Frequently Asked Dental Questions

When should old silver fillings be removed?

This is a question I am asked pretty much every time I encounter a new patient with amalgam or silver fillings. There are many controversies surrounding silver fillings and the fact that they contain mercury. My own opinion is that I wouldn't want them in my mouth so I am certainly not placing them in my patients' mouth! That being said this does not mean that all silver filling need to be removed immediately.

Here is the good news! Amalgam fillings are never used in our practice. In fact they are pretty much obsolete throughout the profession. Most silver fillings have a lifespan of about ten years in the mouth.

The determination to remove them is made if there is evidence that leakage is occurring or there is a fracture in the material. To determine if leakage is occurring we use digital x-ray to help us see if there is recurrent decay under the filling. However, decay is not always visible with an x-ray alone due to the silver filling masking the decay when viewed on the x-ray. A clinical determination is also necessary. We look at the filling at the interface where the filling meets the natural tooth, if the filling is leaking you will see a dark line or a grayish hue on the tooth.

Here is the bad news! Leaking fillings don't cause pain until it is often too late! This means that early detection and maintenance of your mouth is critical to prevent the need for root canals and extensive dentistry.

When I drink or eat something hot or cold I feel sensitivity on a particular tooth. What may be causing this?

It is possible that the particular tooth may have a cavity. If the sensitivity is severe and lasts a prolonged period of time it is possible that root canal therapy may be necessary. If there is an existing filling in the tooth the sensitivity may be caused by a leaking filling. In this case, often replacement of the filling is all that is needed.

Candy and very sweet foods cause a particular tooth to be sensitive. What may be causing this?

It is possible that the particular tooth may have a cavity. If the sensitivity is severe and lasts a prolonged period of time it is possible that root canal therapy may be necessary. If there is an existing filling in the tooth the sensitivity may be caused by a leaking filling. If it is determined that it is a leaking filling, often replacing the filling is all that is necessary.

Crowns vs. Veneers what is the difference?

Typically the determination of weather a patient should have veneers or crowns is based on what the patient and dentist are looking to achieve.

While both procedures can be highly aesthetic the two treatments have different uses. Typically veneers are used when a patient would like to improve the shape and color of their teeth. Crowding and excess space issues can also be alleviated. Veneers are thin (approximately finger nail thickness) beautifully shaped porcelain that is customized for each individual patient based on the desired aesthetic or functional need.

Frequently crowns are used in cases in which there is less tooth structure due to tooth decay or in cases in which a tooth has undergone root canal therapy or trauma. Crowns can achieve all of the aesthetic advantages of veneers and should only be used when necessary.

Is veneer therapy painful?

The placement of veneers should not be painful. During the procedure, typically the patient is anesthetized and in some cases patients may request nitrous oxide. While the teeth are being prepared for veneers there should be no pain or discomfort at all.

Shortly after the procedure patients are given a non-steroid anti-inflammatory (NSAID) such as Advil. This is all that should be needed to prevent the breakthrough of any pain associated with the preparation for veneers.

The next part of the procedure involves the cementation of the veneers. Again the patient is anesthetized. Anesthetic is need here because the temporaries are removed and the teeth may be sensitive due to the exposure of the teeth after the removal of the temporaries.

After the veneers have been cemented teeth are sometimes sensitive due to the procedure. Again Advil or another NSAID is used to prevent the breakthrough of pain.

Plenty of water is needed to keep teeth cool during the procedure. Teeth need to be properly disinfected to ensure longevity and health of the restorations.

Veneers will enable you to Smile Smile Smile and should be a comfortable painless experience...

What is the solution for tetracycline or internal stain?

Horizontal grayish lines are often from antibiotic use while teeth are developing and as such are what is referred to as internal or inherent stains. Other internal staining may be a result of anomalies in genes or illness during the development of teeth.

These stains often present a challenge for any of the whitening products and procedures. However results are seen with in-office whitening products such as zoom whitening or GC Ion followed by a home regiment with at-home whitening products such as Night White in custom trays.

If you are unable to acquire the results you desire from in office whitening, veneers will certainly get you the results you are looking for. Veneers are thin, beautifully shaped ceramic shells that are placed over teeth and will mask the horizontal lines or any other internal stains. As an added benefit the shape of teeth can be enhanced and customized based on a patient's desires and functional needs.

Why floss?

Flossing helps to clean plaque in hard to reach places on the tooth surface, specifically in between the teeth where the toothbrush can not reach. Accumulation of plaque left on the tooth surface can lead to the formation of tartar which is a hard structure that contains bacteria. Tartar can only be removed professionally by your dentist or hygienist. Build up of tartar can lead to inflammation of the gums also called gingivitis. Regular flossing coupled with good oral hygiene can help to prevent gum disease.

I have sensitivity to cold at the gum line. What may be the cause of this?

There may be recession over the tooth exposing the root surface. Often root surfaces tend to be sensitive when they become exposed. Sometimes when a root surface is exposed aggressive tooth brushing can wear away at the root and cause increased sensitivity. An appointment with your dentist can pinpoint the cause of the sensitivity and often there is a simple solution.

What are the benefits of mouth wash?

Mouthwash or specifically antibacterial mouthwash helps to reduce the amount of bacteria in the mouth. This is important because these bacteria produce sulfur compounds which are the actual cause of bad breath or halitosis.

Other mouth washes contain fluoride which helps to harden the outer surface of tooth structure and prevent bacteria build up and tooth decay.

Is whitening safe?

Based on clinical studies tooth whitening products are not harmful when used as directed. These studies demonstrate that there is no concern about harm to the dental enamel or any tooth structure.

Will my teeth continue to whiten with continued use of whitening products?

Every individual patient will have different whitening results. Additionally each individual has their own saturation point or point in which their teeth will longer whiten. This is why it is important to use these products under the supervision of your dentist. The dentist can identify this saturation point and determine if additional whitening is necessary and will be effective.

How do I maintain veneers?

One wonderful characteristic about porcelain veneers is their resistance to staining. However they are not completely impervious to stain. We often see staining with patients who frequent coffee, red wines, or food with high chromatic value.

Daily maintenance should include brushing with a soft bristle toothbrush and non- abrasive toothpaste (ie. Non-whitening) and flossing.

If the staining progresses and cannot be handled with daily maintenance, in-office whitening can be used to help eliminate some stain.

In some cases recession occurs around the veneer and may appear as stain. In this case the veneers can be replaced or a gum tissue graft can be done to cover the recession.

Lastly if the staining is more than whitening can handle the veneers can be replaced in the same manner they were placed the first time.

My teeth are shifting and are overlapping in some areas. What are my options?

Sometimes teeth do shift. If that is the case you should see your dentist to determine if Invisalign, a simple aligner or traditional braces is right for you. Shifting teeth can cause other problems in the mouth, it is best to catch tooth shifting early. Often when it is caught early shifting of teeth requires very little to get the teeth back into alignment. This will avoid the possibility of bite problems down the line.

How does Invisalign work?

Invisalign is a series of aligners that incrementally moves teeth as prescribed by the dentist based on the required results of the patient and dentist.

The aligners are replaced every two weeks. Each aligner moves the teeth a little more towards the goal of straightening the teeth.

Once all the information is gathered patients can view the final results of their alignment on the computer imaging program before committing to treatment. This enables the patient to preview the results and be a part of the treatment planning.

My teeth have white or grey discolorations. What is this?

This can be a result of hypo or hyper calcifications. It could also be a result of antibiotic therapy with tetracycline while the teeth were still in development.

What are different options for whitening?

In office whitening or professional whitening is the most predictable and effective way to whiten your teeth when followed by an at-home whitener for 7-14 days. The whitening results from the in-office procedure needs to be stabilized by an at-home technique. The in-office whitening procedure starts with the isolation and protection of the gum tissue and lips. The whitening material is applied to the teeth, after which a high intensity light is focused on the teeth. Typically 3 passes are done to achieve the greatest whitening results, and with each pass new whitening material is placed. The doctor can control the concentration of the material as well as how long the material is applied to achieve the most effective whitening results.

At-home whitening uses custom trays that are made from molds of our patients' teeth. Whitening material is placed in the trays to apply the material to the teeth. The trays are worn for only 1 to 2 hours at a time to reduce any patient sensitivity. With these procedures an improvement of anywhere from 4 to 8 shades can be expected depending on various factors including the starting shade and extrinsic staining from foods that have a high "chromogenic" index, i.e. stains caused by foods such as soy sauce, tea, coffee, red wine or cigarette smoking.

How does whitening work?

The outer surfaces of our teeth are made of enamel rods which are porous. These tiny pores have a tendency to collect non-harmful stains that brushing alone can not reach. Whitening products and procedures use either carbamide peroxide or hydrogen peroxide to breakdown stains and internal colors from within the enamel pores. The chemical reaction is an oxidation process in which stain is broken down. High intensity light is used in in-office procedures and serves to accelerate the oxidation reaction.

How does professional whitening differ from at-home whitening?

The most important difference and advantage of in-office or professional whitening is the ability to have your dentist determine if in fact you are a good candidate for the procedure. In addition it is important that the teeth and gums are healthy, free from tooth decay and the teeth are clean. In office procedures can be monitored by the dentist, gum tissue and lips can be isolated and the proper concentration and length of treatment can be determined. Also the concentration of peroxide is greatest when administered by the dentist.

What is your in home whitening recommendation?

This depends on the starting shade of the tooth, since some shades are more difficult to whiten. For difficult shades, the tray and gel system fabricated by the dentist is highly effective. The tray and gel systems use carbamide peroxide. This system should be monitored carefully by the patient and dentist and if sensitivity arises a shortened cycle may be necessary.

How should I care for my teeth after whitening?

After whitening treatments, specifically in-office treatments the teeth are more susceptible to taking on stain within 48 hours after the procedure. During this time, I always recommend that patients do not eat or drink anything that may stain a white t-shirt as a reference. As far as maintenance goes, whitening trays which can be used to touch up your teeth after the procedure work great but the proper concentration of material is critical here. With any of the procedures, at-home or professional, it is very important to be supervised by a dentist, there is a point of saturation in which teeth will no longer whiten and your dentist can determine if you are at that point.

Composite vs. porcelain veneers?

Both treatments involve full or partial facings of teeth that when properly done can enhance the beauty of your smile. Today's composite materials can provide a life like beautiful appearance that is conservative of tooth structure and can last for a long time. Veneer therapy is used in cases in which more is needed to be done to accomplish natural esthetics. Veneers can be used in more severe tooth misalignment, tooth form, tooth color and spacing issues.

With composite veneers the resin is applied in layers to the tooth and sculpted directly in the mouth to achieve the desired esthetic the patient is looking for. Composite veneers are used in situations in which there is chipping or discoloration of natural teeth. They are also used where there are minor misalignments of teeth to give teeth the appearance of more aligned teeth.

The greatest advantage of composite veneers is that it is an additive process that is reversible and can be removed and replaced as needed. Beautiful natural aesthetics can be achieved in the right hands. Composite veneer therapy is an art. Aesthetic dentistry is not for all dentists and involves extreme attention to detail. When accomplished properly no one should know you had the treatment.

Porcelain veneer therapy involves removal of a thin approximately finger nail thickness layer of the tooth's enamel followed by the bonding of a thin sculpted porcelain veneer. This procedure is used when there is more severe discoloration, malformation or misalignment of teeth.

Advantages of porcelain veneers are their extreme resistance to stain and chipping as compared to composite veneers. They are even more resistant to stain than natural teeth.

In general both procedures can produce beautiful natural aesthetic results. Your doctor can help you decide which procedure or combination of procedures is right for you.

Sensitivity and whitening procedures

Sensitivity is sometimes a result of either in-office or at-home whitening systems. The sensitivity ranges from no sensitivity at all, to very sensitive. Typically sensitivity does not last longer than 24 to 48 hours. If sensitivity persists past that time there could have been underlying conditions that may have been triggered and it is recommended that you discuss this with your dentist.

The best remedy is an NSAID (non-steroidal anti-inflammatory drug) such as Advil or Aleve. Typically our patients are given an NSAID before they leave and are instructed to take it at the end of the procedure and before bed time. If symptoms do occur they typically do not occur directly after the procedure. Rather they occur multiple hours after the procedure. Taking the NSAID ahead of time may prevent the sensitivity from surfacing. In addition different pastes containing high concentrations of fluoride can be placed on the teeth that are administered by the dentist or given to the patient to apply to the teeth that help to alleviate the symptoms.

What are alternatives to dentures?

There are many treatment alternatives to dentures. The most frequent complaint about dentures is the retention and stability of the lower denture.

Treatments can range from as little as two implants to support the lower denture to a full mouth of implants to replace each individual tooth.

Typically implants are strategically placed so that bridges can be placed to replace the missing teeth.

When I awake in the morning my jaw hurts. What may be the cause of the pain?

It is possible that you are clenching grinding or brushing your teeth while you sleep. The best thing to do is to schedule an appointment with your dentist to determine if there is a TMJ. If this is the case your dentist can determine the extent of the problem. Often a night guard helps alleviate the symptoms and your dentist can fit you with the proper night guard for the specific TMJ issue. This type of pain is not something that should be ignored if caught early it can be treated and damage to the TMJ can be prevented.

When I brush my gums bleed. What may be the cause of the bleeding?

The bleeding gums could be caused from too aggressive brushing. It may also be that plaque and tartar accumulation on the teeth is irritating the gums and the brushing is further irritating the gum and causing them to bleed. In any case gums should not bleed from brushing alone. A visit to the dentist is most probably in order to see if a cleaning or a deep cleaning is necessary to bring back the health of the gums or to determine any other underlying cause.

What is a canker sore?

A canker sore, also know as an aphthous ulcer presents as a painful sore inside of the mouth. They can be white, yellow, grey and often have a small red border surrounding them. Canker sores are one of the most common oral conditions. It is estimated that 10% of the population gets canker sores. Canker sores are not contagious and should resolve within 7-10 days. If canker sores persist longer than two weeks you should see your dentist.

Why is dental care and oral hygiene so important during pregnancy?

During pregnancy oral health is more important than ever. Pregnancy cause hormonal change that increase the risk of gum disease or periodontal problems. If you are planning to be pregnant you should see your dentist prior to getting pregnant for a through cleaning, dental exam and examination of your gums. This will ensure that any necessary treatment is done before you are pregnant to reduce any risk to your developing baby.

When can I be treated while pregnant?

To be on the safe side, treatment during the first trimester and the second half of the third trimester should be avoided. These are critical development times for your baby and any undue stress on the body should be avoided if possible. Any routine dental treatment can be done in the second trimester but elective dentistry should be done after birth of the child.

If possible avoid all dental X-rays during pregnancy except in an emergency. If it is completely necessary you can take X-rays but your dentist should take extra precautions to help protect you and your developing baby. Dr. Sellinger uses digital X-rays and the dose of radiation is substantially reduced than traditional X-rays.

Do not avoid regular dental visits while you are pregnant. Cleanings are extremely important during pregnancy. Pregnancy hormones effect the gums and professional cleanings along with monitoring your gum health by your dentist is necessary to avoid more serious gum problems.

Dental plaque is a sticky, colorless film that continually forms in between and on the surface of the teeth. Dental plaque is a biofilm that is made up of microorganisms such as streptococcus mutans and other bacteria. It can develop on teeth above the gum line (supragingival), below the gum line on the roots of teeth (subgingival) and along the gum line (gingival).

What is Dental Plaque?

Dental Plaque is a colorless and sticky film that forms on teeth, and in between teeth from everyday eating and drinking. It is made up of microorganisms including streptococcus mutans and various other bacteria found in the mouth. It is removed with regular brushing and flossing. If left on the teeth it can harden, this hardening of plaque is referred to as calculus or tarter.

What is Dental Calculus or Tarter?

Dental calculus also known as tarter, forms by the hardening of dental plaque on teeth if it is not removed. Dental plaque can be removed by regular home care including brushing and flossing. Dental calculus can only be removed during a professional cleaning. If dental calculus forms below the gum line it can irritate the gums leading to inflammation and infection. This inflammation coupled with infection can lead to gum disease if untreated. This is why it is so important to keep a regular schedule with your hygienist and dentist to monitor your oral health.

Why are mouth guards important while playing sports?

Mouth guards or sports guards are important during sports because they reduce the risk of damage to teeth and the mouth caused by trauma during sports. According to the ADA there is a 60% reduced risk of injury to the teeth when athletes were a mouth guard. Common sports in which a mouth guard should be worn include:

• Ice, field and street hockey
• Kick boxing
• Baseball
• Football
• Racquetball
• Martial arts
• Boxing
• Soccer
• Rugby
• Basketball
• Softball
• Rollerblading
• Skateboarding
• Wrestling
• Volleyball
• Mountain biking
• Motocross

What is halitosis and what can be done?

Halitosis is the scientific term for bad breath. Studies suggest that 85% of people with halitosis have an underlying dental condition that causes it. Possible causes include, gum disease, cavities, poor oral hygiene, oral cancer or bacteria that have colonized at the back of the tongue. Mouth rinses and tongue scrapers help to get rid of bacteria that cause halitosis. If it is gum disease or cavities these can be treated by your dentist.

Why do I need a crown after a root canal?

A crown is used on teeth that have been treated with a root canal to strengthen the tooth. A root canal is done when decay has gotten so\o deep that it has penetrated into the nerve or the root canal of the tooth. When this occurs, the inside of the tooth is cleaned of the infection and is filled with a rubber sealant called gutta percha. Once a root canal has been done the tooth becomes weaker due to the tooth structure that is removed in order to get into the or inside of the tooth. The crown is fitted over the tooth like a cap and holds the tooth together and prevents the tooth from fracture from biting forces.

Is it possible for me to see how I would look after a cosmetic dental treatment before it is actually done?

Yes! In fact it is part of Dr. Sellinger's treatment planning and is done with all aesthetic work done. There are two main ways this can be accomplished. One way is through computer imaging. In this case Dr. Sellinger takes various pictures of your smile and he is able to make changes based on your cosmetic desires. Another way is through a wax up done on models of your teeth. Wax is formed and shaped over the teeth on the model and the teeth are and formed to give the greatest aesthetics with all the function. A mould of the wax up can be used to transfer the shape of the wax up to the mouth using a resin material. This enables you to actually visualize the results in your mouth. Typically for extensive cosmetic work both techniques, computer imaging and the wax up are done.

My old bonding in the front of my mouth has turned dark, can the bonding be bleached?

Unfortunately bonding can not be bleached with whitening products. However, often surface stains can be removed with polishing. If the staining is extensive the bonding may need to be resurfaced or replaced. Veneers can also replace bonding with the advantage of greater strength and increased resistance to staining. Ask your dentist which option is right for you typically the most conservative approach to achieve your goals is best.

How long does bleaching last?

The longevity of whitening varies form person to person. How long whitening lasts depend greatly on you're your diet. People who regularly consume food and beverages with color such as coffee, red wine, soy sauce or even vegetables with color tend to need whitening more frequently. Also smokers tend to stain their teeth at a faster pace. Other variable include the original color of the teeth and the ability of your teeth to absorb the whitening product. Typically every six months to a year touch ups can be done to keep you smiling. Dr. Sellinger provides whitening trays and whitening product to use at home for touch up with all of his in-office whitening procedures. This way maintenance is easy and reliable.

There is a dark or grey line at the gum line below a crown what is the cause of this?

The grey line above an older crown can be caused by the metal used in making the understructure of the crown. Another possibility is that the natural tooth under the crown is discolored and is showing through the gum. Newer high strength porcelain is now used as the understructure of crowns and is often the solution to this problem. Often once the crown is removed and replaced with an all porcelain crown takes care of the grey or dark line from an older crown.

My gums bleed when I brush or floss, what is the cause of this and is it normal?

Plaque accumulation on teeth can cause the gums around teeth to become irritated and inflamed. This plaque, if not cleaned can lead to formation of calculus which further irritates the gums. Inflamed and irritated gums will bleed when flossing. Bleeding gums are not normal and need to be tended to. Diligent professional cleanings and more regular flossing strengthens the gums and they will be less likely to bleed over time. See your dentist to diagnose inflamed gums and rule out any other contributing factors.

How often should I have my teeth cleaned?

How often teeth should be cleaned varies from person to person. Some people have a tendency to accumulate more plaque and calculus than others. Many factors contribute to an increased accumulation of plaque including diet, alignment of teeth and bacteria load in the mouth. Additionally some people have periodontal conditions and need to be seen more frequently. If you have a healthy mouth, two cleanings per year is recommended. Cleanings every three to four months may be necessary if a persons mouth has a propensity for plaque accumulation and gum disease.

Why do I need to have x-rays? Do they cause cancer?

X-rays also referred to radiographs are necessary for diagnosis of infection. Weather it is an abscess or a cavity often radiographs are the only way to detect them. Additionally radiographs help to detect bone loss, impacted teeth, cysts and tumors. The newest radiographs are digital and they reduce the dose of radiation by about 90%.

What are dental implants?

Dental implants are used as a replacement of the root of a missing tooth lost due to an accident, tooth decay or periodontal disease. They are made of titanium and integrate into the jaw where the original root of the tooth was. Once the implant has integrated, a crown is placed on top. Implants are the best way to replace missing teeth; they look and feel natural and best of all you can floss around them just as a normal tooth.

How do I know if I am a candidate for dental implants?

Typically with today's dentistry if you have a missing tooth or several teeth, more often than not you are a candidate for an implant. Implants can be used to replace a single missing tooth or a whole mouth of missing teeth. Additionally implants can be used as an anchor for a denture or a partial denture to stabilize them. Sometimes grafting may be necessary to provide more bone to support the implant. A through evaluation with radiographs and if needed a CT-Scan (3-d image) of the bone can be taken to evaluate the quality of the bone to receive implants.

How long do dental implants last?

Studies suggest that implants can last 35 year or more.

How long have dental implants been around?

Implants have been around for better than thirty years.

What are smile makeover categories?

There are 5 general categories that patients fall into which prompts them come to the office to obtain a smile makeover. Our patients can have any combination of these contributing factors that may need to be improved:

1. Discolored teeth:

• Patients can have extrinsic stains like stains from food such as wine, coffee, tea or soy sauce.
  
• In this case whitening may be the treatment of choice
• Patients can have intrinsic stains like stains caused from antibiotics during tooth development, calcifications, hypo calcifications or genetic anomalies during tooth development.
• In this case the treatment can consist of bonding, veneers, whitening or a combination of any of the procedures .
  

2. Misaligned teeth:

• Patients can have small arch discrepancies
• Twisted or rotated teeth
• Crowded teeth or have spaces between the teeth.
• In this case invisalign may be a treatment option as well as in some cases bonding and veneers to correct these misalignments.

3. Chipped or missing teeth:

• Small chips can be repaired with bonding or veneers.
• Larger chips can be repaired with veneers or crowns and in some severe cases implants may be necessary.
• Missing teeth can be replaced with bridges or implants.

4. Narrow arches or Narrow smile

• Some patients present with narrow smiles giving the appearance of a small or short smile
• In this case veneers bonding, invisalign or any combination of these procedures can be used to create a more full beautiful smile.

5. Unhealthy or inflamed gums

• In this case periodontal therapy or a deep cleaning is needed to get the gums back to health
• The gums are the foundation to a healthy smile. Healthy gums are necessary to ensure healthy beautiful teeth for the long haul.