Gum disease (gingivitis) and tooth decay are primarily caused by dental plaque. Dental plaque is a whitish, sticky film that accumulates daily along the gumline and on the surfaces of your teeth. Composed of bacteria, it is controllable through good oral hygiene habits — most importantly, effective brushing.

Controlling plaque and preventing gingivitis and tooth decay will make it more likely that you keep your teeth through your lifetime and will also improve your general health. Scientific studies have linked gum disease and diseases of the heart and circulatory system.

“I know how to brush my teeth. I've been doing it since I was a toddler,” you may be saying. But you may not be performing this daily ritual in the most effective way.

Let's take another look at tooth brushing. First, your grip: Hold the brush in your fingertips with a light pressure. Position the brush so the bristles are at a 45 degree angle to your gumline, and then brush with a gentle scrubbing motion. Don’t scrub too hard, or you may damage your sensitive gum tissue.

Some electric brushes can remove plaque more quickly than a regular hand-held brush, but if you brush well any kind of brush works. A brush will last several months. Get a new one when the bristles become worn or splayed out.

Use a toothpaste that contains fluoride. When used consistently, fluoride toothpastes make your teeth more resistant to decay. Spit out the toothpaste after brushing, but don't rinse or you will wash the fluoride away.

After brushing, complete your cleaning job by using floss to clean between your teeth where the brush does not reach. Wrap it in a “C” shape around each tooth and move it vertically up and down, removing plaque from the tooth surfaces where your teeth meet. You can also use an antibacterial mouth rinse.

Thoroughly clean your teeth at least once a day, brushing and flossing. A plaque film takes 12 to 24 hours to form itself again.

To be certain you are brushing correctly, ask our office or one of our hygienists to demonstrate brushing techniques for you in your own mouth. You can also assess the quality of your brushing technique by checking with your tongue after brushing to make sure your tooth surfaces feel smooth and slick. Your gums should not bleed after brushing. Bleeding is a sign of infection. If you have a habit of consistent brushing but your gums continue to bleed, it's time for a visit to our office.

Contact us today to schedule an appointment to discuss your questions about oral hygiene. You can also learn more by reading the Dear Doctor magazine article “Oral Hygiene Behavior.”

Damaging the crown of a tooth (the part of the tooth that is visible above the gums) is the most common type of dental injury. The tooth may be broken or chipped. It is good to be prepared by knowing how such cases should be treated.

What is the first thing to do if my tooth is chipped or broken?
If fragments broke off the tooth, try to find and save them. They can probably be reattached to the tooth by bonding.

Does a chipped or broken tooth hurt?
The tooth may be sensitive to touch, hot and cold. Depending on the type of injury and how much of the tooth's inner surface is exposed, there may also be pain.

How long can I wait before getting treatment?
Get treatment right away, within 12 hours if possible. Teeth with crown fractures can be treated within 12 hours without affecting long-term outcomes.

What types of treatment may be used?
The treatment recommended depends on the tooth and the type and severity of the injury. Exposure of a tooth's inner pulp can be treated by a pulpotomy (partial pulp removal) technique. Front teeth can be temporarily restored with special cements, or the original tooth fragments may be reattached by bonding. Composite resin bonding may be used to restore the tooth's original appearance and function. Composites can be made in a wide range of tooth colors and can match the original tooth almost exactly.

Is treatment different if the damaged tooth is a primary (baby) tooth?
Chipped or broken primary teeth are generally treated similarly to permanent teeth. The treatment depends on the extent of the injury and damage to the tooth. Treatment of fractured primary teeth also depends on the proximity of the injured tooth to the permanent tooth beneath it, which will ultimately replace it. If a fractured primary tooth cannot be saved, it may be removed.

What if my tooth is loosened but not broken?
If the tooth is loosened but not cracked, broken or chipped, no dental treatment may be required. However, we will collect baseline clinical and x-ray information and keep an eye on the tooth or teeth in the future. We will need to check the tooth during recall visits to see whether the dental pulp is still living or whether it has died as a result of its injury. The latter condition can lead to a variety of problems and will require treatment.

Contact us today to schedule an appointment to discuss your questions about repairing a chipped tooth. You can also learn more by reading the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”

Getting enough sleep is necessary for good health. We all know how energetic we feel when we are sleeping well at night. Yet, many of us do not feel rested, even after seven or eight hours of sleep. Let's answer some common questions about snoring and sleep apnea, problems that are often called sleep related breathing disorders (SRBD).

What is the purpose of sleep?
Scientists know we need sleep, at a particularly deep level, to be rested, but they are not sure why we need sleep. Sleep may have evolved as a way to conserve energy in the body, to conserve food supplies, or to reduce our risk during darkness. Sleep appears to give the brain a chance to store and organize its information and the body a chance to recuperate. Sleep studies have shown that in order to get the full benefits of sleep we need to sleep long and deeply enough to enter into a series of sleep cycles including Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep.

What kinds of problems get in the way of the type of sleep we need?
There are eight main categories of sleep disorders, but the ones affecting the largest numbers of people are insomnia, SRBD, and Circadian Rhythm Sleep Disorders. SRBDs include snoring and Obstructive Sleep Apnea (OSA), which is a serious health problem.

How do I know if I have OSA or another SRBD?
Often, your bed-partner will tell you that you snore. Chronic loud snoring is an indicator of OSA. To make a diagnosis your physician must take a thorough sleep and medical history. The diagnosis may then be confirmed by a study in a sleep lab.

What causes sleep apnea or OSA?
Snoring and OSA happen when your tongue and other soft tissues in the back of your throat collapse backwards and block airflow through your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stage of sleep your body needs.

What are the treatments for sleep apnea?
Treatments include CPAP therapy, in which patients wear a mask while sleeping. The mask pushes air through the airway, keeping it open. In Oral Appliance Therapy (OAT) patients wear a device that moves the lower jaw forward, allowing more room for air to move down the airway. Oral surgical procedures and orthodontic approaches also have the goal of moving the tongue away from the throat. These are all treatments that can be carried out by a dentist who has training and experience in treatment of sleep disorders.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea Frequently Asked Questions.”

Losing a baby tooth is an important milestone in a child's life. Be sure to take a photo of that toothless smile — it will be something you treasure as your child grows up.

You may be wondering what is really happening when a baby tooth becomes loose and eventually falls or is pulled out. Read on for some answers.

What are baby teeth?
An infant's teeth begin to form before birth, by the fifth to sixth week after conception. When the baby is born, 20 primary (baby) teeth are almost completely formed inside the jaws. These first teeth, also called deciduous teeth, begin to erupt through the gums at about the time the baby begins to eat solid food. The front teeth (incisors) are usually the first to come in, at age six months to a year.

Why are they called deciduous teeth?
Deciduous means “falling off at maturity.” The same term refers to trees that lose their leaves every fall. In many mammals, including humans, it refers to the first teeth, which need to come out to make room for the larger permanent teeth to come in.

What causes the deciduous teeth to become loose?
While your child is using his primary teeth to bite and chew, his adult (permanent) teeth are quietly growing inside his jawbone. Starting with tooth “germs” (the word comes from germination, meaning the start of growth), the top part of each tooth, called the crown, grows first. Then the bottom part, or root, begins to grow and elongate. As the roots develop and the permanent teeth take up more room in the child's jaw, they begin to push against the baby teeth. This causes the roots of the baby teeth to melt away or resorb. Eventually little or nothing is left to hold the baby teeth inside the child's gums, they become wiggly, and finally they can easily be pulled out. This may leave a little bleeding gum tissue that quickly heals.

What should you watch for in the transition from primary to permanent teeth?
As the permanent teeth erupt (push through the gums and become visible), you may notice that they are too crowded, have too much space between them, or are crooked. It's a good idea to have an orthodontic (from ortho, meaning straight and dont, meaning tooth) evaluation at age five to seven. Watch to see that the baby teeth are lost in the right sequence. If one is lost prematurely, for example from decay, make sure that the space that it occupied is maintained to make room for the adult tooth that will replace it. We can help you with this.

Contact us today to schedule an appointment to discuss whether your child's baby teeth are being lost in the right sequence and if the adult teeth are coming in correctly. For more information see the Dear Doctor magazine article “Losing a Baby Tooth.”

A pregnant woman has a lot to think about while preparing to welcome a new member of her family. It's important to think about her oral health as well. She is sharing her body with the developing infant, so problems with her health — including her dental health — can affect the baby. The following facts will help you understand the relationship between oral health and pregnancy.

1. A baby's primary (baby) teeth begin to form during the sixth week of pregnancy. They begin to form their enamel (the hard outer layer of the teeth) and dentin layer (just under the enamel) at about the third or fourth month. The calcium, phosphorous, and protein that are needed for these structures must all be provided by the mother's diet.
2. A good diet for a pregnant mother, in order to provide for both her needs and those of the fetus (the developing baby), includes whole grains, fruits, vegetables — including green leafy vegetables — proteins and dairy products. A doctor may also recommend iron and/or folic acid supplements.
3. If the mother's diet does not provide enough calcium for the baby's bones and teeth, it will come from calcium stored in her bones — not from her teeth. The old idea that a mother's teeth lose calcium during pregnancy has been found to be a myth.
4. Progesterone, a normal female hormone, is elevated during pregnancy. This hormone stimulates production of prostaglandins, substances that cause inflammation in gum tissues if the bacteria that cause periodontal (gum) disease are present. The resulting swelling, redness, and sensitive gum tissues, called pregnancy gingivitis, are common during the second to eighth months of pregnancy.
5. The bacteria involved in periodontal disease can affect whole body conditions such as heart disease and strokes, diabetes, and respiratory diseases. The inflammation resulting from such bacteria can also cause premature delivery (birth before 37 weeks of pregnancy) or low birth weight in the baby.
6. Periodontal disease is also related to pre-eclampsia, or high blood pressure, during pregnancy.
7. Dental x-rays do not expose the mother to very high radiation, but in any case every precaution is taken to minimize exposure to the fetus. These include a leaded apron that shields the baby from exposure.
8. Most drugs commonly used in dentistry, including local anesthetics, can safely be given to pregnant women without affecting the fetus. However, it is important to let your dentist know you are pregnant before embarking on any treatment to make sure anything that is done will be safe for the fetus and its developing teeth.

Contact us today to schedule an appointment to discuss your questions about pregnancy and your oral health. You can also learn more by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”