, the implant procedure can be more complicated for individuals with periodontal (gum) disease, active diabetes, immune deficiencies, and for patients who smoke. To ensure that you get the treatment that’s right for you, keep Dr. Douglas and his team informed and up-to-date about your entire medical history and dental habits.
What are the benefits of a dental radiograph (x-ray) examination?
- Small areas of decay between teeth or below existing restorations (fillings)
- Deep cavities
- Infections that can develop in the mouth bones
- Periodontal (gum) disease
- Abscesses or cysts
- Developmental abnormalities
- Some types of tumors
- TMJ Dysfunction
X-rays, also known as radiographs, are commonly used in dental exams of patients of all ages. Panoramic X-rays, which are taken every five to seven years and show the entire mouth, are particularly useful diagnostic tools. Panoramic X-rays are taken with a machine that circles your head providing a complete overview of all the teeth as well as the roots, upper and lower jawbones, the sinuses, and other hard surfaces in the mouth. Many problems with teeth and the surrounding tissues cannot be seen when we visually examine your mouth. An X-ray examination is needed to reveal:
Detecting and treating dental problems at an early stage can save you unnecessary discomfort, money, and time. In cases where X-rays help us detect oral cancer and periodontal disease early, radiographs can also help save your life!
When I floss, my gums bleed. If they don’t hurt and my teeth look fine, is it really a big deal?
If your gums are not sore, it's safe to assume your bleeding gums are not the result of hard brushing or flossing. Bleeding gums that apparently have no cause are always a warning sign, often indicating such conditions as gingivitis or even gum disease. Gingivitis (inflamed, bleeding gums) is not a one-way ticket to gum disease; in fact, if it’s caught early enough, gingivitis can be treated and even reversed. The first lines of treatment when it comes to gingivitis are lifestyle changes. Poor oral hygiene, smoking, uncontrolled diabetes, and high levels of stress can all contribute to gingivitis. Choosing a toothbrush with soft bristles can ease gum damage, too, and getting regular dental cleanings will control plaque and tooth decay. It's important to stop gingivitis before it progresses, as studies have shown more and more serious illnesses are associated with gum disease. Heart disease, strokes, diabetes, even osteoporosis and inflammatory diseases such as Rheumatoid Arthritis have been linked to poor oral health.
Though not the first suspect in a simple case of bleeding gums, oral cancer is also a possibility. Oral cancer can be difficult to diagnose because many of its symptoms are associated with other medical conditions. They include sores, difficulty swallowing or moving the jaw, bleeding gums or cheeks, and a continuous pain in the mouth. If Dr. Douglas finds no other causes for your bleeding gums, he may recommend a visit to a specialist.
Regular check-ups are vital to cancer prevention, as are good oral hygiene, avoiding tobacco, and maintaining a balanced diet. Inform your dentist if you’re experiencing any of the above symptoms. You’d go to the doctor if a cut on your hand were infected—do your gums the same service! They’ll thank you later.
We look forward to getting to know you!