A Conversation About Plaque

Arianna Marsden, RDH

A Conversation About Plaque

Has your hygienist ever recommended that you brush twice daily?  I made this recommendation to a patient recently, and he informed me that because he brushed his teeth at night, he did not need to brush his teeth in the morning.  This patient asked me, “why would I need to brush my teeth in the morning?  I didn’t eat anything while I was sleeping, so my teeth are still clean.”

It became apparent to me that this patient had a misunderstanding of how plaque develops on his teeth, and I think that other people may have the same misconception about how plaque forms.  This patient and I were able to have an educational conversation about how plaque develops, and my patient was surprised to learn something new at the dentist.

So, first of all, what is plaque?  Plaque is the white, fuzzy stuff you feel on your teeth after not cleaning your teeth for a while.  This plaque is filled with bacteria that cause gum disease and cavities.  Seconds after a cleaning, whether from your hygienist or from brushing your own teeth, the plaque starts to come back.  It begins as a protein layer of slime that our mouths produce naturally, called the acquired pellicle.  Bacteria that are always present in our mouths bind to this pellicle and begin to colonize.  When bacteria colonize, they bind together into a film that you can see and feel on our teeth; the white fuzzy stuff we call plaque.  This plaque will form whether or not food is eaten.   It’s important to remove plaque about once every 12 hours, or twice per day, to help reduce the amount of bacteria present in our mouths, and to prevent cavities and gum disease.

During my conversation with my patient about how plaque is formed, we speculated about why he might have had a misunderstanding about plaque.  He asked me, “I thought you were supposed to brush after eating, because the food makes the plaque and the plaque gives you cavities.”  Part of this is true; brushing after meals does help to prevent cavities, but not for the reasons he initially thought.  The plaque that is already present uses the sugars in the foods we eat, and produces an acid, which is what causes the cavities.  By brushing after we eat, we remove the plaque so it doesn’t have the opportunity to produce acid; we also neutralize any acid that may have already been produced, thus preventing cavities.  We also discussed that removing, or disrupting plaque about once every twelve hours prevents the colonized plaque from mineralizing into calculus.  Calculus is the hard stuff that gets stuck on your teeth that you can’t brush off; it most commonly develops on the tongue side of lower front teeth.  This calculus, and the embedded bacteria, are one of the main causes of gum disease.  Calculus can’t be removed with a toothbrush, so it’s important to see your hygienist regularly for professional cleanings to remove the calculus deposits which have formed.

When my patient understood why brushing more than once per day would benefit his oral health, he expressed that he would consider brushing twice daily, and we would observe the results of his efforts at his next cleaning appointment.  Often times understanding why we do something is half the battle.

Sources:
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Why Do We Need to Brush and Floss?

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Andra Mahoney, BS RDH

Why Do We Need to Brush and Floss?

Many of you know two questions that your Dental Hygienist will inevitably asked you when you go in for your regular check-up visit:  “Are you brushing two times a day?” and “How is your flossing going?”

As an Hygienist, we do not asked these questions to get after you.  We promise we do not love nagging you to floss.  We do it because we genuinely care for your health and helping our patients understand how brushing and flossing can keep you healthy is one of our professional goals.

Most of you know the guidelines. For optimum dental health, you should brushing two times a day for two minutes, and floss one time a day.  We know that is what we are supposed to do.  But do we know why?

Plaque (that soft, filmy, white stuff that grows on our teeth) accumulates constantly.  24/7.  It never stops growing.  Even if you do not eat food, it grows (common misconception that plaque only grows when you eat).  Inside plaque lives bacteria.  This is the bacteria that causes cavities and gum disease.  It is recommended that we brush two times a day to remove the plaque and disrupt the bacteria’s harm on our mouth.  If we do not remove the plaque, then we are allowing the bacteria to start creating cavities and cause inflammation and infection in our gums.

If the plaque is left in an area for a while then it will harden and calcify.  This is what we can tartar build-up, or you may even hear us refer to it as calculus.  While plaque is soft and can be removed with a toothbrush and floss, tartar is like a rock cemented onto your tooth.  You can brush and floss all day long, once it’s turned into calculus, it’s not going any where.  The biggest down side of that is that it still has the bacteria inside of it.  Now it’s stuck on your tooth, not going anywhere, with all this bacteria.  Even better for gum infections and things to occur.

Don’t worry, your awesome Hygienist will save you.  We have the tools and know-how to remove that calculus and get your mouth back to health!  But, so do you!  You can brush and floss every day, remove that plaque, and prevent that calculus from even forming!

Now many of you do brush your teeth.  Which is fantastic!  We love when you do that!  However, not as many of you floss.  I’m not sure why.  It’s just as important, and doesn’t really take that long.  Here’s something to remember when you want to skip flossing tonight… You can be THE most amazing brusher in the whole world, but you will never be able to clean between your teeth with just a toothbrush.  It’s a fact.  The best technique will not maneuver those toothbrush bristle to places they cannot physically reach.  Floss is the only way to clean the remaining 35% of your tooth that the brush did not get.  Floss is a toothbrush’s best friend.  They go hand in hand.  One just as important as the other.

I hope this helped you understand a bit more why we always ask these two simple questions.  If you have any other questions, we are here for you!  Just ask!

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.mouthhealthy.org/en/az-topics/f/flossing

http://kidshealth.org/en/teens/teeth.html

http://www.nhs.uk/Livewell/dentalhealth/Pages/Teethcleaningguide.aspx

http://www.businessinsider.com/what-happens-if-you-dont-brush-and-floss-your-teeth-2014-2

What is Calculus?

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Lora Cook, RDH

What is calculus and what dangers does it cause to the health of your mouth.

Calculus or tartar, same thing is calcified plaque.  Plaque is the soft sticky film that will start to form twenty minutes after you brush your teeth.  Another name for the soft sticky plaque is biofilm.  This is basically a bacteria that grows in your mouth, a “slime layer”.  Plaque is white or pale yellow soft, sticky, slimy stuff.  This is what makes your teeth feel “fuzzy” when you first wake up and at the end of a long day.  So do all these pleasant descriptions make you want to go brush your teeth yet?

So where does calculus come from?  Calculus is calcified plaque.  When plaque is allowed to stay hiding in your mouth for twenty-four hours or more is has the opportunity to harden and turn into tartar. Calculus/Tartar, same thing, this is calcified plaque. Once this soft sticky substance (biofilm) becomes hard it will attach itself to the tooth surface, then you will not be able to remove it yourself with your tooth brush or your floss. Calculus will form above and below your gum tissue.

The calculus will be a physical irritant to your gum tissue, causing inflammation.  The calculus also becomes a source that harbors bacteria that causes harm to the tissue and bone around the teeth.  This aggressive bacteria may lead to periodontal disease. What is periodontal disease?  In short, it is bone loss around the teeth.  This bone loss may range from slight to moderate, to severe.  Some people will build up tartar more quickly than others, and some people are more prone to the bacteria that causes periodontal disease (bone loss).

So this brings the questions; What can I do to prevent calculus build up?

USE AN ELECTRIC TOOTHBRUSH: electric tooth brushes have been proven to be more effective at cleaning than manual brushes. Use the rechargeable electric brushes, not the battery spin brushes.

CHANGE YOUR TOOTHBRUSH EVERY THREE MONTHS: Do not go longer than three months with the same tooth brush or tooth brush head.  Once the bristles start to wear out they cannot do a good job for you.

TIME YOUR BRUSHING ROUTINE: Brush for at least two minutes, preferably two to three minutes.  Sometimes just adding more time to your routine can make a big difference, most people will brush for only forty to sixty seconds. So try timing yourself, you will be surprised.  Two minutes feels like forever when you are brushing.

FLOSS DAILY: You don’t have to floss two times daily, once a day is sufficient. Make flossing part of your nightly routine.  Flossing techniques are important, because some techniques are more effective than others. It is important to floss under the gum tissue where everything likes to hide, not just in between the teeth.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.colgate.com/en/us/oc/oral-health/conditions/plaque-and-tartar

https://www.quora.com/Does-tartar-cause-gum-disease-purely-through-MECHANICAL-means/

Tips for Toddlers

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Tips for Toddlers

Have you ever tried to brush the little one’s teeth and been so frustrated you just give up?!?  I have!  With 4 children of my own, I can tell you first hand that it’s not the easiest task to accomplish and each child is so different and will respond just a little differently.  So if one of these techniques don’t work for you, just try, try again.

Tip #1: For the babies who are teething or whose teeth are just breaking through, chewing on a toothbrush is an excellent idea!  No toothpaste needed, just the brush and lots of saliva!  

Tip #2:For the little ones, just when they’re starting to get their teeth – You sit on the floor, criss-cross apple sauce, and lay their head in your lap with their legs facing away from you.  (It will look like they’re laying in a dental chair, without the chair.)  Then have them extend their chip up towards you as you lightly brush their teeth in circular motions, just doing the best you can.  At first, you may be only able to brush for a few seconds, but after a while, they’ll get more used to it (and you, too) and before you know it, you’re brushing morning and night!  There are finger brushes that you can try as well if they don’t like the toothbrush.

Tip #3: Use a timer.  Any timer will do, just make sure that it stays in the bathroom where they’ll see it on the counter and use it.  It can be a one minute timer, one minute for the top and then flip it and do it again for the bottom teeth.  That way they are counting down to when they’re finished.

Tip #4: SING!  Sometimes I sing so much that my children tell me to stop, however, it truly works.  Find a song they like to sing or a number they like to count up to, and do it while you are brushing their teeth!  Some songs that worked well for my littles were “Itsy Bisty Spider,” sung twice, The ABC song, Wheels on the Bus, or London Bridges.  Whatever the song, decide how to break it up into two sections, brush the bottom teeth first, pause for a second to let them swallow and then finish on the top.  They think it’s fun and brushing time will go quickly and end up being fun instead of a drag.

Most importantly…..BE PATIENT!  It will come and eventually they will brush their teeth on their own.  It just takes time and lots of patience.  Don’t let this little thing become a battle early in their little lives.  If you need extra tips or help, don’t be afraid to ask your hygienist on your next visit in to see us!  Happy Brushing!
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Wendy Parker, R.D.H. and also known as M.O.M.

Keeping Your Teeth For a Lifetime

KarenK

Karen Kelley RDH

Keeping Your Teeth For a Lifetime

Our dental practice has more over 50 year olds than under 50.  As aging adults, we need to be aware of certain things that can keep us from retaining our teeth our entire lives.

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Judith Ann Jones, DDS, a spokesman on elder care for the American Dental Association and director of The Center for Clinical Research at the Boston University Goldman School of Dental Medicine spoke about 5 things that are especially important to the over 50 crowd.

Tooth Decay:  Contrary to what many people believe, adults keep getting cavities!  I’m always surprised when people are stunned to learn they have a cavity as an adult.  Areas of the teeth that have never had a cavity can decay, but  areas  where we see more problems are where an old filling is leaking and at the base of an older crown.  The best prevention is brushing well each day along the gumline.  An electric toothbrush is very helpful in accomplishing this as well as the use of fluoride.  An over the counter fluoride rinse nightly is great and in our office we have special prescription strength fluoride that is wonderful for cavity prevention as well as help with sensitivity.
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Dry Mouth:  Keeping Your Teeth For a Lifetime We see so many people with this problem.  “Saliva protects our teeth.  The calcium and phosphate present in saliva prevent demineralization of your teeth”, Jones says.  Many drugs cause dry mouth as well as some diseases and as we get older, we are on more medications thus we see this commonly in older adults.  This is a difficult one to deal with for those affected.  The best thing is to drink lots of water, use saliva substitute and try xylitol products.  Also, if you smoke, stop, it just makes your mouth drier.

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Gum Disease:  If your gums are swollen, red, or bleed easily, you have gum disease.  If left untreated, gum disease (gingivitis) will become more serious and will cause deterioration of the bone that holds the teeth, we call this periodontitis.   If this condition continues without treatment, it can cause the loss of the teeth.  The best way to prevent gum disease is to clean your teeth well each day with brushing, flossing, and use of interdental cleaners like soft picks or go betweens. And of course, seeing your friendly dental hygienist as often as recommended.  We can remove the mineralized bacteria from your teeth that you can’t remove with brushing.

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Tooth Crowding:  “As you age, your teeth shift”, according to Lee W. Graber, D.D.S., M.S, Ph.D., Past President of the American Association of Orthodontists. And “that can be problematic, not because you’ll look different, but because it can make your teeth more difficult to clean, leading to more decay.  It’s also of concern because misaligned teeth can lead to teeth erosion and damage to the supporting tissue and bone”, Graber says.   “Add to that the tendency of older adults to have periodontal disease, and you could end up losing your teeth even faster.”   If your teeth have really shifted, and you find you are having a difficult time keeping your teeth clean and food keeps getting caught in certain areas, ask our doctors about orthodontics.  We offer Invisalign to our patients and we’ve had patients in their later years choose to straighten their teeth.  I just finished with my invisalign treatment.  I had braces when I was a teenager but my teeth had shifted and I was experiencing these problems I just mentioned.  I decided to do Invisalign.  It’s easy to do and my teeth are so much straighter.   They are now in the correct alignment and my teeth and gums will be healthier.   If you choose not to do orthodontics, more frequently exams and cleanings may be necessary.

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Oral Cancer:  According to The Oral Cancer Foundation, more than 43,000 Americans will be diagnosed with oral cancers this year, and more than 8,000 will die from it.  “Oral cancer incidence definitely increases as you get older”, Jones says, and “is very often linked to smoking and heavy alcohol use.”   Jones also said, “Only about half of people who develop oral cancer survive the disease.”   If discovered early, there is an 80 percent chance of surviving for five years.  When we do your periodic exams when you come in for your cleaning, you will be checked for oral cancer.  We also offer Velscope, Identafi, or Oral ID technologies to help in finding oral cancer earlier.

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Keep brushing, flossing and smiling!  We want to help you keep your teeth healthy your entire lives!

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Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.huffingtonpost.com/2014/09/28/common-dental-problems-_n_5844434.html

https://aga.grandparents.com/

How to Care For Your Infant’s Teeth

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Lora Cook RDH 

How to Care For Your Infant’s Teeth

When to start cleaning your baby’s teeth

          You can start before your baby even has teeth, it is best to incorporate mouth cleaning at bath time.  This routine will help your baby get used to you cleaning their mouth, which can allow a smoother transition when you do begin to brushing their teeth. This will also help you to know when your babies teeth first start to push through their gum tissue.

The bacteria that lives in the mouth is not harmful to the gum tissue, but can be harmful to the teeth.  The enamel on baby teeth are 50% thinner than adult teeth.  Therefore baby teeth are more susceptible to the bacteria that causes cavities.

How to clean your infants teeth

          To clean your babies mouth before tooth eruption use a clean wet wash cloth.  Wrap wash cloth around your finger then rub it gently around your babies gums.

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When to transition to a tooth brush.

            When the teeth have started to erupt, this will be time to transition from a wash cloth to a baby tooth brush.  Look for a tooth brush specifically made for infants. This will usually start around six months old.  This will also be the time to change from bath time mouth cleaning to brushing two times daily.

It is fine to just dry brush with just tap water, or a fluoridated tooth paste can be used. When using toothpaste, use the tiniest smear.  It is never too early to help create a good brushing routine for your child.

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Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://www.myhealthunit.ca/en/livehealthyandprotectyourhealth/Caring-for-Your-Child-s-Teeth.asp

http://m.oralb.com/products/oral-b-stage-1-disney-baby-pooh-toothbrush

www.babycenter.com

Black Line Stain

AriannaM

Arianna Ritchey, RDH

BLACK LINE STAIN

During the regular prophylaxis cleaning for a recent patient, she inquired as to the black stain on her teeth.  She had excellent brushing and  flossing habits, saw us every six months for her professional cleanings, and has only one filling on her permanent teeth.  This patient does not participate in any behaviours that normally result in staining; she does not drink coffee, tea, wine, and she does not use any tobacco products.  She was also concerned, because this same type of stain is also present on her infant’s teeth, who is strictly breastfed.  So, where was this stain coming from?!

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It was explained to this patient that the stain she was experiencing was most likely a type of stain called “Black Line Stain,” or sometimes simply “Black Stain”.  Black Line Stain is more common in women than men, and can occur in patients with excellent oral hygiene.  It appears as a thin black line, which is firmly attached to the tooth surface, and most commonly near the gumline of the facial and lingual surfaces of a tooth.  This type of stain is associated with a low incidence of cavities in children and adults, and is caused by a type of Gram-positive bacteria that produces a certain colour, or chroma, which makes it identifiable. It is possible that this patient’s child has the same type of Gram-positive chromogenic bacteria on his teeth, creating the same type of Black Line Stain.  This is especially likely if the child has good oral hygiene and a low incidence of cavities.

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This non-metallic type of stain is absorbed onto the tooth surface deposits, such as tartar, plaque, or even the acquired pellicle.  The acquired pellicle is a thin film made up of proteins in our saliva, that forms almost instantly after a tooth is cleaned.  Because this type of bacteria is able to attach to the acquired pellicle,  this condition is not related to oral cleanliness or the presence of periodontal disease.

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To prevent this stain from building up as quickly, patients can use a toothbrush to effectively clean the teeth twice a day, while using a toothpaste that helps to prevent staining.  Powered toothbrushes can often clean the teeth most effectively without causing trauma to the gums.  Once the stain has settled onto the teeth,  the most effective way to remove this Black Line Stain is by a professional cleaning with a dental hygienist.  The hygienist may professionally remove the stain with an ultrasonic scaler, coronal polishing using an abrasive prophy paste, or by using an air-jet polisher with an abrasive powder.

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The only real downside to removing the Black Line Stain from the teeth, is that repeated stain removal using an abrasive paste or powder removes micro-millimeters of enamel from the tooth surface.  The top layer of the teeth which is partially removed during polishing, is the most fluoride-rich part of the tooth, so if frequent polishing is utilized to remove Black Line Stain, it is advisable to have a professional fluoride treatment administered after the polishing to replenish the depleted fluoride from the teeth.  Fluoride is available in a few different forms, the most effective of which are a fluoride varnish or a fluoride foam.

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There are some other types of dark stain that are caused by other sources, including dietary components, beverages, tobacco, mouthrinses and other medicaments. These types of stain have a different source than Black Line Stain, but are removed in a very similar fashion.  If you have any questions or further concerns about staining on your teeth, feel free to ask your dental hygienist!

 

 

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

http://jairjp.com/JANUARY%202013/02%20SRUTHY%20PRATHAP.pdf

http://www.sammyboy.com/showthread.php?154192-Black-stain-in-teeth-by-chromogenic-bacteria

http://medical-dictionary.thefreedictionary.com/black+line+dental+stain

http://www.carolinasdentist.com/wp-content/uploads/2013/06/toothpaste.jpg

http://www.youngdental.com/wp-content/uploads/2013/09/dlishezpak4.jpg

http://www.sanclementeperiodontist.com/portals/165/images/fluoride.jpeg

 

Dental “Myth Busters”

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Becky Larson, RDH

Dental “Myth Busters”

There are a lot of dental myths out there that are sometimes mistaken for dental truths.  Here are a few facts to help clear up some of the confusion.

Myth #1: You don’t need to brush baby teeth because they will fall out eventually anyway. 

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Absolutely not!  Baby teeth can still get cavities, which can spread to other teeth and cause pain.  Some baby teeth may even fall out too soon and cause problems with bite or improper development of a child’s permanent teeth.  It’s also important to establish good oral hygiene habits early on.  Children’s teeth should be brushed twice daily (just like adult teeth).

Myth #2: Fluoride is poisonous and should be avoided. 

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Wrong!  Each day the enamel layers of our teeth lose minerals (demineralization) due to the acidity of plaque and sugars in the mouth.  The enamel is remineralized from food and water consumption.  Too much demineralization without enough remineralization leads to tooth decay.  Fluoride helps strengthen enamel, thus making it more resistant to acidic demineralization.  Fluoride can sometimes reverse early tooth decay.  According to the American Dental Association, community water fluoridation is the single more effective public health measure to prevent tooth decay.  Many dental offices also offer in office fluoride treatments that can help both children and adults.

Myth #3:  You lose one tooth each time you have a child.

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Now that’s just silly.  Some women think that when they are pregnant the baby leeches a lot of their calcium supply.  That may be, but it doesn’t mean she will lose any teeth.  However, pregnant women are prone to cavities or having other dental problems.  This is due to morning sickness and vomiting, dry mouth, and a desire/craving for more sugary or starchy foods.  Pregnant women in these circumstances should be sure to continue their regular dental check-ups and try to maintain pristine oral home care.

Myth #4:  If your gums are bleeding you should avoid brushing your teeth and flossing.

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I can’t even begin to stress how wrong this one is!  If your gums are bleeding it means there is active inflammation and infection present.  That means you need to improve on oral hygiene by brushing more frequently or more effectively.  Bleeding gums is a sign of periodontal disease.  If caught early (in the gingivitis stage) it can be reversed.  Brushing should be done twice daily with a soft-bristled toothbrush.  Flossing should be done at least once daily.

Myth #5:  Placing a tablet of aspirin beside an aching tooth can ease the pain.

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Wrong again.  In order to ease the pain caused by a toothache, aspirin must be fully swallowed.  Placing aspirin on gum tissue for long periods of time can actually damage the tissue and possibly cause an abscess.

Myth #6:  You don’t need to see the dentist if there is no visible problem with your teeth.

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Unfortunately not all dental problems will be visible or obvious.  You should continue to visit the dentist for regular check-ups at least twice per year, in conjunction with your cleanings.  Dental radiographs or other instruments can detect cavities or other problems that might not be causing any symptoms yet.  It’s best to catch things early to minimize the treatment needed.

Myth #7:  After a tooth has been treated for decay it will not decay again.

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There are no guarantees in dentistry!  While the dentist will do their best to restore teeth to last for as long as possible, there is no way of knowing when or if a tooth will get recurrent decay.  Proper oral home care can prolong the life of dental restorations.

Don’t always believe what you hear!  If you have questions or concerns about your dental health be sure to ask your dentist, hygienist, or other dental professional.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

 

Sources:

http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation

http://www.webmd.com/oral-health/guide/fluoride-treatment

http://www.livescience.com/22463-gain-a-child-lose-a-tooth-myth-or-reality.html

http://tips4dentalcare.com/2008/06/21/popular-myths-about-dentistry/