An abscessed tooth is collection of infectious material
that results in a bacterial infection in the center of the tooth. The infection
will congregate in the affected area and persist until the bacterial infection
is properly treated, an abscess will form as a result of the infection. In
order to properly address the infection the pus must be drained from the
infected area. An abscessed tooth is typically a result of untreated tooth
decay. It is important to properly treat all tooth decay to avoid a potential
abscess. An abscessed tooth can also result from trauma to the tooth such as a
chipped or broken tooth.
Periodontal disease (gum disease) can also
cause an abscess to form in the area of concern. Gum disease causes the gum
tissue to pull away from the tooth creating a pocket which can trap food. An
exposed pocket will allow bacteria to begin to grow and buildup in the area. An
untreated abscess can also cause bone loss and if the bone loss becomes to
extensive, the tooth will become loose and may have to be extracted. As the
infection begins to spread and bone loss occurs, you may experience less pain,
but the infection will persist until the area is properly treated. If you think
you may have an abscessed tooth, it is important that you see us immediately.
If the infection is not treated, it could possibly spread to other areas of the
body and potentially become life threatening.
of a tooth abscess:
irritation, pain is elevated when pressure is applied to the area.
||Red, swollen, and
||Odd taste in your
||Swelling in face,
jaw or gum tissue
||Bump on the cheek
side or tongue side of the gum near the infected area.
be prescribed to destroy the bacteria causing the infection.
||A hole may be
placed in the tooth to allow the infection to drain.
||If necessary, a
small incision will be made in the surrounding tissue to allow drainage.
treatment may be necessary if the infection and decay is to extensive.
||If the root canal
treatment is not successful an extraction may be recommended.
There are many
different forms of medications available to create a more relaxed and
comfortable dental visit. There are medications to control pain, create a
relaxed feeling, and others that can put you to sleep during the dental
treatment. It is best to ask us which options are available and would suit your
best needs. We will take many factors into consideration when deciding which
form anesthesia is best for you: the types of dental procedures being
performed, health history, allergies, anxiety level, and any other potential
Local anesthesia is used to prevent pain by blocking
nerves in the area being treated. Topical anesthesia can also be applied to the
area to reduce sensitivity and numb the tissue in preparation for the local
anesthetic injection. Topical anesthetic is also used to reduce sensitivity
during cleanings and other invasive procedures. Injectable anesthesia is
typically administered for placement of fillings, crown preparations, root
canals, extractions, and treatment of periodontal disease.
are the most common form of anesthesia to address toothache or pain after a
dental treatment has been completed. These medications include aspirin,
acetaminophen, and ibuprofen. For more severe pain wet may prescribe a narcotic
based medication such as those containing codeine, which act on the central
nervous system to relieve pain.
Intravenous Sedation is typically
reserved for more complex dental treatment, extreme dental phobic patients, and
individuals that cannot receive dental care under local anesthetic for one
reason or another. This type of sedation does have some risks, which is why it
is important that you know your health status, and tell us about any illnesses
or health concerns you may have. If you have questions or concerns about your
oral health care, don't hesitate to talk to Dr. Howell and discuss your options
for your dental care.
Bad Breath (Halitosis)
Bad breath is an unpleasant condition that can be embarrassing and a
potential health concern. Some individuals that have bad breath aren't even
aware that they have a problem. Some patients are more prone to bad breath
because of health problems, medications, low salivary flow, dietary regiment or
dry mouth. Maintaining good oral hygiene by properly flossing, brushing and use
of mouthwash can sometimes only temporarily mask the odor. Dieters can also
develop an unpleasant odor because of infrequent eating habits. Food that is
collected between teeth, on the tongue, and in the gums can begin to rot and
cause a foul odor. If you are concerned about halitosis, please consult with
Dr. Howell about the potential causes and treatment options.
is a condition that occurs when the flow of salvia decreases and causes a dry
mouth. Saliva is necessary to cleanse the mouth and remove any food particles
from the mouth that may cause an odor. Changes in oral health, anxiety,
medications, breathing through your mouth, aging, and salivary gland issues can
cause a reduction of saliva flow. Some indications of dry mouth include cracked
lips, sticky feeling, difficulty in chewing, swallow, talking or tasting, and
Bad breath can also indicate the possibility of a medical
disorder. These medical concerns can include:
||Cancer in the
||Liver or kidney
If your mouth is healthy we may refer you to your
general health provider or a specialist to determine the cause of your
halitosis. It is important that you visit us for regular checkups to allow us
to check for periodontal disease, xerostomia or any other conditions that may
cause bad breath. Good oral hygiene is crucial to help with the reduction of
bad breath, continue to brush 2 times a day, floss regularly, and clean your
tongue to remove bacteria. Please consult with us about treating your halitosis
and any possible products that could be helpful to you.
Bleaching (Tooth Whitening)
Everyone loves the appearance of a beautiful, healthy looking white
smile and there are a variety of options available to achieve that beautiful
white smile. Many of our dental facilities have at home and in-office whitening
options. Whitening options may not completely reverse all types of
discoloration such as brownish-colored or grayish-hued teeth. For the most part
individuals with yellowish-hued tooth coloration will respond well to
bleaching. It is important to understand that the whiteners will not effect
existing restorations such as crowns or tooth-colored fillings. In cases of
existing restorations you may want to consider replacement of the restorations
prior to proceeding with your bleaching process.
Internal bleaching is
used to lighten a discolored tooth a chemical process. This procedure may
require more than one office visit and each visit may take from 30 minutes to
one hour. It involves placing a chemical oxidizing agent within the coronal
portion of a tooth to remove discoloration. The etiology of tooth discoloration
can be intrinsic, extrinsic, or both; it can involve dentin, enamel, or pulp;
it may be brought on by diet, age, or habits; it may be local or systemic.
There are several products available for use at home, which we can
dispensed. These products contain peroxide(s), which actually bleach the tooth
enamel. These products typically rely on percent carbamide peroxide as the
bleaching agent, carbamide peroxide comes in several different concentrations
(10% & 15%). Peroxide-containing whiteners come in a gel and are placed in
a bleach tray that is fabricated by our staff to provide a custom fit.
There are some potential side-affects to using a whitening system,
teeth can become sensitive during the period when you are using the bleaching
solution. In many cases, this sensitivity is only temporary and will subside
once the whitening treatment is completed. Use of a fluoride gel in your bleach
tray after your bleaching session is strongly recommended to reduce potential
sensitivity. Please ask us which options is best for you and if you are
eligible to receive whitening.
A bridge may be recommended if you're missing one or more teeth.
Gaps left by missing teeth eventually cause the remaining teeth to rotate or
shift into the empty spaces, resulting in a bad bite. The imbalance caused by
missing teeth can also lead to gum disease and temporomandibular joint (TMJ)
disorders. Bridges are commonly used to replace one or more missing teeth. They
span the space where the teeth are missing. Bridges are cemented to the natural
teeth or implants surrounding the empty space. These teeth, called abutments,
serve as anchors for the bridge. A replacement tooth, called a pontic, is
attached to the crowns that cover the abutments. As with crowns, you have a
choice of materials for bridges. Dr. Howell can help you decide which to use,
based on the location of the missing tooth (or teeth), its function, aesthetic
considerations and cost. Porcelain or ceramic bridges can be matched to the
color of your natural teeth.
Unlike a removable bridge, which you can take out and clean, since
the bridge is permanently fixed bridge and if necessary should only be removed
in our office to avoid fracturing your natural teeth or damaging the bridge.
Implant bridges are also very effective at replacing missing teeth without
having to rely on natural teeth for support. Depending on which type of bridge
we recommend, its success depends on its foundation. So it's very important to
keep your remaining teeth healthy and strong.
Bruxism (Teeth Grinding and Clenching)
Bruxism is a
clinical term for clenching, gnashing, or grinding of the teeth. This condition
affects both children and adults. Some individuals with bruxism unconsciously
clench their teeth together during the day, often when they are stressed or
tense. Clenching can exert an immense amount of pressure and stress on the
muscles, tissues, and other surrounding structures of the jaw. Clenching can
cause jaw joint disorders, headaches, neck pain, ear pain, muscle tension, and
excessive wear on the occlusion surface of the teeth. These symptoms are
referred to as TMJ problems (temporomandibular joint). If clenching of the jaw
is not properly treated it can cause permanent damage to the temporomandibular
The majority of the individuals that experience
clenching throughout the day also are affected by nighttime grinding. Grinding
is when the individual slides their teeth back and forth over each other in a
sideways motion. This is often a subconscious behavior that is not realized by
the individual. Typically the condition is not diagnosed until we observe
significant occlusion wear, visual cracks and fractures, abfractions, and
complaints of jaw pain by the patient. A partner or significant other will
often times be the first to hear the noise of the individual grinding their
teeth at night. If left untreated, excessive grinding can cause significant
damage to the occlusion surface of the teeth. Researchers have not been able to
pinpoint the exact cause of bruxism, but many specialists agree that stress and
anxiety play a major role.
While the symptoms of bruxism can be
treated, usually the condition cannot be cured. Treatment typically focuses on
reliving acute symptoms and limiting permanent damage to teeth. Stress and
anxiety must be considered as a factor in bruxism. Reducing stress can be
achieved by a number of techniques such as visual imagery and autosuggestion,
aversive conditioning (such as awakening the patient during episodes of teeth
grinding), massed negative practice (the patient voluntarily clenches the teeth
for 5 seconds and then relaxes the jaw for 5 seconds), pharmacologic therapy to
suppress REM sleep, and changes in sleep position (lying supine with neck and
knee support allows the lower jaw to rest). We may also suggest a nightguard or
splint to prevent damage to the teeth. The appliance is custom made to your
bite for proper fit and comfort. Over-the-counter appliances are not
recommended because of the ill-fit and possible dislodging of the appliance
during bruxism. Please consult with Dr. Howell if you believe you are clenching
or grinding your teeth.
Canker/Cold sores are unpleasant and irritating and typically caused
by a bacterial, viral or fungal infection. They can also be caused by an
ill-fitting denture, fractured tooth, or orthodontic appliance or wire. Some
patients with a disease or medical disorder may also have mouth sores. Most
mouth sores come and go within a week, any sores that lasts a week or longer
and return on a regular basis, should be examined by Dr. Howell.
canker sore is a painful, open sore in the mouth, which is white or yellow and
surrounded by a bright red area. Canker sores will develop inside of the mouth
and are non-contagious. Canker sores usually appear on the inner surface of the
cheeks and lips, tongue, soft palate, and the base of the gums. It is possible
to have several canker sores or only one and they often return. Canker sores
can run in families. They may also be linked to problems with the body's immune
system. The sores may occur after a mouth injury due to dental work, aggressive
tooth cleaning, or biting the tongue or cheek. The exact cause of canker sores
is uncertain but many experts contribute their presence to immune system
problems, bacteria, fatigue, stress, allergies or viruses. Intestinal problems,
such as ulcerative colitis and Crohn's disease, also seem to make some people
Canker sores typically heal on their own after a week
or two, but an outbreak may occur. It is important to avoid hot, spicy, or
acidic foods, which can irritate the sore and prolong the healing process.
Rinsing with warm salt water will also help and speed up the healing process.
Antibiotics and some oral bandages can reduce a secondary infection. Cold sores
that are often times referred as fever blisters or herpes simplex (HSV-1) are
groups of fluid-filled blisters. The outbreak usually occurs around the lips,
mouth, and occasionally inside the mouth. It is highly recommended not to come
into contact with any other person while you experience a cold sore, as the
virus can be easily transmitted. The initial infection (primary herpes), which
often occurs before adulthood, may be confused with a cold or flu and can cause
painful lesions to erupt throughout the mouth. It is important to not touch an
active cold sore and then touch other parts of your body. Be especially
careful about touching your eyes, if it gets into the eyes, HSV-1 can cause a
lot of damage. In fact, if you have a cold sore or you're around someone with a
cold sore, try to wash your hands as often as possible. Once a person is
infected with primary herpes, the virus stays in the body and causes occasional
attacks, for some individuals they will only carry the virus but will never
show signs of its presence and will remain inactive. An attack may follow a
fever, sunburn, skin abrasions or emotional upset.
Cold sores usually
heal within 7-10 days by themselves. Although there are no prescriptions that
can make the infection go away, over-the-counter topical anesthetics can
provide some relief. Prescription antiviral drugs may reduce these kinds of
Leukoplakia is a thick, whitish-color patch that
forms on the inside of the cheeks, gums or tongue. Not all white patches are
Leukoplakia, just the ones that cannot be rubbed off and cannot be diagnosed as
any other condition or disease. It is important to keep an eye on these white
patches because over time they can develop into oral cancer. Many times the
exact cause of these patches cannot be identified, however, many experts
believe the patches are caused by excess cell growth and are more common for
individuals that use tobacco products. We may recommend a biopsy if the patch
appears threatening. Please notify us if you believe that you may have an
advanced case of Leukoplakia.
In treating Leukoplakia, we will examine
the lesions and possibly recommend a biopsy of the tissue if there appears to
be problem. The results will help determine how to manage the disease. Types of
treatment depend on several things, including the location of the Leukoplakia,
size, age, habits, and other medical problems. Treatment begins with removing
the factors that contribute to the lesion in the first place: quitting tobacco,
replacing ill-fitting dentures, attempt to curb cheek biting, or replace
current bridges. For cases that are moderate or severe, removal of the white
patches may be done by traditional scalpel excision, electrocautery, liquid
nitrogen application, or laser surgery. Each of these removal options has its
advantages and disadvantages, it is important to discuss which removal process
is best for you.
Tooth decay is the destruction of tooth enamel, which occurs when
foods containing carbohydrates are frequently left on and in-between the teeth
over a prolonged period of time. Plaque interacts with food deposits on your
teeth to produce acid that will slowly dissolve the calcium in your teeth, the
surface of the tooth..."enamel" is 97% calcium, causing tooth decay and some of
the other products cause gum disease and bad breath. The acidic plaque rests
against the tooth and the acid dissolves the calcium molecules from the tooth
surface. When enough calcium dissolves from the tooth surfaces, the surface
breaks and forms a hole. Cavities have been identified as a bacterial infection
caused by a specific bacteria. The bacteria that caused the decay are called
streptococcus mutans. If tooth decay is left untreated for a prolonged period
of time the complications can be intensive, lengthy, and costly to treat.
Tooth decay can be prevented by:
||Brush twice a day
with a fluoride based toothpaste.
fluoride trays on a routine basis to remineralize your teeth.
your teeth daily with floss.
and balanced meals and limit frequent snacking.
|| Check with us
about receiving tooth sealants.
regularly for professional cleanings and oral examination.
Balanced pH levels and proper oral hygiene will
help prevent tooth decay, however, some individuals are more prone to tooth
decay than others even if they are taking all the necessary steps in tooth
Changes that occur with aging make cavities an adult
problem as well and not solely isolated to children. Recession of the gums
creating separation from the teeth, combined with an increased potential of
periodontal disease can expose tooth roots to plaque and bacteria. Tooth roots
are softer than enamel and more susceptible to caries if exposed. The majority
of people over the age of 50 have some signs of gum recession, this combined
with changes in salivary flow, health issues, and an increase in medication can
expose this age demographic to higher amounts of tooth decay and periodontal
disease. Decay around edges or margins of existing restorations are common to
older adults. Using fluoride will help prevent decay and remineralize your
teeth. Utilizing a diagnodent (laser technology) can help us determine if a
patient has failing restorations or an area of concern. Please ask us if a
diagnodent assessment would be a vital asset to maintaining your oral health.
A dental crown is a tooth-shaped "cap" that is placed over a
misshapen or broken tooth to restore its shape and size, strength, and/or to
improve its appearance. A crown is not only intended to improve the aestethics
of a tooth but also to aid in functionality of the tooth structure. Crowns can
be used to salvage a tooth that has been badly decayed or broken and increase
the strength of a weakened tooth. A crown can be utilized to cover and support
a tooth that has a large restoration where there isn't a large portion of
natural tooth remaining. A crown is also used to cover a dental implant.
Crowns come in a variety of different materials including all gold,
porcelain-fused-to-gold, all resin or all ceramic. There are also instances
when a crown can be a mix of two different types of materials. Patients that
have a small clearance between opposing teeth or that grind their teeth may
benefit from the advantages of a gold crown. Gold crowns are fabricated from
yellow gold and give patients more room for placement and the mailability of
the gold are gentle on the opposing tooth. These crowns are typically reserved
for molars. For areas of aesthetics an all ceramic crown may be recommended to
give natural and cosmetic appearance. Please ask us about possible crown
upgrades and which type of crown is best for you.
It is possible for
your newly seated crown to create discomfort or sensitivity to your natural
supporting tooth. Your newly crowned tooth may be sensitive immediately after
the procedure as the anesthesia begins to wear off. If the tooth that has been
crowned still has a nerve in it, you may experience some hot and cold
sensitivity. Pain or sensitivity that occurs when you apply pressure to the
area usually means that the crown is too high on the tooth. If this is the
case, Dr. Howell may be able to make a minimal adjustment to the occlusion of
the crown or the opposing tooth.
Crowns made of all porcelain can
sometimes chip. If the chip is small, a composite resin can be used to repair
the chip with the crown remaining in your mouth. If the chipping is extensive,
the crown may need to be replaced for proper fit.
Sometimes crowns fall
off which can be caused by the cement washes out from under the crown. Not only
does this allow the crown to become loose, it allows bacteria to leak in and
cause decay to the tooth that remains. If your crown feels loose, contact our
office. Crowns also fall off because of an improper fit or a lack of cement.
You can replace the crown temporarily using dental adhesive or temporary tooth
cement that is sold in stores for this purpose. Contact our office immediately.
We may be able to recement your crown in place; if not, a new crown will need
to be made.
A dark line next to the gum line of your crowned tooth is
normal, particularly if you have a porcelain-fused-to-metal crown with a metal
margin. This dark line is simply the metal of the crown showing through. This
can be reduced by adding a cosmetic upgrade porcelain margin to the restoration
(please ask Dr. Howell about this crown upgrade). All-porcelain crowns are also
a great option to eliminate the dark line appearance.
A denture is a removable appliance that is used to
replace missing teeth and surrounding tissue. There are two types of dentures
available, complete and partial dentures. Complete dentures are used when all
teeth are missing in an arch and a partial denture is used to replace missing
teeth in an arch that has natural teeth still remaining.
In some cases,
an immediate denture can be fabricated prior to removing the teeth, which will
be placed at the time of extraction. The benefit of an immediate denture is
that the patient does not have to be without teeth during the healing period.
Shortly after the extractions and placement of the immediate denture, the gums
and jawbone will begin to shrink. As a result the immediate denture will need
adjustments for proper fit throughout the healing process. An immediate denture
should be considered a temporary solution until a complete denture can be
Complete dentures are made after the teeth have been
removed and the gum tissue has completely healed, a conventional denture is
ready for placement in the mouth about 8 to 12 weeks after the teeth have been
removed. In some cases a longer amount of healing time may be required before
starting the fabrication process. It is important that the tissue and jaw bones
are completely healed before starting a complete denture.
Even if you
wear full dentures, you still must take good care of your mouth. Brush your
gums, tongue and palate every morning with a soft-bristled brush before you
insert your dentures to stimulate circulation in your tissues and help remove
New dentures may feel awkward for a few weeks after initial
placement until you become accustomed to them. The dentures may feel loose
while the cheek and tongue muscles learn to operate with the new appliance. It
is possible to experience soreness or minor irritation as well as a temporary
increase in salivary flow. As the mouth becomes accustomed to the new dentures
these issue should begin to subside. Two or three follow-up appointments may be
required to make any necessary adjustments for proper fit or to address any
sore areas that the denture has created. It is important that you consult with
Dr, Howell if any problems persist, particularly prolonged irritation or
Dentures are delicate and can easily break if not properly
handled. When the dentures are not being used it is important to clean the
dentures to remove food deposits and plaque. Daily maintenance is important to
prevent permanent staining and helps the gums stay healthy. It is best to use a
soft bristled toothbrush to clean the denture, hard bristled toothbrushes can
damage the denture. Please consult with us on which over-the-counter cleaning
products would be best for your particular denture.
A dry socket is a complication of an extraction. A dry socket
is any tooth socket in which a patient is having pain due to the loss of the
blood clot thus exposing the bone to air, food, and fluids along with an
offensive odor. A dry socket can be very painful for three to five days. It is
normal to have some pain after an extraction, but the pain should begin to
diminish after the second day. Patients should avoid smoking or any sucking
actions such as sneezing, sucking or spitting. The sucking action creates a
negative pressure, which can dislodge the blood clot that has developed at the
extraction site. The blood clot helps healing and prevents the area from
developing a dry socket.
Most teeth extractions will have some level of
discomfort at the extraction site. In most cases where a dry socket forms, the
patient will typically notice that the level of discomfort is not diminishing
with in the first few days. If the pain begins to intensify between three to
five days after the extraction, you should us or your oral surgeon to address
If a dry socket does develop Dr. Howell or your oral surgeon
will place medicated gauze in the affected area. Once the medication is placed
the pain should significantly diminish. The use of an irrigation syringe to
keep the area clean and free of debris may also be recommended.
An extraction is a removal a nature tooth
because the tooth is non-salvageable, experienced trauma, crowding, severe bone
loss in the area due to periodontal disease, or teeth associated with cysts or
tumors. There are two types of extractions, simple and surgical.
simple extraction is one in which we can remove the tooth by loosening the
surrounding tissue, grasping the crown of the tooth above the gum line and then
applying side-to-side lateral motion on the tooth until it loosens from the
bone. Teeth are normally held in the bone by a thin sheathe of soft tissue. The
key to simple extractions is to rock the tooth side to side slowly enlarging
the socket in the bone while at the same time breaking the ligament, which
binds the tooth in the socket.
A surgical extraction is more difficult
and invasive procedure to remove a tooth. Typically this involves the removal
of the root of the tooth by using a sharp instrument that can be forced between
the root and the surrounding bone. When dealing with multiple rooted teeth, the
roots are separated and individually removed. An incision in the tissue
surrounding the tooth may also be made to raise a flap of gum, exposing the
tooth, roots, and surrounding bone. The use a drill to remove obstructing bone
to aid the extraction of the tooth may also be necessary. Once the tooth has
been removed from the bone sutures are placed in the surrounding tissue so the
healing process can begin.
After the tooth has been extracted we will
advise you on a post-operative regimen to follow. In some cases, a small amount
of bleeding at the extraction site is normal. Avoid anything that may prolong
the healing time. It is best not to smoke or rinse your mouth vigorously, or
drink through a straw for 48 hours. These activities can dislodge the blood
clot that has formed at the extraction site and delay healing. It is important
to continue to brush and floss your teeth as usual, but avoid abrasive cleaning
the area of the tooth socket. Keep the area clean to avoid a buildup of food
and debris in tooth socket. You should be able to return to your normal daily
cleaning regiment at the extraction site within 5-7 days after the extraction.
Please consult with your us or oral surgeon if you believe that there may be a
problem with the extraction site.
There are two
types of fillings available to restore missing tooth structure, composite/resin
(tooth-colored) or amalgam (silver).
(tooth-colored) are comprised of glass and quartz filler in a resin medium that
creates a tooth-colored filling. Composite fillings are beneficial for many
fractures in small to medium sized restorations.
||Can withstand a
large amount of chewing pressure.
removal of less tooth structure when preparing the tooth.
bonded to the tooth rather than held in with retention, which allows for more
conservation of natural tooth structure.
(silver) have been used by dentists since the mid-1800's, when they became the
first true standard of filling material. Amalgam is a stable alloy that is
created by mixing mercury, silver, tin, copper and other metallic elements.
Once the amalgam capsule is thoroughly mixed the dentist will begin packing
amalgam in the area where the decay was removed. The dentist will typically
remove healthy tooth structure in order to allow retention of the mercury
filling. There have been many studies regarding the safety of mercury based
filling and the results have shown that they are safe in accordance with dental
standards. Amalgam fillings are very durable, easy to place, resistant to wear,
and many times less expensive than composite based fillings. Patients that have
received amalgam fillings have complained of short-term hot and cold
sensitivity after the placement of the filling. One of the biggest complaints
by patients of amalgam fillings is the unnatural appearance of the silver.
*Dr. Howell is aware of the recent studies regarding the
safety of amalgam, but has chosen to abandon the use of mercury-based amalgam
fillings in the best interests of our patients and to maintain a high standard
of dental care. If you have any questions regarding this issue please ask prior
to proceeding with the placement of your fillings.
Research and studies have found that the
use of fluoride in individuals of all ages has been major factor in the
reduction of dental caries. When used appropriately and in moderation fluoride
is safe and effective in preventing dental caries. There are three primary
factors that contribute to dental caries (tooth decay): a susceptible site on a
tooth, an infective strain of bacteria (streptococcus mutans), and sugars or
other nutrients that stimulate the bacteria's growth. As these bacteria grow,
they produce an acidic by-product that can dissolve the minerals in the enamel
and eventually destroy the tooth. Fluoride directly inhibits bacterial growth
so less acid is produced in the mouth and fluoride stored in plaque is released
when the bacteria produce enough acid to lower the acid-base balance on the
tooth. Fluoride enters the tooth through tiny pores in the enamel, which
replace the hydroxyl ions of the hydroxyapatite crystals. These ions and
crystals are part of the tooth's enamel; the fluoride helps form a new compound
called fluorapatite, which strengthens the tooth. This form of enamel is less
soluble to acid and helps protect against decay. Fluoride can be found in many
different sources such as fluoridated water, toothpaste, tablets, drops, and
rinses. Many of our dental practice can fabricate fluoride trays that can very
effective in properly administering the fluoride to the teeth. Please consult
with us about the benefits of using fluoride trays to boost your oral health
and reduce your exposure to tooth decay.
Periodontal disease is an infection
that attacks the tissue and bone structure that supports your teeth. The sulcus
is a shallow u-shaped crevice located between the tooth and gums. Gum disease
attacks just below the gum line in the sulcus where the supporting tissue and
attachments of the tooth begin to breakdown. As the supporting tissues are
damaged by the infection, the sulcus begins to develop a pocket. The depth and
magnitude of the pocket depend on the severity and advancement of the
periodontal disease. Periodontal classifications are determined by the severity
of the disease. The two major stages of gum disease are gingivitis and
periodontitis. Gingivitis is a milder form of periodontal disease that only
affects the gums. Gingivitis may lead to more serious, destructive forms of
periodontal disease called periodontitis. Treatment methods of periodontal
disease depend on the severity and extent of its progress.
factors that can increase the likelihood of developing periodontal
||All forms of
such as diabetes.
||Some types of
medication such as steroids, some types of anti-epilepsy drugs, cancer therapy
drugs, some calcium channel blockers and oral contraceptives.
Warning signs of periodontal disease:
||Gums that bleed easily and
|| Red, swollen, tender gums.
|| Gums that have developed pockets
in the sulcus or tissue separation from tooth.
|| Persistent bad breath or odd
||Permanent teeth that have become
|| Changes in your natural bite or
the way your teeth fit together.
||. Changes in the fitting of
existing partial dentures
It is possible to have periodontal disease without
have any signs of its presence. That is why regular checkups with your dental
provider are crucial to avoiding periodontal disease. Good home care and
maintenance can help ensure that you maintain beautiful and healthy gums.
Regular brushing, flossing, balanced diet, and regular dental visits can
provide for a lifetime of healthy, beautiful smiles.
A dental implant is an artificial tooth
root that is placed into your jaw to hold a replacement tooth or bridge. Dental
implants are an ideal option for people with good general oral health who have
lost a tooth or teeth due to periodontal disease, an injury, or some other
reason. While high-tech in nature, dental implants are actually more tooth
saving than traditional bridgework, since implants do not rely on surrounding
teeth for support. Dental implants are so natural looking and feeling that you
will forget you ever lost a tooth. You know that your confidence about your
teeth affects how you feel about yourself, both personally and professionally.
Perhaps you hide your smile because of spaces from missing teeth. Maybe your
dentures don't feel secure. Perhaps you have difficulty chewing. Under proper
conditions, such as placement by a periodontist and diligent patient
maintenance, implants can last a lifetime. Long-term studies continue to show
improving success rates for implants. Dental implants can replace one or more
teeth without affecting bordering teeth, support a bridge and eliminate the
need for a removable partial denture, provide support for a denture, making it
more secure and comfortable.
Placement of the implant
you have a bone graft or not, the dental implant must be surgically placed in
your jawbone. This is done in the comfortable setting of your dental office
under local anesthetic. During the surgery, your gum is cut open to expose the
bone where the implant is going to be placed. Then a hole is drilled in the
bone to allow placement of the implant. Once the implant is securely placed in
the bone the gum tissue is positioned into its original location and sutures
are placed to hold the gum tissue together. The sutures are typically removed
two weeks after placement.
Once the implant is
placed bone integration begins, this is a process where the bone begins to fuse
with the dental implant. This process typically takes between 5-6 months. This
time allotment allows for a thorough healing and a strong foundation for the
Placement of abutment and implant
Approximately at the 6-months from the time of the implant
placement the area is reopened and a healing abutment is placed to allow the
gum to properly heal around the restoration. This healing abutment is screwed
into the implant and the tissue surrounding the implant is contoured for the
implant restoration. The healing abutment will remain temporarily for
approximately 4 weeks. Once the healing abutment is removed an impression for a
custom abutment and implant crown are taken of the area. The abutment and crown
typically take approximately 3 weeks for the lab to fabricate.
The Importance of Early Detection
In the United States more than 30,000 cases of oral cancer is diagnosed
annually. There are many forms of oral cancer that affect the tongue, lip,
cheek, throat, and other areas of the mouth. In all cases, the cancer involves
abnormal growth process, which if left untreated can result in death. Currently
only half of all patients diagnosed with oral cancer survive more than five
Dr. Howell has the knowledge and accessible tools to
diagnose early signs of oral cancer and pre-cancerous conditions. Early
detection and regular check-ups can help avoid oral cancer. If we detect any
potential signs of oral cancer a scalpel biopsy or brush biopsy may be
recommended. Normally you will be referred to an oral surgeon to address the
Signs of Oral Cancer:
along the side of the tongue, cheek or on the lip.
thickening or roughness of the tongue, cheek or floor of the mouth.
||A sore that
bleeds easily or does not heal.
bleeding in the mouth or throat.
||A color change of
the oral tissues.
tenderness, or numbness in the back of the mouth or throat.
chewing, swallowing, speaking or moving the jaw or tongue.
Other Important Information about Oral
||Smoke and chewing
tobacco users are more susceptible to oral cancer.
consumption in addition to tobacco use greatly increases risk.
exposure to the sun increases the risk of oral cancer.
||More than 25% of
oral cancers occur in people who do not smoke and have no other risk
the age of 40 are more at risk.
shown that diets high in vegetables and fruits can help prevent the development
of oral cancer.
Braces (also called orthodontic appliances) can have a variety of
appearance options. The braces can either be as inconspicuous as possible or as
noticeable as you would like. Brackets that hold the retention wires in place
are attached to the facial side of the tooth. In some cases, smaller brackets
can be placed on the back of the tooth, which is significantly less noticeable.
The brackets can be made of metal, ceramics, plastics or a combination of these
materials. The brackets can either have a metallic or tooth-colored appearance.
Treatment should begin when the malocclusion often become noticeable
between the ages of 6 and 12, as the child's permanent (adult) teeth erupt.
Malocclusions can be caused by trauma, disease, malnutrition, hereditary or
unhealthy dental habits. Orthodontic treatment often begins between ages 8 and
14 but is not limited to those ages. Orthodontic treatment that begins while a
child is still growing helps produce optimal and ideal results. Children should
have an evaluation by the age of 7 as whether or not orthodontia could be
beneficial to the patient. By that age the child will have a mix of primary and
permanent teeth. We can assess areas of concern with emerging teeth and jaw
growth in the early stages of development, while primary teeth are present.
Regular dental visits starting early in life is important to an individual's
Adults can also benefit from the positive results of
orthodontics such as crooked or crowded teeth, overbites, underbites, incorrect
jaw position, or jaw-joint disorders. The fundamentals and biological process
of moving teeth is the same no matter the age of the patient. Orthodontia in
adults typically requires a longer duration of treatment because an adult's
facial bones are no longer developing or as malleable as a child's bone
structure. No matter your age, it's never too late to improve your dental
health and beautify your smile.
Most general dentists receive very
little orthodontic training in dental school. This requires that general
dentists, such as Dr. Howell, receive special training and certification to
properly practice orthodontics and Dr. Howell is
Certified The purpose of orthodontics is to treat malocclusions with braces or
aligners to correct teeth and jaw alignment problems.
Dental plaque is a general
term for the diverse microbial community (predominantly bacteria) found on the
tooth surface, embedded in a matrix of polymers of bacterial and salivary
origin. Plaque develops naturally on teeth, and forms part of the defense
systems of the host by helping to prevent colonization of enamel by exogenous
(and often pathogenic) microorganisms (colonization resistance). Plaque is
found preferentially at protected and stagnant surfaces, and these are at the
greatest risk of disease and lesions. If plaque is not properly removed from
the surface of the tooth it will eventually buildup calculus or tartar.
Brushing and flossing become more difficult once the tartar and
calculus has buildup above the gum line. If the tartar and calculus begins to
develop subgingivally (beneath the gum line) the tissue may become irritated,
swollen, and may bleed. These are typically early signs of periodontal disease.
To prevent plaque buildup it is important to brush your teeth and floss your
teeth twice a day and visit your us regularly for professional cleanings and
oral examinations. We may also recommend application of a tooth sealant to
protect the tooth.
The American Heart
Association (AHA) has recommended that patients with certain heart conditions
take prescription antibiotics prior to receiving dental care to prevent
infective endocarditis (IE), which is a bacterial infection. Infective
endocarditis is an infection in the lining or valves of the heart. These
bacteria enter these areas of the heart through the bloodstream. Bacteria are
naturally found in a variety of locations throughout the body including in the
mouth and on the skin. The ADA had expressed the concern surrounding the
necessity of a premedication because of the exposure of bacteria to the
bloodstream when dental work is done. Even a standard cleaning can disrupt
bacteria and any exposure to bleeding allows the bacteria to access the
bloodstream. According to latest guidelines released by the AHA regarding the
necessity of premedications prior to dental work: the AHA recommends that
most of these patients no longer need short-term antibiotics as a preventative
measure before their dental treatment. In addition to the findings by the
AHA, the Infectious Diseases Society of America and the Pediatric Infectious
Diseases Society also endorses the approved guidelines.
created guidelines are based on scientific experts belief that the risks of
taking antibiotics for preventative measures outweigh the benefits for most
patients. Some of the risks associated with taking a premedication include:
adverse reactions to antibiotics, inappropriate use can lead to drug-resistant
bacteria, and overuse of antibiotics. Experts also found that there is no
concrete evidence to support prior claims that taking preventative antibiotics
before dental work prevent infective endocarditis in patients who are at risk
of exposure to a heart infection.
New guidelines indicate that patients
who have taken prophylactic antibiotics routinely in the past but no longer
need prophylactic antibiotics include people with:
conditions such as ventricular septal defect, atrial septal defect and
New guidelines for preventative antibiotics prior
to a dental procedure are advised for patients with:
|| Congenital heart
disease only in the following categories:
or incompletely repaired cyanotic congenital heart disease, including those
with palliative shunts and conduits.
repaired congenital heart defect with prosthetic material or device, whether
placed by surgery or by catheter intervention, during the first six months
after the procedure.
repaired congenital heart defect with residual defect at the site or adjacent
to the site of a prosthetic patch or a prosthetic device.
transplantation recipients with cardiac valvular disease.
The American Academy of Orthopaedic Surgeons
(AAOS), and the
American Dental Association (ADA) has found that
there is insufficient evidence to recommend the routine use of antibiotics for
patients with orthopaedic implants to prevent infections prior to having dental
procedures because there is no direct evidence that routine dental procedures
cause prosthetic joint infections.
*If there are any questions
regarding the necessity of a Premedication, please contact your primary
physician for clarification.
Root canal therapy is designed to correct
disorders of the soft tissue inside the tooth that contains nerves, blood
vessels, and connective tissues (dental pulp). Abscessed teeth or infected
nerves that were once extracted can now be salvaged through the benefits of
modern endodontic procedures. Once the dental pulp is traumatized or injured
the tooth cannot repair itself on its own. The most common cause of pulp death
is a fractured tooth or deep untreated tooth decay. If left untreated the
dental pulp will become infected, pus will develop at the root tip and jawbone,
forming an abscess. The abscess can also cause damage to surrounding tissue and
Symptoms of pulpal nerve damage may include:
pressure is applied to the tooth.
sensitivity to hot and cold.
A root canal therapy typically involves one to
three dental visits. The treatment begins with your general dentist or
endodontist removing the pulp of the tooth. The pulp chamber and tooth canal(s)
are cleaned, enlarged, and sealed with a buildup. The final step in the process
is the fabrication of a dental crown which is permanently placed over the
A dental sealant is a thin plastic coating that is applied to the
pits and grooves of the chewing surface of molar teeth to aid in the prevention
of decay caused by bacterial plaque and acids. The sealants are easy to apply
and only take a few minutes to apply to each tooth. It is important for the
occlusion surface of the tooth to be completely clean of debris and bacteria.
The sealant material is painted onto the tooth enamel, where it bonds to the
tooth. In some cases, a curing light may be used to help the sealant dry and
Sealants can withstand the normal forces caused by chewing and
will typically last for a couple years before a new sealants need to be
applied. Sealants can provide the same benefits to adults just as they do for
children. The barrier that is created by the dental sealant will also help
adults in the prevention of attracting decay and causing damage to a tooth. It
is an effective way to reduce the need for fillings and more expensive
treatment that may be required to repair the damage from cavities, so sealants
can also save you money.
TMJ/TMD describes a group
of diseases that can involve the jaw joints, the muscles that control jaw
movements and the dental occlusion. TMJ/TMD are physical disorders arising from
an imbalance in the delicate working relationship of the jay and skull with the
muscles that move the jaw as well as the nervous system associated with these
systems. This imbalance results in muscle fatigue, spasm and/or joint
dysfunction, and even changes in teeth, which in turn cause a variety if
symptoms, unique for each person. Treatment options for patients with TMJ/TMD
may include stress reduction exercise, medications, or wearing a nightguard to
alleviate some the stress on the teeth. Many conditions that cause TMJ/TMD may
be related, but can vary, and are often difficult to pinpoint. Your dentist may
also recommend a specialist to treat your TMJ/TMD conditions.
A porcelain veneer is a thin shell of
porcelain that fits over damaged, discolored, or misshaped teeth. This
procedure has several advantages over other tooth restoration procedures.
Porcelain is an extremely durable material with a color, translucence and
texture that is similar to tooth enamel. It is not susceptible to decay and
resists staining while maintaining a natural appearance. Veneers can
effectively close diastemas (gaps between teeth), lengthen and reshape teeth,
repair chipped, broken, or misshapen teeth, and cover stains and
discolorations. Benefits of porcelain veneers are that they provide a natural
tooth appearance, stain resistant, and offer a conservative approach to
changing a tooth's color and shape. Some disadvantages of porcelain veneers is
that the process is nonreversible, usually not repairable should they crack or
chip, may cause slight sensitivity to hot or cold, and teeth with veneers are
still susceptible to decay. Individuals that clinch or grind their teeth are
typically not good candidates for veneers because of the increase likelihood of
chipping or cracking of the veneers. Please ask us how veneers can add to your
Wisdom teeth (Third Molars)
Wisdom teeth, or third molars, are the last to come in and can
frequently cause problems. Most often, they are trapped in the jawbone or gums,
and fail to come in at all. These impacted teeth can cause many problems; they
may grow sideways, partially emerge from the gum, or even remain trapped
beneath the gum & bone. Partial eruption can leave an opening around the
tooth in which bacteria can grow and eventually cause infection. The results
include swelling, stiffness, pain & illness. If these teeth are not
removed, they will continue to grow damaging adjacent teeth. Extraction of
third molars is typically recommended when the tooth is only partial erupted
and no longer breaking through the tissue, eruption is causing crowding of
other teeth, cyst formation that begins to destroy surrounding tissue and bone
or taking preventative measures to avoid any possible complications in the