16. What should I know about dental treatment during pregnancy?

You should advise your physician that you are continuing routine dental care during your pregnancy (regular cleanings). There are a numbers of reasons why dental care is vital during your pregnancy. Tooth development in the embryo begins as early as the fifth or sixth week of intrauterine life often before your pregnancy has been confirmed. Hormonal changes during pregnancy make the gum tissue very sensitive to plaque and irritation commonly causing gingivitis. In addition, your eating habits may change, causing changes in your oral health. Normally it's best to schedule necessary visits during the second trimester of your pregnancy. Morning sickness commonly occurs in the first trimester, and during the last trimester it may be less comfortable for you to sit in one position for any length of time. If you should have a dental "emergency" (such as unexplained pain or facial swelling) during your pregnancy you should contact your dentist immediately. Also remember to inform your dentist about your pregnancy before taking any medications.

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17. What is the normal Eruption sequence of baby teeth?

At about 5-8 months, the first 2 baby central incisors erupt on the bottom.

• From 8-10 months, four upper incisors come in.
• At 10-16 months, the first baby molars and the lower lateral incisors and the first baby molars come in.
• At 16-22 months the cuspids ("fangs" or "canines") erupt.
• Finally, when the child is 2-31/2 years old, all 20 baby teeth have usually
• arrived.

(These times are approximate.)

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18. When is it appropriate to pull a baby's teeth?

The baby teeth perform 2 functions that help the proper eruption of the permanent teeth. First, the baby tooth hold the spaces available for the permanent tooth by preventing the movement of the adjacent teeth into the space. Second, the roots of the baby teeth help to guide the permanent teeth into place if all goes as planned. Sometimes when the baby teeth are pulled early, the gums heal over the site and the adult tooth has a difficult time breaking through the healed gum tissue. There are three times when it is appropriate to pull a child's teeth.

If they are in the way of other permanent teeth trying to erupt in the wrong place.

If they are interfering with the child's eating (usually because of infection), or If the baby tooth is fused to the bone and inhibiting the permanent tooth eruption.

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19. What are dental Sealants?

Cavities most commonly start on the biting surfaces of the back teeth (molars and premolars) due to the existence of developmental grooves. These cavity prone grooves are sometimes too narrow for your toothbrush bristle to reach and clean. A Dental sealant is a tooth colored material that is applied to cover these deeper susceptible grooves to "seal-out" the harmful bacteria and therefore reduce the chance of decay. Sealants are most beneficial at an early age, when the teeth are most susceptible to decay. As decay may start in the deeper section of the groove and go undetected, it is important for the dentist to make sure that there is no hidden decay before placing the sealant. As this may seal the decay under the sealant- dentist.net recommends that the dentist flare the groove first to ensure there is no underlying decay. As sealants are weaker and susceptible to chipping we recommend the use of Preventive Resin Restorations instead. Ask your dentist if sealants are an option for your child. It is recommended that sealants be applied to a child's primary (baby) molars by the age of three or four years. Once the six-year molars (the first permanent back teeth) appear, it is best to apply preventive resin restoration if needed. As a child's most cavity prone years continue until the mid-teens, the premolars should also be sealed as they appear.

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20. Can children get too much fluoride?

Yes. If excess fluoride is ingested it can result in a condition known as fluorosis. Fluorosis can cause varying degrees of staining and irregular enamel formation in your child’s permanent teeth. Most municipal water supplies are fluoridated at safe levels (1.0 ppm). If your water source is an independent well, or if you drink only bottled water, you will have to investigate the level of fluoride that the water contains. Another potential source of excess fluoride is fluoridated toothpaste. Children should use a "pea" size dab of fluoridated toothpaste and expectorate as much as possible. Parents should always supervise young brushers.

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21. When is it the right time to seek the services of an orthodontist?

Often it will be obvious early that the permanent teeth are not coming in properly. This is usually due to some level of overcrowding. However this does not always mean that braces or removable retainers should be put in at once. In conjunction with the braces specialist [orthodontist] the decision must be made as to whether the adult teeth should be allowed to come in before the braces are placed, or whether the orthodontist should intervene immediately, and possibly place appliances twice - once early, and again after the permanent teeth erupt. One of the main factors to consider in early intervention is whether the child has to move the jaw to the left, right, or forward to make the teeth fit together. This can lead to jaw growth problems and should be treated right away. I otherwise wait for the permanent teeth to come in to put braces on. Of course there are many other factors to weigh and an orthodontist should always be consulted.

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22. Why should I have orthodontics now?

There are a number of reasons for deciding to have orthodontic treatment as an adult. Orthodontics can help you enjoy a straighter smile, more even teeth and greater self-confidence in social and business settings. Other benefits include easier brushing and reduced chances of developing periodontal (gum) disease later on.

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23. Why do I need root canal treatment?

When a tooth dies on the inside where the nerve is, it becomes an area that is ripe for infection. If left alone, the tooth will become infected and pressure will build up causing a toothache. It is very difficult to treat the inside of a tooth like a regular infection, because blood carrying antibiotics cannot reach inside the tooth to help kill the bacteria. So the dentist opens into the center of the tooth, removes the bacteria and debris (removing the infection), and fills the center with a rubbery substance to seal the dead space.

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24. Does a root canal hurt?

Once anesthetized (numbed) or if the nerve is non-vital (dead) the procedure is usually painless and comfortable. But sometimes, if the tooth is a "hot one" (acute abscess) it can be painful when the dentist "drops in" to the tooth chamber. At this stage the anesthetic [like Novocain] can be placed directly in the chamber and the rest of the procedure will be comfortable.

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25. What are dental implants?

Dental Implants are made of titanium which is biocompatible. These are surgically placed into the jawbone to anchor permanent replacement teeth. Replacement teeth are then attached to that part of the implant that projects from the gums. Approved and tested dental implant systems are very successful. In fact, some have lasted more that 20 years with a better than 90 percent success rate. Patients who have good oral hygiene habits and regular dental checkups can enjoy implants that last a lifetime. (Click here to read more about dental implants)

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26. Why do I need dental implants?

Fifty million teeth will be removed this year as a result of infection, gum disease or trauma (accident and injury). When teeth have been removed, several problems occur. The remaining teeth shift, rotate and become crooked, causing a bad bite and making it difficult to chew food properly. Unsightly spaces or large gaps between your teeth may cause embarrassment.

You need to ask yourself these questions:

• Do I feel comfortable when I smile, speak or eat?
• Do my dentures slip or cause sore spots when I chew?
• Do I hide my smile because of unsightly spaces between my teeth or missing teeth?
• Are my teeth loose and need to be stabilized following treatment for advanced gum disease?
• Do I regularly need my dentures relined because of bone resorption?

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27. What are some of the symptoms of TMJ? (TMD)

There are many signs and symptoms of TMD syndrome, not all necessarily present in all cases. Here are some of the most common:

• Tenderness of the jaw muscles with limitation in opening
• Pain in or around the ear that often spreads to the face
• Pain or difficulty in chewing, yawning or opening wide
• Headaches, particularly present upon awakening
• Jaws that get stuck or lock
• Earache or pain when no infection is present
• Dizziness
• Clicking or popping or grating sounds when opening or closing the mouth

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28. How is TMJ treated?

Dentist.net believes that a conservative treatment approach is best. Because every patient is different, treatment also varies from patient to patient. Treatment may include but not limited to:

• Firstly, eliminate the muscle spasms and pain
• In some situations, correct the way in which the teeth fit together
• Stress relieving conditioning is recommended.

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29. What is an impacted wisdom tooth and what can I do about them?

When you approach 17 years of age, your last set of teeth are due to erupt. These teeth are called third molars or wisdom teeth. Often since the jaw is already formed when they erupt, there is not enough room for the wisdom teeth and they become wedged between the back of your lower jawbone and the tooth in front of them. This is called an impaction.

Impactions usually are brought to your attention when they begin hurting because of infection of the surrounding gum and then need to be extracted as an emergency. Most specialists (oral surgeons) recommend that even impacted wisdom teeth that are not causing you problems should be removed when you are young because of potential problems when you are older (the bone is more resistant and the teeth are harder to extract). In cases where braces are put on, most dentists/orthodontists want wisdom teeth extracted so that they don't erupt and ruin the straightened teeth.

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30. What is a crown and/or bridge?

Crown and Bridge treatment is a permanent method of replacing missing teeth. A crown is placed on an individual tooth, (somewhat like a thimble over your finger) where there is no longer sufficient tooth structure left to place a filling. A bridge spans a space where one or more teeth have been lost in the dental Arch. The teeth on either end of the span are crowned, and are referred to as Abutments. The false teeth in a bridge that join the abutments are referred to as pontics. Crowns and bridges are most often made from a combination of precious metals (gold), platinum palladium and porcelain, or space age reinforced resins and porcelain with no metal. Both esthetics (appearance) and function are considered when selecting the material most suitable for you.

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31. What does it mean if your gums start to dent in? The area above my teeth have no gum and what can I do to stop it and does it get worse??

Sounds like you have gum recession. It comes usually from either or grinding / clenching ones teeth and or brushing your teeth too aggressively i.e. abrasion. Also the use of acidic foods and dinks is implicated with erosion of the enamel in the gum-tooth junction. Dentist.net recommends the use of extra soft toothbrush and wear a night guard at night. Also be aware not to clench your teeth during the daytime and try to rinse your mouth with water after eating or drinking acidic foods/drinks. I recommend you see a gum specialist (Periodontist) in case you may need a gum graft if the condition is moderate to severe.

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