We say that we are going to have our teeth cleaned — but a lot more than simple cleaning takes place during a visit to a dental hygienist.

1. Health History
   Your hygienist will ask you about your general health and your dental health and any recent changes in either. By doing so she will pinpoint any issues that require special precautions during your cleaning.
2. Cancer Screening
   Next, the hygienist carefully examines the skin in and around your mouth looking for lumps, bumps, sores, tenderness or swellings and refers areas of concern to the dentist for further evaluation. The hygienist is one of the few people who get to closely assess your whole mouth, so she is trained to spot cancer and other diseases.
3. Evaluating Your Periodontal Health
   Your hygienist will look closely at the state of your periodontal health (from peri meaning around and dont meaning tooth). This includes checking your gums and the other tissues surrounding your teeth for inflammation (gingivitis) or bleeding.
4. Checking for Decay
   The hygienist will examine your teeth for decay and will note the location and condition of stains or hard mineral deposits (calculus or tartar). These deposits result from a buildup of plaque (a film of bacteria) that has not been removed by daily brushing.
5. Scaling
   The hygienist uses hand tools or a sonic scaler to remove the calculus from your teeth.
6. Polishing
   A mechanical polisher and an abrasive polishing compound are used to polish the surface of your teeth so that they are smooth, making them more resistant to plaque, removing stains and leaving your teeth feeling squeaky clean.
7. Measuring
   The hygienist uses a tiny probe to measure the space between your teeth and gums. Periodontal disease begins by forming pockets between the teeth and gums, so this measuring is key to your periodontal health. Generally a space of 3mm or less indicates healthy gums, pockets of 4 to 5mm indicate periodontal disease that may be reversed with good oral care at home, and pockets that are 6mm deep or more require specialized treatment by a dentist or periodontist (a dentist who specializes in care of gums).
8. Education
   Based on the observed conditions of your gums and teeth, the hygienist will provide information aimed at improving your home oral cleansing routines and about your risk for tooth decay and gum disease.
9. Making Your Next Appointment
   The hygienist will make an appointment for your next cleaning — in three, four, or six months depending on the health of your gums and teeth. Keeping these appointments not only keeps your teeth looking their best, but it also assures good management of your dental health.

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

Temporomandibular Disorder (TMD), which was formerly known as Temporomandibular Joint Disorder (TMJ), is a condition that is unusual in that it frequently is quite hard to diagnose, because it often mimics many other conditions. For this reason, many healthcare professionals refer to it as “the great imposter.” The condition arises when there are problems inside the temporomandibular joint and the muscles that attach to it causing pain. The pain is most often due to muscle spasm, thereby limiting the ability to open and close the jaw and to function normally. TMD can impact anyone and has a wide range of similar symptoms.

One of the common causes of TMD is stress, and it may manifest itself through clenching or grinding of teeth while awake or asleep. These habits are often completely subconscious until pointed out by a dental professional or sleeping partner. With stress-induced TMD, the pain often comes and goes in cycles. In other words, it may be present when you are stressed, seem to disappear for a while, and then reappear when you are stressed again. Another cause of TMD can be from an injury or trauma, such as a blow to the jaw. However, regardless of the cause of TMD, the pain is real and needs to be treated properly.

If you feel that you might have TMD, please let us know so that we can address your concerns, starting with a full history and conducting a thorough examination. Or if you are in constant or severe pain, contact us immediately to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

It is not uncommon to have one or more teeth that are particularly sensitive to heat, cold, or pressure. If you have such a tooth, you probably want to know what caused it and what you can do about it. Here are some frequently asked questions, and their answers.

What causes teeth to become sensitive?
The most common cause of sensitivity is exposure of the tooth's dentin, a layer of the tooth's structure that is just below the outer protective layer (the enamel).

The dentin is sensitive but the enamel layer is not. Why?
The enamel is composed of minerals that are hard and protective. It is not living tissue and has no nerve supply. The dentin layer underneath is bone-like living tissue that does contain nerve fibers. It is protected by enamel above the gum line and by gum tissue in the area of the tooth's root, below the gum line. If the tooth's protective covering is reduced, the nerve fibers in that section of the dentin are exposed to changes in temperature and pressure, which they conduct to the inner pulp layer (nerve) of the tooth. The sensations that reach the tooth's interior pulp layer cause pain.

What causes exposure of the dentin layer in teeth?
Often the dentin is exposed by receding gums, causing areas of the tooth that are normally below the gum surface to be uncovered.

What makes gums recede?
One cause of receding gums is excessive, rough brushing techniques. This is particularly common in individuals who have a family history of thin gum tissues. Removing the film of bacteria called plaque requires only gentle action with a soft brush. This is one reason that we stress the value of learning proper and effective brushing techniques. Gum recession becomes worse after the uncovered dentin of the tooth's root is exposed to erosion from sweet and acidic foods and beverages, such as fruit juices.

Doesn't tooth sensitivity indicate decay?
Decay can also cause tooth sensitivity. As decay destroys a tooth's structure, it eventually invades the inner pulp of the tooth, causing greater and greater pain.

How can you prevent or reduce tooth sensitivity?
As we mentioned above, learn proper brushing techniques; we would be happy to demonstrate them. Use a toothpaste that contains fluoride, which increases the strength of the tooth's protective coating. In more serious cases, we can apply a fluoride varnish or a filling material as a barrier to cover sensitive areas. If you experience long-term tooth sensitivity, make an appointment for an assessment and diagnosis so that we can determine the cause and proper treatment.

Contact us today to schedule an appointment to discuss your questions about sensitive teeth. You can also read the Dear Doctor magazine article “Sensitive Teeth.”

As a Pro Football Hall of Famer and first runner up on the hit television show Dancing with the Stars, Jerry Rice has a face and smile that truly has star quality. However, that was not always the case. During an interview with Dear Doctor magazine, the retired NFL pro discussed his good fortune to have had just a few minor dental injuries throughout his football career. He went on to say that his cosmetic dentist repaired several of his chipped teeth with full crowns. Rice now maintains his beautiful smile with routine cleanings and occasional tooth bleaching.

If you have chipped, broken or missing teeth, or are considering a smile makeover, we want to know exactly what you want to change about your smile, as the old adage is true: Beauty is in the eyes of the beholder. This is one reason why we feel that listening is one of the most important skills we can use during your private, smile-makeover consultation. We want to use this time to ensure we see what you see as attractive and vice versa so that together we can design a realistic, achievable blueprint for your dream smile.

For this reason, we have put together some questions you should ask yourself prior to your appointment:

• What do you like and dislike about the color, size, shape and spacing of your teeth?
• Do you like how much of your teeth show when you smile and when your lips are relaxed?
• Are you happy with the amount of gum tissue that shows when you smile?
• Do you prefer a “Hollywood smile” with perfectly aligned, bright white teeth, or do you prefer a more natural looking smile with slight color, shape and shade variations?

To learn more about obtaining the smile you want, continue reading the Dear Doctor magazine article “Great Expectations — Perceptions In Smile Design.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and discuss your cosmetic and restorative dentistry treatment goals. And if you want to read the entire feature article on Jerry Rice, continue reading “Jerry Rice — An Unbelievable Rise To NFL Stardom.”

If you are experiencing cracking in the corners of your mouth, you have a common condition called perleche or angular cheilitis. Perleche comes from a French word meaning “to lick,” because people tend to lick the irritated areas of their mouths. Angular cheilitis comes from cheil meaning “lip,” and itis meaning “inflammation.”

Sufferers from perleche are usually young children who drool in their sleep, young adults with braces, and older adults who have developed skin wrinkling with deep lines at the corners of their mouths. Perleche may become worse in the winter, when cold weather and dry air dries out the skin of your lips. You may lick your lips often to keep them moistened. This constant licking of the cracked areas can lead to infection, most commonly from a type of yeast called candida albicans. Sources of infection can also include dentures that are not cleaned frequently enough, missing teeth that cause facial changes and added skin wrinkling, and health conditions such as iron-deficiency anemia, vitamin B deficiency, diabetes and cancer.

Conditions associated with perleche can be treated in a number of ways. Yeast is a type of fungus, so to combat a chronic yeast infection you need antifungal medication. This may be taken orally or applied to the cracking places as an ointment. You may be asked to dissolve a medicated lozenge in your mouth and then swallow it, so that its medicine treats both the mouth surface and the entire body. Antifungal medications may be combined with other medications to lessen inflammation and assist skin repair.

If the skin-cracking is related to serious underlying conditions such as missing teeth, improperly fitting dentures, or systemic health conditions, these must be treated in order to keep the perleche from recurring. We can perform a dental assessment to check the health of your teeth, gums, and lips, and you may also want to visit a dermatologist to see if treatments can improve and rejuvenate the quality and appearance of your facial skin.

Contact us today to schedule an appointment to discuss your questions about cracks at the corners of your mouth. You can also learn more by reading the Dear Doctor magazine article “Cracked Corners of the Mouth.”