Frequently Asked Questions

Brushing What is Dental Decay? Simply, dental decay is a bacterial infection of the tooth. Everyone's mouth is full of bacteria - both good and bad. In a healthy individual, with a healthy diet, a balance occurs which keeps the bacteria and the decay process in check. As far as the su rface of the teeth are concerned: demineralization (loss of minerals) and remineralization (gain of minerals) is constantly occurring based on features of the surrounding environment of the mouth. When acidity of the mouth increases (pH below 5.5) the teeth lose minerals faster than they can gain them. This weakens the teeth and they become more prone to the bacterial invasion. This is dental decay. Is brushing enough? A tooth has five sides. Even if you brush perfectly you are only removing the bacteria from 3 sides. Bacteria which form in between the teeth can only be removed by flossing. *Reminder: water pics and tooth pics do not remove bacteria.

How Important is diet? Your diet is very important. Actually dental decay can be controlled by diet alone. By controlling the types of food and drinks you buy, you can prevent 90% of the decay we see in children. Soda and Sports Drinks Drinking pop is double trouble. A 12 oz. can of soda contains 10 sugar cubes and has the acidity of pH 2.3. Sports drinks have an acidity of pH 2.7. To put the pH levels in perspective: water, which is neutral, has a pH of 7 and the acid in you car battery has a pH of 1. Diet sodas also have phosphoric acid added to them. The sugars in the soda feed the bacteria around the teeth creating a highly acidic environment. The sugars also multiply the number of bacteria in the mouth. In addition, the acids themselves weaken the tooth surface enabling additional bacteria to invade the tooth surface. Fluoride There are two main types of fluoride used in dentistry. Digestible fluoride which is distributed through drops or tablets and surface fluoride which is placed directly on the teeth through toothpaste, swish-swash programs and topical treatments in the dental office. Digestible fluoride works on the developing tooth. Fluoride ions are absorbed into the body and bond to the developing tooth making the "entire" tooth harder and not just the surface of the tooth. Do medications cause dental decay? Yes, but they do so indirectly. Remember a healthy mouth contains many types of bacteria which remain in balance. Your saliva is essential to maintaining this balance. Decreased saliva flow is a common side effect of many medications. With decreased saliva flow or xerostomia, the acid loving and acid producing bacteria take over resulting in active uncontrolled decay. What types of medications cause decreased saliva flow? Actually, over 400 prescription drugs and many over OTC (over the counter) drugs cause xerostomia. Some of the more common are: antidepressants, antihypertensives, antihistamines, diuretics, antipsycotics, decongestants, and opiads. Illicit drugs like metamphetamines and cannabis also cause "dry mouth". In addition, systemic disorders like Sjorgen's Syndrome, TB, HIV, and uncontrolled diabetes can cause "dry mouth" symptoms. Habits like tobacco and alcohol use also contribute to the problem.

Grinding or "Bruxism" and clenching of ones teeth is a fairly common malody in our modern stress driven society. In fact, Bruxism affects 30-40 million children and adults in America. Most people do not know they are bruxers because it occurs in the deepest levels of sleep and only for short periods of time. Since people can generate 300-400 lbs. of pressure on their teeth when they brux the results can be very destructive. Headaches, earaches, cracked and broken teeth, and hypersensitivity of teeth to hot and cold are some of the the more common symptoms of bruxers. In addition, broken crowns and bridges, jaw pain, and worn teeth enamel can occur exposing deeper more sensitive areas of the tooth. Bruxism seems to be common in personality types who tend to internalize anger and coping with stress. Custom fitted nightguards protect the teeth and restorations and help "remind" the brain not to brux. Pictured on right is a 43 year old female with severe bruxing habit as evidenced by extreme wear on the gold crown.

Proper Dental Hygiene is the cornerstone of successful dentistry and long-term retention of natural teeth. The naturally occurring bacteria of the mouth form a "film" on the surface of the teeth every 6-8 hours. Every 24 hours these bacteria organize into colonies and begin producing acids and toxins. The toxins invade the gum tissue resulting in a low grade infection called "gingivitis". This is a precursor of periodontal disease or Pyorrhea which is responsible for 90% of adult tooth loss. In addition, other bacteria invade the teeth themselves. This process is called dental decay or dental carries. As people age, and if they have not followed up with regular cleanings or dental prophylaxis, the film calcifies forming a hard, crusty substance called tartar. The tartar or calculus is 90% bacteria. The surface of the tartar is active bacteria and removing this layer can only be done with a professional dental cleaning. Our hygienists use "state of the art" techniques to remove tartar in the most efficient and comfortable way possible.

For most people, twice a year should keep tartar formation to a minimum. As people age, and depending on their home care, tartar may accumulate more often requiring more frequent cleanings. Also patients with active periodontal disease require more frequent treatment. The good news is that insurance companies recognize the importance of regular sixth-month cleanings. They often pay at 100% for this preventative service.

For 90% of people with bad breath the cause is not brushing or flossing correctly on a consistent schedule. The bacteria in dental plaque (which forms every 6-8 hours) produce gases which are the main culprit in "bad breath". Its important to remember these bacteria originate on the tongue. Brushing the tongue helps in reducing their numbers. Other factors include smoking, stress, eating certain foods, and various systemic disorders like diabetes, alcoholism, and certain types of cancers. Medications leading to "dry mouth" also contribute to "bad breath".

Even though children do not collect a lot of tartar, regular dental cleanings are important. They give us a chance to evaluate and remind the child of the importance of their home care. The application of topical fluoride helps to harden the teeth and make them more decay resistant. Caries (cavities) tend to progress quickly in children. Their enamel, large pulps, questionable flossing habits and sugary diets work against children as they try to prevent dental decay.

This is a term meant to describe periodontal scaling. Individuals who have had a more advanced form of gum disease "periodontitis", require a more technical cleaning. Periodontal disease results in the loss of supportive bone around the teeth. Pockets which harbor bacteria then form. These areas cannot be cleaned with normal brushing and flossing.

A filling is a way to restore a tooth damaged by decay back to its normal function and shape. A filling is also used to change or modify a tooth's appearance for cosmetic reasons. What are Amalgams (silver/mercury) fillings made of? Amalgam fillings are made up of a combination of metals (silver 65%; Copper 6%; Zinc 2%; and Tin 25%) bound together in a mixture with 50% mercury. Even though they have good longevity there are some significant downsides. Mainly the silver fillings leak. Bacteria seep under the restorations and they re-decay. Also the mercury expands and contracts with hot and cold temperatures.This causes the teeth to break and split What are Bonded Composite (tooth colored) fillings made of? Composites are the other type of common restorations. They are a combination of plastic and micro glass particles. Composites are chemically bonded to the tooth to create a "seal". Instead of weakening the tooth, composites can restore up to 85% of the tooth's strength. The good news is that they also return your tooth to its natural color. Bonded composites are made with tooth colored material, not silver. What fillings do our office use? Our practice is and has been "mercury free" for over 20 years. We treat decay by bonded composite restorations only.

Amalgam Restorations, more commonly referred to as Silver/Mercury fillings, were the standard from the 1930's to the mid 1990's. Today bondable composites are the new standard. The picture on the left shows a failing restoration. The dark coloring indicates caries or dental decay which exists along the side of the restoration due to the inability of the amalgam to seal to the tooth. The second picture shows the decay present after the removal of the old restoration. Note the cracking of the tooth which is a result of years of expansion and contraction from the mercury in the amalgams. Dental xrays will not show this type of decay. The final picture shows the end result of a new bondable composite restoration.

Whitening is a relatively quick, easy, and inexpensive method of improving your smile. In many cases whitening alone will give you the smile of your dreams. Many methods are available but the bleach dispensed by the dentist in custom trays has been shown to be the most effective method with no damage to your teeth. "How white will my teeth be after whitening?" Clinical studies show that treatments average about nine shades lighter. Results vary, of course, because everyone's teeth respond differently. In most cases, results are dramatic. The goal is to achieve your own optimal, natural whiteness. The dentist reviews the result that can be expected. "How long will it last?" Long-term results depend mostly on the patient. Tobacco, coffee, tea, dark soft drinks and lax attention to dental care can work against the results. Regular professional care will help maintain a new smile for up to a year. "Is it safe?" Yes. The procedure does not soften enamel or existing fillings. For more than 100 years, dentists safely used hydrogen peroxide, the main ingredient in the whitening gel. The dental community considers this material an effective whitening ingredient. The percentage of hydrogen peroxide used in the special gel is 15 percent, much lower than the higher 22 to 35 percent in other in-office whitening gels. "Will my dental insurance cover this procedure?" As with most cosmetic dental treatment, insurance will not cover the cost. "Is this procedure for everyone?" Just about every person seeking a lighter smile can benefit from a brighter smile, including those with severe coffee, food, tobacco or tetracycline stains. An exam before the procedure will determine promising candidates for whitening. People with a history of TMJ problems, extreme sensitivity to hot and cold food or drinks, and those with many fracture lines in teeth may not be candidates. "Will the procedure whiten existing crowns, veneers, bondings?" The treatment successfully removes stains from caps, veneers or bonded teeth. But a whitening treatment in general cannot change the color of crowns, veneers or bondings. A consultation with a dentist will help determine what to expect. "Can I have this done if I am pregnant?" While there are no known constraints for women who are pregnant, some might experience gum sensitivity. Pregnant women might wish to delay the procedure until after pregnancy. "How can I maintain my new whiter teeth?" Brush twice daily or after each meal. Floss daily. Use a whitening toothpaste and a soft-bristle toothbrush. Visit your dentist for regular hygiene visits and check-ups at least every six months.

Veneers are thin tooth colored coverings bonded on the front of teeth. They are usually used to improve the appearance of one's smile. They can rearrange or reshape the teeth, improve the color, and fill in gaps. Does the porcelain veneer cover the entire tooth? A porcelain veneer generally covers only the front and top of a tooth. When is a porcelain veneer the best choice of treatment? Porcelain veneers are often the best treatment to close spaces between teeth, lengthen small or misshapen teeth, or to whiten stained or dark teeth. Are there any other advantages to porcelain veneers? When teeth are chipped or beginning to wear, porcelain veneers can protect them from further damage and restore their original appearance. Will it feel like there are bulky coverings on the teeth? Once in place, the porcelain veneers virtually become part of the teeth. We can use them exactly as our own teeth, because the bond is extremely strong. The final result: natural, beautiful looking teeth. What determines the color and shape of the porcelain veneers we choose? The shape of the face, whites of the eyes, skin tones, height, and body type of the patient are factors in designing porcelain veneers. Do porcelain veneers look as natural as original teeth? The luster, shine and translucency of porcelain make it a near-perfect copy of natural enamel. How long do porcelain veneers last? Porcelain veneers last between ten and twenty years. Porcelain is a strong, highly resilient material that will not stain or wear from brushing. And the thin façade of porcelain that is bonded to the enamel becomes extremely strong-and durable!

A root canal is a procedure that repairs and saves a badly damaged or infected tooth. The pulp (center of tooth) is removed and replaced with an invert material. A root canal is also known as endodontic treatment. Why is a root canal needed? Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. Is there alternate treatment? The only other treatment that can be done is the removal of the tooth. What does the procedure involve? The damaged pulp is removed, the canal of the tooth is then cleaned, disinfected, filled and sealed with an invert material. After the root canal is done, is there any other treatment that is needed? Yes, once the tooth has a finished root canal, the tooth will be closed with a filling or build up. Often times, the tooth will need to be treated with a crown.

A dental crown is a tooth shaped cap that is cemented over a tooth. Crowns are used to hold weak, broken or cracked teeth together. They are also used to restore the strength of the tooth, change the shape and size of the tooth and improve its overall appearance. Special Crowns are used for the restoration of dental implants. How many appointments will I need? The dentist will require two dental visits to prep and cement the crown. First the dentist will need to prepare the tooth for the crown to be fitted over it. He will take an impression to send to the lab so that they can make the crown. The creating of a crown at the Dental Lab is a complex and exacting procedure. Think of each crown as a hand-made piece of jewelry. What happens to the tooth when I wait for the crown to be made at the lab? The patient will leave the office on the first appointment with a temporary crown. The second visit will be a couple weeks later when the crown is ready. The dentist will remove the temporary crown and cement the new crown on to the tooth. How long will the crown last me? A crown will generally last five to ten years, and with good oral hygiene will last much longer. Once the tooth is crowned can it still get a cavity? Yes, if plaque is allowed to collect at the margin of the tooth, a cavity can begin. You still need to brush and floss a crowned tooth the same as all your other teeth. Also, maintain regular dental exams so your dentist can monitor crowns that you have.

A dental implant is a titanium post (like a tooth root) that is surgically positioned into the jawbone beneath the gum line that allows your dentist to mount replacement teeth in the area Can implants replace multiple teeth? Yes. Implants are a great way to replace single missing teeth as well as multiple teeth replacement. Implants can be used with dentures to snap in right over your implants to help secure your loose denture. Once the implant is placed how long do I have to wait to get a tooth? Once the implant is placed, it takes 3-6 months for the implant to completely integrate into the bone and be ready for the restorative portion of your treatment. After it has fully integrated you may return to your general dentist for the final restoration. Why do people get Dental implants? Dental implants are the most conservative method of replacing missing teeth. They have the highest success rate with the lowest rate of recurrent problems. Dental implants are the closed replacement to your natural teeth. What is the success rate of a dental implant? Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. A consult with your doctor will tell you if you are a good candidate for a dental implant.

A bridge is one method of replacing missing teeth. Crowns are prepared on the natural teeth adjacent to the missing teeth and false teeth (pontics) are fused to the crown. The whole unit of crowns and replacement teeth (pontics) is the bridge. It is cemented onto the natural teeth. The bridge is not removable, it stays fixed to the teeth. In the past, this was the highest standard of care for replacing missing teeth and in some cases it still is. Implants can also be considered for tooth replacement.

Dentures are a method of restoring missing teeth. A complete denture can be made to replace all of the teeth or a partial denture can be made to replace a few teeth. They can be made after the teeth have been removed or placed the same day the teeth are extracted. This is called an immediate denture. Complete Dentures Dentures are a prosthetic device that is designed to replace all of the patients teeth. Dentures can improve a patient's facial appearance. When teeth are absent it can lead to a sunken or collapsed appearance in the mouth. A denture will restore the missing teeth and gum. A denture is the easiest and least expensive method to restore a normal appearance when someone has lost their teeth. Implant Dentures Complete dentures are hard to wear. Implants can be placed to eliminate many issues that come with wearing dentures. In an upper denture, most people do not like the palate of the mouth covered. Patients who have a tendency to gag often cannot wear dentures at all. When you have four implants under a upper denture it will hold securely so that the size of the denture is reduced by removing the palate all together. In addition, implant dentures allow the patient to use their front teeth, which is not possible with standard dentures. The lower denture is more difficult to wear because there is no suction to hold it in place. It will constantly move and press on the gum tissues possibly inflaming the tissue. With just a few implants under a lower denture it will keep it from moving around and become secure and easier to wear. The ability to chew is one of the biggest benefits to implant dentures. The denture anchor on the implants instead of sitting or resting on the gum tissues. They allow patients to bite harder and not have much discomfort. Biggest benefit of implant dentures is NO MORE ADHESIVES!

It is estimated that 1 in every 10 adults snores. For most people snoring has no serious medical complications. However, for an estimated 1 in 100 snorers, habitual snoring is the first indication of a potential life threatening disorder called "Obstructive Sleep Apnea (OSA)". Snoring is the result of a partial airway collapse. As pressure to breathe builds, muscles of the diaphragm, chest wall, and heart must work harder. The greater the effort, the more the airway walls collapse as the sleeper struggles to breathe. Allergies, weight, anatomy, and alcohol usage are all contributing factors to "snoring" severity and frequency. Mandibular repositioning appliances (snoreguard), which gently hold the mandibular forward during sleep, help keep the airway open and can result in a decrease or elimination of snoring. The result can help patients with a more refreshed sleep, which in turn attributes to an improved lifestyle. Nightguards and Bruxism Bruxism (teeth grinding) and habitual clenching of teeth are all too frequent damaging habits in our modern, stress-filled world. Often occurring during the deepest levels of sleep, patients can place over 300 lbs of pressure on their teeth and jaw joints. Results of this can be: headaches, broken or cracked teeth, severe and irreversible wear of the teeth, and broken crowns and bridges. In addition, abnormal pressure on the TMJ can lead to Temporal Mandibular Joint (TMJ) disorders, generalized sensitivity of the teeth and early bone loss. Customized Dual-Flex nightguards provide some relief and offer protection to the teeth until the underlying causes can be addressed.

This is a case of a 8 year old girl that presented with her front tooth completely "knocked out" from a playground accident. Her tooth could not be saved and had to be extracted. The picture to the right shows the tooth missing. This is the same patient at the age of 13 after completing orthodontics and temporary repair of her right central tooth. The patient at age 18, after completion of growth and ready for implant restoration of her front tooth. This is the completed care with Emax crown on front right tooth and implant plus restoration on front left tooth.

60 Year old woman presented with extremely short front teeth. Due to years of abnormal wear. Her teeth were half of the normal length. This picture shows patient after completion of orthodontic treatment. Teeth have been lengthened with temporary plastic restorations and crown lengthening surgery. This is final photo, after placement of new upper and lower Emax crowns restoring patient to the size of her original teeth. The final result.

Patient presented with multiple teeth that had old or missing fillings. Large fractures were also present. Replacing the fillings was not an option because of the existing fractures in the teeth. Crowning the teeth was truly the best option. Here are the final results. Dr. Erler and the patient were very happy with the results that were achieved.

75 year old male. Presents with severe carries, tooth loss, and teeth ground down to ½ the normal size. Final results after completed root canals, perio gum surgery, and full mouth reconstruction.

42 year old woman that presented with enamel missing on the upper teeth and also broken teeth due to overclosure that was causing pain. Treatment was redo of all upper teeth with crowns to fix all teeth and to have the patient close correctly, patient is no longer having jaw pain.

72 year old female , excessive wear, restoration of teeth with zirconia crowns.