William F. Dismuke, Jr, DDS, PC

Q:  What is plaque (and tartar)?

 

A:   Plaque is a sticky, colorless layer of harmful bacteria and sugars that sticks to teeth, especially near the gum line and between teeth.  Everyone develops plaque because bacteria are constantly forming in our mouths. These bacteria use ingredients found in our diet and saliva to grow.  Plaque causes cavities when the acids from plaque attack teeth after eating. With repeated acid attacks, the tooth enamel can break down and a cavity may form.  Plaque that is not removed can also irritate the gums around your teeth, leading to gingivitis (red, swollen, bleeding gums), periodontal disease and tooth loss.   Additionally, if not removed, it may become hard and is called calculus (tartar). Calculus can only be removed by the dentist or a dental hygienist. Plaque and tartar will harm your teeth and gums if it is not cleaned off regularly.

 

Q:  How Can I Prevent Plaque and Tartar Buildup?


A: It's easy to prevent plaque buildup with proper care. Make sure to:

  1. Brush thoroughly at least twice a day to remove plaque from all surfaces of your teeth. 
  2. Floss daily to remove plaque from between your teeth and under your gumline, where your toothbrush cannot reach.  (About 35% of your tooth surfaces can only be reached by proper flossing and cannot be reached with a toothbrush.)
  3. Limit sugary or starchy foods, especially sticky snacks and acidic drinks (sodas, punches, etc).
  4. Schedule regular dental visits for professional cleanings and dental examinations.

Q: Which type of toothbrush should I use?

A: The brand of the toothbrush is not as critical as the type of bristle and the size of the head. A soft toothbrush with a small head is recommended because medium and hard brushes tend to cause irritation and contribute to recession of the gums, and a small head allows you to get around each tooth more completely and is less likely to injure your gums. It's unnecessary to "scrub" the teeth as long as you are brushing at least twice a day and visiting your dentist at least twice a year for cleanings.

Q: Is one toothpaste better than others?

A: Generally, no. However, it's advisable to use a toothpaste containing fluoride to decrease the incidence of dental decay. We recommend our patients use what tastes good to them as long as it contains fluoride and has the ADA Seal of Approval.

Q: How often should I floss?

A: Proper flossing of the teeth once per day helps to prevent cavities from forming between the teeth where your toothbrush can't reach. Flossing also helps to keep your gums healthy and prevents tartar buildup on the edges and between the teeth.  Unhealthy gums will bleed when you floss.  However, after about two weeks of daily, effective flossing, your gums will no longer bleed and would be considered healthy.

Q:  How do I know that my health is not at risk when I am in your office?

A:  Our protocol for infection control is very effective at preventing cross-contamination.  All surfaces are disinfected and the most-used surfaces are additionally covered with a barrier that is changed after each appointment.  Most supplies are disposable, eliminating the possibility of cross-infection and those supplies, such as instruments, which need to be reused, are placed in a disinfectant in an ultrasonic cleaner, rinsed, packaged and then sterilized in our computerized autoclave.  The intense temperature and pressure changes within the autoclave kill ALL the bacteria and viruses.  Our autoclave’s effectiveness is tested each week by an outside lab to ensure that we are successful in complete sterilization of each load.

Q: What's the difference between a "crown" and a "cap?"

A: These are restorations to repair a severely broken tooth by covering all or most of the tooth after removing old fillings, fractured tooth structure, and all decay. The restoration material is made of gold, porcelain, composites, or even stainless steel. Dentists refer to all of these restorations as "crowns". However, patients sometimes refer to the tooth-colored ones as "caps" and the gold or stainless steel ones as "crowns."

Q: What's the difference between a "bridge" and a "partial denture?"

A: Both bridges and partial dentures replace missing teeth. A bridge is permanently attached to abutment teeth or, in some cases, implants. A partial denture is attached by clasps to the teeth and is easily removed by the patient. Patients are usually more satisfied with bridges than with partial dentures.

Q: What about "silver" fillings versus "white" fillings?

A: Although the U.S. Public Health Service issued a report in 1993 stating there is no health reason not to use amalgam (silver fillings), more patients today are requesting "white" or tooth-colored composite fillings. We also prefer tooth-colored fillings because they "bond" to the tooth structure and therefore help strengthen a tooth weakened by decay. Tooth-colored fillings are also usually less sensitive to temperature, and they look better. However, "white" fillings cannot be used in every situation, and if a tooth is very badly broken-down, an onlay or a  crown will usually be necessary and provide better overall satisfaction for the patient.

Q: Do I need to have a root canal just because I have to have a crown?

A: No. While most teeth which have had root canal treatments do need crowns to strengthen the teeth and to return the teeth to normal form and function, not every tooth needing a crown also needs to have a root canal.

Q:  What Are X-rays?


A:  In 1895, physicist Wilhelm Roentgen was intrigued by glowing cathode tubes and decided to see what they could do. He found that the rays they emitted could pass through certain solid objects and leave a shadowy image of that object on a fluorescent screen. He was even more amazed to find that when the rays passed through body parts, such as his hand, the bones beneath the skin became clearly visible on the screen. Because he didn't know exactly what was causing this phenomenon, he labeled the rays " X," which is the mathematical symbol for anything that is unknown.

     Scientists today know that X-rays are a form of energy that travels in waves. X-rays can enter solid objects, where they either are absorbed or continue to pass through the object. The denser the material X-rays enter, the more they are absorbed and the less they are able to pass through.

     Teeth and bone are very dense, so they absorb X-rays, but gums and cheeks are much less dense, so X-rays pass through more easily. That's why cheeks and gums appear dark and without detail on the X-ray film, but teeth show up much lighter. And fillings, which are even denser than bone, will show up as a solid, bright white area. Dental caries (cavities) will show up on an X-ray as a darker patch in a light tooth.

 

Q:  How are X-rays Used?


A:  X-ray images, also called dental radiographs, are among the most valuable tools a dentist has for keeping your mouth and teeth healthy. By understanding what the structures of the mouth look like normally on an X-ray film, dentists can diagnose problems in the teeth and jaws. For adults, radiographs can:

·        Show areas of decay that your dentist may not be able to see with just a visual examination, such as tiny pits of decay that might occur between teeth

·        Find decay that is developing underneath an existing filling

·        Find cracks or other damage in an existing filling

·        Alert the dentist to possible bone loss associated with periodontal (gum) disease

·        Reveal problems in the root canal, such as infection or death of the nerve

·        Help your dentist plan, prepare and place tooth implants, orthodontic treatments, dentures or other dental work

·        Reveal other abnormalities such as cysts, cancer and changes associated with metabolic and systemic diseases (such as Paget's disease and lymphoma)

·        For children, radiographs are used to watch for decay and to monitor tooth growth and development. Dentists will use periodic X-rays to see whether a space in the mouth to fit all the new teeth, whether primary teeth are being lost quickly enough to allow permanent teeth to erupt properly, whether extra (supernumerary) teeth are developing or whether any teeth are impacted (unable to emerge through the gums). Often, major problems can be prevented by catching small developmental problems early and then making accommodations.

 

Q:  How Often Should Your Teeth Be X-rayed?


A:  Even though no X-ray can be considered routine, many people require X-rays on a regular basis so that their dental condition can be monitored. Exactly how often this happens will depend on your medical and dental history and current condition. Some people may need X-rays as often as every six months. For others, X-rays may not be needed for as long as two years. A full set of  X-rays or a Panorex may be taken only every five years or so.  Who needs more frequent or regular radiographs? They include:

  • Children - Many children need X-rays every six months to one year, depending on age, because they are highly likely to develop caries. X-rays also help monitor tooth development.
  • Adults with extensive restoration work, including fillings - All the conditions that helped create the caries to begin with continue, making it necessary to check for decay beneath existing fillings or in new locations.
  • Anyone who drinks sugary sodas, chocolate milk or coffee or tea with sugar - Even mildly sugary beverages create an environment in the mouth that's perfect for decay, so anyone who drinks these beverages regularly will need to have more regular X-rays.
  • People with periodontal (gum) disease - Periodontal treatments may need to be stepped up if there are significant or continuing signs of bone loss.
  • People who are taking medications that lead to dry mouth, also called xerostomia - Saliva helps keep the acid levels (pH) in the mouth stable. In a dry mouth, the pH decreases, causing the minerals in the teeth to break down, leaving them prone to caries. Medications that can decrease saliva are those prescribed for hypertension, antidepressants, antianxiety drugs, antihistamines, diuretics, narcotics, anticonvulsants and anticholinergics.
  • People who have dry mouth because of disease, such as Sjögren's syndrome, or because of medical treatments that damaged the salivary glands, such as radiation to the head and neck for cancer treatment.
  • Smokers, because smoking increases the risk of periodontal disease.

Q:  What are the types of X-rays?

 

A:  X-rays are divided into two main categories: intraoral, which means that the X-ray film is inside the mouth; and extraoral, which means that the film is outside the mouth.

    • Intraoral radiographs
      Intraoral X-rays are the most common radiographs made. If you're like most people who visit the dentist, you've had many sets of intraoral radiographs in your life and you'll likely have many more. Because they give a high level of detail, these are the X-rays that allow dentists to find caries, look at the tooth roots, check the health of the bony area surrounding the tooth, see the status of developing teeth, and otherwise monitor good tooth health. The various types of intraoral X-rays show different aspects of the teeth:
      • Bitewing x-rays  highlight the crowns of the teeth. On each radiograph, the upper and lower teeth in one portion of the mouth are shown, from the crown to about the level of the jaw.   These are the xrays we take most often, as they show the areas we need to monitor more closely and frequently.
      • Periapical X-rays highlight the entire tooth. On each radiograph, the teeth from either the upper or lower jaw in one portion of the mouth are shown. The difference from bitewings is that in a periapical X-ray, the whole tooth is shown, from the crown down past the end of the root to the part of the jaw where the tooth is anchored.   We may take periapical x-rays (aka PA’s) in lieu of bitewings if you have much restorative work (crowns, etc).  We also take this type of x-ray if we are trying to see if a tooth has an abscess or a cyst.
      • Periodically, a dentist may recommend a "full-mouth radiographic survey," or FMX. This means that every tooth, from crown to root to supporting structures, will be X-rayed using both bitewing and periapical radiographs. We generally take a FMX OR a Pan (see below) an average of every five years in most cases.
      • Occlusal X-rays are larger and highlight tooth development and placement. On each radiograph, nearly the full arch of teeth in either the upper or lower jaw is shown. These X-rays are taken with the X-ray machine either pointing straight down from near the nose (to take pictures of the upper jaw and teeth), or straight up from under the chin (to take pictures of the lower jaw and teeth).
      • Digital radiographs are one of the newest X-ray techniques around. We use digital radiography for intraoral imaging in our office on almost everyone (generally elementary school and older). With digital radiographs, film is replaced with an electronic sensor. The X-rays hit the pad the same way they hit the film. But instead of developing the film in a dark room, the image is electronically sent directly to a computer where the image appears on the screen. The image can then be stored on the computer or printed out. One of the great advantages of this process is that radiographs can be digitally compared to previous radiographs in a process called subtraction radiography. The computer can digitally compare the two images, subtract out everything that is the same and give a clear image of anything that is different. This means that tiny changes that may not be noticeable with the naked eye can be caught earlier and more clearly with digital-subtraction radiography. Subtraction radiography requires a specialized projection technique and additional software.
    • Extraoral radiographs
      Extraoral X-rays are made with the film outside the mouth. These can be considered the "big picture" X-rays. They show teeth, but their main focus is on the jaw or skull. Extraoral radiographs are used for monitoring growth and development, looking at the status of impacted teeth, examining the relationships between teeth and jaws and examining the temporomandibular joint or other bones of the face. Extraoral X-rays are less detailed than intraoral X-rays, so they are not used for detecting caries or flaws in individual teeth.
      • Panoramic radiographs show the entire mouth area - all teeth on both upper and lower jaws - on a single X-ray. This type of X-ray requires a special panoramic X-ray machine. The tube head that emits the X-rays circles behind the patient's head, while the film simultaneously circles across the front. That way, the full, broad view of the jaws is captured on one film. Because the machine moves in a set path, the patient has to be positioned very carefully. And, because the beam and the film are both moving, any movement from the patient will blur the image on the screen. That's why such care is taken to keep the patient's head absolutely still in exactly the right position. The machines may have chin rests, forehead rests, and side head positioners, plus bite-blocks that patients will be asked to close their teeth around. All this may look and feel intimidating, but the process is very safe and often uses less radiation than intraoral radiographs.   If you need to have your wisdom teeth removed, implants placed, etc, you will need this type of x-ray.  Otherwise, we generally alternate it with an FMX every five years.

Q:  Are x-rays safe?


A:  All types of radiation can cause damage to body cells. In very high doses, such as might be released during a nuclear reactor accident, the damage can be swift, leading to "radiation burn" and other serious effects. People who receive large doses of radiation as part of their cancer treatment can also experience skin burns or damage to healthy body tissue near the cancer.

     The X-rays used in dental and medical offices emit extremely small doses of radiation. However, cells can be damaged by many small doses of radiation that add up over time. Although the amount of radiation used in dental X-rays is very small, the effect is cumulative, so all radiation counts. That's why experts recommend that X-rays be used judiciously and with precautions to help protect the patient from unnecessary radiation exposure. To keep exposure to X-rays low for their patients, dentists and regulatory agencies have done several things:

  • Reduced X-ray dose -
    The single most important way dentists keep their patients safe from radiation is by limiting the beam to the small area being X-rayed and by reducing the amount of radiation that strays from that path. This is done by a process called collimation, in which the machine directs the X-rays through a lead-lined column and out a tiny opening at the end. So although an X-ray machine looks quite large, the X-rays are limited to a small area less than three inches in diameter as they come out of a small cone at the end. X-ray machines are well shielded and there is very little radiation exposure beyond the diameter of the primary beam.
  • Improved X-ray film -
    The speed of films used for dental X-rays has been improved so less exposure is needed to get the same results.
  • Changed to using film holders -
    Do you remember the days when dental patients had to hold X-ray film in their mouths with their fingers? Those days are long gone. Now, fingers have been replaced by holders that not only keep the film in place, but also help the dentist aim the X-ray machine. By using film holders, there is less chance of the film slipping or being held in the wrong place, which means that fewer repeat X-rays need to be taken.
  • Required regular X-ray machine checks and licensure -
    Federal law requires that X-ray machines be checked for accuracy and safety every two years, and some states require more frequent checks. Once the machine passes the testing process, the dentist receives a license to operate the machine. If you have any doubts about the safety of the X-ray machine in your dentist's office, feel free to ask to see a copy of the inspection license.
  • Recommended or required use of lead shields -
    Before making radiographs, dentists will cover a patient from the neck to the knees with a lead-lined full-body apron. If the apron doesn't extend up to the neck, a separate neck protector called a thyroid collar may also be used. These shields have been used for decades to help protect patients from radiation scatter. Many states now require lead shields to be used. Although this type of protection was very important in the old days of high-scatter machines, today the lead aprons offer more peace of mind than actual protection because stray radiation from modern dental X-ray machines is almost nonexistent.
  • Developed digital radiography -
    A new system of taking X-rays, called digital radiography, reduces radiation by as much as 80 percent.

 

Q:  What are Cavities?


A:  "Cavities" is another way of saying tooth decay. Tooth decay is heavily influenced by lifestyle, what we eat, how well we take care of our teeth, the presence of fluoride in our water and toothpaste. Heredity also plays a role in how susceptible your teeth may be to decay.  While cavities are generally more common among children, adults are also at risk. The types of cavities include:

  • Coronal cavities—the most common type occurring in both children and adults, coronal cavities usually are located on chewing surfaces or between the teeth
  • Root cavities—as we age, our gums recede, leaving parts of the tooth root exposed. Since there is no enamel covering tooth roots, these exposed areas easily decay
  • Recurrent decay—decay can form around existing fillings and crowns.  This is because these areas may have a tendency to accumulate plaque, which can ultimately lead to decay
  • Adults are especially at risk for cavities if they suffer from xerostomia (aka dry mouth), a condition due to a lack of saliva. Dry mouth may be caused by illness, medications, radiation therapy and chemotherapy, and may be either temporary (days to months) or permanent, depending on its cause.

    Cavities are very serious. Left untreated, a cavity can destroy your tooth and kill the delicate nerves at its center, which may result in an abscess, an area of infection at the root tip. Once an abscess forms, it can only be treated with a root canal, surgery or by extracting the tooth.

 

Q:  How Do I Know if I Have a Cavity?


A:  Only your dentist can tell for sure whether you have a cavity. That's because cavities develop below the tooth's surface, where you can't see them. When you eat foods that contain carbohydrates (sugars and starches), these carbohydrates are eaten by the bacteria in plaque, producing acids that eat into the tooth. Over time, the tooth enamel begins to break down beneath the surface while the surface remains intact. When enough of the sub-surface enamel is eaten away, the surface collapses, forming a cavity.

Cavities are most likely to develop in pits on the chewing surfaces of the back teeth, in between teeth, and near the gumline. But regardless of where they occur, the best way to spot them and treat them before they become serious is by visiting your dentist regularly for checkups.

 

Q:  How Can I Help Prevent Cavities?

 

A:  By doing the following:

  • Brush at least twice a day and floss daily to remove plaque from between teeth and below the gumline
  • Have regular dental checkups. Preventive care can help stop problems from occurring and keep minor problems from becoming major ones
  • Eat a well-balanced diet that limits starchy or sugary foods. When you do eat these foods, try to eat them with your meal instead of as a snack to minimize the number of times that your teeth are exposed to acid
  • Use dental products that contain fluoride, including toothpaste
  • Make sure that your children's drinking water is fluoridated. If your water supply does not contain fluoride, your dentist or pediatrician may prescribe daily fluoride supplements
  • Use XYLITOL, an artificial sweetener found in many sugarless gums, some toothpastes and rinses, and also as a sugar substitute you can find in healthfood stores.  For more on Xylitol, read below.

Q:  What is Xylitol and why should I consume it?

 

A:  Xylitol FAQs  <----(click this link)

 

Q:  What is Novamin?

 

A:  Revitalize Teeth! NovaMin Tooth Remineralization For Oral Care Products<----(click this link)

 

Q:   What is RECALDENT and how is it helpful?

 

A:    http://www.recaldent.com <------(click this link)

Home
Meet the Doctor and Staff
SMILEDASH (Virtual Front Desk)
Preventive/Diagnostic Services
Basic Services
Advanced/Major Services
NEWS
FAQ
Office Schedule & Hours
Payment
Directions to Our Office

Appointment Request
Dental Education
Refer Our Office
Contact Us
 
 
© Images contained in this website are protected by copyright and may not be downloaded, republished, retransmitted, reproduced or otherwise used as a stand-alone file.