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Oral Health Information from A to Z


Please select an item below for more information.

Abscessed Tooth Fluoride Treatment
Anesthesia Gum/Periodontal Disease
Bad Breath (Halitosis) Implants
Bleaching (Tooth Whitening) Oral Cancer
Bridges Orthodontics
Bruxism (Teeth Grinding) Plaque
Canker/Cold Sores Premedications
Cavities/Caries Root Canal Treatment
Crowns Sealants
Dentures TMJ/TMD
Dry Sockets Veneers
Extractions Wisdom Teeth
Fillings Zebra - From A to Z needs a Z

Abscessed Tooth
An abscessed tooth is collection of infectious material that results in a bacterial infection in the center of the tooth. The infection will congregate in the affected area and persist until the bacterial infection is properly treated, an abscess will form as a result of the infection. In order to properly address the infection the pus must be drained from the infected area. An abscessed tooth is typically a result of untreated tooth decay. It is important to properly treat all tooth decay to avoid a potential abscess. An abscessed tooth can also result from trauma to the tooth such as a chipped or broken tooth.

Periodontal disease (gum disease) can also cause an abscess to form in the area of concern. Gum disease causes the gum tissue to pull away from the tooth creating a pocket which can trap food. An exposed pocket will allow bacteria to begin to grow and buildup in the area. An untreated abscess can also cause bone loss and if the bone loss becomes to extensive, the tooth will become loose and may have to be extracted. As the infection begins to spread and bone loss occurs, you may experience less pain, but the infection will persist until the area is properly treated. If you think you may have an abscessed tooth, it is important that you see us immediately. If the infection is not treated, it could possibly spread to other areas of the body and potentially become life threatening.

Symptoms of a tooth abscess:
Pain and irritation, pain is elevated when pressure is applied to the area.
Red, swollen, and irritated gums.
Odd taste in your mouth.
Swelling in face, jaw or gum tissue.
Bump on the cheek side or tongue side of the gum near the infected area.

Treatment options:
Antibiotics may be prescribed to destroy the bacteria causing the infection.
A hole may be placed in the tooth to allow the infection to drain.
If necessary, a small incision will be made in the surrounding tissue to allow drainage.
A root canal treatment may be necessary if the infection and decay is to extensive.
If the root canal treatment is not successful an extraction may be recommended.



Anesthesia
There are many different forms of medications available to create a more relaxed and comfortable dental visit. There are medications to control pain, create a relaxed feeling, and others that can put you to sleep during the dental treatment. It is best to ask us which options are available and would suit your best needs. We will take many factors into consideration when deciding which form anesthesia is best for you: the types of dental procedures being performed, health history, allergies, anxiety level, and any other potential complications.

Local anesthesia is used to prevent pain by blocking nerves in the area being treated. Topical anesthesia can also be applied to the area to reduce sensitivity and numb the tissue in preparation for the local anesthetic injection. Topical anesthetic is also used to reduce sensitivity during cleanings and other invasive procedures. Injectable anesthesia is typically administered for placement of fillings, crown preparations, root canals, extractions, and treatment of periodontal disease.

Analgesics are the most common form of anesthesia to address toothache or pain after a dental treatment has been completed. These medications include aspirin, acetaminophen, and ibuprofen. For more severe pain wet may prescribe a narcotic based medication such as those containing codeine, which act on the central nervous system to relieve pain.

Intravenous Sedation is typically reserved for more complex dental treatment, extreme dental phobic patients, and individuals that cannot receive dental care under local anesthetic for one reason or another. This type of sedation does have some risks, which is why it is important that you know your health status, and tell us about any illnesses or health concerns you may have. If you have questions or concerns about your oral health care, don't hesitate to talk to Dr. Howell and discuss your options for your dental care.



Bad Breath (Halitosis)
Bad breath is an unpleasant condition that can be embarrassing and a potential health concern. Some individuals that have bad breath aren't even aware that they have a problem. Some patients are more prone to bad breath because of health problems, medications, low salivary flow, dietary regiment or dry mouth. Maintaining good oral hygiene by properly flossing, brushing and use of mouthwash can sometimes only temporarily mask the odor. Dieters can also develop an unpleasant odor because of infrequent eating habits. Food that is collected between teeth, on the tongue, and in the gums can begin to rot and cause a foul odor. If you are concerned about halitosis, please consult with Dr. Howell about the potential causes and treatment options.

Xerostomia is a condition that occurs when the flow of salvia decreases and causes a dry mouth. Saliva is necessary to cleanse the mouth and remove any food particles from the mouth that may cause an odor. Changes in oral health, anxiety, medications, breathing through your mouth, aging, and salivary gland issues can cause a reduction of saliva flow. Some indications of dry mouth include cracked lips, sticky feeling, difficulty in chewing, swallow, talking or tasting, and mouth sores.

Bad breath can also indicate the possibility of a medical disorder. These medical concerns can include:

Cancer in the digestion tract.
Infection of respiratory tract.
Chronic sinusitis.
Postnasal drip.
Liver or kidney concerns.
Gastrointestinal disturbance.

If your mouth is healthy we may refer you to your general health provider or a specialist to determine the cause of your halitosis. It is important that you visit your dental health location for regular checkups to allow us to check for periodontal disease, xerostomia or any other conditions that may cause bad breath. Good oral hygiene is crucial to help with the reduction of bad breath, continue to brush 2 times a day, floss regularly, and clean your tongue to remove bacteria. Please consult with us about treating your halitosis and any possible products that could be helpful to you.




Bleaching (Tooth Whitening)
Everyone loves the appearance of a beautiful, healthy looking white smile and there are a variety of options available to achieve that beautiful white smile. Many of our dental facilities have at home and in-office whitening options. Whitening options may not completely reverse all types of discoloration such as brownish-colored or grayish-hued teeth. For the most part individuals with yellowish-hued tooth coloration will respond well to bleaching. It is important to understand that the whiteners will not effect existing restorations such as crowns or tooth-colored fillings. In cases of existing restorations you may want to consider replacement of the restorations prior to proceeding with your bleaching process.

Internal bleaching is used to lighten a discolored tooth a chemical process. This procedure may require more than one office visit and each visit may take from 30 minutes to one hour. It involves placing a chemical oxidizing agent within the coronal portion of a tooth to remove discoloration. The etiology of tooth discoloration can be intrinsic, extrinsic, or both; it can involve dentin, enamel, or pulp; it may be brought on by diet, age, or habits; it may be local or systemic.

There are several products available for use at home, which we can dispensed. These products contain peroxide(s), which actually bleach the tooth enamel. These products typically rely on percent carbamide peroxide as the bleaching agent, carbamide peroxide comes in several different concentrations (10% & 15%). Peroxide-containing whiteners come in a gel and are placed in a bleach tray that is fabricated by our staff to provide a custom fit.

There are some potential side-affects to using a whitening system, teeth can become sensitive during the period when you are using the bleaching solution. In many cases, this sensitivity is only temporary and will subside once the whitening treatment is completed. Use of a fluoride gel in your bleach tray after your bleaching session is strongly recommended to reduce potential sensitivity. Please ask us which options is best for you and if you are eligible to receive whitening.




Bridges
A bridge may be recommended if you're missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders. Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Dr. Howell can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.

Unlike a removable bridge, which you can take out and clean, since the bridge is permanently fixed bridge and if necessary should only be removed in our office to avoid fracturing your natural teeth or damaging the bridge. Implant bridges are also very effective at replacing missing teeth without having to rely on natural teeth for support. Depending on which type of bridge we recommend, its success depends on its foundation. So it's very important to keep your remaining teeth healthy and strong.



Bruxism (Teeth Grinding and Clenching)
Bruxism is a clinical term for clenching, gnashing, or grinding of the teeth. This condition affects both children and adults. Some individuals with bruxism unconsciously clench their teeth together during the day, often when they are stressed or tense. Clenching can exert an immense amount of pressure and stress on the muscles, tissues, and other surrounding structures of the jaw. Clenching can cause jaw joint disorders, headaches, neck pain, ear pain, muscle tension, and excessive wear on the occlusion surface of the teeth. These symptoms are referred to as TMJ problems (temporomandibular joint). If clenching of the jaw is not properly treated it can cause permanent damage to the temporomandibular joint.

The majority of the individuals that experience clenching throughout the day also are affected by nighttime grinding. Grinding is when the individual slides their teeth back and forth over each other in a sideways motion. This is often a subconscious behavior that is not realized by the individual. Typically the condition is not diagnosed until we observe significant occlusion wear, visual cracks and fractures, abfractions, and complaints of jaw pain by the patient. A partner or significant other will often times be the first to hear the noise of the individual grinding their teeth at night. If left untreated, excessive grinding can cause significant damage to the occlusion surface of the teeth. Researchers have not been able to pinpoint the exact cause of bruxism, but many specialists agree that stress and anxiety play a major role.

While the symptoms of bruxism can be treated, usually the condition cannot be cured. Treatment typically focuses on reliving acute symptoms and limiting permanent damage to teeth. Stress and anxiety must be considered as a factor in bruxism. Reducing stress can be achieved by a number of techniques such as visual imagery and autosuggestion, aversive conditioning (such as awakening the patient during episodes of teeth grinding), massed negative practice (the patient voluntarily clenches the teeth for 5 seconds and then relaxes the jaw for 5 seconds), pharmacologic therapy to suppress REM sleep, and changes in sleep position (lying supine with neck and knee support allows the lower jaw to rest). We may also suggest a nightguard or splint to prevent damage to the teeth. The appliance is custom made to your bite for proper fit and comfort. Over-the-counter appliances are not recommended because of the ill-fit and possible dislodging of the appliance during bruxism. Please consult with Dr. Howell if you believe you are clenching or grinding your teeth.



Canker/Cold Sores
Canker/Cold sores are unpleasant and irritating and typically caused by a bacterial, viral or fungal infection. They can also be caused by an ill-fitting denture, fractured tooth, or orthodontic appliance or wire. Some patients with a disease or medical disorder may also have mouth sores. Most mouth sores come and go within a week, any sores that lasts a week or longer and return on a regular basis, should be examined by Dr. Howell.

A canker sore is a painful, open sore in the mouth, which is white or yellow and surrounded by a bright red area. Canker sores will develop inside of the mouth and are non-contagious. Canker sores usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums. It is possible to have several canker sores or only one and they often return. Canker sores can run in families. They may also be linked to problems with the body's immune system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the tongue or cheek. The exact cause of canker sores is uncertain but many experts contribute their presence to immune system problems, bacteria, fatigue, stress, allergies or viruses. Intestinal problems, such as ulcerative colitis and Crohn's disease, also seem to make some people more susceptible.

Canker sores typically heal on their own after a week or two, but an outbreak may occur. It is important to avoid hot, spicy, or acidic foods, which can irritate the sore and prolong the healing process. Rinsing with warm salt water will also help and speed up the healing process. Antibiotics and some oral bandages can reduce a secondary infection. Cold sores that are often times referred as fever blisters or herpes simplex (HSV-1) are groups of fluid-filled blisters. The outbreak usually occurs around the lips, mouth, and occasionally inside the mouth. It is highly recommended not to come into contact with any other person while you experience a cold sore, as the virus can be easily transmitted. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or flu and can cause painful lesions to erupt throughout the mouth. It is important to not touch an active cold sore and then touch other parts of your body. Be especially careful about touching your eyes, if it gets into the eyes, HSV-1 can cause a lot of damage. In fact, if you have a cold sore or you're around someone with a cold sore, try to wash your hands as often as possible. Once a person is infected with primary herpes, the virus stays in the body and causes occasional attacks, for some individuals they will only carry the virus but will never show signs of its presence and will remain inactive. An attack may follow a fever, sunburn, skin abrasions or emotional upset.

Cold sores usually heal within 7-10 days by themselves. Although there are no prescriptions that can make the infection go away, over-the-counter topical anesthetics can provide some relief. Prescription antiviral drugs may reduce these kinds of viral infections.

Leukoplakia is a thick, whitish-color patch that forms on the inside of the cheeks, gums or tongue. Not all white patches are Leukoplakia, just the ones that cannot be rubbed off and cannot be diagnosed as any other condition or disease. It is important to keep an eye on these white patches because over time they can develop into oral cancer. Many times the exact cause of these patches cannot be identified, however, many experts believe the patches are caused by excess cell growth and are more common for individuals that use tobacco products. We may recommend a biopsy if the patch appears threatening. Please notify us if you believe that you may have an advanced case of Leukoplakia.

In treating Leukoplakia, we will examine the lesions and possibly recommend a biopsy of the tissue if there appears to be problem. The results will help determine how to manage the disease. Types of treatment depend on several things, including the location of the Leukoplakia, size, age, habits, and other medical problems. Treatment begins with removing the factors that contribute to the lesion in the first place: quitting tobacco, replacing ill-fitting dentures, attempt to curb cheek biting, or replace current bridges. For cases that are moderate or severe, removal of the white patches may be done by traditional scalpel excision, electrocautery, liquid nitrogen application, or laser surgery. Each of these removal options has its advantages and disadvantages, it is important to discuss which removal process is best for you.



Cavities/Caries
Tooth decay is the destruction of tooth enamel, which occurs when foods containing carbohydrates are frequently left on and in-between the teeth over a prolonged period of time. Plaque interacts with food deposits on your teeth to produce acid that will slowly dissolve the calcium in your teeth, the surface of the tooth..."enamel" is 97% calcium, causing tooth decay and some of the other products cause gum disease and bad breath. The acidic plaque rests against the tooth and the acid dissolves the calcium molecules from the tooth surface. When enough calcium dissolves from the tooth surfaces, the surface breaks and forms a hole. Cavities have been identified as a bacterial infection caused by a specific bacteria. The bacteria that caused the decay are called streptococcus mutans. If tooth decay is left untreated for a prolonged period of time the complications can be intensive, lengthy, and costly to treat.

Tooth decay can be prevented by:
Brush twice a day with a fluoride based toothpaste.
Utilizing fluoride trays on a routine basis to remineralize your teeth.
Clean between your teeth daily with floss.
Eat nutritious and balanced meals and limit frequent snacking.
Check with us about receiving tooth sealants.
Visit us regularly for professional cleanings and oral examination.

Balanced pH levels and proper oral hygiene will help prevent tooth decay, however, some individuals are more prone to tooth decay than others even if they are taking all the necessary steps in tooth decay prevention.

Changes that occur with aging make cavities an adult problem as well and not solely isolated to children. Recession of the gums creating separation from the teeth, combined with an increased potential of periodontal disease can expose tooth roots to plaque and bacteria. Tooth roots are softer than enamel and more susceptible to caries if exposed. The majority of people over the age of 50 have some signs of gum recession, this combined with changes in salivary flow, health issues, and an increase in medication can expose this age demographic to higher amounts of tooth decay and periodontal disease. Decay around edges or margins of existing restorations are common to older adults. Using fluoride will help prevent decay and remineralize your teeth. Utilizing a diagnodent (laser technology) can help us determine if a patient has failing restorations or an area of concern. Please ask us if a diagnodent assessment would be a vital asset to maintaining your oral health.



Crowns
A dental crown is a tooth-shaped "cap" that is placed over a misshapen or broken tooth to restore its shape and size, strength, and/or to improve its appearance. A crown is not only intended to improve the aestethics of a tooth but also to aid in functionality of the tooth structure. Crowns can be used to salvage a tooth that has been badly decayed or broken and increase the strength of a weakened tooth. A crown can be utilized to cover and support a tooth that has a large restoration where there isn't a large portion of natural tooth remaining. A crown is also used to cover a dental implant.

Crowns come in a variety of different materials including all gold, porcelain-fused-to-gold, all resin or all ceramic. There are also instances when a crown can be a mix of two different types of materials. Patients that have a small clearance between opposing teeth or that grind their teeth may benefit from the advantages of a gold crown. Gold crowns are fabricated from yellow gold and give patients more room for placement and the mailability of the gold are gentle on the opposing tooth. These crowns are typically reserved for molars. For areas of aesthetics an all ceramic crown may be recommended to give natural and cosmetic appearance. Please ask us about possible crown upgrades and which type of crown is best for you.

It is possible for your newly seated crown to create discomfort or sensitivity to your natural supporting tooth. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some hot and cold sensitivity. Pain or sensitivity that occurs when you apply pressure to the area usually means that the crown is too high on the tooth. If this is the case, Dr. Howell may be able to make a minimal adjustment to the occlusion of the crown or the opposing tooth.

Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced for proper fit.

Sometimes crowns fall off which can be caused by the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact our office. Crowns also fall off because of an improper fit or a lack of cement. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact our office immediately. We may be able to recement your crown in place; if not, a new crown will need to be made.

A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown with a metal margin. This dark line is simply the metal of the crown showing through. This can be reduced by adding a cosmetic upgrade porcelain margin to the restoration (please ask Dr. Howell about this crown upgrade). All-porcelain crowns are also a great option to eliminate the dark line appearance.



Dentures
A denture is a removable appliance that is used to replace missing teeth and surrounding tissue. There are two types of dentures available, complete and partial dentures. Complete dentures are used when all teeth are missing in an arch and a partial denture is used to replace missing teeth in an arch that has natural teeth still remaining.

In some cases, an immediate denture can be fabricated prior to removing the teeth, which will be placed at the time of extraction. The benefit of an immediate denture is that the patient does not have to be without teeth during the healing period. Shortly after the extractions and placement of the immediate denture, the gums and jawbone will begin to shrink. As a result the immediate denture will need adjustments for proper fit throughout the healing process. An immediate denture should be considered a temporary solution until a complete denture can be fabricated.

Complete dentures are made after the teeth have been removed and the gum tissue has completely healed, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed. In some cases a longer amount of healing time may be required before starting the fabrication process. It is important that the tissue and jaw bones are completely healed before starting a complete denture.

Even if you wear full dentures, you still must take good care of your mouth. Brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.

New dentures may feel awkward for a few weeks after initial placement until you become accustomed to them. The dentures may feel loose while the cheek and tongue muscles learn to operate with the new appliance. It is possible to experience soreness or minor irritation as well as a temporary increase in salivary flow. As the mouth becomes accustomed to the new dentures these issue should begin to subside. Two or three follow-up appointments may be required to make any necessary adjustments for proper fit or to address any sore areas that the denture has created. It is important that you consult with Dr, Howell if any problems persist, particularly prolonged irritation or soreness.

Dentures are delicate and can easily break if not properly handled. When the dentures are not being used it is important to clean the dentures to remove food deposits and plaque. Daily maintenance is important to prevent permanent staining and helps the gums stay healthy. It is best to use a soft bristled toothbrush to clean the denture, hard bristled toothbrushes can damage the denture. Please consult with us on which over-the-counter cleaning products would be best for your particular denture.



Dry Socket
A dry socket is a complication of an extraction. A dry socket is any tooth socket in which a patient is having pain due to the loss of the blood clot thus exposing the bone to air, food, and fluids along with an offensive odor. A dry socket can be very painful for three to five days. It is normal to have some pain after an extraction, but the pain should begin to diminish after the second day. Patients should avoid smoking or any sucking actions such as sneezing, sucking or spitting. The sucking action creates a negative pressure, which can dislodge the blood clot that has developed at the extraction site. The blood clot helps healing and prevents the area from developing a dry socket.

Most teeth extractions will have some level of discomfort at the extraction site. In most cases where a dry socket forms, the patient will typically notice that the level of discomfort is not diminishing with in the first few days. If the pain begins to intensify between three to five days after the extraction, you should us or your oral surgeon to address the pain.

If a dry socket does develop Dr. Howell or your oral surgeon will place medicated gauze in the affected area. Once the medication is placed the pain should significantly diminish. The use of an irrigation syringe to keep the area clean and free of debris may also be recommended.



Extractions
An extraction is a removal a nature tooth because the tooth is non-salvageable, experienced trauma, crowding, severe bone loss in the area due to periodontal disease, or teeth associated with cysts or tumors. There are two types of extractions, simple and surgical.

A simple extraction is one in which we can remove the tooth by loosening the surrounding tissue, grasping the crown of the tooth above the gum line and then applying side-to-side lateral motion on the tooth until it loosens from the bone. Teeth are normally held in the bone by a thin sheathe of soft tissue. The key to simple extractions is to rock the tooth side to side slowly enlarging the socket in the bone while at the same time breaking the ligament, which binds the tooth in the socket.

A surgical extraction is more difficult and invasive procedure to remove a tooth. Typically this involves the removal of the root of the tooth by using a sharp instrument that can be forced between the root and the surrounding bone. When dealing with multiple rooted teeth, the roots are separated and individually removed. An incision in the tissue surrounding the tooth may also be made to raise a flap of gum, exposing the tooth, roots, and surrounding bone. The use a drill to remove obstructing bone to aid the extraction of the tooth may also be necessary. Once the tooth has been removed from the bone sutures are placed in the surrounding tissue so the healing process can begin.

After the tooth has been extracted we will advise you on a post-operative regimen to follow. In some cases, a small amount of bleeding at the extraction site is normal. Avoid anything that may prolong the healing time. It is best not to smoke or rinse your mouth vigorously, or drink through a straw for 48 hours. These activities can dislodge the blood clot that has formed at the extraction site and delay healing. It is important to continue to brush and floss your teeth as usual, but avoid abrasive cleaning the area of the tooth socket. Keep the area clean to avoid a buildup of food and debris in tooth socket. You should be able to return to your normal daily cleaning regiment at the extraction site within 5-7 days after the extraction. Please consult with your us or oral surgeon if you believe that there may be a problem with the extraction site.



Fillings
There are two types of fillings available to restore missing tooth structure, composite/resin (tooth-colored) or amalgam (silver).

Composite fillings (tooth-colored) are comprised of glass and quartz filler in a resin medium that creates a tooth-colored filling. Composite fillings are beneficial for many reasons:

Provide good durability.
Resistant to fractures in small to medium sized restorations.
Can withstand a large amount of chewing pressure.
Aesthetic and cosmetic appearance.
Requires the removal of less tooth structure when preparing the tooth.
Material is bonded to the tooth rather than held in with retention, which allows for more conservation of natural tooth structure.

Amalgam fillings (silver) have been used by dentists since the mid-1800's, when they became the first true standard of filling material. Amalgam is a stable alloy that is created by mixing mercury, silver, tin, copper and other metallic elements. Once the amalgam capsule is thoroughly mixed the dentist will begin packing amalgam in the area where the decay was removed. The dentist will typically remove healthy tooth structure in order to allow retention of the mercury filling. There have been many studies regarding the safety of mercury based filling and the results have shown that they are safe in accordance with dental standards. Amalgam fillings are very durable, easy to place, resistant to wear, and many times less expensive than composite based fillings. Patients that have received amalgam fillings have complained of short-term hot and cold sensitivity after the placement of the filling. One of the biggest complaints by patients of amalgam fillings is the unnatural appearance of the silver.

*Dr. Howell is aware of the recent studies regarding the safety of amalgam, but has chosen to abandon the use of mercury-based amalgam fillings in the best interests of our patients and to maintain a high standard of dental care. If you have any questions regarding this issue please ask prior to proceeding with the placement of your fillings.



Fluoride Treatment
Research and studies have found that the use of fluoride in individuals of all ages has been major factor in the reduction of dental caries. When used appropriately and in moderation fluoride is safe and effective in preventing dental caries. There are three primary factors that contribute to dental caries (tooth decay): a susceptible site on a tooth, an infective strain of bacteria (streptococcus mutans), and sugars or other nutrients that stimulate the bacteria's growth. As these bacteria grow, they produce an acidic by-product that can dissolve the minerals in the enamel and eventually destroy the tooth. Fluoride directly inhibits bacterial growth so less acid is produced in the mouth and fluoride stored in plaque is released when the bacteria produce enough acid to lower the acid-base balance on the tooth. Fluoride enters the tooth through tiny pores in the enamel, which replace the hydroxyl ions of the hydroxyapatite crystals. These ions and crystals are part of the tooth's enamel; the fluoride helps form a new compound called fluorapatite, which strengthens the tooth. This form of enamel is less soluble to acid and helps protect against decay. Fluoride can be found in many different sources such as fluoridated water, toothpaste, tablets, drops, and rinses. Many of our dental practice can fabricate fluoride trays that can very effective in properly administering the fluoride to the teeth. Please consult with us about the benefits of using fluoride trays to boost your oral health and reduce your exposure to tooth decay.



Gum/Periodontal Disease
Periodontal disease is an infection that attacks the tissue and bone structure that supports your teeth. The sulcus is a shallow u-shaped crevice located between the tooth and gums. Gum disease attacks just below the gum line in the sulcus where the supporting tissue and attachments of the tooth begin to breakdown. As the supporting tissues are damaged by the infection, the sulcus begins to develop a pocket. The depth and magnitude of the pocket depend on the severity and advancement of the periodontal disease. Periodontal classifications are determined by the severity of the disease. The two major stages of gum disease are gingivitis and periodontitis. Gingivitis is a milder form of periodontal disease that only affects the gums. Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis. Treatment methods of periodontal disease depend on the severity and extent of its progress.

Some risk factors that can increase the likelihood of developing periodontal disease:

All forms of tobacco use
Systemic diseases such as diabetes.
Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives.
Poor fitting bridges.
Crooked teeth.
Defective fillings.
Pregnancy.

Warning signs of periodontal disease:
Gums that bleed easily and frequently.
Red, swollen, tender gums.
Gums that have developed pockets in the sulcus or tissue separation from tooth.
Persistent bad breath or odd taste.
Permanent teeth that have become loose.
Changes in your natural bite or the way your teeth fit together.
Changes in the fitting of existing partial dentures.

It is possible to have periodontal disease without have any signs of its presence. That is why regular checkups with your dental provider are crucial to avoiding periodontal disease. Good home care and maintenance can help ensure that you maintain beautiful and healthy gums. Regular brushing, flossing, balanced diet, and regular dental visits can provide for a lifetime of healthy, beautiful smiles.








Implants
A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people with good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. While high-tech in nature, dental implants are actually more tooth saving than traditional bridgework, since implants do not rely on surrounding teeth for support. Dental implants are so natural looking and feeling that you will forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants. Dental implants can replace one or more teeth without affecting bordering teeth, support a bridge and eliminate the need for a removable partial denture, provide support for a denture, making it more secure and comfortable.

Placement of the implant
Whether you have a bone graft or not, the dental implant must be surgically placed in your jawbone. This is done in the comfortable setting of your dental office under local anesthetic. During the surgery, your gum is cut open to expose the bone where the implant is going to be placed. Then a hole is drilled in the bone to allow placement of the implant. Once the implant is securely placed in the bone the gum tissue is positioned into its original location and sutures are placed to hold the gum tissue together. The sutures are typically removed two weeks after placement.

Bone growth
Once the implant is placed bone integration begins, this is a process where the bone begins to fuse with the dental implant. This process typically takes between 5-6 months. This time allotment allows for a thorough healing and a strong foundation for the dental implant.

Placement of abutment and implant crown
Approximately at the 6-months from the time of the implant placement the area is reopened and a healing abutment is placed to allow the gum to properly heal around the restoration. This healing abutment is screwed into the implant and the tissue surrounding the implant is contoured for the implant restoration. The healing abutment will remain temporarily for approximately 4 weeks. Once the healing abutment is removed an impression for a custom abutment and implant crown are taken of the area. The abutment and crown typically take approximately 3 weeks for the lab to fabricate.



Oral Cancer
The Importance of Early Detection
In the United States more than 30,000 cases of oral cancer is diagnosed annually. There are many forms of oral cancer that affect the tongue, lip, cheek, throat, and other areas of the mouth. In all cases, the cancer involves abnormal growth process, which if left untreated can result in death. Currently only half of all patients diagnosed with oral cancer survive more than five years.

Dr. Howell has the knowledge and accessible tools to diagnose early signs of oral cancer and pre-cancerous conditions. Early detection and regular check-ups can help avoid oral cancer. If we detect any potential signs of oral cancer a scalpel biopsy or brush biopsy may be recommended. Normally you will be referred to an oral surgeon to address the potential issue.

Signs of Oral Cancer
White patches along the side of the tongue, cheek or on the lip.
Swelling, thickening or roughness of the tongue, cheek or floor of the mouth.
A sore that bleeds easily or does not heal.
Unexplained bleeding in the mouth or throat.
A color change of the oral tissues.
Persistent pain, tenderness, or numbness in the back of the mouth or throat.
Difficulty chewing, swallowing, speaking or moving the jaw or tongue.

Other Important Information about Oral Cancer
Smoke and chewing tobacco users are more susceptible to oral cancer.
Alcohol consumption in addition to tobacco use greatly increases risk.
Long-term exposure to the sun increases the risk of oral cancer.
More than 25% of oral cancers occur in people who do not smoke and have no other risk factors.
Individuals over the age of 40 are more at risk.
Research has shown that diets high in vegetables and fruits can help prevent the development of oral cancer.



Orthodontics
Braces (also called orthodontic appliances) can have a variety of appearance options. The braces can either be as inconspicuous as possible or as noticeable as you would like. Brackets that hold the retention wires in place are attached to the facial side of the tooth. In some cases, smaller brackets can be placed on the back of the tooth, which is significantly less noticeable. The brackets can be made of metal, ceramics, plastics or a combination of these materials. The brackets can either have a metallic or tooth-colored appearance.

Treatment should begin when the malocclusion often become noticeable between the ages of 6 and 12, as the child's permanent (adult) teeth erupt. Malocclusions can be caused by trauma, disease, malnutrition, hereditary or unhealthy dental habits. Orthodontic treatment often begins between ages 8 and 14 but is not limited to those ages. Orthodontic treatment that begins while a child is still growing helps produce optimal and ideal results. Children should have an evaluation by the age of 7 as whether or not orthodontia could be beneficial to the patient. By that age the child will have a mix of primary and permanent teeth. We can assess areas of concern with emerging teeth and jaw growth in the early stages of development, while primary teeth are present. Regular dental visits starting early in life is important to an individual's dental health.

Adults can also benefit from the positive results of orthodontics such as crooked or crowded teeth, overbites, underbites, incorrect jaw position, or jaw-joint disorders. The fundamentals and biological process of moving teeth is the same no matter the age of the patient. Orthodontia in adults typically requires a longer duration of treatment because an adult's facial bones are no longer developing or as malleable as a child's bone structure. No matter your age, it's never too late to improve your dental health and beautify your smile.

Most general dentists receive very little orthodontic training in dental school. This requires that general dentists, such as Dr. Howell, receive special training and certification to properly practice orthodontics. Dr. Howell is Invisalign Certified and is a member of The American Orthodontic Society. The purpose of orthodontics is to treat malocclusions with braces or aligners to correct teeth and jaw alignment problems.



Plaque
Dental plaque is a general term for the diverse microbial community (predominantly bacteria) found on the tooth surface, embedded in a matrix of polymers of bacterial and salivary origin. Plaque develops naturally on teeth, and forms part of the defense systems of the host by helping to prevent colonization of enamel by exogenous (and often pathogenic) microorganisms (colonization resistance). Plaque is found preferentially at protected and stagnant surfaces, and these are at the greatest risk of disease and lesions. If plaque is not properly removed from the surface of the tooth it will eventually buildup calculus or tartar.

Brushing and flossing become more difficult once the tartar and calculus has buildup above the gum line. If the tartar and calculus begins to develop subgingivally (beneath the gum line) the tissue may become irritated, swollen, and may bleed. These are typically early signs of periodontal disease. To prevent plaque buildup it is important to brush your teeth and floss your teeth twice a day and visit your us regularly for professional cleanings and oral examinations. We may also recommend application of a tooth sealant to protect the tooth.



PreMedications
The American Heart Association (AHA) has recommended that patients with certain heart conditions take prescription antibiotics prior to receiving dental care to prevent infective endocarditis (IE), which is a bacterial infection. Infective endocarditis is an infection in the lining or valves of the heart. These bacteria enter these areas of the heart through the bloodstream. Bacteria are naturally found in a variety of locations throughout the body including in the mouth and on the skin. The ADA had expressed the concern surrounding the necessity of a premedication because of the exposure of bacteria to the bloodstream when dental work is done. Even a standard cleaning can disrupt bacteria and any exposure to bleeding allows the bacteria to access the bloodstream. According to latest guidelines released by the AHA regarding the necessity of premedications prior to dental work: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventative measure before their dental treatment. In addition to the findings by the AHA, the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society also endorses the approved guidelines.

The newly created guidelines are based on scientific experts belief that the risks of taking antibiotics for preventative measures outweigh the benefits for most patients. Some of the risks associated with taking a premedication include: adverse reactions to antibiotics, inappropriate use can lead to drug-resistant bacteria, and overuse of antibiotics. Experts also found that there is no concrete evidence to support prior claims that taking preventative antibiotics before dental work prevent infective endocarditis in patients who are at risk of exposure to a heart infection.

New guidelines indicate that patients who have taken prophylactic antibiotics routinely in the past but no longer need prophylactic antibiotics include people with:

Mitral valve prolapse.
Rheumatic heart disease.
Bicuspid valve disease.
Calcified aortic stenosis.
Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

New guidelines for preventative antibiotics prior to a dental procedure are advised for patients with:
Prosthetic cardiac valve.
Previous endocarditis.
Congenital heart disease only in the following categories:
° Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits.
° Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure.
° Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device.
•. Cardiac transplantation recipients with cardiac valvular disease.

The American Academy of Orthopaedic Surgeons (AAOS), and the American Dental Association (ADA) has found that there is insufficient evidence to recommend the routine use of antibiotics for patients with orthopaedic implants to prevent infections prior to having dental procedures because there is no direct evidence that routine dental procedures cause prosthetic joint infections.

*If there are any questions regarding the necessity of a Premedication, please contact your primary physician for clarification.



Root Canal Treatment
Root canal therapy is designed to correct disorders of the soft tissue inside the tooth that contains nerves, blood vessels, and connective tissues (dental pulp). Abscessed teeth or infected nerves that were once extracted can now be salvaged through the benefits of modern endodontic procedures. Once the dental pulp is traumatized or injured the tooth cannot repair itself on its own. The most common cause of pulp death is a fractured tooth or deep untreated tooth decay. If left untreated the dental pulp will become infected, pus will develop at the root tip and jawbone, forming an abscess. The abscess can also cause damage to surrounding tissue and bone.

Symptoms of pulpal nerve damage may include:

Pain when pressure is applied to the tooth.
Localized sensitivity to hot and cold.
Facial swelling.
Throbbing pain.

A root canal therapy typically involves one to three dental visits. The treatment begins with your general dentist or endodontist removing the pulp of the tooth. The pulp chamber and tooth canal(s) are cleaned, enlarged, and sealed with a buildup. The final step in the process is the fabrication of a dental crown which is permanently placed over the tooth.



Sealants
A dental sealant is a thin plastic coating that is applied to the pits and grooves of the chewing surface of molar teeth to aid in the prevention of decay caused by bacterial plaque and acids. The sealants are easy to apply and only take a few minutes to apply to each tooth. It is important for the occlusion surface of the tooth to be completely clean of debris and bacteria. The sealant material is painted onto the tooth enamel, where it bonds to the tooth. In some cases, a curing light may be used to help the sealant dry and harden.

Sealants can withstand the normal forces caused by chewing and will typically last for a couple years before a new sealants need to be applied. Sealants can provide the same benefits to adults just as they do for children. The barrier that is created by the dental sealant will also help adults in the prevention of attracting decay and causing damage to a tooth. It is an effective way to reduce the need for fillings and more expensive treatment that may be required to repair the damage from cavities, so sealants can also save you money.



TMJ/TMD
TMJ/TMD describes a group of diseases that can involve the jaw joints, the muscles that control jaw movements and the dental occlusion. TMJ/TMD are physical disorders arising from an imbalance in the delicate working relationship of the jay and skull with the muscles that move the jaw as well as the nervous system associated with these systems. This imbalance results in muscle fatigue, spasm and/or joint dysfunction, and even changes in teeth, which in turn cause a variety if symptoms, unique for each person. Treatment options for patients with TMJ/TMD may include stress reduction exercise, medications, or wearing a nightguard to alleviate some the stress on the teeth. Many conditions that cause TMJ/TMD may be related, but can vary, and are often difficult to pinpoint. Your dentist may also recommend a specialist to treat your TMJ/TMD conditions.



Veneers
A porcelain veneer is a thin shell of porcelain that fits over damaged, discolored, or misshaped teeth. This procedure has several advantages over other tooth restoration procedures. Porcelain is an extremely durable material with a color, translucence and texture that is similar to tooth enamel. It is not susceptible to decay and resists staining while maintaining a natural appearance. Veneers can effectively close diastemas (gaps between teeth), lengthen and reshape teeth, repair chipped, broken, or misshapen teeth, and cover stains and discolorations. Benefits of porcelain veneers are that they provide a natural tooth appearance, stain resistant, and offer a conservative approach to changing a tooth's color and shape. Some disadvantages of porcelain veneers is that the process is nonreversible, usually not repairable should they crack or chip, may cause slight sensitivity to hot or cold, and teeth with veneers are still susceptible to decay. Individuals that clinch or grind their teeth are typically not good candidates for veneers because of the increase likelihood of chipping or cracking of the veneers. Please ask us how veneers can add to your natural appearance.







Wisdom teeth (Third Molars)
Wisdom teeth, or third molars, are the last to come in and can frequently cause problems. Most often, they are trapped in the jawbone or gums, and fail to come in at all. These impacted teeth can cause many problems; they may grow sideways, partially emerge from the gum, or even remain trapped beneath the gum & bone. Partial eruption can leave an opening around the tooth in which bacteria can grow and eventually cause infection. The results include swelling, stiffness, pain & illness. If these teeth are not removed, they will continue to grow damaging adjacent teeth. Extraction of third molars is typically recommended when the tooth is only partial erupted and no longer breaking through the tissue, eruption is causing crowding of other teeth, cyst formation that begins to destroy surrounding tissue and bone or taking preventative measures to avoid any possible complications in the future.


Dental Health of Longmont 303-678-1125
1260 South Hover Street, Unit H, Longmont, CO. 80501 Hours: 7:30-5 Monday-Thursday

Serving the preventative, restorative, cosmetic and dental wellness needs for Longmont, Berthod, Mead, Niwot, Dacono, Firestone and Frederick.

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