A:

Dental implants are an excellent option for restoring one or more missing teeth.  You can think of the typical implant as a carefully engineered screw that has a thread on the outside surface to allow it to be placed securely into the jawbone, and an internal thread that will ultimately allow for a connection to the tooth or teeth that will replace the missing ones.  Most implants today are made of a surgical grade titanium alloy.  Implant companies are very careful to design and manufacture implants to ensure that all of the necessary parts fit together very precisely.  One of the reasons why we are highly selective in which implant companies we use for our patients is to ensure that the quality control and long-term availability of parts is there - we expect your dental implant to last for many years, far longer in most cases than with other restorative options.  Dr. Tanabe will discuss treatment risks, benefits, and options with you prior to moving forward with treatment, and you should have a really good understanding of what to expect during the healing period and how the replacement tooth or teeth will be made by your restorative dentist once the implant has healed.

For a single tooth replacement, the dental implant is carefully positioned within the jawbone, essentially replacing the root of the missing tooth.  This surgery can range in complexity depending on your individual situation.  In some cases the implant can be placed on the same day the tooth was removed.  In other cases, a delay after extraction may be recommended for the best results.  Once the implant is ready to be restored, an impression will be made of your implant and the surrounding teeth and a restoration will be designed by your dentist to fit precisely into your mouth.

If more than one tooth is missing, it is possible to design replacement teeth that will be supported by two or more dental implants.  These replacement teeth may be connected directly to the implants in a semi-permanent fashion, or the implants may have attachments placed that will stabilize a removable set of teeth.  The particulars of your individual case will dictate what options you have, and your restorative dentist and Dr. Tanabe will help you make an informed choice. 

For someone who has struggled to function with dentures that are not adequately stable or comfortable, dental implants may be a wonderful solution.

Keep in mind that with almost everything in dentistry, there are treatment alternatives that must be considered.  Your dentist and Dr. Tanabe can review the pro’s and con’s of dental implants compared to bridges, dentures, or even no treatment.

A:

You may have heard about how painful a “dry socket” is from someone who had one after a tooth was removed.  Or you may have been unfortunate enough to have experienced one yourself.  Either way, dental professionals and researchers are still not absolutely sure what causes a dry socket, nor can we predict who will get one.  So unfortunately, we haven’t figured out how to prevent them.

A dry socket occurs when the healing blood clot that usually forms in the socket of the extracted tooth is lost – hence the socket is now bare or “dry” instead of filled with the protective clot.  And the walls of the bony socket that should be covered are now exposed, leaving sensitive nerve endings exposed. 

The main symptom of a dry socket is almost always severe throbbing pain that radiates along the jawline.  This pain generally starts on the second or third day after an extraction.  The patient may also have a bad taste and/or odor from the mouth.  There are many treatment solutions, and generally your surgeon will do what works best in his or her experience.  Common solutions include gentle debridement of the socket to remove food debris and/or packing the socket with a dressing and medication.  There are cases where there is an active infection at the surgical site, but there is no solid scientific evidence that dry sockets are caused by bacteria.  So not all cases will require antibiotics, and the fact that you may not have been given a prescription for antibiotics after your surgery doesn't mean that a dry socket would have been prevented if you had been given antibiotics.

In simple terms, after a tooth is removed there is a hole left behind in the jaw.  The size of the hole depends on the size of the roots, whether or not the tooth was impacted or buried under the gums or bone, how much bone had to be removed to get the tooth out, and whether or not there was any pathology or infection present that may have eaten away at some of the surrounding bone.  Essentially, the hole left behind after the extraction is the size of what was removed from the bone.  The more complex the extraction and the more surgical time spent to remove the tooth seem to be factors in who gets a dry socket.  Research indicates that there are non-surgical factors that may make a patient more susceptible to dry sockets – smoking, birth control pills, poor oral hygiene, and older age. 

After an extraction, the body heals this hole by first filling it with a blood clot.  Over time, the gums close over the hole, and eventually bone fills the space where the roots or tooth was once embedded within the jaw.  So development and retention of this blood clot is the key to preventing a dry socket.  Gentle and skilled surgical technique may be the best way to minimize risk of a dry socket, but even with that there is a certain percentage of cases - research says between 1-5% - that will occur for no foreseeable reason.

A:

We all hear this term used as commonly as “baby teeth”, but how did the term wisdom teeth come to be?  We understand that our primary teeth, or baby teeth, start erupting into the mouth within the first year of life and are maintained until they get loose and fall out when our secondary teeth develop and make their way into the mouth.  And it is generally known that our main chewing teeth are our molars.  Our molars come in three’s with the first molars typically erupting at around 6 years of age, the second molars at around 12 years of age, and the third molars – otherwise known as wisdom teeth – developing in the teens.

So if you look back at Greek and Roman ancient history, with a lifespan certainly more limited than ours is today, you can see how the late teens in that era would be associated with a certain maturity and prudence, and therefore wisdom.

So assuming that we believe that the term “wisdom teeth” derives from a more ancient time when teenagers were at mid-lifespan, why do we still have them?  From an anthropologic standpoint, it may be true that the jaws of ancient man were larger and could accommodate for more teeth, and a more organic diet would include rougher textures that would wear teeth down in comparison to our refined, modern diet.  It also makes sense that in earlier times when dental hygiene was not as commonplace as it is today, more teeth would be lost prematurely which would create both a need for and space for these wisdom teeth.  But now, more often than not, if the wisdom teeth make an appearance there simply is not enough room for them to erupt into a functional and hygienic position.

In cases where there is adequate room to maintain these teeth as cleanable and useful molars, there may be no good reason to remove them.  And if they are discovered on x-ray later in life, but have remained quiet and caused no problems, often times it is more prudent to retain them as the surgical risks are greater than taking the chance that they create a problem down the road. 

But where the wisdom teeth are starting to emerge through the gums but have no reasonable chance of erupting fully into a maintainable position, it is often wise to remove the them in those teenage years to prevent infections, damage to adjacent teeth, and to minimize the risk of injury to vital structures such as nerves if the teeth were to develop further.

As always, each case is different and there may be other reasons to retain or remove wisdom teeth.  Your dentist may refer you to an oral surgeon for an examination and to discuss your treatment options.

A:

How dental insurance works: Many of our patients have dental insurance coverage as a benefit of employment.  Alternatively, some patients pay for their dental insurance on their own.  Dental insurance is a contract that is made with a dental insurance company.  The insurance company has negotiated the benefits you receive under the terms of the contract, not your dentist or our office.  No relationship exists between our office and the insurance company.  In some cases, surgical treatment that you need or want may not be covered by your insurance plan.  It is also likely that the treatment covered by your insurance is not paid at 100%, and in fact may even be paid at a lower percentage in our office than in your dentist’s office.  You may also have a deductible that you must pay each year.  If your deductible has not been met by the time of our treatment, it will be included in your share of the payment.

What we do to help you: We have extensive experience in helping you obtain the highest level of benefits to which you are entitled.  We will use all of our resources to get as accurate an estimate as possible for your treatment.  We will review the amount of benefit provided under your dental insurance coverage with you, and we will inform you of your estimated share of the payment.  As a courtesy to you, we will also complete and submit your dental insurance forms for you.  Because the insurance reimbursement process is often very complicated, please understand that we may need to request your assistance in certain cases to help us process your claim.  In rare cases, and despite our best efforts, our office may not be able to resolve every issue with your insurance company.

If you find it necessary to know the exact amount of coverage from your insurance company, you may request that our office send in a pre-determination of benefits prior to treatment.  This process may take up to six weeks, but it may be the only way to confirm the correct benefit information.  Oral confirmations are estimates and may not always be accurate.

Our office will do everything we can to help you maximize your insurance benefits.  Please understand that in the event your dental insurance company fails to pay for all or part of your treatment, you are responsible for all fees.  If the insurance company pays less than our estimate, we will bill you for the balance; if we are paid more than our estimate, we will promptly refund what you overpaid.  You are entering into a relationship with our office in which the doctor agrees to provide treatment and you agree to pay for that treatment.

Our philosophy: Our office is dedicated to providing the best possible care for all of our patients, and assisting in the complicated process of dental insurance claims is one of the ways we try to help you.  Please feel free to ask us about any part of the billing process.  

A:

Bad breath, or “halitosis”, is something that everyone deals with at least some of the time.  Many of us do not even realize that we have bad breath, but it can certainly be unpleasant and embarrassing. 

The main cause of bad breath is probably bacteria in the mouth.  Even in a healthy and well-maintained mouth, there are millions of bacteria present at any given time.  If a person has poor oral hygiene the bacterial count increases, and combined with the food debris that may be collecting around and in-between the teeth, you can imagine that this is a 24-hour buffet for the bacteria.  Who would want to leave that party?  And as the gums and bone structure break down over time, colonies of bacteria can embed themselves into the crevices that are now nearly impossible to eliminate without the expertise of a dental professional.

Dental restorations may also be a collecting ground for bacteria.  If a filling is cracked, even a little bit, or if a crown does not fit precisely, then bacterial colonies can move in.  And patients who wear dentures but do not clean or maintain them properly will get bacteria embedded in the plastic, leading to bad breath.

Saliva is an important part of how our body naturally cleanses our mouths.  Sometimes a medical condition can cause a decrease in salivary flow, and several medications do the same.  Patients who have persistently clogged nasal passages may breathe through their mouths, and this can also dry the mouth significantly.  A dry mouth alters the normal environment of the mouth and can lead to an increase in bacterial count, causing bad breath.

Smoking is another one of those habits that can dry the mouth, cause damage to the gums and bone, and leave behind a chemical residue that causes bad breath. 

Some foods can create bad breath in a number of ways as well.  Garlic, onions, and other extra-flavorful foods can leave residues behind in the mouth, create gas in the stomach that adds odor to our breath, and even may be breathed out through our lungs. 

The best defense against bad breath is effective home care with a toothbrush and dental floss combined with regular maintenance visits to your dentist.  There are many dental products out there that promise to cure your bad breath, and some are more effective than others.  If you have good hygiene habits and add oral health care products that work for you, bad breath episodes can be minimized.  Just keep in mind that there are many factors involved in creating bad breath, and unfortunately it happens to every one of us.

A:

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

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: 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 (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

A:

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.

• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.

• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.

• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.

• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.

• Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen.

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.

• Persistent bad breath – Caused by bacteria in the mouth.

• New spacing between teeth – Caused by bone loss.

• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).

• Pus around the teeth and gums – Sign that there is an infection present.

• Receding gums – Loss of gum around a tooth.

• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

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

A:

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!

A:

With many state-of-the-art dental treatments and prevention options available in dentistry today, there are fewer reasons for having to extract (remove) teeth.  When something does go wrong with a tooth, we try to do everything possible to restore the tooth to its original function.  Removing a tooth is the last option because we know that removal may lead to severe and costly dental and cosmetic problems if the tooth is not replaced.

Losing a tooth can be a very traumatic experience and it’s very unfortunate when it does happen.  Injury, accident, fracture, severe dental decay, and gum disease are the major reasons for having to remove a tooth.  If teeth are lost due to injury or have to be removed, it is imperative that they be replaced to avoid cosmetic and dental problems in the future.

When a tooth is lost, the jaw bone that helped to support that tooth begins to atrophy, causing the teeth on either side to shift or tip into the open space of the lost tooth.  Also, the tooth above or below the open space will start to move towards the open space because there is no opposing tooth to bite on.  These movements may create problems such as decay, gum disease, excessive wear on certain teeth, and TMJ (jaw joint) problems.  These problems and movements do not result immediately, but will eventually appear, compromising your chewing abilities, the health of your bite, and the beauty of your smile.

Options for replacement of missing teeth:

Removable bridges - This type of bridge is a good solution for replacing one or more missing teeth, especially in complex dental situations where other replacement options are not possible. They are usually made of tooth-colored, artificial teeth combined with metal clasps that hook onto adjacent natural teeth. Removable bridges are the most economical option for replacing missing teeth, but may be the least aesthetically pleasing. This is because the metal clasps on the appliances are often impossible to completely conceal.

Fixed bridges - This type of bridge is generally made of porcelain or composite material and is anchored (cemented) permanently to a natural teeth adjacent to the missing tooth site. The benefit of this type of bridge is that it is fixed (not removable) and it is very sturdy. The disadvantage is that in order to create a fixed appliance, two healthy, natural teeth will have to be crowned (capped) to hold the bridge in place.

Dentures - This type of tooth replacement is used when most or all of the natural teeth are missing in one dental arch. Dentures are removable artificial teeth that are made to closely resemble the patients’ original teeth.

Implants - Are a great way to replace one or more missing teeth. They may also be great to support ill fitting dentures. A dental implant is an artificial root that is surgically placed into the jaw bone to replace a missing tooth. An artificial tooth is placed on the implant, giving the appearance and feel of a natural tooth. Implants are very stable, durable, and are the most aesthetically pleasing tooth replacement option.

If you are missing teeth, ask us if they need replacement and what options are available to you. Together we will select the best replacement option for your particular case. Prevention and early treatment is always less involved and less costly than delaying treatment and allowing a serious problem to develop.

A:

We’re all at risk for having a tooth knocked out.  More than 5 million teeth are knocked out every year!  If we know how to handle this emergency situation, we may be able to actually save the tooth.  Teeth that are knocked out may be possibly reimplanted if we act quickly, yet calmly, and follow these simple steps:

1. Locate the tooth and handle it only by the crown (chewing part of the tooth), NOT by the roots.
2. DO NOT scrub or use soap or chemicals to clean the tooth.  If it has dirt or debris on it, rinse it gently with your own saliva or whole milk.  If that is not possible, rinse it very gently with water.
3. Get to a dentist within 30 minutes.  The longer you wait, the less chance there is for successful reimplantation.

Ways to transport the tooth

• Try to replace the tooth back in its socket immediately.  Gently bite down on gauze, a wet tea bag or on your own teeth to keep the tooth in place.  Apply a cold compress to the mouth for pain and swelling as needed.
• If the tooth cannot be placed back into the socket, place the tooth in a container and cover with a small amount of your saliva or whole milk.  You can also place the tooth under your tongue or between your lower lip and gums.  Keep the tooth moist at all times.  Do not transport the tooth in a tissue or cloth.
• Consider buying a “Save-A-Tooth” storage container and keeping it as part of your home first aid kit.  The kit is available in many pharmacies and contains a travel case and fluid solution for easy tooth transport.

The sooner the tooth is replaced back into the socket, the greater the likelihood it has to survive and possibly last for many years.  So be prepared, and remember these simple steps for saving a knocked-out tooth.

You can prevent broken or knocked-out teeth by:

• Wearing a mouthguard when playing sports
• Always wearing your seatbelt
• Avoiding fights
• Avoid chewing hard items such as ice, popcorn kernels, hard breads, etc.

A: We do our best to obtain accurate information from your insurance company to try to get an estimate of what you will need to pay for your procedure.  We ask that you be prepared to pay the portion that we calculate in full on the day of treatment, and we accept cash, credit cards, and personal checks.  If there is a balance due after the insurance company pays, we will bill you.  If there is an overage, we will issue you a refund promptly.