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FAQs and Glossary How many times per day should a person brush his or her teeth? When the brushing technique is efficient, one time would be enough. However, to secure good dental hygiene it is recommended to do it twice or three times per day, and especially before going to bed. How often should a person change a toothbrush? The toothbrush must have active filaments that are capable of eliminating plaque. The useful life of a toothbrush is no superior to three months because bristles then are too deteriorated. Is fluor only good for little kids? Fluor is an element that increases the resistance of teeth to cavities. Little kids and adolescents get the most benefit out of it but it is also useful for adult. Especially those who have exposed roots like the elderly and people who suffer from periodontal disease. Fluor helps them avoid root decay and cavities. Besides that, fluor is a great desensitizing agent. What is a profilaxis? A cleaning or profilaxis is a treatment that helps to eliminated tartar and stains from teeth. It is a preventive treatment because tartar build-up can cause gum disease (gingivitis, bleeding, periodontitis ...), cavities and bad breath. What is local anesthesia? It is a process through which an anesthetic is placed near one or more nerve endings or nerves. This substance produces a temporal blockage of the pain information to the brain and lets the dentist work without producing any pain in the patient. What is a sealer? A sealer is a preventive treatment which closes grooves, pits and fissures in teeth with a resin that prevents the appearance of cavities in places of high risk. It is very useful in little kids and adolescents. Should we forbid kids from eating sweets? Not, if the consumption is reasonable and good dental higiene is observed. What are cavities? Cavities or dental caries is a multifactorial disease which affects hard tissues in the mouth or teeth. A caries can appear only if the bacteria (microorganisms) get together to form plaque in the surface of teeth when sugar is present (fermented carbohydrates). The acid formed by the bacteria attacks the surface of teeth causing the destruction of the tissue and creating cavities. Good brushing technique removes and eliminates plaque and thus preventing cavities. Do teeth hurt when they have a cavity? In the initial phases teeth with cavities don’t hurt at all. However, when the lesion gets closer to the nerve it begins to hurt with cold and sweets. This is why it is important to frequently visit the dentist so he can diagnose cavities at their early stages. When do kids star changing teeth and when do permanent teeth erupt? Incisives start to be changed between five and seven and first molars erupt which are the first permanent teeth to come out. From that time and on, all teeth that erupt are permanent. Between fourteen and sixteen, all permanent teeth are present, except by wisdom teeth or thirds molars which can appear can finish forming at twenty four years of age. What should be done if a permanent tooth brakes? One should take the kid to the dentist with the fractured piece of tooth. If the tooth has come out due to an accident or because he has received a punch, it should be kept inside of the mouth or inside a bowl with milk while one gets to the dentist’s office. Why is it important to treat decidual teeth or milk teeth and molars? It is important because the future of the permanent dentition depends on milk teeth. Permanent teeth are beginning to develop and they are very sensible to infections caused by caries in milk teeth and molars. Permanent teeth could exhibit enamel defects in the future due to irregular calcification like changes in the color, shape, etc. Besides that, a healthy dentition will help the kid develop an adequate masticatory function. At what age should teeth start to be cleaned? Parents should help their kids clean their teeth from the moment they erupt. When they are three or four they can start doing it by themselves. The most important aspect about brushing is to keep an order, always starting in the same place using circular motion to avoid damage at the neck of teeth. How often should a kid visit the dentist? A kid should visit the dentist at least every six months or as often as the dentist recommends in each particular case. Can certain habits as the use of a pacifier or sucking of the thumb affect teeth? Yes, when habits are kept after two years of age because they interfere with the normal development of the maxillaries and could most likely cause a malocclusion in the future. What is a filling? A filling is a treatment that eliminates dental caries from a tooth and reconstructs the damage surface of the tooth. There are basically two types of fillings and many different sizes. There are black and white fillings. The black ones are a mixture of different metals and mercury and the white ones are resins. According to the size they can cover only a groove, a cavity or even affect the nerve. In this last case, a root canal would have to be performed. What is the best material to make a filling? Today, professionals have a wide variety of materials to make filling. Dental amalgam, for example, has been used during a hundred years while white fillings have been around for a couple of decades. Dental amalgam contains silver, mercury and other metals such as copper, zinc and tin. Composites or resins are materials that come from plastic that has been reinforced with glass and quartz. Resins come in different shades, so the dentist can choose the one that is most similar to the tooth. Which ones last longer? The duration of a filling not only depends on the material used (amalgams or composites), but also on the amount of destruction present in the tooth, the depth, location of the lesion and if there is compromise of the nerve or not. These factors influence the restoration regardless of its type. However, composites have proven to be less stable than amalgam and they suffer changes in color with time; especially if the patient consumes tobacco, coffee and tea. Does the nerve have to be removed to place a filling? No. Most of the time, if a tooth doesn’t hurt even if it has a cavity, is because the nerve is not affected. The treatment consists on the removal of the caries and the placement of a restorative material. In the other hand, if the tooth hurts; it means that the nerve is affected. Then a root canal would have to be done. The treatment is the same in a tooth that starts hurting once the filling is placed. Does it mean that the filling is poorly done? No. When fillings are very wide and deep, there is a possibility that they are sensible to cold and foods that are very acidic or sweet. Generally, these symptoms disappear in about 20 to 30 days. If the pain continues it may be necessary to replace the restoration or perform a root canal. A filling can prevent new cavities from appearing in the tooth? No. Fillings only replace tissues that have been destroyed by caries so that the function is restored. However if proper dental hygiene is not observed, the tooth can suffer from a new caries. Are sweet foods the main responsible one for caries? The main cause for caries to appear is the lack of dental hygiene, but the consumption of sweets can help in the development of this lesion; especially if these are consumed between meals and before going to bed. If the foods are sticky (cookies, gum, pies, etc) this is even more dangerous because of the amount of time that the foods are in contact with the surfaces of teeth. These foods aid in the adhesion of dental plaque to the enamel. Is the sensitivity of a tooth to cold, hot, and sweets a symptom of dental caries? When these symptoms are present it is necessary to go and see the dentist for a checkup. Most of the time, these symptoms are not a sing of caries, but of dental hyperesthesia (an increment of sensitivity in teeth). This situation can be decreased with the use of special toothpastes and mouthwashes. What is a root canal? When dental caries reaches the nerve and pain and inflammation are present. However, there are cases when the patient has no pain whatsoever. Not all teeth in the mouth are the same, because there are tooth that have one, two, three or more nerve endings. When a root canal is performed, the first thing that is done is to eliminate the caries and then the nerves are pulled out. Then the conducts where the nerves were are cleaned until everything is completely clean. After that, a sealant material is placed in the conducts. The complete process can be achieved in one or more appointments. Teeth that have received a root canal are weakened to gain access to the canals for the elimination of the nerves. Some times, post, cores and crowns need to be placed to completely restore the tooth. Can a tooth suffer from caries alter the nerve has been removed? Yes. The root canal treats the pain, but if the hygiene is not good, the tooth can suffer from caries again. This time, there will be no pain because there is no nerve. That is why periodic check ups are very important to detect early caries. Does a toot with a root canal need some sort of special treatment? A toot that has been correctly treated with the correct technique is just like the rest of teeth in its chewing capability and its response to external aggression. This means that caries can appear again. This is the reason to have adequate dental hygiene and regular check ups. What is orthodontics? Orthodontics is a specialty of dentistry that is concerned with the study, prevention and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jay relationships, or both. When is the best time to get an orthodontic treatment? It is important to visit the dentist when the kid is six years old to determine if this treatment will be necessary or not. It is also important to know if teeth are going to erupt in the right place and sequence and also to determine if the growth of the maxillaries is adequate. Can an adult person have an orthodontic treatment? Although it is important to insist in the early treatment, the adult treatment can be achieved in a multidisciplinary approach. Can all cases be solved? We have to be aware that orthodontic treatment has its limitations. Each case is different and unique and some times, it is necessary to combine orthodontic treatment with surgery or another type of treatment. Is orthodontic treatment painful? Orthodontic treatment is generally not painful. During the first days, braces can be uncomfortable, but discomfort disappears once the person gets used to it. If discomfort persists is always good to call the dentist and schedule an appointment. Is there some special care that needs to be taken when using braces? Teeth and braces need to be clean. Braces don’t cause caries, but they help leftover food to get trapped and this helps plaque attack teeth and produce decalcification. It is necessary to brush teeth regularly with the special toothbrushes that the dentist has recommended at least three times per day, and also use the mouthwash to help decrease plaque accumulation and inflammation. How should a person brush her teeth when he or she has braces? It is necessary to go to the special class where the dentist will teach you how to clean your teeth and braces. It is good to use the special brushes to clean in between the teeth and floss to remove leftovers. It is also good to use a mouthwash to prevent inflammation and keep plaque down. If the brushing technique is adequate, teeth and band will stay shinny. Does orthodontic treatment harm teeth? No. Braces are the instrument that dentistry uses to correct bit problems. Thanks to them it is possible to improve the state of teeth, gums and maxillaries. What happens as with all fixed apparatus, they aid with the retention of food and that is why it is so important to brush properly. What should be done if a kid looses his or her teeth too early? When this happens, the rest of teeth move to occupy the free space. If the loss affects a molar, it is desirable to use a space maintainer. This appliance keeps the space for the permanent tooth. The dentist will decide which type of space maintainer to use in each case. What are periodontal diseases? They are a group of illnesses that affect support tissues and that if not treated they provoke the loss of teeth. In the early stages, we find gingivitis which is produced by the accumulation of dental plaque between teeth and gums. Gums are inflamed and they bleed easily. When gingivitis is not treated, the following stage is called periodontal disease or piorrea. Periodontal disease is more severe because it directly affects support tissues and causes teeth mobility and root exposure. Who suffers the most from periodontal disease? There are no sex differences. But in some women, severe inflammation of the gums appears as a result of the menstrual cycle. And thus helps the appearance of periodontal disease. During pregnancy, periodontal disease can be worse due to hormonal changes. This process is completely reversible once pregnancy is over. Is it true that periodontal disease causes teeth to be lost? Yes. Although the process is very slow. If periodontal disease is not treated on time, it evolves until teeth are lost. Are these diseases frequent? Periodontal diseases together with dental caries are the most frequent pathologies of the mouth. What are dental implants? A natural tooth consists of a crown (the part you see above the gum), and the root (the part hidden under the gum, within the jawbone) and the root which holds the natural tooth in place. When a person is missing a tooth, the dentist must decide how to re-create the crown portion, and he must choose the best method to hold it in place. Dental implants were created for this purpose. In the past, dentists would try to keep or replace teeth with treatments such as root canals, bridges, and fixed or removable dentures. Unfortunately, a significant number of root canal treated teeth fail, bridges require that healthy adjacent teeth be cut down and removable dentures can often be unstable and require the use of sticky adhesives. Dental implants are a solution to these problems, and many of the concerns associated with natural teeth are eliminated, including dental decay. Dental implants were created for a person who has a missing tooth. They mimic the root of teeth with a metallic part and are placed into the jawbone where original roots of teeth once existed. They are natural-looking replacements for missing teeth that also provide the same function as your natural tooth root. They have also been used to anchor other types of restorations for greater success and patient satisfaction. These root-like cylinders are used to secure a replacement tooth in place in a spot where a tooth is missing. Dental implants are made out of surgical metal called titanium due to its compatibility with human biology. They are surgically placed in the jawbone, right in the dentist’s office, using a local anesthetic. Approved and tested implant systems are very successful. In fact, some have lasted more than 20 years with a better than 98% success rate. Patients who have good oral hygiene and take care of their new teeth can enjoy implants that last a lifetime. Single tooth implant When is this used? Single-tooth implants can be used in people who are missing one or more teeth. An implant is surgically placed in an opening that is made by the dentist in the jawbone. After the implant integrates (attaches) to the bone, it acts as a new "root" for the crown that will be replacing the missing tooth. A crown (cap) is attached to the implant and fills the space left in the mouth by the missing tooth. For this procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, a bone augmentation procedure might be necessary. In addition, natural teeth and supporting tissues near the implant site must be in good health How does it work? An implant-restored tooth consists of several parts. The implant, which is made of titanium, is placed in the upper or lower jawbone. One may have one implant for each missing tooth, or the dentist may skip one or more spaces because there's not enough jawbone to support the implant or implants or because the space is too close to a nerve or your sinus cavity. The abutment can be made of titanium, gold or porcelain. It is attached to the implant with a screw. This part connects the implant to the crown. Abutments can be pre-fabricated or custom made by the dental lab. The restoration (the part that looks like a tooth) is a crown (porcelain fused to a metal alloy) or a series of porcelain-fused-to-metal crowns (porcelain attached and fused to a substructure of metal). The crown or crowns are attached either to the abutment, to each other to form a bridge or directly to the implant. It can be screwed or cemented onto the abutment. If the crown is screwed to the abutment, the screw hole will be covered with restorative material such as tooth-colored filling material (composite). Implant-supported bridge What is it? An implant-supported bridge is similar to a regular dental bridge, but it is supported by implants and not by natural teeth. In most cases, when an implantsupported bridge is used, one implant is placed in the jawbone for each missing tooth and then, instead of placing a separate crown on top of each implant, the crowns are connected to each other to form one piece. When is this used? An implant-supported bridge is used when more than one tooth is missing. It also may be used when your dentist is concerned that you might put too much pressure on individual implants that are not connected to each other. For example, clenching or grinding your teeth can put a lot of pressure on individual implants and increase the chance that they will loosen from the bone and fail. If an implant-supported bridge is used, it reduces the pressure on the individual implants in the bone, and spreads it across the entire bridge. How does it work? In some cases, your dentist may not want to put an implant in a certain place in your mouth because there's not enough jawbone to support the implant, or because the implant would be too close to a nerve or sinus cavity (located above your upper teeth). In that case, your dentist can avoid the area by placing implants on both sides of the space, and then placing an implant-supported bridge on top. An implant-supported bridge also can be made similar to a traditional bridge where a crown can be suspended between two implant-supported crowns. Implant-supported Denture What Is It? An implant-supported denture is a type of overdenture that is supported by or attached to implants. A regular denture rests on the gums, and tends to fit less firmly in the mouth. An implant-supported denture is used when a person doesn't have any teeth in the jaw and implants have been placed to add firmness to the denture. An implant-supported denture has special attachments that snap onto attachments on the implants. Implant-supported dentures usually are made for the lower jaw because regular dentures tend to be less stable there. Usually, a regular denture made to fit an upper jaw is quite stable on its own and doesn't need the extra support offered by implants. However, you can receive an implant-supported denture in either the upper or lower jaw. You can remove an implant-supported denture easily. Some people prefer to have fixed (permanent) crown and bridgework in their mouths that can't be removed. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options. How Dos It Work? There are two types of implant-supported dentures: bar-retained and ball-retained. In both cases, the denture will be made of an acrylic base that will look like gums, with porcelain or acrylic teeth that look like natural teeth attached. Bar-retained dentures: A thin metal bar that follows the curve of your jaw is attached to the implants that have been placed in your jawbone. Clips or other types of attachments are fitted to the bar the denture, or to both. The denture fits over the bar and is securely clipped into place by the attachments. Ball-retained dentures or stud attached dentures: Each implant that has been placed in the jawbone holds a metal attachment that fits into another attachment on the denture. In most cases, the attachments on the implants are ball-shaped ("male" attachments), and they fit into sockets ("female" attachments) on the denture.