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  • I am a dental phobic… what is sleep dentistry?

    QDear Dr. Smiles, I was severely traumatized by a dentist when I was young. As a result, I am a dental phobic and cannot tolerate invasive dental procedures. I hear advertisements about sleep dentistry and wanted to know more about this method of providing care and other options available to phobics like me. Priscilla, Palo Alto
    A

    Dear Priscilla, Dentistry has done an incredible job over the last thirty years of improving its techniques to diminish or eliminate patient pain. However, even with these improvements, it is still extremely difficult for phobics to manage and endure even the most minor dental procedures. Sleep Dentistry also known as Sedation Dentistry can offer anxious […]

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  • What’s the difference between the silver fillings and the tooth colored fillings?

    QDear Dr. Smiles, What is the difference between the silver fillings and the tooth colored fillings used by dentists now? Just wondering, Woodside
    A

    Dear Just Wondering, There are many choices in filling materials today. Among them, gold, ceramic porcelain, resin composite (tooth colored filling) and amalgam (silver filling).  Amalgam and gold used to be the only materials available to dentists for many years for restoring teeth.  When the cost of gold became prohibitive, amalgam’s versatility and ease of […]

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  • What is the relationship between my Diabetes and my mouth?

    QDear Dr. Smiles, I recently found out that I have Type 2 Diabetes. I am not very over weight and I have done a fair amount of exercise so I do not seem to fit the typical profile but must take oral medications anyway. My doctor talked to me about my oral health but I did not understand the importance of the relationship between Diabetes and my mouth. Can you enlighten me? Pauline, Palo Alto
    A

    Dear Pauline, People with diabetes and cardiovascular disease are more vulnerable to oral infections like periodontal disease, often characterized by bleeding gums and bad breath. When a person has diabetes, unstable blood sugar levels can affect the blood circulation to the bone and gums around the teeth. This can lead to bone loss and ultimately […]

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  • Why do dental offices all have a similar smell when you walk in the door?

    QDear Dr. Smiles, This may be a stupid question, but why do dental offices all have a similar smell when you walk in the door? It smells like some kind of medicine and I only notice it when I go to the dentist. What causes this smell? Marissa, Palo Alto
    A

    Dear Marissa, There are no stupid questions! Actually this is a great question and I’m sure the readers will be interested in knowing the answer to this common shared experience. The familiar fragrance people associate with dentist’s office is most likely from a chemical known as Eugenol. Eugenol is the principle ingredient found in the […]

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  • My Mouth & Gums Are Sensitive… Is That Because I Am Pregnant?

    QDear Dr. Smiles, I am a scuba diver and my instructor told me that bad dental work can explode at depth. What is the real story? How could something like that happen? Sam, Mountain View
    A

    Dear Sam, Scuba diving is one of my favorite past times. In all of my training and hours at depth, I have never experienced any problems like that, and hope I never do. But, conceivably, there is a situation that could arise that would lead to tooth trouble. If a tooth has an abscess and […]

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  • What is a gum lift and why would someone have this done?

    QDear Dr. Smiles, I was reading in my Glamour magazine that there is a procedure some models have done known as a “gum lift”. What is this and why would someone have this done? Christina, 16, Menlo Park
    A

    Dear Sam, A “gum lift” is a procedure that is performed when circumstances require more tooth to be exposed. The terms used among professionals that mean that same thing is “crown lengthening and gingivectomy”. With the advent of cosmetic dentistry and shows like the “Swan” and “Extreme Makeover”, a more pleasing term has been coined, […]

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  • Can Scuba Diving Effect My Teeth?

    QDear Dr. Smiles, I am a scuba diver and my instructor told me that bad dental work can explode at depth. What is the real story? How could something like that happen? Sam, Mountain View
    A

    Dear Sam, Scuba diving is one of my favorite past times. In all of my training and hours at depth, I have never experienced any problems like that, and hope I never do. But, conceivably, there is a situation that could arise that would lead to tooth trouble. If a tooth has an abscess and […]

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  • At what age is it appropriate to professionally whiten teeth?

    QDear Dr. Smiles, At what age is it appropriate to professionally whiten teeth? My daughter wants to whiten her teeth, but she is only 13. I bleached my teeth, but not until I was in my 30’s. What do you advise? Audrey, San Carlos
    A

    Dear Audrey, Professionally supervised whitening procedures should be performed after the age of 16. Whether it is the custom tray and gel technique or in-office laser whitening, it is important that the teeth have fully matured and finished growing into the mouth. Once a permanent tooth appears intra-orally, it is not fully grown and mature […]

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  • What is that band of gum that stretches across my son’s upper teeth?

    QDear Dr. Smiles, When my 11 year old son smiles and his lip slides above his teeth, he shows quite a lot of gum tissue. He is becoming very self conscious about a thick band of gum that stretches vertically from between his two front teeth to the undersurface of his lip. His classmates tease him about it and ask him what it is. He has great teeth, no cavities and his dentist has never said anything about this area of gum tissue. I don’t know what it is or what can be done about it. What do you advise? Perplexed Mom, Palo Alto
    A

    Dear Perplexed Mom, Thanks for the question and the detailed description of your son’s lip and gum tissue arrangement. Sometimes it is hard to know exactly what the questions I receive refer to, but in your case I think I can give you some sound advice. The feature that you describe as a “thick band […]

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  • Are Lines Running Up and Down My Teeth Anything To Worry About?

    QDear Dr. Smiles, When I look at my front teeth up close in the mirror, I can see a lot of lines running up and down the teeth. I’m afraid my teeth are going to break into pieces because of this. Are these lines anything to worry about? Sandra, West Menlo
    A

    Dear Sandra, This is a very common concern and frequently asked question. The good news is that there is nothing to worry about. These lines, also referred to as “craze lines”, become more apparent the older we get. They do not mean that the teeth are going to break. The enamel in our teeth is […]

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  • What Would Happen If I Swallowed A Crown?

    QDear Dr. Braun, Today at my dentist office, I almost swallowed a crown that they were trying on. It really scared me! What would they have done if I had swallowed it? Merrilee, Mountain View
    A

    Dear Merrilee, This is every dentist’s concern when trying in crowns or using small instruments in the mouth when the patient is reclined. A common technique to help prevent this from happening is the use of a “throat pack”, a protective gauze that protects the back of the throat, or a dental dam. If the […]

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  • How can cancer therapy affect my mouth?

    QDear Dr. Smiles, I was recently diagnosed with cancer and I will be undergoing radiation and chemotherapy treatment. My oncologist wants me to see a Dentist before I begin cancer therapy. Why is this important ? How can cancer therapy affect my mouth? How should my dentist be involved? Just Wondering, Mountain View
    A

    Dear Just Wondering, Each year, close to 1.2 million Americans are diagnosed with cancer and out of those, approximately 400,000 will develop problems with their mouth from their treatment. Cancer treatments including bone marrow transplant, radiation and chemotherapy can affect the patient’s oral health, even when the cancer is not in the head and neck […]

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  • When is it suitable for a child to have her wisdom teeth removed?

    QDear Dr. Smiles, When is it suitable for a child to have her wisdom teeth removed? If the removal of wisdom teeth is needed, should all 4 teeth be removed at the same time? If the teeth are already crowded, should I wait for the wisdom teeth to emerge (probably "squeezing" the other teeth even more), or should I remove them before they appear? What should I watch out for when wisdom teeth are removed? Thank you in advance for your answers. Regards, Mom in Palo Alto
    A

    Dear Mom in Palo Alto, Thank you for your question. It is a common concern among parents and there is often a surprised reaction when the child is in their early teens and they are advised to have them out. The criteria for determining when wisdom teeth are suitable to be removed are multifold. The […]

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  • Why Did My Teeth Give Me a Headache While Flying?

    QDear Dr. Smiles, On my plane ride home last week, I had the worst toothache on my upper left side. It came on suddenly while we were climbing to altitude and it lasted most of the cross country trip. I have never had trouble with these teeth before, as a matter of fact, I don’t have any fillings at all up there. Once we landed, and over the past few days, I have not had any pain in that area. I thought for sure I would need to see the dentist, but it went away completely. What do you think caused it and what do you recommend I do next? Perplexed, Palo Alto
    A

    Dear Perplexed, It can be pretty disconcerting when something like that happens out of the blue (no pun intended). The most likely explanation involves your sinuses. As you know, sinuses are openings in the facial bones found around the nose. There are four pairs of sinuses connected to the nasal cavity by small openings. The […]

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  • Why Hasn’t My 6 Year Old Lost His Baby Teeth Yet?

    QDear Dr. Smiles, My son is 6 ½ years old and he has not lost any baby teeth yet. I just noticed this morning that two of his permanent teeth are growing in behind his baby teeth on his lower jaw. One of them is angled and I’m worried that is may not come in straight. What should I do? Owen’s mom, Palo Alto
    A

    Dear Owen’s Mom, Thank you for your question. The situation you describe is not unusual and can be managed over the course of time. The lower anterior central incisors are the first teeth to become loose and exfoliate (fancy word for ‘fall out’). This can take place any time between the ages of five to […]

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  • How Can I Avoid a Dark Line From My Crown?

    QDear Dr. Smiles, I'm getting a crown replaced on my front tooth. The old one has a dark line at the top by the gum line. I never saw the dark line when it first was put in my mouth about 20 years ago. Over time, it became more and more visible. Will the same thing happen to my new crown? How can this be avoided? Keith, Palo Alto
    A

    Dear Keith, This is a common concern among many people that have needed crowns on their front teeth and not an unusual thing to see in people’s mouths when they smile. It really detracts from the beauty of the crown, no matter how perfect a color match it is. Fortunately, this black line phenomenon is […]

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  • My Forks Gives Me a Shock!

    QDear Dr. Smiles, The weirdest thing is happening to me! I recently got a new gold crown on my lower molar and when I eat anything with my fork and it touches the crown, I get a shock. I also notice when I chew sometimes, I feel a shock in my tooth. I’ve heard jokes about people being able to tune into radio stations through their teeth because there is so much metal in their mouth! But, having a shock in my tooth is a real concern, what is going on? Laura, Palo Alto
    A

    Dear Laura, What you are describing is called a galvanic reaction. A galvanic reaction is the basis for how batteries work today. The Galvanic cell, named after Luigi Galvani, consists of two dissimilar metals and an electrolyte. In 1780, Galvani observed that the leg muscle of a frog would contract when two different metals were […]

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  • Eating Before a Procedure

    QDear Dr. Smiles, Last week, I was turned away from my appointment to have my wisdom teeth removed because I had something to eat in the morning even though I was instructed no to eat or drink anything after midnight. What is the big deal? All I had was a cup of coffee and a piece of toast because I was hungry. Just wondering. Preston, Palo Alto
    A

    Dear Preston, The instructions the surgeon gave you about not eating after midnight usually pertain to patients that are going to have general anesthesia or intravenous sedation. If you were planning on being “put to sleep” while having your wisdom teeth removed, those instructions are really important to follow. If you were planning on having […]

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  • Tetracycline & Teeth Discoloration

    QDear Dr. Smiles, As a teenager and adult I took tetracycline for nearly 20 years. My teeth are very gray. Is there anything I can do to brighten them without having to result to veneers or caps? Thank you, Michael
    A

    Dear Michael, Disguising tetracycline staining is one of the biggest challenges dentists face in the realm of cosmetic dentistry. Tetracycline staining can be very severe, affect the entire tooth with a gray discoloration , create a distinct band, or cause a mild dingy, dull appearance to the enamel. Depending on the severity of staining, whitening […]

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  • Symptoms & Side Effects of Anesthetics

    QDear Dr. Smiles, Something keeps happening to me at the dentist that I cannot understand. After being given an injection to get my tooth numb, I experience a surge of symptoms that make me feel panicky and anxious. My heart races and my breathing changes, then after a few minutes it all goes away. It is so weird because I am not at all nervous about having dental work done and don’t mind going to the dentist. What is going wrong? Elizabeth, Palo Alto
    A

    Dear Elizabeth, When strong symptoms such as you describe appear for no apparent reason, it can really be unsettling, especially when you are not predisposed to being nervous at your dentist. The most probable cause of your symptoms could be related to the local anesthetic that is being used. In dentistry, like medicine, the most […]

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  • Cardiovascular Disease and Infection in the Mouth

    QDear Dr. Smiles, Last March I suffered a mild heart attack. I am 57 years old and the attack came as a big surprise because I consider myself to be pretty healthy despite a little extra weight that I’m carrying. Early in the course of my treatment, my doctor asked me if I had been to the dentist within close proximity to the heart attack. What would my heart attack have to do with a visit to my dentist? Dirk, Redwood City
    A

    Dear Dirk, Recent medical research is providing us with proven facts that there is a direct link between cardiovascular disease and infection in the mouth, specifically Periodontal Disease. Statistics have shown that 85% of heart attack patients studied had periodontal disease and that people with periodontal disease are 1.5-2 times at greater risk for heart […]

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  • Chlorine & Teeth Health

    QDear Dr. Smiles, I’m a swimmer and occasionally my gum tissue above my two front teeth feels like it is stinging and tingly when I first get in the pool and start swimming. This lasts a few minutes and then dissipates. When I look closely at the gum tissue, it’s color and appearance is normal. I’ve asked other swimmers if they have experienced the same thing but no one else has had a similar experience. What do you think could be causing this? Wendie, Menlo Park
    A

    Dear Wendie, This is a bit of a mystery because the sensation you are experiencing is isolated to your gum tissue above your two front teeth and not all of your gums. Some people can be more sensitive to others to chemicals like chlorine and this can be expressed with symptoms such as itching, burning […]

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  • Jon Gordon Raises Awareness

    QHi Dr. Braun, I saw a poster in town advertising an event featuring Jon Gordon that you are sponsoring. What is the event for and who is Jon Gordon? Charlotte, Menlo Park
    A

    Dear Charlotte, Thanks for asking, yes, I am sponsoring a fund raiser to be held at Hiller Aviation Museum on October 13, 2005 from 7-9 PM. It will feature Jon Gordon who is a motivational speaker whose moniker is “The Energy Addict”. He’s the keynote speaker and promises to deliver an energetic presentation on positive […]

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  • Cinnamon… A Great Natural Remedy!

    QDear Dr. Smiles, I’ve heard recently that cinnamon is good natural remedy for the mouth. Can you explain how it benefits the mouth and how one should use them. Thank You, I enjoy your column very much, Mary, Palo Alto
    A

    Dear Mary, Cinnamon comes from the cinnamon tree which is an evergreen native to Sri Lanka. We see it in our grocery stores in two forms, cinnamon sticks and ground powder. Cinnamon actually comes from the bark of the tree. First they grow the tree for two or three years, then cut it down to […]

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  • Veneers Can Be a Great Option

    QDear Dr. Smiles, I am 38 years old and the father of two and I am concerned about my front teeth. They seem to be getting shorter as I get older and some of the enamel has worn off the front surfaces. I want to do what is best to preserve my teeth. My twin brother has the same problem and he got veneers. My dentist and I have reviewed my options and I am considering having veneers put on my teeth also. My wife is really supportive butr I’m hesitant to proceed though, because I think of veneers as strictly cosmetic and an uncommon thing for a male to do. How common is it for men to consider and have veneers done? Mark , Palo Alto
    A

    Dear Mark, It is probably more common for men to request and have veneers put on their teeth than you think. Often, men are more reluctant to raise their concerns about the appearance of their teeth, but once they ask questions and begin to understand what types of procedures can be done and the benefits […]

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  • Sore Gums… Whats With That?!

    QDr. Braun, I have a sore in my gums behind my upper front teeth. It has been there for over three weeks. My dentist took xrays but found nothing wrong. He prescribed an oral antibiotic but it has had only minimal effect. I rinse my mouth with mouthwash twice a day and refrain from eating acidic foods. I also use a retainer on my upper teeth. Can you give me some advice about the cause and cure of my problem? Sincerely Marta
    A

    Dear Marta, I’m curious to know if your dentist took a look at your retainer and how it is fitting against the roof of your mouth. The tissue behind your upper front teeth can become irritated from a number of sources, including your retainer, your lower teeth if they close and impinge the tissue and […]

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  • Cracked Lips & Yeast Infections

    QDear Dr. Smiles, The corners of my mouth are always red, cracked and irritated. I’ve tried ointments, wearing chapstick or Vaseline ,but no matter what I do, I cannot seem to clear it up. My dentist thinks I may have a yeast infection. Is that possible? I thought only babies got that. Wondering what to do in... Palo Alto
    A

    Dear Wondering,What you describe sounds like your dentist may be right.  If all of your remedies have failed, it may take a specific medicine to treat the skin at the corners of your mouth.  This area is vulnerable to yeast infections when conditions exist that contribute to the area always being moist.  Candida Albicans is […]

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  • Periodontal “Pockets” & Treatment Options

    QDr. Braun, My dentist said that I have some pockets that are 5mm deep and if I had laser treatments they could be reduced to 3mm deep. I do not have insurance and the treatment is expensive, what do you advise? Thank you for your advice column, is it very informative. Faith, Cupertino CA
    A

    Dear Faith, Here’s what I would advise.  Ask your dental hygienist and/or dentist to give you three more months to work diligently on your oral hygiene with electric tooth brush, flossing and other tools they think would help you remove plaque and reduce inflammation. Ask about prescription strength anti-microbial mouthwashes that could be helpful for […]

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  • Test Tube Teeth!

    QDear Dr. Smiles, Did you see the article in August 2005 issue of Scientific American about “Test-Tube Teeth?” I never realized that teeth were organs, or that tissue engineers are using teeth as the “first wave or replacement organs”. I thought it was interesting and wanted to make you and your readers aware of the article. Love your column... Thanks! Katie, Portola Valley
    A

    Dear Katie, Yes, I did see the article and found it fascinating and really enjoyed studying the pictures of how “Mother Nature” forms teeth.  The miracle of the human body never ceases to amaze me.  An embryo at just 6 weeks has the beginning of a tooth developing and by 14 weeks an area is […]

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  • Herpes Cold Sores & Laser Treatments

    QDear Dr. Smiles, This is not so much a question for you, but rather a testimonial that I would like you to share with your readers. Over the course of the last six months I have been suffering with repeated Herpes cold sore outbreaks on my lower lip. I was getting them every two to three weeks. They are very painful and seem to take forever to go away, and soon after one healed, another one would appear! I have been a dental assistant for close to twelve years and my dentist recently incorporated Laser into the practice. I asked my doctor if there was anything that could be done with the Laser to treat my Herpes cold sore... Wendy, San Mateo
    A

    First, doctor asked me about my diet and if there had been any changes to my eating habits.  After some thought, I realized that on my recently adopted eating regimen for weight loss, I was incorporating more fruits, vegetables and especially nuts. What I found out with doctor’s help is that a diet heavy in […]

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  • Flouride Varnish Treatments

    QDear Dr. Braun, I recently had fluoride varnish placed on my teeth after my cleaning. Is this better than the fluoride treatments I used to get with foam and trays in my mouth? Kristin, Palo Alto
    A

    Dear Kristin,Fluoride varnish was introduced into the United  States in the 1990’s after being widely accepted in Europe for over 30 years as a topical fluoride. The traditional method of delivering fluoride to the teeth using foam inside trays is still accepted and effective. Fluoride varnish has some advantages though and is likely to replace […]

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  • The Universal Numbering System for Teeth

    QDear Dr. Smiles, When I go to the dentist, they use funny sounding names, letters and numbers to describe the teeth. I also notice these same numbers and letters when I get my statement or an explanation of benefits from my insurance. Can you help me understand what all of this means? Suzanne, 23 San Carlos
    A

    Dear Suzanne, Your question is great because I think a lot of other people are wondering the same thing.  Dentistry has a universal system for identifying teeth and each surface, so that wherever you go in the world, the communication is as easily understood and communicated as “left and right”.  It is actually called “The […]

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  • Eating Disorders & Your Teeth

    QDear Dr. Braun, I am 22 and have recently recovered from Anorexia. It has been a very long process and the multitude of health problems that I face now is overwhelming. At my most recent visit to the dentist, I was informed that I have rampant decay and many of my teeth do not have very much bone around them and I may lose them. Can you comment on why this happens and if someone with Bulimia would face the same problems? Justine, Menlo Park
    A

    Dear Justine,Thank you for your question and congratulations on your recovery, I’m sure it has taken a lot of hard work, therapy and will power.  Anorexia and bulimia manifest themselves and take their toll on the body differently but with similar devastating cumulative effects. Anorexia is an eating disorder where the individual is in a […]

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  • Your Diet & Your Teeth

    QDear Dr. Smiles, My 7 year old keeps getting cavities. He is brushing and flossing regularly now, so I think the source of the problem is related to diet. Which foods do you recommend for healty snacks that will not contribute to his decay problem? Suzanna, Palo Alto
    A

    Dear Suzanna,Snacking is a great way to keep your child’s energy needs replenished during the day. Unfortunately, choosing the wrong kinds of foods can wreak havoc with their dental health. While eating a full meal such as breakfast or lunch, the saliva flow is heavy to aid in the digestive process, and this in turn […]

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  • Pros & Cons of Teeth Sanitizers

    QDear Dr. Smiles, I recently saw an advertisement for a tooth brush sanitizer. Do they really work and are they necessary? Karen, Palo Alto
    A

    Dear Karen,Yes, the sanitizers do work, but it is an expensive way to accomplish a simple task.  They can cost anywhere from $60- $80 dollars. Simply rinsing your brush well and letting it air dry will help prevent germ growth and keep it clean.  If you are worried about bacteria and cross infection, keep your […]

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  • Periodontal Disease & Your Heart

    QDear Dr. Smiles, My husband recently had a heart attack. During his recovery, he has been doing some research about the risk factors and how they relate to his health history. He also has a history of periodontal disease, as did his parents. His father also had coronary heart disease. What is the most recent research in dentistry saying about the link between periodontal disease and cardiovascular disease? Curious, Menlo Park
    A

    Dear Curious,There is more and more evidence linking the association between coronary disease and gum disease and the research is ongoing. In a recent study by the Department of Periodontology-Dental Surgery in Liege, Belium, E.H. Rompen said “The results of this study showed that periodontitis in cardiac patients was significantly more frequent than in noncardiac […]

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  • CEREC & Crowns

    QDear Dr. Braun, My dentist has a service he refers to as CEREC for crowns. What is CEREC and how does it differ from the type of crown patients usually get at the Dentist? Paul Mountain View
    A

    Dear Paul, CEREC is an acronym for Chairside Economical Restoration of Esthetic Ceramic. CEREC is a high tech cad-cam delivery system for crowns, inlays, onlays and veneers.  It is basically a powerful computer with a 3-D imaging system and software that assists the dentist in designing a crown from a picture of a tooth. Conventionally, […]

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  • Teeth Whitening & Age

    QDear Dr. Smiles, I want to get my teeth whitened, but my mom says not yet. How old is old enough? I am 12. Katie, Los Altos
    A

    A.Dear Katie,Thanks for asking such a great question!  Your mother is correct. Twelve years old is still too young to whiten your teeth.  At twelve, your teeth are still developing their nerves, roots and blood supply. You face and jaw structure is also growing. Remember, it has not been very long since you lost your […]

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  • Donating Blood & Dentistry

    QDear Dr. Smiles, I recently donated blood and during the screening process was asked if I had seen a dentist within the previous 72 hours. I was just wondering why the blood donor bank would want to know if I had been to the dentist. Thanks Ellen Palo Alto
    A

    Dear Ellen,The blood bank’s primary purpose in screening its donors prior to giving blood is to make sure that the blood can be used without transmitting any diseases to the recipient.  The reason they ask about going to the dentist is because some dental procedures can cause bacteria from the mouth to enter the bloodstream.  […]

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  • Tongue & Lip Piercing

    QDear Dr. Smiles, Is it safe to have your tongue and lip pierced, and if not what are the consequences? Janet, Menlo Park
    A

    Dear Janet, Tongue and lip piercing is a very popular body adornment these days, unfortunately, we rarely hear about the serious consequences that can occur. Dentists are confronted with these “side effects” and have to deal with them in a timely manner. With tongue piercing, the wound never entirely heals and the risk of infection […]

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  • Sonic vs Manual… You Decide!

    QDear Dr. Smiles, Do Sonic Brushes really work better than manual and electric spin toothbrushes? There are so many choices, how do you know which one is best? Puzzled in Palo Alto
    A

    Dear Puzzled, I really do commiserate with my patients and everyone’s questions about what products to buy, be it toothpaste or electric tooth brushes. When I go to Long’s or Rite Aid and walk through the dental products aisle, I am stunned by the humongous selection there is to choose from. It takes me twenty […]

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  • Dry Mouth

    QDear Dr. Smiles, My hygienist commented on how dry my mouth has become. I have noticed this along with a strong urge to clench, even during the day. This is a new development for me and the only other thing that is different for me is that I am on an anti-depressant. Is this a possible side effect? Just Curious, Palo Alto
    A

    Dear Curious, You are exactly right to link your recent dry mouth and clenching with the anti-depressant prescription. Prozac, Paxil and Zoloft are all known to be linked to these side effects. Headaches can also result from the clenching and the medicine. These families of medicines treat the serotonin levels and feedback mechanisms that regulate […]

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  • Mouth Protection

    QDear Dr. Smiles, Thank you for your piece on traumatic tooth injuries last week. As a follow up to that topic, can you comment on the necessity to wear mouth protection while playing sports? I have 2 very active sport loving sons. Joanna, Portola Valley
    A

    Dear Joanna, Children between the ages of 13-18 are at the highest risk for dental injuries while playing sports. In theory, this age group is more vulnerable because of their likelihood to engage in more high risk behavior. Children with prominent incisors, overbites and lips that do not cover the teeth tend to acquire the […]

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  • Quick Response to Dental Trauma

    QDear Dr. Smiles, My twelve year old nephew back East, dove into a swimming pool and knocked out his two front teeth! Sadly, he will not be able to keep his front teeth, he has lost them forever. If my sister had known more what to do in an emergency, things could have turned out better. What should be done when there is trauma to the mouth and teeth are injured? What should we expect our dentists to do? Joanne, Palo Alto
    A

    Dear Joanne, Accidents happen and when they involve teeth, the sooner the dentist is contacted the better. Oral injuries are painful and often very bloody due to the abundant vascularity that supplies the area. The dental injuries most commonly encountered are either soft tissue only, teeth only or a combination of the two. When teeth […]

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  • A New Community: SmilesVCN!

    QDear Dr. Smiles, What resources on the internet can you suggest for good information about dentistry, health wellness and prevention? How can the public determine if the content is reliable or not? I have been to WebMD and I find that the resources for dental health and information are limited. Thanks for the advice. William, Palo Alto
    A

    Dear William, There are many resources available on the internet that are full of reliable information about dentistry and overall health. It just takes a little time to hunt them down. One important feature that should be included in the site to verify its authenticity is the HON Code Label. This stands for Health on […]

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  • Teeth on the Move

    QDear Dr. Smiles, Over time I have noticed that my teeth are moving apart. It used to be really hard to floss between them, and now there are many places that the floss goes in and our really easily. What is causing this and should I be concerned? Judy, Woodside
    A

    Dear Judy, It is often surprising to people when they find out that teeth move, even with out orthodontics and putting braces and wires on them. Teeth are not rigidly fixed to our jaw bones and will tend to drift forward and backward and drop down into empty spaces if given the opportunity. The phenomenon […]

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  • Sonrisas Shines on the Coast!

    QDear Dr. Braun, What resources are there for the less financially fortunate folks for dental care? When I was a child, we lived in a rural area, my family was from Mexico and we were migrant workers, and many of us suffered with bad teeth. It seemed like there was no one or no place that could help us out. I would like to know because now, I’m in a position to help out if there is a need for volunteers or financial support. Thanks Ramon, Redwood City
    A

    Dear Ramon, Thank you for your question. Living in the Bay Area among communities like Atherton and Woodside, we tend to develop horse blinders to the less fortunate among us and forget that there is a real issue when it comes to these folks needs and desires to access quality dental care. The Mid-Peninsula Dental […]

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  • Veneers Solve Dental Dilemmas

    QMy 21 year old daughter’s front tooth is a slightly gray color especially noticeable in photographs. She needed a root canal in the tooth during her braces. It has been whitened inside a few times, but the gray color keeps coming back. My daughter wants to have it veneered. Will this really cover the gray color completely? What about at the gum line – will it turn black like so many people’s front teeth I notice when they have crowns on them? Won’t the veneer be bulky and unnatural looking? Worried, Palo Alto
    A

    Dear Worried, Your daughter has one of the most challenging cosmetic situations that dentist’s face – fixing a single front tooth and making it look exactly the same as the adjacent central incisor. Fortunately for your daughter, esthetic materials today can come very, very close to perfect, where from a conversational distance, no one is […]

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  • Key to Todder Oral Health

    QDear Dr. Smiles, I took my three year old child to the dentist and they found a lot of plaque on his teeth and areas that the enamel shows early breakdown. My husband and I brush his teeth for him, with varying degrees of cooperation and success. Is there anything else we can do to prevent him from getting cavities? Beverly, Menlo Park
    A

    Dear Beverly, You and your husband are on the right path for success because of your involvement with your child’s brushing at an early age. That is the good news. Unfortunately, it sounds like the plaque removal is not as complete as it could be. Children need supervision and direct parental involvement until the age […]

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  • Poorly Fitting Dentures

    QDear Dr. Smiles, I am having problems with my lower partial denture. It’s as if the metal bar under my tongue is digging into my gums and causing pain, the few remaining teeth I have in front of my mouth seem to be fine. It has been very comfortable for a long time, I’m 78 years old and I would rather not get a new one. Is there anything that can be done to this one to make it feel better? Grant, Los Altos
    A

    Dear Grant, Wearing a partial that is pinchy and painful is a real problem, so you definitely need to get it checked by your dentist. A poorly fitting denture can damage teeth and supporting bone if not repaired. A number of things could be going on that are causing the partial to feel uncomfortable. Make […]

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  • Celiac Disease

    QDear Dr. Braun, My six year old daughter has Celiac disease. Her permanent teeth are coming in and the enamel is missing in some areas. Can this happen as a result of this gluten intolerance disease? Marianne MountainView
    A

    Dear Marianne, Yes, Celiac Disease has been shown to cause an interruption in the normal formation of the enamel and in some instances of the entire tooth. In my practice, one child is missing several permanent teeth due to this problem. As the permanent teeth begin to erupt, ask your dentist if the enamel appears […]

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  • Tooth Discoloration

    QDear Dr. Smiles, My three year old’s front tooth has slowly turned a dark gray color. It doesn’t seem to be painful for him, but I don’t like the way it looks. What causes this and what can be done about it? Cynthia, Woodside
    A

    Dear Cynthia, The most common cause of this type of tooth discoloration is history of trauma. Parents often notice the discolored tooth in a photo or when a relative or friend that has not seen the child often, comments about it. What typically happens in the life of a toddler is they take a spill […]

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  • Antibiotics

    QDear Dr. Braun, I developed a problem tooth recently and when I saw my dentist, it turns out I have a fractured tooth that has an abscess and needs to be extracted. I had a root canal on it years ago and it has never given me any trouble. My dentist put me on a five day course of antibiotics called Amoxicillin and on the fourth day I started getting hives and having trouble sleeping. I’ve never reacted negatively to any medicines in my entire life, I’m 62 years old. My wife says I’m allergic to Penicillin. Could this be possible? Eric, Palo Alto
    A

    Dear Eric, Yes, it could be entirely possible. Allergies to medications can occur later in life, not just in childhood or upon first exposure. The immune system is very complex, and in certain situations, the body has been exposed to the drug or substance just enough times to sensitize the immune response. This sensitization may […]

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  • Understanding Cold Sores

    QI get these awful cold sores and they come at the absolute worst time. They are painful and really unattractive. Is there anything a Dentist can do to treat these so they don’t hurt so much and last so long? Carrie, Menlo Park
    A

    Dear Carrie, Cold sores are a very big nuisance for anyone that gets them. It is important to know that cold sores are caused by the Oral Herpes Virus and are very contagious. In the early stages of blistering they can be spread easily by kissing, touching or sharing lipsticks or utensils. There are a […]

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  • Snoring

    QDear Dr. Smiles, I heard that dentists can help people who snore. My wife, over the last few years, has increasingly become a very loud snorer. What solutions do dentists have to offer people who snore? Alvin, Atherton
    A

    Dear Alvin, Snoring is the sound of partially obstructed breathing during sleep. When you breathe normally, air passes through the nasal passages, past the soft palate, uvula and tongue. During waking hours, muscles work at holding the airway open. While sleeping, the muscles relax and under normal circumstances, the airway remains open. Snoring occurs when […]

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  • First & Second Phase Braces

    QDear Dr. Smiles, My seven year old son was recently evaluated by an Orthodontist. A treatment was proposed that progresses in two phases. I think this means that he has to wear braces twice and I wanted to know why this approach would be preferable to having braces only one time. Why is a second phase necessary? Sigrid, Palo Alto
    A

    Dear Sigrid, Orthodontic treatment is very customized to the individual and each treatment plan is developed to address the occlusion taking into account the young patient’s skeletal patterns, jaw shape and size, orientation and relationship. Depending on the severity of the situation, there are times when treating a problem early with an “initial” phase can […]

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  • Mapping & Probing

    QAt my most recent dental appointment, the hygienist used some sort of measuring tool and recorded a bunch of numbers in my chart. What do all of these numbers mean, the hygienist really did not explain what it all meant? Patti Palo Alto
    A

    Dear Patti,To put it most simply, the hygienist was “mapping” the supporting structures of your teeth.  This is also known as probing, because a millimeter marked periodontal probe is used to measure all of the areas that need recording. The numbers that are recorded are in millimeter measurements. There are several things the patients needs […]

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  • Root Canals

    QMany years ago I had a root canal done on one of my molars. The procedure was uneventful and the tooth has felt fine ever since. Just recently I started having pain in that tooth and when my dentist checked the area, she told me that the root canal had failed and that it needs to have another root canal and possibly a surgery? Can you explain why a root canal fails and whether or not it is worth fixing? Jim , Woodside
    A

    DearJim,Failure analysis is a valuable process and can help us understand and hopefully avoid failures in the future.  Dentistry has worked hard at this over the years, but unfortunately has been unable to avoid failure 100% of the time. Endodontic treatment,  also known as  root canal therapy, has played a huge part in saving many […]

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  • Coffee & Your Teeth

    QI’m 70 years old and my teeth are really dark from all the coffee I drink. My grandchildren always ask me about them. I’d like to do something about this and I’ve heard a lot about bleaching teeth. Am I too old to get started with this process? If not, what is involved? I’ve been very blessed with good teeth as I haven’t needed much dentistry done over the years. Thanks, Bob, Menlo Park
    A

    Dear Bob, You are in luck! There is no age limit to bleaching your teeth and it is a great way to improve your smile. There are a few methods to choose from that will likely be successful for you. The first thing you need to do is get a thorough cleaning and polishing and […]

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  • Teeth Whitening

    QI am trying to whiten my teeth. My dentist made trays to fit over my teeth that I put gel into and wear for an hour every day. After I’m done whitening, my teeth are really sensitive. Why does this happen? Should I be worried about long term harm? Are there any other methods that work faster and cause less sensitivity? Lucille, Los Altos
    A

    Dear Dear Lucille, First let me reassure you that teeth whitening is very safe and long term studies have shown that the enamel and tooth structure affected by the products are not harmed. So with that concern put aside, let’s talk about sensitivity and why that happens. There are many whitening systems available to dentists […]

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  • Dental Dams

    QAt a recent dental visit I had some fillings done and a device was used on my mouth that the dentist called a “dental dam”. It felt really strange at first because I didn’t know what it was or what to expect. Can you tell me more about what a dam is and why dentist’s use it? Thank you. Thomas, Palo Alto
    A

    Dear Thomas, A dental dam, also known as a rubber dam, is a device that is designed to isolate an area of the mouth to enhance access, visibility and infection control. Dentists have been trained to use dental dams in school dating back to the 1950’s. Some dentists, once out of school, do not use […]

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  • Teeth Grinding

    QIs I think I grind my teeth at night because my husband has heard me and I notice jaw tiredness in the morning. My dentist told me that I should consider a night guard. I’ve heard them advertised on the radio, but I’m not sure how good those are compared to the one that my dentist would make me. Can you offer some advice? Thanks, Terri, Portola Valley
    A

    Dear Terri, Nighttime grinding is a common problem that many people deal with, especially in Silicon Valley! Researchers are not completely clear about the cause of it, but factors involved are the usual culprits, such as stress, long hours and lack of rest, and too much caffeine late in the day. It has also been […]

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  • Electric Toothbrushes

    QMy dentist and hygienist recommend I use an electric tooth brush. In the past, I have used them, however, the battery dies so quickly, it does not seem worth the expense if I always have to replace them. Am I doing something wrong? Angie, Palo Alto
    A

    Dear Angie, The most common mistake owners make with the electric tooth brushes, whether they are Oral-B’s or Sonicare’s or another brand, is leaving it on the charging stand all the time between uses. When you initially set up your new toothbrush, you need to fully charge it in the stand. Once it is fully […]

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  • Adult Teeth Not Forming

    QIs it true that it is possible that certain teeth never form in the adult? I have a five year old child and never thought of the possibility that a tooth could be missing. Both my husband and I have all of our teeth. Which teeth can this happen to? Beth and John, Portola Valley
    A

    Dear Beth and John, It is true that in the adult dentition there is the possibility of an adult tooth not forming. Although any tooth may be congenitally missing, there is a tendency for certain teeth to be missing more frequently than others. Studies have shown that third molars (aka wisdom teeth) are absent in […]

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  • About Gingivitis

    QI am the mother of a teenage daughter. On a recent visit to the Dentist, she was told she has gingivitis and that this could lead to more serious gum problems in the future if she does not take better care of her teeth at home. What can I do to impress on her the importance about this? She seems resistant to my suggestions. Thanks for the help, Claudia, Palo Alto
    A

    Dear Claudia, There are some strategies that have worked for other frustrated parents I’ll share with you. The age group between 11-16 are most at risk for gingivitis and when good oral hygiene habits are not adhered to, their oral health can suffer and long term consequences can result. In pre-adolescent females, there are hormone […]

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  • Hygienists & Assistants

    Q
    A

    Dear Melanie, In the dental profession, the clinical duties and responsibilities of the hygienist and assistant are very distinct and important. Working together in a dental office, both assistants and hygienists work intimately with the patients, just in different ways. Dental hygienists are highly educated to recognize disease in the mouth and work closely with […]

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  • What is Trismus?

    QI had my wisdom teeth removed recently and I cannot open my mouth all the way. My surgeon told me I have trismus. I do not understand what trismus is, can you explain it to me? Thanks. Josie, East Palo Alto
    A

    Dear Josie, I hope you mouth felt better by Thanksgiving Day and you were able to enjoy your turkey dinner! If you look up trismus in the dictionary it mentions “lockjaw”. While lockjaw is a scary side effect associated with Tetanus, trismus is more common place and very curable. Trismus is defined as an inability […]

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  • Childrens Cavities

    QMy child is 7 years old and our last trip to the dentist was a disaster. He had so many new cavities, it is very distressful. They seem to be forming in between his baby teeth molars. I’m worried that this will continue into his permanent teeth if we don’t get this under control. What can I do to prevent further cavities from forming? Upset, Palo Alto
    A

    Dear Upset, You have good reason to be dismayed. Having so many cavities in his baby teeth is analgous to a forest fire. It has to be brought under control and then vigilantly watched for hot spots from recurring. Dental decay is an infection caused by bacteria like Streptococcus Mutans, can spread from tooth to […]

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  • Prosthodontists

    QThis week my dentist referred me to a Prosthodontist. I'm confused because it seems like there are more and more specialties and I can't seem to remember one from another. Can you help me sort out the different specialties in dentistry and what they do? Thanks needing clarification in Cupertino.
    A

    Dear Needing Clarification, Thank you for your question, I think there are many people that would appreciate this information.  I’ll try to keep it simple.  First of all, every  specialist in Dentistry has undergone specialty training.  This usually involves at least two additional years of training in a specialty program at a dental school  after […]

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  • X-Rays & Exposure

    QI am really concerned about radiation exposure and heard that digital x-rays are much safer. The last time I went to my dentist, they recommended that I have a full mouth set of x-rays taken. I thought I had just had a full set but they told me it was only bite-wings. What is the difference between bite-wings and a full mouth set and with what frequency should these be taken? Do digital x-rays really make that much of a difference in terms of exposure? Dan, Menlo Park
    A

    Dear Dan,X-rays provide your dentist with an important tool for diagnosis and it is vital to your overall care that they are up to date. The bitewings provide a snap shot for the dentist to screen the majority of your posterior teeth for bone loss and for cavities that cannot be detected clinically just by […]

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  • Implants & Replacement Options

    QI recently had a tooth ache. I went to my dentist who sent me to a specialist to evaluate the tooth for a root canal. I was told the tooth had a fracture and could not be fixed and would need to be extracted. What are my options to replace this tooth? My dentist mentioned an implant. Could you tell me more about this? Curious, Los Altos
    A

    Dear Curious, Your options may depend on the location of the tooth to be extracted. If there are teeth remaining on either side of the lost tooth or if it is the very last one in the arch or   next to an already toothless area in the mouth the options available  may be affected. Overall […]

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  • Extreme Makeovers

    QI've been watching Extreme Makeover and am amazed at what they can do with the participant's teeth is such a short time. They make everything look so easy, how realistic is it to expect the same type of turn around with my own dentist? Chris, Palo Alto
    A

    Dear Chris,Extreme Makeover is an incredible show and  many people’s lives have been profoundly affected by going through the head to toe process. As each show progresses, it is very captivating to become acquainted with the participant’s profiles as they are presented and give their pre and post operative interviews. It is very emotionally touching […]

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  • Floss, Floss, Floss!

    Q"Floss, floss, floss!" That is all I seem to hear when I am at my dentist. Is it really necessary to floss and if so, must I do it all the time? Florence, East Palo Alto
    A

    Dear Florence, Yes, I’m sure it does sound like a broken record at times, but flossing is a vital part of good oral hygiene and health.  Flossing or some sort of cleaning inter-dentally is necessary on a daily basis to protect yourself from decay and gum disease. When you floss, you are wiping the surfaces of […]

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  • Uncemented Crown

    QDr. Braun, I recently had a crown installed over a molar without benefit of cement. It fit so tightly upon first fitting that the Dr. decided it was just as well to leave it. I have other molars that have been in place for over ten years..they were cemented in. My concern is that, without cement, food particles and decay germs will work their way under the new crown and cause failure..possibly to the extent that the crown cannot be cemented back on. That would really be disastrous since the molar is also used as ananchor tooth for a partial bridge. What would you recommend? The only assurance I have at this point is that the crown is guaranteed for two years...providing I come in for a checkup every 6 months. thanks, L. Richey
    A

    Dear L. Richey, Your dilemma is good news and bad news.  The good news is that the crown fit is extremely accurate and it will be a very good long term restoration.  The bad news is that it is stuck on  your tooth without benefit of cement.  Your concerns about bacterial infiltration are astute and […]

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  • Fosamax & Plaque

    QIs it possible that taking Fosamax could increase the formation of plaque on my teeth?
    A

    Dear N. Ramos, Fosamax is a bone-restoring agent used for osteoporosis.  There is some evidence that these medications may help reduce bone loss in the structures that support the teeth.  No where does it state that a possible side effect of this medication   could be an increase of plaque formation on teeth.  The most common […]

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