Frequently asked questions and answers for patients of Santa Barbara Cosmetic Dentist Del Pinho, DDS. Our dental office is located at 19 W. Micheltorena Street, Santa Barbara, California.
What Is A Dental Emergency?
Injuries to the mouth may include teeth that are knocked out (avulsed), forced out of position and loosened (extruded) or fractured. In addition, lips, gums or cheeks are often cut. Oral injuries are often painful and should be treated by a dentist as soon as possible.
How soon should I been seen by your office?
Immediately. Getting to a dentist within 30 minutes can make the difference between saving or losing a tooth.
When a tooth is knocked out:
- Immediately call our practice for an emergency appointment.
- Handle the tooth by the crown, not the root. Touching the root (the part of the tooth below the gum) can damage cells necessary for bone re-attachment.
- Gently rinse the tooth in water to remove dirt. Do not scrub.
- Place the clean tooth in your mouth between the cheek and gum to keep it moist. It is important not to let the tooth dry out.
- If it is not possible to store the tooth in the mouth of the injured person, wrap the tooth in a clean cloth or gauze and immerse in milk.
When a tooth is pushed out of position:
- Attempt to reposition the tooth to its normal alignment using very light finger pressure, but do not force the tooth.
- Bite down to keep the tooth from moving.
- It may be necessary to splint the tooth in place to the two healthy teeth next to the loose tooth.
When a tooth is fractured:
- Rinse mouth with warm water.
- Use an ice pack or cold compress to reduce swelling.
- Use ibuprofen, not aspirin, for pain.
Immediately call our office, we will determine treatment based on how badly the tooth is broken. Only a dentist can tell how bad the break is.
Minor fracture: Minor fractures can be smoothed with a sandpaper disc or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days.
Moderate fracture: Moderate fractures include damage to the enamel, dentin and/or pulp. If the pulp is not permanently damaged, the tooth may be restored with a full permanent crown. If pulpal damage does occur, further dental treatment will be required.
Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery.
When tissue is injured:
Injuries to the inside of the mouth include tears, puncture wounds and lacerations to the cheek, lips or tongue. The wound should be cleaned right away with warm water, and the injured person taken to a hospital emergency room for the necessary care. Bleeding from a tongue laceration can be reduced by pulling the tongue forward and using gauze to place pressure on the wound.
What can I do to be prepared?
Pack an emergency dental care kit, including:
- Our office phone number
- Saline solution
- Small container with lid
- Ibuprofen (Not aspirin. Aspirin is an anti-coagulant, which may cause excessive bleeding in a dental emergency.)
What Is A Dental Implant?
A dental implant is an artificial tooth root (synthetic material) that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don’t rely on neighboring teeth for support, they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth.
Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jawbone, like natural tooth roots; the second is used when the jaw structure is limited; therefore, a custom-made metal framework fits directly on the existing bone.
How do they work?
Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.
Can anyone receive dental implants?
We would be happy to talk about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.
What can I expect during this procedure?
The dentist must perform surgery to anchor the “artificial root” into or on your jawbone. The procedure is done in the dental office with local anesthesia. Medications may be prescribed for soreness.
How long does the process take?
The process can take up to nine months to complete. Technology, however, is trying to decrease the healing time involved. Each patient heals differently, so times will vary. After the screws and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months.
What is the success rate of implants?
The success rate for implants depends on the tooth’s purpose and location in the mouth. The success rate is about 95 percent for those placed in the front of the lower jaw and 85 percent for those placed in the sides and rear of the upper jaw.
How do I care for implants?
Your overall health may affect the success rate of dental implants. Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day, without metal objects. We will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.
What is the cost of implants?
Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. Our staff can help you with this process.
What Is A Root Canal?
Underneath your tooth’s outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth’s nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.
Why do I feel pain?
When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.
What is a root canal procedure?
A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with gutta percha, a rubber like material, to prevent recontamination of the tooth. The tooth is then permanently sealed with possibly a post and/or a gold or porcelain crown. This enables patients to keep the original tooth.
Why do I need root canal therapy?
Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall-out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it’s always best to keep your original teeth.
What is involved in root canal therapy?
Treatment usually involves one to two appointments.
First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, a gap is drilled from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp and reshaped. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or we may go right ahead and fill the canals.
If you’re given a temporary filling, usually on the next visit it’s removed and the pulp chamber and canal(s) are filled with rubber like gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.
What are the risks and complications?
More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal-filing instrument used-both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.
What happens after treatment?
Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods on the treated tooth, and us regularly.
What Is A Sealant?
A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972.
How effective are sealants?
Scientific studies have proven that properly applied sealants are 100 percent effective in protecting the tooth surfaces from caries. Because sealants act as a physical barrier to decay, protection is determined by the sealants’ ability to adhere to the tooth. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.
How are sealants applied?
Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light. Other sealants are applied and allowed to harden much the same way nail polish is applied to fingernails. Sealant treatment is painless and could take anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.
How long will a sealant last?
Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental check-ups are necessary to monitor the sealants’ bond to the tooth.
Who should receive sealant treatment?
Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child’s teeth are most susceptible to cavities and the least benefited by fluoride. Surveys show that approximately two-thirds of all cavities occur in the narrow pits and grooves of a child’s newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.
Are sealants covered by insurance?
Although insurance benefits for sealant procedures have increased considerably, coverage is still minimal. The trend is toward expanded coverage of this benefit, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.
What is Bruxism?
Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren’t diagnosed with bruxism until it is too late because so many people don’t realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.
Can bruxism cause harm?
People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.
What are the signs?
When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth, which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ)-the jaw-which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching.
What can be done about it?
During regular dental visits, we would automatically check for physical signs of bruxism. If the signs of bruxism are noticed, the condition may be observed over several visits to be sure of the problem before recommending and starting therapy.
The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that’s worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient’s destructive behavior.
Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.
What Is Gum Disease?
Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.
What causes gum disease?
Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.
Are there other factors?
Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body’s ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body’s immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control.
What are the warning signs of gum disease?
Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That’s why patients are advised to get frequent dental exams.
What does periodontal treatment involve?
In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.
How do you prevent gum disease?
Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. We can design a personalized program of home oral care to meet your needs. Children also should be examined.
Is maintenance important?
Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy. Patients should visit the dentist every 3-4 months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily, and brush their tongue. Proxy brushes (small, narrow brushes) are the best way to clean in between the recesses in the teeth, and should be used once a day. Wooden tooth picks and rubber tips should only be used if recommended by us.
What Is Halitosis?
More than 90 million people suffer from chronic halitosis or bad breath. In most cases it originates from the gums and tongue. The odor is caused by bacteria from the decay of food particles, other debris in your mouth, and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.
What causes bad breath and what can be done about it?
Bad breath is primarily caused by poor oral hygiene, but can also can be caused by retained food particles or gum disease. Proper brushing including brushing the tongue, cheeks, and the roof of the mouth will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. Mouth rinses are effective in temporary relief of bad breath. Consult with us and/or physician if the condition persists.
Does bad breath come from other sources than the mouth?
Bad breath also may occur in people who have a medical infection, gum disease, diabetes, kidney failure, or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate post-nasal drip. This is where the mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor. Bad breath originating in the stomach, however, is considered to be extremely rare.
Why is saliva so important in the fight against bad breath?
Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva allowing the bacteria to grow inside the mouth. To alleviate “morning mouth,” brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware because the odor may reappear even if you’ve brushed your teeth.
Do certain foods cause bad breath?
Very spicy foods, such as onions and garlic, and coffee may be detected on a person’s breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.
How do I control bad breath?
It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. To alleviate the odor, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control the odor. If you have dentures or a removable appliance, such as a retainer or mouth guard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouth rinses, deodorizing sprays or tablets, talk with your dentist because these products only mask the odor temporarily, and some products work better than others.
What is my dentist’s role?
Visit your dentist regularly because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, we can help determine its source. We may ask you to schedule a separate appointment to find the source of the odor. Or, if we believe that the problem is caused from a systemic source (internal), such as an infection, we may refer you to your family physician or a specialist to help remedy the cause of the problem.
Why Do I Need X-rays?
Radiographic or X-ray examinations provide us with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.
Do all patients have X-rays taken every six months?
No. Your radiographic schedule is based on our assessment of your individual needs, including whether you’re a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.
What kind of X-rays does my dentist usually take?
Typically, most dental patients have “periapical” or “bitewing” radiographs taken. These require patients to hold or bite down on a piece of plastic with X-ray film in the center. Bitewing X-rays typically determine the presence of decay in between teeth, while periapical X-rays show root structure, bone levels, cysts and abscesses.
My dentist has prescribed a “panoramic radiograph.” What is that?
Just as a panoramic photograph allows you to see a broad view such as the Grand Canyon, a panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.
Why do I need both types of X-rays?
What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which a periapical or bitewing X-ray cannot show. On the other hand, periapical or bitewing X- rays show a highly detailed image of a smaller area, making it easier for your dentist to see decay or cavities between your teeth. X-rays are not prescribed indiscriminately. We have a need for the different information that each radiograph can provide to formulate a diagnosis.
Should I be concerned about exposure to radiation?
All health care providers are sensitive to patients’ concerns about exposure to radiation. We have been trained to prescribe radiographs when they are appropriate and to tailor radiographic schedules to each patient’s individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, we know which techniques, procedures and X-ray films can minimize your exposure to radiation. Our office utilizes digital radiography which greatly reduces your exposure to radiation as compared with older film-type X-rays.