If you are one of the millions of Americans who are affected by obstructive sleep apnea (OSA) and want to explore your treatment options, talk to your dentist about whether a mandibular advancement device (MAD) is a good option for you. These devices are also known as a mandibular advancement splint and are only a treatment option for obstructive sleep apnea. Central sleep apnea requires different types of treatment.
The two common treatment options for obstructive sleep apnea are a continuous positive airway pressure machine (CPAP) and mandibular advancement devices. A CPAP machine supplies the patient with a stream of air through a mask worn while sleeping. Many patients find CPAP machines uncomfortable, noisy, and difficult to adapt to.
A mandibular advancement device is a sleep apnea appliance that fits over the patient’s upper and lower teeth and is worn while the patient is asleep. It treats sleep apnea and snoring by moving the jaw forward and opening up the airway. A mandibular advancement device is much less obtrusive than a CPAP. It is silent and while it takes some patient a little while to get used to wearing the device, it is much more comfortable than a CPAP.
One problem encountered with mandibular advancement devices is that they can move a patient’s teeth over time if they are improperly fitted. It is very important to have the device properly fitted and adjusted by a dentist with the proper training and experience. Never buy a mandibular advancement device from a vendor who claims that no fitting is needed. These devices can cause serious dental problems. Avoid these problems by obtaining the device from a qualified dentist and follow up with regular dental checkups.
Individuals lose teeth for any number of reasons. It may be from trauma, a history of gum disease, or advanced decay. In the past the only options available for tooth replacement were fixed bridges, partials or dentures. Modern dentistry has brought us far from that! Dental implants are no longer the tooth replacement of the future, but are the tooth replacement option of the present.
Dental implants are made of a titanium post that serves as an artificial root for the replacement tooth. This post is placed into the socket or jawbone of the missing tooth. Titanium is very biocompatible so that the bone naturally osseointegrates around it, forming a stable “root” that can support an artificial tooth.
On top of this post is an abutment to which a porcelain crown will be attached. This crown is similar to other dental crowns throughout the mouth, making it appear as a natural tooth. There is no need to prepare or adjust teeth next to the implant that may have nothing wrong with them.
In cases of more than one missing tooth, implants can be used to affix bridges or dentures. The stability offered by implants helps these larger units to stay in place during normal eating and talking.
Compared to other tooth replacement methods, dental implants are the most “natural” option that is available. Keeping them clean is easy. Normal brushing and flossing, or using a Waterpik is all that patients need to do in order to keep the area healthy.
Sometimes patients may not have enough bone structure to support an implant. It is fairly common to use bone grafts that can encourage new bone growth in the area. If you would like to find out about dental implants, or determine if they are the right choice for you, talk to your dentist or oral surgeon.
Dental x-rays are very important because they help dentists to monitor and diagnose treatment needs between the teeth and below the gumlines. Otherwise these areas are out of the range of vision and could allow decay or gum disease to harbor until it was far too late.
While dental x-rays are already safe and use low doses of radiation, digital x-rays use far less radiation than traditional films. In fact, digital films require about 80% less radiation exposure than traditional dental x-rays. Even though exposure is very low, we also use additional personal protective equipment such as lead aprons with a collar to shield patient’s vital organs and thyroid gland.
Appointments time becomes more efficient with digital x-rays, because the images are viewable almost immediately as they are integrated into the office software system. This means there is less time waiting between taking the films and the examination, because no process time is needed.
Your dentist will share your digital x-rays with you during the appointment to help diagnose your treatment needs and allow you to further understand the treatment process. Because the copies are soft, they can also easily be submitted along with insurance claims or when making referrals between offices.
Routine bitewing x-rays are taken about every 12 months, while full mouth series of films are taken ever 3-5 years. These timelines are based on the ADA standard of care and allow dentists to appropriately monitor dental health. Sometimes one or more x-rays may be needed on specific teeth for diagnosis or treatment needs. Each type of x-ray is angled in a different manner to target specific viewpoints.
Special needs patients require special dental care providers. Because routine dental procedures like cleanings and x-rays can be exhausting to the patient and their caregiver, sedation dentistry allows the patient to be able to relax and have all of their treatment completed during one appointment. Sedation appointments also help dental providers to be more efficient in the care that they provide, as these appointments allow each patient to be extremely cooperative for the entire length of their procedure.
Sedation is achieved either by an oral medication taken before the appointment, or through intravenous delivery of medication. For cases where a deeper stage of sedation is needed, intravenous is the method of choice.
In the past it was difficult for caregivers to find and schedule sedation dentistry appointments for special needs patients such as patients with developmental disabilities, dental anxiety, or an uncontrollable severe gag reflex. Dentists who specialize in sleep and sedation dentistry offer sedation services on a routine basis for not only patients with special needs, but also every patient that requests sedation services.
Because the patient is sedated into a level of sleep, very large treatment cases can be treated all at once. These appointments may last for up to a few hours in order to complete all of the care, but the patient will never notice. They will wake up rested and comfortable, as local anesthetic is still used to numb the area where treatment took place.
If you have been trying to find a dental care provider for the special needs patient in your life, look for a dentist that specializes in sleep and sedation dentistry.
Composite fillings, also called “white” fillings are made of a tooth-colored material. They blend very well with the natural tooth and are able to be placed in a variety of areas that traditional silver fillings are not. The color of the filling is chosen from various shades to match the teeth surrounding it.
Because they bond directly with the tooth, white fillings require less tooth preparation than silver amalgam fillings. They can be used on smooth areas like root surfaces in areas of gum recession or enamel abrasion. Composite fillings help to recreate lost tooth structure or protect areas of the teeth that should not be exposed. Because silver fillings are wedged into the tooth, they treat the decay but do not help regain lost strength from the missing tooth enamel. However, white fillings do because they bond and repair the tooth.
White fillings can be used in any area of the mouth. While they are obviously used for the front teeth, they may be used for back teeth as well, so they won’t show when you laugh, talk or smile. You can also have your silver fillings replaced with a white composite filling for a whiter smile.
As fillings become old and need to be replaced, it is easier to replace white fillings than silver ones. Each time a tooth needs to be re-prepped for a silver filling, the tooth becomes less and less stable. Composite fillings are less invasive, so this means the tooth can be retreated easier without necessarily having to place a crown on the tooth.
There is no risk of white fillings leaking metal color into the surrounding enamel or gum tissue. They hold their bond very well. As silver fillings age, the discoloration often leaks into the tooth and is difficult to treat with whitening products.
Simple bonding procedures such as correcting a gap or misshaped tooth also use white filling material. It is a fairly inexpensive cosmetic procedure that can make a huge impact.
Once a tooth has a very large filling, as the tooth and filling begin to age there is less tooth to work with for future treatments. Maintaining the structural stability in these teeth mean that covering its entire surface is the only way to help it maintain the strength to handle every day chewing. A crown does this for us.
Sometimes called a “cap”, dental crowns cover the entire surface of a tooth above the gumlines. Crowns are made of porcelain, porcelain fused to metal, or gold. The material is based depending on the area to be treated and the patient’s personal preferences. Porcelain crowns are made to match the rest of the teeth in the mouth, so that they appear as natural as possible.
Crowns are also used in dental bridges when a person is missing one or two teeth. For crowns and bridges, a crown is placed on the teeth adjacent to the area of the missing tooth, and a pontic crown is fused between the two, creating the appearance of a tooth between them. These bridges function for chewing the way any other dental crowns would. The only difference is that there is an area beneath the bridge that does require an extra step in daily oral hygiene routines.
For teeth that have large fractures or decay, failing to place a crown on the tooth will ultimately result in further fractures and eventual loss of the tooth. Sometimes the nerve of the tooth can become infected if a crown is delayed, resulting in the need for a root canal. Crowns are used when a tooth is treated with root canal therapy, in order to protect the stability of the non-living tooth structure that still remains.
Our teeth naturally begin to darken over time due to the stain that is absorbed through our food and drink. This can cause teeth to look dingy and our smile to have less of a luster. Some foods discolor teeth worse than others, like coffee, tea or red wine. These may increase tooth stain and make it more evident. What makes this stain significant is that it is inside of the tooth enamel. Abrasive toothpastes do not polish it off. The answer is to reach it inside of the tooth.
In-office tooth whitening is an effective way to eliminate this stain and make teeth appear whiter, healthier and more beautiful. For this procedure a whitening agent is applied to the teeth by a dental professional and accelerated with the use of an ultraviolet light. Within just one appointment your teeth will noticeably be several shades lighter. In office teeth whitening is the fastest way to achieve a brighter smile.
Another whitening option is with custom bleaching trays. Your dentist will take an impression of your mouth in order to create a custom fitted appliance. The finished whitening tray will hold a small amount of gel against the tooth surface of the teeth that are to be whitened. Because these are custom fitted, the chance of tissue irritation and discoloration is minimal – unlike over the counter products that are made as a one-size-fits-all tray. Commercial trays have a tendency to allow gel access to the sensitive gum tissue, resulting in irritation. Custom trays also use a professional grade whitening agent that is more effective than what you can purchase at any store.
Sedation dentistry is an excellent way for many patients who either avoid dental care or are physically unable to receive dental care in a traditional setting to get the dental care they need. Patients suffering from dental anxiety, special needs patients, those who cannot get numb with Novocain, severe gag reflex, and other patients whose have physical or mental challenges that make it difficult or impossible to sit still in the dentist chair.
Sedation dentistry can be a little confusing for dental patients. Sedation dentistry can cover everything from the mildest level of sedation such as nitrous oxide or mild oral sedatives to full unconscious sedation. Sedation levels should be thought of as a continuous sliding scale of sedation rather than distinct levels.
The mildest level of sedation is meant to simply relax the patient and relieve some anxiety. Nitrous oxide (laughing gas) and mild oral sedatives that most dental practices offer to their patients. Stronger oral sedatives produce a moderate level of sedation.
Intravenous sedation produces a drowsy, very relaxed state with some suppression of pain as well. Intravenous sedation is easier to control than oral sedation by adjusting the amount of sedative. Patients are conscious and can respond to questions though in many cases the patient will doze off during the procedure. Patients usually do not remember having the procedure.
Full unconscious sedation is the safest and most humane alternative for some dental patients. Dental procedures under full unconscious sedation are performed in a specially equipped surgical suite with the assistance of an anesthesiologist.
Most dentists can offer the mildest forms of sedations, but dentists who practice intravenous sedation and full unconscious sedation have received extensive specialized training in sleep and sedation dentistry.
For many years, traditional porcelain veneers have been a popular alternative to transform stained or misaligned teeth into a beautiful, bright white smile. Recent advances in veneer technology has led to the development of prepless or minimal prep veneers that can be an excellent alternative for many patients.
Veneers are wafer thin shells of porcelain or similar material that are bonded to the front of the patient’s teeth to create an aesthetically pleasing smile. Veneers can be a very effective and relatively inexpensive solution for stained, yellowed, and misaligned teeth. The entire process can be completed in a matter of a week or two and typically requires only two or three office visits. Ease of placement and excellent results have made veneers a popular alternative to braces, whitening, caps, and other far more invasive and time consuming procedures.
However, placing traditional veneers requires shaping and preparing the surface of the patient’s teeth. This procedure requires numbing with anesthetic and results in the permanent loss of the tooth enamel. Once the veneers are placed, there is no going back.
Prepless veneers are attractive because they are so thin that they require no surface preparation or, at worst, very minimal surface preparation. Anesthetic is usually not required and the veneers can be removed without damaging the patient’s teeth.
For the right patient, no prep veneers can be an excellent alternative. They may not be the best choice for severely crooked teeth or heavily discolored teeth. Your cosmetic dentist will thoroughly examine your teeth and explain your options depending on your particular situation.
When choosing a dental practice, most patients focus on the dentists and the scope of the dental practice. However, for routine dental care such as regular dental cleanings and checkups, most patients will spend the majority of their time with the dental hygienist without fully understanding the important role the dental hygienist plays in maintaining the patient’s oral health.
Dental hygienists are the primary providers of critically important preventative dental care. Most patients understand that the dental hygienists job is to provide dental cleaning (also called prophylaxis). Cleaning teeth and removing plaque, tartar, and stains is a major role filled by dental hygienists, but in addition to cleaning teeth, they take and interpret dental X-rays, provide patient education about oral health issues, apply sealants and fluoride, perform the initial assessment of the patient’s oral health and handle other duties.
Dental hygienists are licensed health care professionals. Most dental hygienists complete at least a two year college level course of study at a university, community college, technical school or dental school. They must also pass a comprehensive written and practical examination before being licensed by the state. Some dental hygienists complete a four or five year college level program.
Except for a few states, a licensed dental hygienist is required to work under the supervision of a dentist. In most general and family dental practices, the dental hygienist is a vitally important part of the dental care team and can be an excellent source of information and advice for keeping your teeth in great shape.
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