Below are some of the most frequently asked questions patients have about dentistry and oral health issues.  If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

Click on a question below to see the answer.

What is Conscious Sedation?

This type of sedation induces an altered state of consciousness that can minimize pain and discomfort through the use of pain relievers (such as anesthetic) and sedatives. Patients who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider.  A brief period of amnesia may erase any memory of the procedure.

How can cosmetic dentistry help improve the appearance of my smile?

If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

What are porcelain veneers and how can they improve my smile?

Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

  • Severely discolored or stained teeth
  • Unwanted or uneven spaces
  • Worn or chipped teeth
  • Slight tooth crowding
  • Misshapen teeth
  • Teeth that are too small or large

Getting veneers usually requires two visits.  Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

The dentist will prepare your teeth, deciding the appropriate amount of tooth removal needed teeth  for the small thickness of veneers.  The veneers are carefully fitted and bonded onto the tooth surface with special bonding cements and occasionally a specialized light may be used to harden and set the bond.

Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.

What can I do about stained or discolored teeth?

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require additional at home bleaching to get the patients optimum whitening goal achieved (If achievable, your doctor will evaluate your expectations and your achievability of those expectations).  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one week.

Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile!

How can I tell if I have gingivitis or periodontitis (gum disease)?

80% of people have periodontal disease and don’t know it! Since the disease is painless in the early stages, it is common for those suffering from it to be unaware. Regular dental check-ups and periodontal exams are an important part detecting periodontal disease.

Periodontal disease begins when plaque, bacteria, food debris, and saliva are left on the teeth and gums. The bacteria produce toxins (acids) that inflame the gums and, if left untreated, will slowly destroy the bone. Regular brushing and flossing will ensure that plaque cannot build up and cause damage.

Poor oral hygiene isn’t the only cause of periodontal disease, though. Here are more factors that may increase the risk of developing gum disease:

  • Using tobacco products – Smokers or chewing tobacco users are more likely to have plaque and tartar form on their teeth.
  • Certain tooth or appliance conditions – If you have dental appliances like bridges that no longer fit properly, crowded teeth, or defective fillings, you have a higher risk of plaque and bacteria buildup in and around these appliances or teeth.
  • Certain medications – Some medications have side effects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums. Among the most common of these are steroids, cancer therapy drugs, blood pressure meds, and oral contraceptives.
  • Changes in hormonal levels – We can’t always control changes in hormones like puberty and pregnancy, but it’s important to know that these changes can cause your gums to become more sensitive to bacteria toxins.
  • Systemic diseases – Diseases that impact many of the body’s systems, such as diabetes, blood cell disorders, and HIV/AIDS, can increase your risk for periodontal disease.
  • Genetics – Patients with a family history of periodontal disease and tooth loss may be predisposed to these conditions.

Signs and Symptoms of Periodontal Disease

  • Red and puffy gums – Your gums should be pink and firm, never red or swollen.
  • Bleeding gums – This is one of the most common symptoms of gum disease. Your gums should never bleed, even from aggressive bleeding.
  • Persistent bad breath – Bad breath is caused by bacteria in the mouth. If your breath is consistently bad, it might be a sign that you have periodontal disease.
  • New spacing between teeth – Bone loss brought on by periodontal disease can create new spaces between your teeth.
  • Loose teeth – Bone loss or weakened periodontal fibers (fibers that support the tooth to the bone) is a cause of loose teeth.
  • Pus around the teeth and gums – This is a sign that there is an infection present. Seek dental care as soon as possible.
  • Receding gums – If your gums seem to be pulling back from your teeth, the cause may be gum disease.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria all irritate the gums and teeth, causing pain.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

What is dental phobia and why do so many people hate the dentist?

Dental phobia is a severe fear of the dentist that over time causes loss of teeth because of the patient’s inability to go to the dentist and receive regular care. The heart of the matter is that dental phobia can rob patients of their self esteem as they become embarrassed about the appearance of their teeth and withdraw from friends, coworkers and loved ones.

Why do people hate and fear the dentist ?

Fear of the dentist is most commonly something that patients learn from traumatic personal dental experiences. If these experiences occur as a child and are accompanied by a real sense of panic, the resulting reaction to the dentist may become deep seated, visceral and life-long. Such patients don’t feel safe in the dental chair. Patients recall of their traumatic childhood experiences often includes being held down against their will, being yelled at, pain and terror. A recent article in the Journal of the American Medical Association showed that people, who suffer abuse as children, may have life-long alterations in their response to stress. If a patient suffers from post-traumatic stress disorder, the dental office may be just one of many situations where such patients feel unsafe. Patients who suffer from panic attacks associated with dental care will do anything not to have that awful feeling again. Sedation, which can block the panic response, can be particularly helpful for dental patients with anxiety attacks.

Other patients may simply have difficulty getting numb after the dentist gives them an injection. If the patient is extremely anxious the patient may be sensitive to the slightest sensation because of the emotional component of their pain. Many patients may not be particularly anxious but still may feel pain during dental care because of anatomical reasons, the presence of infection or hypersensitivity of the tooth. Local anesthetics (AKA Novacaine, Novocain or Novocaine), used by dentists to numb the tooth or jaw may rarely cause patients to become excitable or anxious in large doses, especially in combination with epinephrine, a common additive. Newly developed injection techniques may help in these situations.

Some patients suffer from a severe fear of needles, also known as needle phobia. As a result people have trouble going to the dentist, and medical. A wide variety of techniques to help at the dentist are available, such as anesthetic pads or gels administered without piercing the skin. Patients can also be sedated with an elixir or pill before any injection.

What can be done to help people who avoid the dentist because of fear of pain or embarrassment?

If you have a severe fear of the dentist, the most important thing is to recognize that there are people ready to help you. Take the time to find the right person. Take the time to communicate your feelings and concerns to your dentist. Make sure the treatment plan that you and your dentist have chosen reflects your cosmetic and long term oral health goals. Choose a quality office that is dedicated to a high level of care and patient satisfaction. Make sure the dentist you’ve chosen has the tools to care for you comfortably and has the patience and experience to guide you through the complete treatment plan. Consider relaxation and distraction techniques available by the dentist such as deep (diaphragmatic) breathing, or headphones.

Oral medications such as a Valium, or something similar, can be used to help you relax and feel more comfortable during long procedures. Intravenous sedation or even general anesthesia may be best for very anxious patients who won’t have dental procedures any other way. Patients who have a very sensitive gag reflex, or have a lot of trouble getting numb with dental injections can also benefit from intravenous sedation. Nitrous oxide (sweet air, laughing gas) also provides pain relief and distraction. Nitrous oxide does help relieve anxiety as well as Valium and its related medicines when taken orally or intravenously. All medications should be administered by dentists (called Dental Anesthesiologists, or sometimes Sleep Dentists) who are well trained and experienced for the best and safest experience. Sedation Dentistry, also called Sleep Dentistry can be a beneficial way for patients to experience dental care without fear, pain or anxiety. Most importantly, it is possible for you to have your dental care in comfort.

What should I do if I have bad breath?

Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

  • Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
  • Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
  • Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
  • Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
  • Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
  • Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
  • Tobacco products – Dry the mouth, causing bad breath.
  • Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
  • Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
  • Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with you dentist.

What can I do to prevent bad breath?

  • Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
  • See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
  • Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
  • Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
  • Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

How often should I brush and floss?

Routine brushing, flossing, and good dental hygiene are the only ways to control the formation and growth of plaque. If plaque is not removed, it turns into tartar (calculus), which can begin to destroy the gums and bone, causing gum disease.

Brushing – You should brush your teeth at least twice a day (especially before going to bed) with an ADA-approved soft bristle brush and toothpaste.

Tips for brushing your teeth:

  • Angle your brush at a 45 degree angle to the gums. Gently brush with a small, circular motion, ensuring that your bristles always reach your gums.
  • Brush each surface of each tooth: outer, inner, and biting surfaces.
  • Don’t forget to brush your tongue to remove bacteria and freshen your breath.
  • We recommend electric toothbrushes, as they are easy to use and can remove plaque efficiently. They are widely available at a range of price points to fit every budget.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. In addition to cleaning these spaces, it prevents plaque from building up and causing damage to the gums, teeth, and bone.

How to floss your teeth:

  • Wrap 12-16 inches of dental floss around your fingers, leaving about 2 inches of floss between the hands.
  • Guide the floss between your teeth, using a sawing motion.
  • Floss under the gumline and around the sides of each tooth by curving the floss into a “C” shape and gently moving the floss up and down.
  • If you have difficulty using conventional floss, try a floss holder.

Rinsing – Rinse your mouth with water after brushing. If you are unable to brush your teeth after a meal, it is a good idea to rinse with water. If you are using or would like to begin using a mouthwash, consult with your dentist or dental hygienist to discuss whether it is necessary for you.

Are amalgam (silver) fillings safe?

Over the years there has been some concern as to the safety of amalgam (silver) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth.  The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe.  Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective.  The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling.  The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels.  For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them.  However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings.  We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

How often should I have a dental exam and cleaning?

You should have your teeth checked and cleaned at least twice a year. Depending on your dental health history, your dentist or dental hygienist may recommend more frequent visits.

At your twice-yearly checkups, we will clean your teeth and check for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. Learn more about what a dental exam includes and why they’re so important.

Why is it important to use dental floss?

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

Dr. Dan Davidian

This page was reviewed and approved by Dr. Dan Davidian, DDS. Dr. Davidian received his Bachelor of Arts at East Carolina University. He continued on to graduate from UNC School of Dentistry with his Doctorate of Dental Surgery. Dr. Davidian has completed additional training in Advanced Life Support Skills at UNC and received his sedation training with the American Dental Society of Anesthesiology.

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