PERSONAL CARE

With proper care, teeth can last a lifetime. A large part of that care is dependent on what you do at home. Proper brushing and flossing can mean the difference between having a healthy mouth for the rest of your life, and having to take more drastic action. Plaque - the sticky bacteria-laden film which constantly forms on the teeth - must be removed every day. If it isn't, it will build up, ultimately causing tooth decay or periodontal disease. Brushing with a soft-bristle tooth brush removes plaque from the exposed surfaces of teeth. It is the tips of the bristles that do the work. If the bristles are frayed or curled, the brush won't be doing an adequate job and must be replaced. As important as the brush itself is, using a toothpaste with fluoride and proper brushing technique are equally important. Proper brushing technique is really very easy. Angle the bristles toward the gumline and move the brush back and forth in small circular motions. Enough pressure should be applied so that the bristles will penetrate just below the gumline, but no more. It's best to brush two or three teeth at a time, overlapping as you go along. Many people neglect the insides of their teeth, concentrating on the visible outsides. It is essential to brush all of the teeth: insides, outsides, behind the back teeth, and the chewing surfaces. Gently brushing the back of the tongue and the roof of the mouth helps to remove bacteria-producing mucous and keeps the breath fresh.

WHY BRUSH?

Brushing your teeth after meals and between-meal snacks not only gets rid of food particles, it removes plaque, the sticky film that forms on teeth. Plaque is made up of bacteria that produce acids that cause tooth decay and gum disease, so thorough removal of plaque is the main goal of brushing. Using a fluoride toothpaste is also important because the fluoride reduces bacteria levels, as well as remineralizes tooth surfaces, making them stronger.

Your California Dental Association (CDA) member dentist or dental hygienist can recommend the best toothbrush for you. Generally, a brush with soft, end-rounded or polished bristles is less likely to injure gum tissue or damage the tooth surface. The size, shape and angle of the brush should allow you to reach every tooth. Children need smaller brushes than those designed for adults. Remember: worn-out toothbrushes can not properly clean your teeth and may injure your gums. Toothbrushes should be replaced every three or four months.

WHY FLOSS?

To prevent tooth decay and gum disease, plaque must be thoroughly removed from all tooth surfaces. Unfortunately, your brush can't reach effectively between your teeth and under the gumline. Because tooth decay and periodontal disease often start in these areas, it is as important to floss on a daily basis as it is to brush.

Flossing is a skill that needs to be learned. Do not be discouraged if you find it difficult at first. Your CDA member dentist or dental hygienist can help you learn to floss properly and give you tips on how to make it easier. With practice, you will find that flossing takes only a few minutes of your time each day.

What about mouthrinses and mouth washes?
Mouthrinses and mouthwashes contain a variety of ingredients to help support your oral health. Products with fluoride can be used to help prevent decay. Mouthwashes with antibacterial properties can help prevent or control gingivitis (gum inflammation). If you are already using an over-the-counter product for your oral health, it is always a good idea to consult with your CDA member dentist on its appropriateness for you. Depending on your individual situation, your CDA member dentist may recommend use of a specific product.

Are regular check ups really that important?
Yes! When your CDA member dentist looks in your mouth, he or she is not only looking for the signs of tooth decay and gum disease, but also for signs of systemic diseases - as your mouth is often a good indicator of your overall health. Conditions such as precancerous or cancerous lesions, diabetes, blocked salivary glands, and even HIV or AIDS can often be detected in an oral exam.

Beyond the information about your general health that your CDA member dentist may discover, regular dental care is essential to preventing more complicated dental problems from developing. Good oral hygiene practices, that includes daily brushing and flossing, eating a healthy diet and visiting your CDA member dentist for a check-up twice a year - or as often as your CDA member dentist recommends - is the best way to keep your teeth healthy and your smile beautiful for a lifetime!

GUM DISEASE and PERIODONTAL CARE

Caring for teeth and gums affected by periodontal disease is more involved and requires different tools and techniques. A toothbrush cannot penetrate fully into the deep separations between the gum and tooth that result from advanced disease. The depressions in exposed root surfaces make it impossible for floss to reach all of the plaque. Special tools are necessary to reach into these areas. Each tool has a specific application, and your dentist will instruct you as to how to use them to greatest effect. Your dentist will work with you to determine the tools most appropriate for you particular hygiene requirements, and will instruct you in their proper use.

PERIODONTAL DISEASE

At first, it's silent, practically invisible and sometimes even painless. But once periodontal disease strikes, it's only a matter of time until it makes its presence known with uncomfortable, unsightly and quite possibly irreparable side effects.

Periodontal disease, also know as gum disease, is the major cause of tooth loss in adults. There are several types and stages of the disease, all of which start with an infection of the gums that can move into the bones and ligaments that support the teeth. In the beginning stages, it is often detected by a dentist or dental hygienist during regular checkups. If left untreated gums and bone can become so seriously damaged, that teeth can fall out or have to be removed.

More than half of all adults, and three quarters of adults over 35, have some form of periodontal disease. Even young children can exhibit signs. If you plan to make your teeth last a lifetime, it's important to understand the causes, symptoms and best methods for treating and preventing periodontal disease.

What causes Periodontal Disease?
The major cause of periodontal disease is the interaction between the bacteria found in plaque-the sticky, virtually invisible film that collects on teeth every day - and the body's response to that bacteria. These bacteria create toxins that irritate and inflame the gums. This inflammatory process destroys the gum tissues and causes them to separate from the teeth. If left untreated, the disease advances to damage the underlying bone.

When plaque is not removed from the teeth regularly, it forms a hard, porous substance called calculus, or tartar. If calculus forms on the roots of the teeth below the gum line, it irritates the gums even further and contributes to even more plaque collection and disease. Only a dentist or dental hygienist can remove plaque and calculus from your teeth.

Once the bacteria in plaque have created inflammation and damage to the gum tissue occurs, a number of other factors can contribute to the severity of periodontal disease and the rate at which it progresses. Among them are:

• Smoking or chewing tobacco
• Poor oral hygiene
• Poorly fitting bridges
• Badly aligned teeth
• Defective fillings
• Food impacted between teeth
• Clenching or grinding teeth
• Poor diet
• Pregnancy or oral contraceptives
• Systemic diseases such as diabetes or AIDS
• Certain medications

What are the stages of Periodontal Disease?
•  Healthy gums are firm, pink and don't bleed. In the earliest stage of periodontal disease, called gingivitis, the gums begin to get red and puffy and may bleed during brushing or flossing. Plaque and tartar may build up at the gum line, but the bone that holds the teeth is still healthy and removing the irritants will restore tissue health.

•  The next stage of periodontal disease is called periodontitis. At this stage, the gums begin to separate from the teeth, the underlying bone is damaged, pockets form and, sometimes, the gums recede. Bacteria-laden plaque spreads into the pockets, making it more difficult to keep tooth surfaces clean and to control the disease process.

•  In advanced stages of the disease, pockets continue to deepen and there is further destruction of the underlying bone. Additionally, the bacteria that live in these deep pockets are more virulent and contribute even further to disease progression. Left untreated, teeth will eventually loosen and fall out.

What are the symptoms of Periodontal Disease?
While the early symptoms of periodontal disease can only be detected by a dentist, there are other indicators that start to appear as the disease progresses. Symptoms like:

• Red, swollen or tender gums
• Gums that bleed during brushing or flossing
• Teeth that have shifted or loosened
• Pus between teeth and gums
• Persistent bad breath
• Teeth that look longer because gums have receded
• Gums that have pulled away from the teeth
• Changes in the way teeth fit together when biting
• Changes in the way partial dentures fit

If you have any of these symptoms, you may have some form of periodontal disease and should consult your California Dental Association (CDA) member dentist. He or she will then measure the depth of the pockets between your teeth and gums and take X-rays to see if damage has occurred to the supporting bone. If, after this evaluation, your CDA dentist determines that you do have periodontal disease, there are a number of treatments he or she will suggest depending on the severity of your situation.

"How can Periodontal Disease be treated?
If periodontal disease is diagnosed in the early stage of gingivitis, it can be treated with a thorough professional cleaning. If the disease has progressed beyond gingivitis to periodontitis, the treatment may involve a process called "deep cleaning" or "root planing," which involves cleaning and smoothing of the root surfaces of the teeth to remove calculus and bacterial deposits below the gum line so that the gums can heal around them. This procedure may require several appointments, depending on the extent of your periodontal disease.

In cases of advanced periodontitis, when deep pockets have formed between the teeth and gums, surgery may be required to allow the dentist to thoroughly clean the roots of the teeth and eliminate the pockets. When there's not enough existing gum, a gum graft might be performed. In some cases of periodontal disease, when the gum and bone has been partially destroyed, certain surgical techniques can assist regeneration of these tissues.

New advances in medications for the treatment of periodontal disease also exist. Local delivery of antimicrobial or antibiotic medications, as well as medications that control the bodies' response to disease producing bacteria, can help slow the progression of the disease.

How can Periodontal Disease be prevented?
The best way to prevent periodontal disease is to practice good oral hygiene. Brushing and flossing every day, eating a balanced diet and scheduling regular checkups with your CDA dentist are essential to keeping periodontal disease at bay. And by doing so, you'll increase your chances of keeping your teeth for a lifetime.

BONDING

Bonding involves applying a tooth-colored plastic putty called composite resin to the surface of your chipped, broken or discolored teeth. The composite resin can also fill in gaps between your teeth and protect roots that are exposed due to gum recession. The entire procedure is virtually painless and is usually completed in one visit. However, complex cases may require several appointments.

TOOTH WHITENING

Whitening lightens teeth that have been stained or discolored by food and age, or darkened as a result of injury. There are three ways to professionally whiten teeth. Your California Dental Association (CDA) member dentist can apply a whitening solution to one or more of your teeth per visit, over the course of several appointments. Or, you can be fitted with a custom-made whitening tray that you wear for a couple of hours every night at home. This process can take one to six weeks. In-office whitening takes a little over an hour. The whitening solution is applied to the teeth and a special light aids in activating the solution and helps it penetrate the surface of the tooth. As the solution is broken down, oxygen enters the enamel and dentin, bleaching colored substances while the structure of the tooth is unchanged .

BAD BREATH (HALITOSIS)

Bad breath, also called halitosis, is a common condition and sometimes a distressing source of embarrassment. Frequently, people aren't even aware there's a problem. While there are many causes for bad breath, it most commonly results from a lack of good oral hygiene. Daily brushing and flossing and regular dental checkups and cleanings are the best prevention for bad breath.

However, when bad breath persists, despite good oral health, there may be other reasons for mouth odor and a consultation with your California Dental Association (CDA) member dentist or physician is in order.

The odor may result from the air you exhale.

Aromatic foods, especially garlic and onions, are often the source of breath odor. Food that is absorbed into the bloodstream is transferred to the lungs, where it is expelled, often with the odor still recognizable. Brushing, flossing and mouthwash will only mask the odor temporarily. Odors continue until the body eliminates the food. Additionally, during the digestion process, the odor may make its way back up the esophagus and is expelled during talking and breathing.

Sometimes odors emanating from the lungs or sinuses will contribute to bad breath. A sinus infection, bronchitis, or other respiratory tract infection can sometimes be detected through breath odor. Furthermore, post-nasal drip that collects at the back of the throat can be a source of mouth odor. Gargling mouthwash can help wash away fluids that coat the throat, reducing this effect.

Tobacco use is another common source of mouth odor, as the tobacco smoke is inhaled, so it is exhaled. If you use tobacco products, consult with your dentist for advice and support on how to quit.

A dry mouth may be the culprit.

Good saliva flow cleanses the teeth and tissues, and is essential to keeping the mouth healthy and in balance. A common side effect of many medications is reduced saliva flow, which results in a dry mouth (also called xerostomia) and increased mouth odor. Dry mouth may also be caused by other problems involving the salivary glands or from continuously breathing through the mouth. Several over-the-counter products are available for xerostomia and your CDA member dentist can advise you on the best way to manage this condition.

There are other medical conditions that contribute to mouth odor.

Beyond infections of the sinuses and lungs, there are other medical conditions that can sometimes be detected through mouth odor. These include diabetes, gastrointestinal disturbances and liver or kidney ailments. If your CDA member dentist determines that your mouth is healthy, you may be referred to your family doctor or a specialist to determine the cause of bad breath.

What else can I do?

The best control for mouth odor is good oral hygiene. Mouthwashes and breath sprays are mostly cosmetic and do not have a long-lasting effect. Additionally, breath mints generally contain sugar or citric acid and, when allowed to dissolve slowly in the mouth are decay producing. These products should be used sparingly. If you constantly use one of these products to mask mouth odor, see your CDA member dentist.

RESTORATIONS

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There are any number of ways in which your dentist can restore your teeth. Whether teeth are damaged, diseased, or decayed, a method exists to return the teeth to a normal appearance and function. These techniques range from the simple to the very complex, but are all designed to protect, repair, or replace your teeth.

Fillings
The most common form of restoration is the filling. The procedure itself is very simple. A local anesthetic is used to completely numb the area of the tooth to be filled. After the area has been anesthetized, any decay is removed and the tooth interior is shaped to accept the filling. The filling material is then pressed into place and shaped to create a natural surface contour. The filling material is then smoothed and polished. The materials used to fill teeth are silver amalgam or resin composites. Silver amalgam fillings are not as natural-looking as tooth-colored restorations, but they have a long history of strength and durability. Resin composite fillings are much more natural-looking, but can be somewhat more expensive than silver amalgam fillings.

Resin Composite Restorations
The procedure for a composite restoration is essentially the same as for a traditional amalgam filling. After the tooth has been cleared of decay and properly shaped, the interior is then etched with a mild acid solution to aid bonding to the composite filling material. In most cases, the tooth is banded, and the composite is applied in successive layers. Each layer in turn is hardened with a high-intensity light. When the cavity is completely filled, the surface of the restoration is shaped to match the contours of the original enamel. A composite restoration is extremely durable, and perhaps the most aesthetically satisfying option. Fillings in particular are subjected to tremendous forces during biting and chewing, and are in constant use. Over time they may simply wear out, and may have to be replaced.

CROWNS

Crowns are used when simply filling a tooth would leave it weak and vulnerable to cracking, or when making cosmetic improvements to the teeth is the goal. A crown is placed over a tooth, replacing most of its enamel. It surrounds the tooth, giving it strength and providing a strong, durable biting surface. Crowns are often used when large fillings wear out, when a tooth cracks, when a cavity is especially large, and after a root canal procedure. A filling does not strengthen a tooth, and if there is not enough tooth structure remaining, the tooth can crack or break. Biting places teeth under tremendous pressure. Sometimes this causes a tooth to crack. Filling a large cavity may leave too little tooth structure to provide enough support. A root canal procedure removes a great deal of material from the center of the tooth. This leaves the tooth weak and vulnerable to failure. In these cases, a crown surrounds the tooth, permanently stabilizing and strengthening the tooth.

TYPES OF CROWNS - Crowns were traditionally made of gold. Gold is still considered by many to be the finest material available for restorations. The appearance of gold, however, is not very natural. Crowns may also be made of steel or aluminum. They are not generally as resilient, or as attractive as other types of crowns, and are used the most for temporary coverage. Crowns may also be made of steel or aluminum. They are not generally as resilient, or as attractive as other types of crowns, and are used the most for temporary coverage.

Procedure
Placing a crown requires two office visits. During the first visit, any decayed material is removed...and the teeth are shaped to receive the crown. From this impression, a working model is made upon which the crown is crafted to precisely fit the prepared tooth. Your dentist will place a temporary crown for the short time that it takes the lab to create the permanent crown. On the second visit, the temporary crown is removed, and the new crown is put in place. Your dentist will then check to see that the fit and bite are correct. At this time, your dentist will make any necessary alterations to the shape and fit of the crown. When everything is just right, a permanent adhesive is applied to the interior of the crown and it is set in place on the prepared tooth. Once the crown has been properly positioned, the excess adhesive is wiped away. The crown and its bond to the supporting tooth are extremely strong. You will be able to use the crowned tooth exactly as you would any other tooth.

BRIDGES

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Bridges are positioned to replace missing teeth. Not only do they fill the unsightly spaces left by lost teeth, but they also help support the teeth adjacent to, and directly opposite, the missing teeth. When a tooth is lost, the adjacent teeth may shift position. The tooth opposite to the lost tooth may begin to extend out of its socket. Shifted teeth are harder to clean, making them more susceptible to cavities and permanent bone loss. The bite may also be altered making it more difficult to chew, possibly damaging the temporomandibular joint - the TMJ or jaw joint. The bridge procedure is frequently completed in two office visits. On the first visit, the teeth on either side of the missing tooth are cleared of any decay and shaped to accept special crowns called abutments. An impression is then taken from which a model of the teeth will be made by the dental laboratory. Your dentist will then place a temporary bridge. Over the next one to two weeks, the lab will create the permanent bridge on the models made from your dental impression. The abutments will attach to and support a pontic - the portion of the bridge replacing the missing tooth. At the next visit, the temporary bridge is removed and the permanent bridge is positioned. Once properly located, it's cemented in place. There are other types of bridges in addition to the anterior bridge, each designed to meet almost any patient's individual needs.

Posterior Gold Bridge
Although not very natural looking, gold is considered by many to be the finest material available for restorations. Gold bridges, however, are usually limited to the posterior, or back teeth - the molars.

Posterior Porcelain and Metal Bridge
A porcelain bridge is constructed like a porcelain crown: layers of porcelain are built-up on a gold or metal core. The metal provides great strength, while the porcelain looks very natural. Most bridges are made in this way.

Maryland bridge
A somewhat less-expensive alternative to other bridges. In cases where the missing teeth are surrounded by healthy, unrestored teeth, it is advisable to retain as much of the natural tooth structure as possible. These teeth are not crowned, but instead, a thin retentive frame which supports the pontic is bonded to them. This produces a strong restoration with minimal or no tooth reduction.

The Multiple-Unit Bridge
When more than one isolated tooth must be replaced, a larger structure is needed. The multiple-unit bridge has the advantages of permanence, coupled with normal performance and appearance.

DENTURES

When you're missing some or all of your teeth, there are several methods for replacing them. Your dentist will discuss your options with you and help you decide the best plan for you. In the event you are missing all of your natural teeth, a complete removable denture is often the recommended way to replace them.

Replacing missing teeth benefits both your health and your appearance. It improves speaking and eating, improves your smile and, especially in the case of a complete denture, helps support your facial muscles, providing a more youthful appearance.

Once I have my dentures is it important to see my dentist again?
When you have been fitted with a new denture, there is a period of adjustment when it is especially important to visit your dentist so that he or she may make minor modifications until your denture fits comfortably. It is also important to visit your dentist periodically during the lifetime of your denture to ensure it continues to fit properly and adjustments are made as soon as they are needed. It is natural for the bone and tissue beneath the denture to change over time, so periodic adjustments will allow a continued good fit and protect the health of the underlying bone and tissue.

How do I identify my denture?
There are sometimes unanticipated circumstances, such as a hospital stay, where denture identification is essential. It is important that your denture is properly labeled with your name or social security number. This identification should be embedded into the denture when it is initially fabricated. Look for this when your dentist delivers your denture to you.

How do I care for my dentures?
Even though you no longer have natural teeth, you must still take good care of your mouth. Plaque will form on your denture and food can get trapped between the denture and your gum tissue. After each meal, remove your dentures and, using a soft toothbrush, brush your gums, your tongue, and all sides of the denture. Here are a few helpful hints about caring for your dentures:

• Dentures are fragile and can break if dropped. It is a good idea to clean your dentures over a sink filled with a few inches of water, or a folded towel laid over the counter top.
• Dentures may warp if they dry out. When your denture is not in your mouth, be sure to store it in a denture bath filled with denture cleaner or water.
• Denture adhesive may be used to assist the retention of your denture, but should not be used with a poorly fitting denture. Poorly fitting dentures should be relined or replaced.

Good denture care and periodic visits to your dentist will ensure that your tissue remains healthy and your denture fits properly . . . for a lifetime of good health!

ROOT CANALS

A Root Canal procedure must be performed when the pulp within a tooth dies or becomes infected. The pulp is comprised of the tooth's nerve and blood supply, and other soft tissues. Unfortunately, an infection in the pulp chamber or root canal will not heal, it will only progress, destroying the pulp. If the infection reaches the jaw bone itself it can create an abscess. This infection will almost certainly compromise the immune system, affecting the entire body. It can also be extremely painful, and potentially life-threatening. Severe gum disease can allow bacteria to reach the root tip itself, where the infection will take hold. From there, it then moves up the root canal to the pulp chamber, and may also cause an abscess. Traumatic injury to the tooth may also kill the pulp, invariably causing an infection.

The Procedure
First, all decay is removed from the tooth, and an opening into the pulp chamber is created. A dental file is then used to completely remove the infected pulp and open the root canals for the filling material that will replace it. At this stage, x-rays are taken to verify that all of the infected tissue has been removed. If a large amount of tooth structure must be removed, a post may be placed in one of the root canals to reinforce the tooth. Normally, a crown will then be placed over the remaining tooth. This is done because root canal-treated teeth frequently crack. The crown will support the underlying tooth structure, and provide a strong, durable biting surface. Root Canals can be done in one visit, but sometimes a second visit is required. If there is an extensive infection, your dentist will apply medication to the root canal and pulp chamber. He will then seal the tooth with a temporary filling, allowing the medication a few days to neutralize the remaining infection. On the second visit the tooth is permanently filled and crowned.

Apicoectomy
If a root canal procedure fails to arrest the infection in the jaw, an apicoectomy may be the last hope. To prevent the infection from progressing, and the resulting abscess from growing, a small incision is made through the gums into the jaw just above the affected tooth. Once exposed, the infected tissue is removed. With the infection stopped and the incision closed, new bone will fill in the abscessed area.

EXTRACTIONS

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What should you expect when you are scheduled for a tooth extraction?
Your dentist will numb the area to lessen any discomfort. After the extraction, your dentist will advise you of what post extraction regiment to follow, in most cases a small amount of bleeding is normal.

Avoid anything that might prevent normal healing. It is usually best not to smoke or rinse your mouth vigorously, or drink through a straw for 24 hours. These activities could dislodge the clot and delay healing.

For the first few days, if you must rinse, rinse your mouth gently afterward, for pain or swelling, apply a cold cloth or an ice bag. Ask your dentist about pain medication. You can brush and floss the other teeth as usual. But don't clean the teeth next to the tooth socket.

When having an extraction, today's modern procedures and follow up care as recommended by your dentist are there to provide you the patient great benefit and comfort.

SEALANTS

Preventing tooth decay can become even easier. You may already be aware that daily brushing and flossing are the most important weapons against the formation of plaque, the primary cause of cavities. In addition to your regular routine of brushing and flossing, your dentist can apply a coat of plastic material - called a sealant - on the top or biting surfaces of your back teeth. This plastic coating creates a barrier on your teeth and seals out the decay-causing bacteria that live in plaque.

What is plaque and why does it cause cavities?
The food and liquids you eat and drink combine with bacteria to produce a sticky film called plaque. Plaque attaches on and in between teeth, where it starts to eat away at the tooth enamel. If plaque is not removed regularly by brushing and flossing your teeth, it can produce acids that will create pits or holes (cavities) in the tooth. This is tooth decay.

Is it difficult to apply sealants?
No. Sealant placement is quick, simple and painless. Most often, sealants will last for several years. At regular check-up visits, your dentist or dental hygienist will check to see that sealants are still in place.

Who should get sealants?
Sealants are most effective in reducing cavities in children with newly formed permanent teeth. In fact, all children should have their molars (back teeth) evaluated for sealants soon after they erupt. For most children, this occurs approximately at ages 6 and 12.

Sealants can also be useful in cutting down formation of decay in adult teeth, as well. An application of sealants is a preventative measure to keep teeth healthy. It is an effective way to reduce the need for fillings and more expensive treatments that may be required to repair the damage from cavities, so sealants can save you money.

Ask your California Dental Association (CDA) member dentist whether sealants would be an appropriate treatment for you and your children to help prevent tooth decay.

IMPLANTS

Dentistry has come a long way since wooden dentures were used to replace George Washington's teeth! Nowadays, when you are missing one or more teeth, there are a variety of methods to replace them, including removable appliances, fixed bridges and implants. Your California Dental Association (CDA) member dentist will discuss your options with you and help you decide the method that is best for you.

What are implants?
Implants have been around for many years and have gained wider and wider acceptance over time as they have proved a successful method for replacing missing teeth. They offer a way to have artificial teeth that look natural and feel secure.

The implant itself, often made of titanium, is used like an artificial root to support the false tooth or teeth. The dental surgeon, usually a periodontist (gum specialist) or an oral surgeon, places the implant into a hole made in the jawbone. A post can then be secured to this "artificial root" and can be used to secure a prosthetic device, such as a crown or bridge, above the gum. Implants can also be used in conjunction with a removable denture to create a more secure and stable base for the denture.

Why implants?
Implants have some advantages over removable dentures. Because removable dentures are not permanently fixed in place, they can move around when you eat and speak. Additionally, over time the bone that supports the denture changes and shrinks, making it increasingly difficult to support a denture comfortably.

Implants also have some advantages over fixed bridges, especially when the teeth adjacent to the missing tooth or teeth are healthy. In order to create a fixed bridge, your CDA member dentist must usually place crowns on these adjacent teeth - as they are the support for the replacement tooth or teeth. If these teeth are free from decay and existing restorations, you may prefer to leave them in their natural state, rather than alter them to hold the necessary supporting restorations. Implants replace the missing tooth or teeth while leaving all adjacent teeth unaltered.

How successful are implants?
While implants are highly successful, the likelihood of success depends on several factors. The amount of bone available to support the implant, the patient's health, whether or not the patient smokes and the quality of ongoing home care all effect long-term success.

Remember, replacing missing teeth is important to maintaining good dental health. Your CDA member dentist will evaluate the conditions in your mouth and help you decide if you are a good candidate for implants.

TMJ PROBLEMS

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More than fifteen percent of American adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or even headaches and neck aches.

A dentist can help identify the source of the pain with a thorough exam and appropriate x-rays. Often, it's a sinus, toothache or an early stage of periodontal disease. But for some pain, the cause is not so easily diagnosed. The pain could be related to the facial muscles, the jaw or temporomandibular joint, located in the front of the ear. Treatments for this pain may include stress reducing exercises, muscle relaxants, or wearing a mouth protector to prevent teeth grinding. They've been successful for many and your dentist can recommend which is best for you.