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.
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.
Symptoms of a tooth abscess:
irritation, pain is elevated when pressure is applied to the area.
and irritated gums.
||Odd taste in
face, jaw or gum tissue
||Bump on the
cheek side or tongue side of the gum near the infected area.
may be prescribed to destroy the bacteria causing the infection.
||A hole may be
placed in the tooth to allow the infection to drain.
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.
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 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.
Xerostomia 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 mouth sores.
Bad breath can also indicate the possibility of a medical disorder.
These medical concerns can include:
||Cancer in the
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)
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
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
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.
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
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 joint.
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.
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.
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.
A 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 more susceptible.
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 viral infections.
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
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
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.
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.
nutritious 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.
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
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 fabricated.
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
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 plaque.
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 soreness.
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.
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 the pain.
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.
A 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.
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.
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
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.
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.
fillings (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.
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
Some risk factors that can increase the likelihood of
developing periodontal disease:
||All forms of
diseases 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
Whether 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 dental implant.
Placement of abutment and implant crown
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
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 years.
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 potential issue.
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.
change of the oral tissues.
pain, 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
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
over the age of 40 are more at risk.
shown that diets high in vegetables and fruits can help prevent the development
of oral cancer.
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.
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
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.
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:
heart 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:
heart disease only in the following categories:
||Unrepaired or incompletely repaired cyanotic congenital heart
disease, including those with palliative shunts and conduits.
||Completely 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 Treatment
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 bone.
Symptoms of pulpal nerve damage may
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 harden.
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
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 future.