Regular dental care is important for everyone, but it can be especially important if you are an expecting mother. Did you know that your dental health is altered by pregnancy hormones? In fact, pregnant mothers are more susceptible to various dental issues and these dental issues can also affect the pregnancy, as well as the baby.

This is primarily due to the fact that a woman’s body changes drastically during pregnancy. More specifically, certain hormones associated with pregnancy are increased while pregnant. Namely these pregnancy hormones are estrogen and progesterone.

Estrogen levels start to increase during the first trimester and are the primary cause of morning sickness, or overall nausea. Throughout pregnancy, estrogen levels will continue to increase and hit their highest point during the third trimester. In a single pregnancy, more estrogen is produced than a female produces in the rest of her non-pregnant lifetime. Estrogen is essential because it allows the uterus and placenta to form blood vessels, facilitate the transfer of nutrients to the fetus, and provide support to the fetus during its development and maturation.

Pregnant woman suffering from morning sickness

Progesterone levels also increase to unusually high levels during pregnancy. While estrogen is primarily responsible for fetal development, progesterone is associated with ligament laxity. The loosening of ligaments allows the uterus to increase in size as the fetus grows. It also causes the ureters between the bladder and kidneys to increase in size.

In addition to the increase of estrogen and progesterone, several hormone levels also fluctuate in response to a pregnancy. These hormones include human chorionic gonadotropin (HGC), relaxin, oxytocin, and prolactin. Although these hormone changes are essential to facilitating the pregnancy, they can affect your oral health.

What dental issues affect pregnant women?

The most common dental issues that affect pregnant women are pregnancy gingivitis, tooth decay, and pregnancy tumors. The Centers for Disease Control (CDC) notes that about 60-75% of women are affected by pregnancy gingivitis and one out of every 4 pregnant women have cavities, while WebMD notes that only 10% of pregnant women are affected by pregnancy tumors. Ultimately, everyone is different and so certain conditions may affect some, while others may not be affected at all. However, pregnant women are more susceptible to the following dental health issues:

Pregnancy Gingivitis:

Gingivitis is a mild form of gum disease caused by the buildup of plaque on the tooth’s enamel. The bacteria within plaque can cause the gums to become inflamed, tender, and even bleed when flossing or brushing. The main concern with gingivitis is that it can progress to periodontitis if not treated. Periodontitis is a more severe form of gum disease that can cause tooth loss. In fact, gum disease is the top cause of tooth loss in adults.

Symptoms of gum disease can include:

Tooth Decay:

Pregnancy also increases the risk of developing cavities. This is primarily because morning sickness increases the acidity in the mouth and wears away the teeth’s enamel. Additionally, some women tend to crave and eat more carbohydrates during pregnancy, which contain excess sugars that feed the bacteria responsible for tooth decay.

Symptoms of tooth decay can include:

Pregnancy Tumors:

Although less common than gum disease and tooth decay, some women are also affected by small gum tumors known as pregnancy tumors, pyogenic granuloma, granuloma of pregnancy, lobular capillary hemangioma, or pregnancy epulides. These are non-cancerous tumours that are red in color and have a raspberry appearance. They often form on the gums between teeth during the second trimester and are often caused by excess plaque. In most cases, they will resolve themselves once the baby is born, however they can cause discomfort and interfere with eating or speaking.  

How Do Dental Issues Affect Pregnancy?

According to the American Dental Association (ADA), dental issues can cause premature delivery, intrauterine growth restriction, gestational diabetes, and preeclampsia. Although the exact relationship between the two is still being researched, there has been a correlation between periodontitis and premature delivery as well as low birth weight.

The American Academy of Periodontics has published a study about the connection between the two, as well as the American Academy of Family Physicians. The Oral Health Foundation also notes that women who experienced premature labor were one and a half times more likely to have gum disease. They also note that premature birth was also more likely to occur in women who had untreated cavities.

Dental Care Tips During Pregnancy:

During pregnancy, you should visit your dentist regularly. Ideally, you should be already visiting Pasha Dental at least once every six months. However, when you become pregnant, you should schedule an additional appointment to have Dr. Pasha begin monitoring your oral health during your pregnancy. Depending on how your initial consultation goes, Dr. Pasha will advise you on how often to visit because some people may require more frequent exams and cleanings than others. Generally, preventative dental care is the type of dental care you can expect to receive during pregnancy. Preventative dental care services at Pasha Dental will consist of dental exams, x-rays, and a professional teeth cleaning.

During a dental exam, Dr. Pasha will examine your teeth, gums, and bite to ensure there are no signs of gum disease or tooth decay. He will also measure your gum pockets to ensure there is no gum recession present. Your medications and any prenatal vitamins you’re taking will also be discussed, as this can affect treatment.

Digital dental x-rays may also be used as an additional diagnostic tool if needed. Finally, a professional teeth cleaning will remove plaque, tartar, and bacteria from your mouth which will decrease the likelihood of developing tooth decay, gum disease, or pregnancy tumors.

Before you leave, Dr. Pasha will also provide you with information on how to take care of your teeth in-between appointments. The basics include brushing your teeth twice a day and flossing once a day. He may also recommend a bland tasting toothpaste and mouth rinsings during morning sickness periods. It is also important to eat a balanced diet and to try and limit the amount of sugary snacks since your teeth are more likely to develop cavities.

Is Dental Care During Pregnancy Safe?

Yes! Dental care during pregnancy is not only safe, but it is highly recommended by dentists and physicians alike to increase the odds of a smooth pregnancy. Most dental care during pregnancy consists of preventative services, but it can also consist of restorative services.

Pregnant woman looking off in the distance with her hands on her belly

It is also important to note that both dental x-rays and local anesthetics are safe for the mother and developing fetus. Compared to regular x-rays, digital dental x-rays use a much smaller amount of radiation that has not been found to cause any problems with pregnancy. As an additional measure, you will also be asked to wear a lead apron to further minimize the amount of radiation that reaches the abdomen.

In August 2015, the Journal of the American Dental Association published a study about pregnant women who were exposed to local anesthetics during dental treatment. Within this study two groups of pregnant women were compared: those who had been given local anesthetics and those who had not. Ultimately the study concluded that there were no differences in miscarriage rate, birth defects, prematurity, or birth weight.

If you plan on becoming or already are pregnant, schedule a consultation with Dr. Pasha Javaheri Saatchi of Pasha Dental today for your pregnancy dental care appointment. Pasha Dental is proud to provide dental services for pregnant women residing in the Brooklyn, NY area as well as to residents of Staten Island, Queens, and Manhattan.

Treating Gum Disease

Your gum disease treatment will depend on several factors, including your personal health history and the stage of your gum disease. This page covers:

  • Professional Cleaning
  • Deep Cleaning – Scaling and Root Planing
  • Periodontal Surgery
  • Bone Graft Surgery and Guided Tissue Regeneration
  • Keeping your teeth and gums healthy after treatment

Professional Cleaning

In the very early stages – when it is gingivitis – you may just need a professional cleaning from your dental team. They can also give you some great advice and tips on how you can keep your teeth and gums healthy.

Deep Cleaning – Scaling and Root Planing

If your gum disease is beyond gingivitis, the first step in treating gum disease usually involves a special deep cleaning called scaling (SCAY-ling) and root planing (PLAY-ning). This treatment may be done over more than one visit, depending on your personal needs.

Scaling: Your dentist or hygienist removes plaque and tartar down to the bottom of each periodontal pocket.

Root Planing: Then, the root surfaces of your teeth are smoothed, or “planed”, to allow the gum tissue to heal and reattach to the teeth.

Your dentist or hygienist may recommend certain medicines to help control infection and discomfort or to aid healing. You may be given pills, a mouthrinse or they may place medication directly into the periodontal pocket after the treatment.

Scaling removes plaque and tartar from below the gumline.
Root planing smoothes the tooth root and helps the gums reattach to the tooth.
Healed pocket after treatment.

Periodontal Surgery

Sometimes, scaling and root planing isn’t enough treatment on its own. If pockets do not heal enough after scaling and root planing, gum surgery may be needed.

Surgery allows your dentist to remove plaque and tartar from hard-to-reach areas. Afterwards, your gums will be stitched into place to tightly hug your teeth.

Surgery can also help to shrink pocket depth and make it easier for you to keep your teeth clean.

Probe shows pockets due to gum disease. Gums are inflamed and bone loss has occured.
The bone is contoured and any remaining tartar is removed.
Healed site after periodontal surgery.

Bone Graft Surgery and Guided Tissue Regeneration

If bone has been damaged or lost by gum disease, then you may need surgery to rebuild or reshape the bone in your mouth. This kind of surgery is called a bone graft.

First, your dentist may use splints, bite guards or other types of tools to hold loose teeth in place and help tissues heal. If too much gum or bone tissue has been lost from your gum disease, he or she may need to also do a bone graft.

Your dentist may place a membrane layer at the surgical area to help your gums stay in place while the tooth root reattaches to the supporting bone tissues. This is called guided tissue regeneration.

To help you heal after surgery, your dentist may put a protective dressing over the area and recommend or prescribe a medicated mouthrinse. You may also be given a prescription to treat infection or for pain relief.

Diseased tissue is removed from the pocket. In some cases, the bone may be reshaped.
Bone has been reshaped.
Grafting material is placed over the bone. A membrane covers the grafting material.
After the healing period

Keep your Gums Healthy After Treatment

Periodic periodontal cleanings help you stay on top of your gum disease
Once your gum disease is under control, it is very important for you to get dental care on a consistent basis. The periodic cleanings recommended after these treatments are called periodontal maintenance care. These cleanings are more extensive than the standard cleaning and will help you keep your gums healthy. Your periodontal maintenance involves cleanings that are deeper than a normal cleaning in the dental office. With periodic maintenance, the amount of plaque bacteria is lowered. Then, the inflammation can get better, pockets can shrink and your gums can become healthier.

Your gum disease won’t go away on its own
Once your gum disease is brought under control, it is very important that you get dental care on a periodic basis. You have a better chance of keeping your teeth if you do. Your gum disease may get worse if you don’t!

Plan for more visits to the dentist
You will need to see your dentist more often than other people. The pockets and other issues from your gum disease will make it harder for you to clean plaque from your teeth.
Your dentist will talk to you about a treatment plan that works best for you, and he or she will recommend a maintenance care schedule that is based on your personal case. Over time, fewer appointments may be necessary. Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Medication

You may also need special medications than can help control the infection and pain or to help your gums heal. The medicine could be a pill, a special mouthrinse, or a medication that your dentist places directly into the pocket right after deep cleaning.

You may have sensitive teeth and gums after your treatment
Your teeth and gums may be sensitive after your treatment. This soreness may make you want to avoid cleaning the treated areas. But it’s important to follow your dentist’s instructions on home care! If plaque is not removed, root decay may form. Talk with your dentist or hygienist if a special toothpaste or other treatments can lower your tooth sensitivity.

Keep up your oral care at home

It is very important that you brush and floss every day – especially if you are healing from gum disease.
• Brush two times every day for two minutes each time. Use a toothbrush with soft bristles and a toothpaste with fluoride (FLOOR-ide). Fluoride is a mineral that helps keep teeth strong.
 Clean between your teeth every day to remove plaque and bits of food from in between your teeth.
If your gums have pulled away from your teeth, it may be best to use special tiny brushes, picks or wider types of floss and picks to clean between your teeth.
• Your dentist may also recommend regularly using a specific mouthrinse.
• Look for the American Dental Association Seal of Acceptance on all of your dental care products. The ADA Seal means these products have met ADA standards for safety and effectiveness.

Don’t Use Tobacco!
Smoking, chewing, vaping and dipping puts you at a higher risk for cancer and other life-threatening diseases. Tobacco use also can make gum disease worse and make it harder to treat it. If you use tobacco, ask your dentist or physician for information about how to quit.

Healthy Mouth, Healthy Body – Making the Connection

Your mouth is a window into the health of your body

Insight about your overall health can sometimes be seen in your mouth. In fact, periodontal (perry-oh-DON-tal) – or gum – disease is common in people with chronic diseases like heart disease or diabetes. This page explains the connection between your oral health and your overall health.

What you should know about gum disease

Gum disease is an infection and inflammation that affects the tissues and bone that support your teeth.The infection is caused by the bacteria in plaque, a sticky film that’s always on your teeth. Your body reacts to the infection and your gums will become inflamed – red, puffy and swollen. If left unchecked, gum disease affects the tissues and bone that support your teeth. It is the most common reason why adults lose teeth.

Gingivitis

When your body reacts to this infection and your gums are inflamed, this condition is called gingivitis (jin-ja-VY-tis), and it can lead to more serious types of gum disease. The good news about gingivitis is that it can be reversed. If the gum disease is caught early enough (when it is gingivitis), you may simply need a professional cleaning. Your dental team can also give you advice for improving your daily oral hygiene.

Periodontitis

If gingivitis is not treated, it can turn into periodontitis (perry-o-don-TIE-tis). Periodontitis is usually not painful, but it can lead to bone loss.

 

Effects of gum disease

Healthy gums and bone hold teeth firmly in place.
Periodontitis happens over time, as plaque builds up along the gum line.

Your body responds to the toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Warning signs of gum disease:

• gums that bleed when you brush or floss • gums that are red, swollen, puffy or tender • gums that no longer tightly hug your teeth • bad breath that doesn’t go away • pus between your teeth and gums • feeling that your teeth are loose • a change in the way your teeth fit together when you bite • a change in the way your partial dentures fit You may notice one or some of these warning signs, or you may not have any signs of gum disease at all. This is why it’s important to see your dentist regularly – treatment of gum disease is most successful when it’s caught early.

The Mouth-Body Connection

Certain chronic diseases are sometimes shown to raise your risk of gum disease. And, sometimes having gum disease is shown to raise your risk and severity of chronic disease. While it may not be clear whether one drives the other, some of the chronic diseases that commonly occur with gum disease are: • arthritis • diabetes • emphysema • heart disease • high blood pressure • liver diseases like the hepatitis C virus • obesity • stroke

Using tobacco raises your risk of gum disease

Keeping your teeth and gums healthy is very important. Using tobacco products of any kind (cigarettes, dip/chew, e-cigs, hookah, etc.) is a common risk factor for many chronic diseases including gum disease. Tobacco increases the risk of getting gum disease. The disease can also get worse the longer you use tobacco. Many of the medications used to treat other diseases can affect your mouth by causing dry mouth. These include medications used to treat blood pressure, allergies, and pain. Dry mouth can increase your risk of tooth decay and gum disease.

Periodontal disease is also known as gum disease

Periodontal (perry-o-DON-tal) Disease is an infection and inflammation that affects the tissues and bone that support your teeth. It’s also called gum disease.

A surprisingly wide variety of bacteria are normally found in your mouth. When certain types of bacteria outgrow the others, this starts the process of gum disease.

When your gums are healthy, your gum tissues tightly hug each of your teeth. When you have gum disease, your gums pull away from your teeth. As the gum disease gets worse, the tissues and bones that support your teeth become damaged. Over time, your teeth may fall out or need to be removed. Treating periodontal disease in the early stages can help prevent tooth loss.

What is the connection between gum disease and other health issues?

Gum disease has been linked to some other diseases. People with diabetes or heart disease are more likely to get gum disease. Strokes and high stress also may be related to gum disease. Researchers are still studying these links.

It is important to talk to your dentist if you suffer from any long-term health problem. Together, you can work out an oral care plan for your best oral and overall health.

Warning Signs of Gum Disease

If you notice any of the signs below, see your dentist. However, you can have gum disease and not notice any of these warning signs. That is why regular dental checkups are very important.

• gums that bleed when you brush or floss
• gums that are red, swollen, puffy, or tender
• gums that no longer hug your teeth tightly
• bad breath that doesn’t go away
• pus between your teeth and gums
• feeling that your teeth are loose
• a change in the way your teeth fit together when you bite
• a change in the way your partial dentures fit

What Causes Gum Disease?

Plaque is a sticky film of bacteria that is always forming on your teeth. Bacteria that live in the plaque can make your gums become red, puffy and swollen. When plaque is left on your teeth and gums, it hardens. Hardened plaque is called tartar (TAR-ter) and can only be removed when your teeth are cleaned in the dental office.

Before professional dental cleaning

When your gums are red, puffy and swollen, they can start to pull away from your teeth. Spaces called pockets start to form between your gums and teeth. These pockets give bacteria a place to collect and grow. The bacteria in your pockets will cause your gum disease to get worse. These bacteria produce toxins, which causes your body to break down the gum tissues and bone around your teeth.

Before treatment

Follow these healthy habits to help prevent gum disease

It generally costs much less to keep your teeth and gums healthy than to wait until you have a problem that needs to be treated. These healthy habits can help:

• Brush your teeth twice a day with fluoride toothpaste and for 2 minutes each time.
• Clean between your teeth with floss or another between-the-teeth cleaner every day to remove plaque and food from areas your toothbrush can’t reach.
• Your dentist or hygienist may recommend using a germ-killing mouth rinse or other products.
• Eat a healthy diet and limit snacks and sugary drinks. Learn more online at www.choosemyplate.gov.
• Visit your dentist regularly.

Tobacco use harms gums

Don’t use tobacco!

If you smoke, chew, or dip tobacco, then it is very important you quit. Using tobacco in any form slows down your healing and raises your chances of getting gum disease again or it getting worse if you already have it. Talk to your dentist or doctor about ways you can quit.

Are You at Risk?

Anyone can get gum disease, but there are things raise your risk of getting it. These include:

• Not taking care of your teeth and gums. 
• Using tobacco of any kind. 
• Diseases that affect the whole body – such as diabetes and HIV infection.
• Older Age.
• Stress. 
• Clenching/Grinding your teeth.
• Many medications.
• Pregnancy, use of birth control pills, or changes in female hormone levels. 
• Family history.
• Passing the bacteria that causes gum disease through saliva.

 

Healthy Gums
Your teeth are held in place by gums, bone and connective tissues. Your gums tightly hug your teeth and there is little or no buildup of plaque and tartar on them.

Periodontitis
In time, your body responds to the toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Advanced Periodontitis
Your teeth become loose or fall out or need to be removed by a dentist. Loose or missing teeth can create problems, like making it hard for you to eat the foods you like.

Checking for Periodontal Disease

Periodontal Probe

Your dentist or hygienist uses an instrument called a periodontal probe to gently measure the depth of the pockets around each tooth. When your teeth are healthy, the pocket depth is 3 millimeters (mm) or less. Usually, the more severe the disease, the deeper the pocket, which give bacteria more room to grow and cause serious damage to your teeth, gums and bone.

Periodontal probe of healthy gums.

Periodontal probe showing a pocket forming between the tooth root and the gums.

Dental X-Rays

Dental x-rays can check on the amount of bone that is supporting your teeth. If low bone levels are spotted, it could be a sign of damage from gum disease.

Healthy gums have bone that supports the teeth.

Gum disease can create bone loss.

You don’t have to lose teeth to periodontal disease. Brush, clean between your teeth, eat a healthy diet and schedule regular dental visits for a lifetime of healthy smiles.

Advanced Periodontitis image courtesy of Dr. John C. Hall.

With good oral care at home and regular dental visits, children can reach adulthood without suffering from tooth decay and other oral health problems.

Diet can affect your child’s teeth

The food and drinks you give your child can affect their oral health. Everyone, including your child, has plaque – a sticky film of bacteria that forms on teeth. Plaque can build up if it isn’t removed from your child’s teeth every day. The plaque bacteria feed on the sugar that’s found in the food and drinks you give your child. The bacteria create acids from this sugar supply.

These acids can attack the hard, protective layer of enamel on your child’s teeth for up to 20 minutes after they finish eating and drinking. Repeated acid attacks can affect your child’s teeth, causing problems like erosion or decay, which can lead to infection in other parts of the body.

For good dental and overall health, be sure your child eats a healthy diet. If your child needs a between-meal snack, choose healthy foods, like fresh fruits, vegetables, and low-fat/high protein foods. To help prevent tooth decay, save sweets for mealtime. For ideas about healthy foods and drinks to give your child, see www.choosemyplate.gov.

Ways to keep your child’s mouth healthy

• Brushing teeth twice a day and cleaning between teeth once a day are important to keep teeth and gums healthy. • Choose a child-sized toothbrush with soft bristles. Replace it every three months or sooner if the bristles are frayed. Worn toothbrushes won’t clean teeth properly.
• Use the right amount of fluoride toothpaste for your child. Be sure you are in charge of the toothpaste and your child knows it is not food. Do not use more toothpaste because your child likes the flavor!
• Teach your child to spit out the toothpaste.
• Supervise children while they brush their teeth. If they can’t tie their shoes, they shouldn’t brush their teeth alone.
• As soon as your child has two teeth that touch, clean between them every day. If floss will not work, use another type of between-the-teeth cleaner. Your dentist can help you decide which type works best for your child’s mouth.

 

Use the right amount of toothpaste for your child

For children under 3 years old.

For children 3 to 6 years old.

Look for the ADA Seal of Acceptance

Choose oral health products that display the American Dental Association Seal of Acceptance. This means they are both safe and effective in keeping your child’s mouth healthy.

Fluoride if nature’s cavity fighter!

Fluoride helps make teeth stronger and protects them from decay. It is a mineral that occurs naturally and is found in many water sources. Children who drink water that has the recommended levels of fluoride are less likely to get cavities than children who do not drink fluoridated water. Fluoride is also found in anti-cavity toothpastes, mouthrinses and treatments applied in the dental office. Talk to your dentist about your child’s fluoride needs. Be sure to tell your child’s dentist if you use well or bottled water; or if you use a water treatment system at home.

Protect teeth with sealants

A sealant is a plastic material that your dentist can easily apply to the chewing surfaces of your child’s back teeth. The sealant flows into the pits and grooves in the teeth – places where a toothbrush might miss. Sealants protect teeth from plaque and acid attacks.

Why regular dental visits are important

Regular dental checkups and dental care – such as cleanings, fluoride treatments and sealants – provide your child with “smile insurance.” Plan your child’s first dental visit within 6 months after the first tooth appears, but no later than the first birthday. Consider it a “well-baby checkup” for your child’s teeth.

Prevent sports-related dental injuries

Many sports-related dental injuries can be prevented by wearing a mouthguard. Mouthguards can be custom-made by your dentist to fit your child’s mouth. Or, you can purchase a “boil-and-bite” mouthguard at sporting goods stores that has the ADA Seal.

 

Orthodontic Treatment for a Healthy, Beautiful Smile

Crooked teeth and bite problems are often solved with orthodontic treatment. Sometimes, even when teeth look straight, the upper and lower teeth may not fit together well causing a bite problem. Braces are the most common way to correct crooked teeth and bite problems. This brochure will talk about braces and other types of orthodontic treatment.

The good news is that orthodontic treatment can lead to a healthy, beautiful smile, regardless of a patient’s age. Orthodontic treatment takes time and patience, but the end result is worth it.

Problems with crooked teeth

There are different causes of a bad bite, also called a malocclusion (mal-oh-CLUE-shun). Sometimes a bad bite happens naturally. Thumb-sucking, losing teeth too early, or accidents also can cause a bad bite.

If a bad bite is not treated, it may cause problems:

• Crooked and crowded teeth are harder to keep clean. This may lead to tooth decay, gum disease, and tooth loss.

• When teeth are in the wrong place, they may keep the jaws from developing properly. An uneven bite may make biting, chewing and speaking harder, cause excessive wear on tooth enamel, and lead to jaw problems.

Types of orthodontic treatment

There are different types of orthodontic treatment that can be used to correct a bad bite. All use constant but gentle pressure to move teeth and align jaws.

Braces

Braces consist of small brackets that are glued to your teeth. They have slots in which a wire is inserted, and the wire is held to brackets using tiny rubber bands (“ligatures”), or through a built-in mechanism that secures the wire (“self-ligating”). The wire, which is what actually moves teeth, is regularly adjusted to slowly shift your teeth and guide jaw growth in patients who are still growing. The brackets may be metal or tooth colored. Sometimes brackets are placed on the backs of your teeth, making them invisible. Braces are available for patients of all ages.

Aligners

Aligners (ah-LINE-ers) are made of clear plastic or acrylic and are worn over your teeth, placing gentle pressure on them to straighten them. Each set of custom-made aligners is worn for a few weeks. Then you get a new set to advance your treatment. This way, your teeth are slowly moved into the correct positions. Aligners are available for teens and adults.

Aligners are removable and need to be taken out before you eat, brush, and floss. Be sure to follow your instructions on how long to wear them each day.

Surgery

When jaws don’t line up, teeth cannot be aligned properly. Some patients may have an upper or lower jaw that sticks out and causes their bite to be uneven. In some cases, patients may need braces or aligners in combination with surgery to achieve a healthy bite.

Most people wear braces or aligners for one or two years, depending on the problem. Then they wear retainers that hold teeth in their new positions.

You can expect a little discomfort during treatment. But today’s materials use a constant, gentle pressure that makes treatment more comfortable for the patient.

Orthodontic treatment for children

When a child is about 7, he or she should have their teeth checked to see how they work together. If the child’s teeth or bite need treatment, it may be advantageous to get an early start. Treatment that begins while a child is growing may deliver results that cannot be achieved once the patient is done growing. Most treatment begins when patients are between 9 and 14.

The type of treatment recommended will be based on the patient’s orthodontic problem, treatment needs, and desired results. Patients will receive instructions on keeping their teeth, gums and “appliance” (the formal name for braces and other devices that move teeth and align jaws) clean throughout treatment.

Before orthodontic treatment

After treatment

Orthodontic treatment for adults

No matter your age, it’s never too late to improve your dental health and beautify your smile. Many adults seek treatment to correct long-time problems or to correct changes that happened over time. Sometimes an adult’s treatment takes a little longer than a child’s treatment.

Do’s and don’ts of braces

Do:

• Keep your teeth clean when wearing braces. Brushing and flossing remove plaque, a sticky film of bacteria that forms on teeth. If plaque is not removed regularly it could lead to tooth decay or gum disease.

• Go to all of your orthodontic appointments. If you delay any adjustments, your treatment may take longer.

• Visit your dentist for cleanings and exams. It is harder to keep teeth clean if you have braces. So having regular cleanings at your dentist’s office is important. Your dentist will also check for tooth decay, gum disease, and loss of minerals in the enamel (called demineralization).

Don’t:

• Eat foods that could get stuck in your braces or bend the wires. These foods include nuts, corn on the cob, popcorn, hard candy, ice, and sticky foods like chewing gum, caramel, or other chewy candy. Ask your orthodontist and dentist which foods to avoid.

• Eat too many sugary foods. This can lead to tooth decay around the brackets that could permanently stain or damage your teeth.

• Play sports and active games without wearing a mouthguard. A mouthguard can protect your mouth and jaw from getting hurt. Your orthodontist or dentist can suggest a proper mouthguard to wear with your braces.

Tooth Whitening for a Brighter Smile

If your teeth are discolored, tooth whitening may help. “Whitening” is any process that can make teeth look whiter. It may be safely done at home or in a dental office. It is best to talk to your dentist before whitening your teeth.

Options for whitening your teeth

Tooth-whitening options range from gentle surface whiteners to stronger ones that can also remove deeper stains. There are three main types of tooth whitening products:

• Whitening toothpaste

• Home-use whiteners

• In-office whitening

Whitening toothpaste help remove stains on the surface of your teeth. They are the gentlest of the whitening options. They work using polishing action rather than chemicals and don’t have many side effects. However, they do not get teeth as white as chemical products. Whitening toothpaste can lighten teeth a little bit at a time, over days or weeks.

Several whitening kinds of toothpaste have earned the American Dental Association’s Seal of Acceptance and have been shown to whiten teeth by removing surface stains.

Home-use whiteners

 come from your dentist or are sold over the counter. They may be applied to your teeth using trays, strips, as a rinse, or with a brush. They usually contain a chemical called peroxide (pur-OX-eyed), which gets below the surface to lighten tooth enamel. Home-use whiteners are meant to be used over days or weeks.

Your dentist may make custom whitening trays for your upper and lower teeth. You put the whitening gel in the trays and wear them for short times during the day or overnight. Your dentist will tell you how long to wear them. If you wear the trays for too long, the peroxide in the gel can irritate your teeth.

In-office whitening

 is done in the dental office. In-office whiteners are much stronger than whitening toothpaste and home-use whiteners because they have more peroxide. They can change the color of your teeth faster than the other methods.

In-office whitening is usually done in about one hour. To help protect your mouth from the peroxide, your gum tissues will be covered with either a thin sheet of rubber or a protective gel. A light or laser may be used in addition to the peroxide.

Before in-office whitening

After in-office whitening

Side effects

Whitening treatment may cause your teeth to be sensitive to very hot or cold temperatures. Whitening may also irritate your gums for a short time. If the side effects do not go away after a few days, see your dentist.

To avoid harming your teeth and gums, always follow the product directions and all instructions from your dentist. If your teeth become very sensitive or if you get sores in your mouth, stop using the products and call your dentist.

There is such a thing as too much whitening! Do not use whitening products for longer than listed in the product directions or by your dentist. Too much whitening can make your teeth and gums hurt badly. It can even harm your tooth enamel.

It’s not for everyone

Tooth whitening is not a good choice for all people. If your gums have pulled away from the teeth in some places, whitening may irritate these areas. If you have tooth decay, cavities or gum disease, your dentist may recommend that these be treated before whitening. Also, it is important to be aware that the color of fillings, crowns, and some stains cannot be changed by tooth whitening.

Talk to your dentist about tooth whitening before you begin. He or she will do an oral exam to find out if it’s right for you.

Keep your teeth white

If you have whitened your teeth recently, they may stain more easily. To keep your teeth white for as long as possible, avoid tobacco products and stain-causing food and drinks (like coffee, tea, and red wine) for several days after whitening. Keep in mind that teeth usually return to their original shade over time. But if you can steer clear of tobacco and large amounts of stain-causing food and drinks, your teeth may stay bright for several years.

Our teeth are covered with a sticky film of bacteria, called plaque (sounds like PLAK). When we eat or drink anything that contains sugar-such as cookies, candy, soda, juice, or sports drinks-bacteria turn the sugar into acids that can attack tooth enamel. Over time, these attacks may cause tooth decay, or cavities. The good news is that there is a way to protect teeth and prevent decay: dental sealants.

Even a toothbrush bristle is too big to reach inside a groove in the tooth (magnified).

Dental sealants are an easy way to help keep teeth healthy

dental sealant is a plastic material that is put on the chewing surfaces of the back teeth. The sealant material flows into the pits and grooves on those surfaces and acts like a barrier, protecting enamel by “sealing out” bacteria and bits of food..

That is how decay starts in the pits and grooves and cavities form. To keep decay from starting here, the dentist may recommend dental sealants.

Sealants help prevent tooth decay and cavities

Your teeth are coated with a sticky film of bacteria, called plaque. Bacteria turn the sugar in what you eat and drink into acids that can break down the hard, outer layer of teeth, called enamel. Over time, the acid can weaken the enamel and may cause tooth decay, or a hole to form in your tooth’s enamel (cavity).

Tooth decay often begins on the chewing surfaces of the back teeth. These surfaces have pits and grooves where plaque, bacteria and bits of food can get trapped. Just like in the pictures below, toothbrush bristles can’t reach into the pits and grooves, and it makes it hard to keep them clean.

Your dentist may recommend dental sealants to keep decay from starting on these chewing surfaces in the pits and grooves.

Tooth surface before a sealant is applied

Tooth surface protected by a sealant

Sealants are easy to apply

It takes only a few minutes for your dentist to seal each tooth. These are the steps your dentist may use to put sealants on your teeth:

1. Your tooth is cleaned and the chewing surfaces are prepared to help the sealant materials stick to your tooth.

2. The sealant is painted onto the chewing surface where it bonds to your tooth and hardens.

3. A special light may be used to help the sealant harden.

Sealants are smooth and you can’t feel them on your teeth. They are usually clear or white and can’t be seen when you smile or talk.

Sealants can last several years

Sealants usually last several years before they need to be replaced. Over time, sealants can come off, which means they may not protect the teeth as well. Chewing on ice or hard foods can also break down sealants.

During regular dental visits, your dentist will check your sealants and reapply them if needed.

Sealants are safe and effective

Research has shown that dental sealants are safe, and they are effective. The American Dental Association recommends that dental sealants are an important step you should take to lower your risk of tooth decay and cavities. If you have any questions, talk to your dentist.

You may benefit from sealants at any age

Sealants are recommended for children and teenagers, since tooth decay can start soon after teeth come in. But, you never outgrow the chance of tooth decay and cavities, so adults can benefit from sealants, too.

A sealant can be placed on a tooth that does not have a cavity in its pits and grooves. If a tooth is stained or has mild decay, your dentist may suggest you get a sealant, or another option may be necessary. If a tooth has more advanced decay, it will need a filling.

A sealant can be placed on a tooth that does not have a cavity in its pits and grooves. If your tooth is stained or has slight decay, your dentist may suggest you get a sealant, though other treatment may be necessary. If your tooth has more advanced decay or has a cavity, it will need a filling.

Prevention is always better than treatment! Sealants are very useful in preventing tooth decay on the back teeth and can save you money over time. Your dentist can make sealants part of your plan for a healthy mouth.

Sealant photos courtesy of Dr. Adam A. Francois.

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