For years the main approach to treating tooth decay (or caries) could best be described as “drill and fill” — remove the decayed tooth material and fill the resulting cavity. But a new approach has come to prominence that addresses not only the results of decay, but seeks to identify and treat the underlying conditions that caused the decay in the first place, and may continue to infect other teeth.

This approach is known as Caries Management By Risk Assessment or CAMBRA. Rather than a “One Size Fits All” approach, CAMBRA individualizes treatment and prevention options by first assessing your own individual risk for tooth decay.

We base this assessment on what might be called the Caries Balance. On one side are factors that increase your risk of tooth decay, easily remembered by the acronym BAD: Bad bacteria that produces acid; Absence of healthy, functional saliva that neutralizes the effects of acid; and Dietary habits that are heavy with sugars, acids and between meal snacking. On the other side are protective factors that reduce your risk, known as SAFE — Saliva and sealants that protect the surfaces of teeth; Antimicrobials that help rid the mouth of bad bacteria; Fluoride, which strengthens teeth against de-mineralization caused by acid; and an Effective diet.

The assessment first involves a survey of questions about your hygiene habits, dental history and lifestyle: Do you brush twice and floss once daily? Do you live in a fluoridated area or use fluoride mouth rinse? Do you smoke? Have you had frequent cavities in the past? These and other questions, along with a complete dental exam and acid level testing, can give us a more accurate understanding of your risk and how best to incorporate treatment that reduces it even further.

Using CAMBRA, you and our dental team develop a true partnership that actually transforms your dental health from simply treating existing caries, to preventing future occurrences.

If you would like more information on the CAMBRA approach to caries prevention, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay: How to assess your risk.”

Once you receive your dental implants, you can have peace-of-mind in knowing that you have chosen a successful tooth replacement option, with long-term success rates of well over 95%. Your implant will look, feel and function just like the natural teeth that it has replaced.

However, despite the natural appearance, when you visit us for a regular cleaning, you may notice that we are using special instruments to clean around the implant. Cleaning around implants differs from the maintenance of your natural teeth for two reasons:

1. Your implants attach to the surrounding bone and gums in a very different way from your natural teeth.
2. The materials that comprise your implants are very different than those that make up your natural teeth.

Cleaning implants is just as important as cleaning natural teeth, because both depend on healthy surrounding tissues for support. Just as bacterial biofilm (plaque) collects on your natural teeth, it can also collect on your implant. That is why it is very important to brush and floss thoroughly on a daily basis at home. Without daily biofilm removal, the gums surrounding your implant can become infected, leading to bone loss and eventually loss of the implant.

Your regular dental cleanings will also play an important role in keeping dental implants infection-free, and we will select the right instruments for a professional cleaning. We will ensure that these instruments will not damage the crown, abutment, or the implant itself. If implants are scratched, they can attract and harbor bacteria. That's why the instruments we use, called scalers and curettes, are most often made of plastics and resins. Natural teeth don't scratch in the same way, and therefore metal instruments need to be used to clean them.

A number of power instruments have nylon or plastic sheaths or tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated on your implant. We use these on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush material.

When it comes to keeping your implants infection-free, keep in mind that the most successful formula will be consistent oral hygiene at home mixed with regular dental cleanings.

If you would like more information about maintaining your dental implants, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Dental Implant Maintenance.”

Participating in athletic activities offers numerous well-documented health benefits — not to mention instilling the intangible values of discipline, teamwork and goal-setting. Of course, in nearly every sport, the possibility of injury exists as well. But don't let that stop you or someone you love from playing! Instead, you can learn about the potential hazards of dental injury, and take some practical steps to minimize the risk.

It should come as no surprise that injury to the mouth is an ever-present possibility in so-called “collision” sports like football and ice hockey. But did you know that the greatest number of dental injuries result from the games of baseball and basketball, which are often played informally? Even non-contact sports like skiing, bicycling and skateboarding carry a real risk of injury.

Who suffers dental injury? Men are slightly more likely than women — but only by a small percentage. Injury peaks in the teenage years, and seems to decrease afterward — but older athletes tend to have more severe problems. In short, most anyone who participates in sports is subject to possible dental injury.

Besides the obvious aesthetic imperfections, a damaged or missing tooth can also result in functional problems with the bite — a potentially serious condition. If a tooth can't be immediately replanted, restoring it can be expensive: The total cost of each tooth replacement is estimated at $10,000-$20,000 over a lifetime. So tooth damage or loss can cause a multitude of troubles.

The American Dental Association (ADA) has recommended that participants in all of the sports mentioned above — as well as two dozen others — should wear a custom-fitted mouthguard. Why? Because when it comes to dental injury, an ounce of prevention really is worth a pound of cure.

Numerous studies have shown that wearing a custom-fitted mouthguard is an effective way to prevent dental injury. According to the Academy of General Dentistry, mouthguards prevent some 200,000 injuries each year. And the ADA says that athletes who don't wear mouthguards are 60 times more likely to sustain harm to the teeth than those who do wear them.

Off-the-shelf mouthguards in a limited range of sizes are available at many sporting-goods stores. But these can't compare to the superior protection and durability offered by a mouthguard that's custom-made just for you. Using an exact model of your teeth, we can individually fabricate a piece of protective gear that fits correctly and feels comfortable in your mouth. A custom mouthguard may be more economical than you think — yet its real payoff comes in preventing dental injury.

If you have questions about mouthguards or sports-related dental injuries, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Athletic Mouthguards” and “An Introduction to Sports Injuries & Dentistry.”

When it comes to childhood injuries — cuts and scrapes, growing pains, even wounded pride — it's often a parent's job to try and make things better. But sometimes it's hard to know whether the hurt indicates a serious problem, or if it's a situation that will resolve itself as soon as the sun comes up. If pain is being caused by a toothache, here are some general rules that can help you figure out what's the best thing to do.

1. Unless it's accompanied by fever and swelling, a child's toothache isn't generally an emergency.

The first thing to do is calm down (both you and the child) — and talk! Find out exactly where the pain comes from, and when and why it might have started. (Your child may have forgotten to tell you about that fall in the gym...) Sometimes, a little sleuthing will give you a clue about what's causing the pain.

2. Tooth decay, a bacteria-induced infection, is the most common cause of toothaches.

Check the teeth for brown spots or tiny holes (cavities) which might indicate decay — especially on the biting surfaces and in the areas between teeth. Next, look at the gums around the hurt tooth. If they show cuts or bruises, that's a sign of trauma. If you see only swelling, it may indicate the formation of an abscess.

3. If nothing looks obviously wrong, try gently flossing both sides of the tooth.

This may dislodge a bit of trapped food or candy, and relieve the pressure and soreness. But if that doesn't help, remember that some conditions — like nerve damage inside the tooth, for example — may have no apparent symptoms except pain.

4. Treat pain with an appropriate dose of acetaminophen or ibuprofen.

Base the dose on your child's age and weight, according to the medication's instructions. You can also apply an ice pack (one minute on, one minute off) to the outside of the jaw. But NEVER rub aspirin (or any painkiller) directly on a child's gums: It can cause burns and severe discomfort.

5. Pain that keeps a child awake at night, or persists into the next day, needs professional evaluation as soon as possible.

Otherwise, unless the pain resolves quickly and you're sure you know exactly what caused the toothache, it's best to bring your child in for an examination as soon as it's practical. You'll feel better having a dental professional, backed with years of experience and training, taking care of your child's health — and you just might prevent a future problem.

If you have questions about toothaches in children, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “A Child's Toothache.”

Porcelain laminate veneers are one of the innovative techniques dentistry has developed for restoring teeth to improve their color and shape so that they look as good as or better than the originals.

What are porcelain veneers? Porcelain is a ceramic material that is baked in a high-heat oven until it becomes glass-like. Your grandmother's antique china teacups are probably made of porcelain. Dental porcelains are especially made to perfectly mimic the color, reflectivity and translucency of natural tooth enamel. A veneer is a covering or shell, a false front; dental porcelains can be fashioned into veneers used to restore the enamel surfaces of teeth.

What is a laminate? A laminate is a structure created by uniting two or more layers of material together. Dental porcelain laminate veneers refer to the combination of tooth enamel bonding material and porcelain veneer.

When are porcelain laminate veneers used? Porcelain veneers are used to enhance the color of stained, darkened, decayed and heavily restored teeth. They are also used to: correct spaces between teeth; straighten slightly rotated teeth; correct problems in tooth shape and some bite problems. They can be good solutions for broken teeth or teeth that have been worn by habitual tooth grinding.

What is the process of placing the veneers? Room generally needs to be created to place a veneer; generally requiring about half a millimeter of reduction of tooth enamel. Artistic dental laboratory technicians fabricate veneers. About a week of laboratory time is usually needed to construct your veneers.

How do I know whether I will like the way my new veneers look? Computer imaging can be used to digitally replicate your teeth and create images of the proposed changes. Models of your teeth can be cast and changes can be made in white wax for your preview. Temporary veneers can also be fabricated as a test drive before the final veneers are fabricated.

How long will porcelain veneers last? Veneers can last 20 years or more. They are very strong but like glass, they can break if extreme force is applied to them. You should avoid such activities as opening bottles, cracking nuts, or biting into candy apples with your veneers.

How do I look after my new veneers? Once the veneers are placed, you should continue daily brushing and flossing. There is no higher incidence of decay around them than with your natural teeth. However, the more dental work you have in your mouth, the more vigilant you need to be. Of course, keeping your sugar consumption low helps to protect all of your teeth from decay.

Contact us today to schedule an appointment or to discuss your questions about porcelain laminate veneers. You can also learn more by reading the Dear Doctor magazine article “Smile Design Enhanced with Porcelain Veneers.”