Dental Health FAQ

Dental amalgam contains mercury. Mercury in certain forms can be toxic. Doesn’t the use of dental amalgam lead to toxic effects?

No. Not all forms of mercury are the same. Dental amalgam is a durable alloy of silver, copper, tin, zinc, and mercury. The elemental mercury found in dental amalgam is inorganic, in contrast to organic forms such as methyl mercury, found largely in fish and seafood, and thimerosal, an ethyl mercury-based preservative found in pharmaceuticals. It is methyl mercury that is found in our food supply and is a cause for concern. Dental amalgam is a stable alloy that has been studied extensively and has an established record of safety and effectiveness.

If dental amalgam is classified as a hazardous material, how can it be safe when it is in the mouth?

“Hazardous,” in this context, is a regulatory classification that dictates appropriate handling procedures. It does not correctly characterize amalgam’s usefulness or safety as a medical device, or its actual environmental effects. Other devices, such as batteries, mercury-containing lamps, computer and television monitors, are common, widely used devices, and are considered hazardous once they are no longer in use. The “hazardous” label ensures such devices are properly disposed or recycled.

Does dental amalgam release mercury vapor in the body?

Amalgam fillings are known to emit minute quantities of mercury vapor during vigorous chewing or grinding. The amounts of mercury vapor emitted by amalgams fall well within levels considered safe, that is, they show no toxicity and cause no adverse health reactions.

Why has dental amalgam become a wastewater issue?

An estimated 0.4 tons of mercury from dental facilities annually enter surface waters in the U.S. via Publically Owned Treatment Works (POTW) effluents, sewage and sludge incinerator emissions. Chair side traps and vacuum systems capture 78% of amalgam waste from dental offices; amalgam separators increase the amount of amalgam particulate captured to about 97%. 

The California Dental Association has policy recommending that all dentists install amalgam separators to ensure that the amount of mercury entering the water supply from dental fillings is reduced to extremely low levels. Amalgam captured in dental offices via traps and amalgam separators can be recycled instead of incinerated as a biosolid, which reduces the amount of mercury emitted into the air and subsequently into surface water. 

Does amalgam that enters the wastewater system convert to the more toxic form of methyl mercury?

Mercury in dental amalgam is highly bound. Studies conducted by Kunkel et al. in 1996 and Okabe et al. in 2003, among others, indicate that mercury remains in the form of amalgam throughout the wastewater conveyance and treatment process. Kunkel et al. studied the potential release of mercury from amalgam in aerobic and anaerobic wastewater treatment systems and did not detect soluble mercury, even when amalgam particles were introduced into the systems at concentrations on the order of 1,000 times the expected concentration of POTW influents.

Now that tooth colored fillings are widely in use, can’t dentists just use those materials instead of amalgam?

Other materials are effectively used for dental fillings, however, they can not completely replace amalgam. There are situations where tooth colored materials, which must be bonded, are difficult to use and where amalgam is the optimal restorative material. The dental material fact sheet, required by the California Dental Board to be distributed to patients, was developed to inform patients of the benefits and risks of each restorative material. The choice to use amalgam, which is a safe and effective filling material, should remain an informed choice that is made by the dentist in consultation with each individual patient.

A tooth consists of two main parts: the crown, which is visible in your mouth and is contacted during chewing; and the root, which is typically not visible in your mouth and is anchored by surrounding bone and gum tissue. Inside each root are one or more channels that run the length of the root, this is the root canal space.

Contained within the canal(s) are blood vessels, nerves, and soft tissue that are collectively called the pulp. The pulp can be irreversibly injured or infected due to deep restorations, decay, fracture, trauma, or periodontal disease. Symptoms of pulpal involvement may include temperature or percussion sensitivity, spontaneous or radiating pain, and swelling.

Knocked Out Tooth
Do not scrub the tooth or remove any attached tissue. Instead, rinse it carefully in running water. Gently insert and hold the tooth in its socket. If this isn't possible, place the tooth in a cup of milk or, in the absence of milk, cool water. Bring it and the patient directly to the dentist within 30 minutes, if possible.

Broken Tooth
Gently clean dirt from the injured area with warm water. Place a cold compress on the face near the injury to decrease swelling. Go directly to the dentist.

Possible Broken Jaw
Do not move the jaw. Secure the jaw in place by tying a scarf, handkerchief, necktie or towel around the jaw and over the top of the head. Apply cold compresses to swollen areas. Go immediately to a hospital emergency room or call your dentist.

Toothache
Do not place aspirin on the aching tooth or gum. Rinse the mouth with warm water. Floss to remove any food that might be trapped between the teeth. See your dentist as soon as possible.

Problems with Braces and Retainers
Cover the ends of irritating wires with a small cotton ball, beeswax or a piece of gauze until you can see your dentist. Do not attempt to remove a wire that is stuck in your cheek, tongue or gum. Go to your dentist immediately. If an appliance becomes loose or a piece breaks off, take the appliance and piece to the dentist.

Dental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants themselves are tiny titanium posts that are placed into the jawbone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, implants can help preserve facial structure, preventing the bone deterioration which occurs when teeth are missing.

Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.

Evaluation

If, like many others, you feel implant dentistry is the choice for you, we ask that you undergo a dental/radiographic examination and health history. During these consultation visits, your doctor will address your specific needs and considerations. Your questions and concerns are important to us and your doctors team will work with you very closely to help make your procedure a success.

Procedure

Dental implants are metal anchors that act as tooth root substitutes. They are surgically placed into the jawbone. Small posts are attached to the implant to provide stable anchors in the gums for replacement teeth.

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your restorative dentist designs the final bridgework or denture, which will ultimately improve both function and aesthetics.

After the implant has bonded to the jawbone, the second phase begins. Your doctor uncovers the implants and attaches a small healing collar. After two weeks your general dentist will be able to start making your new teeth. An impression must be taken. Then posts or attachments can be connected to the implants. The teeth replacements are then made over the posts or attachments. The entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life.

Most patients are familiar with the general dentist. The general dentist is educated to provide comprehensive services from dental examinations to dental surgery. While most dental procedures can be provided by the general dentist, a patient may be referred to a specialist if the general dentist feels special expertise is necessary. The American and California Dental Associations (ADA and CDA) recognize these nine types of dental specialist:

Endodontist
Deals with the prevention, diagnosis and treatment of disease and injuries of the internal soft tissue of the tooth (root canals).

Oral & Maxillofacial Surgeon
Treats injuries and deformities, extracts teeth and performs surgery of the mouth, jaw and face.

Orthodontist
Prescribes and places corrective devices, such as braces, to align teeth and improve health and appearance.

Pediatric Dentist
Specializes in the dental health of children from birth through adolescence.

Periodontist
Treats diseases of the gums.

Prosthodontist
Designs and fits bridge-work and dentures.

Public Health Specialist
Coordinates and administers community-wide dental care programs, including public education on the prevention of dental disease.

Oral & Maxillofacial Radiologist
Uses imaging and associated technology for diagnosis and management of a range of diseases affecting the mouth, jaw, and related area of the head and neck.

Oral Pathologist
Researches the causes, development, and effects of oral diseases.

How can I choose a dentist?

Here are some tips to keep in mind when choosing a dentist:

• Call the San Mateo County Dental Society (SMCDS) office at (650) 637-1121.
• Search the SMCDS Member Directory on this website to find a dentist close to your home or work. You can also search for a specialty dentist.
• Ask family, friends, neighbors or co-workers for recommendations.
• Ask your family physician or local pharmacist.
• Ask faculty members of local dental schools.
• If you are moving, your current dentist might be able to provide you with a recommendation.

What should I look for when choosing a dentist?

You may wish to consider several dentists before making your decision. During your first visit, you should be able to determine if this is the right dentist for you. Consider the following:

• Is the appointment schedule convenient for you?
  
• Is the office easy to get to from your home or job?
• Does the office appear to be clean, neat and orderly?
• Was your medical and dental history recorded and placed in a permanent file?
• Does the dentist explain techniques that will help you prevent dental health problems? Is dental health instruction provided?
• Are special arrangements made for handling emergencies outside of office hours? (Most dentists make arrangements with a colleague or emergency referral service if they are unable to tend to emergencies.)
• Is information provided about fees and payment plans before treatment is scheduled?
• You and your dentist are partners in maintaining your oral health. Take time to ask questions and take notes if that will help you remember your dentist's advice.

What is the difference between a DDS and a DMD

The DDS (Doctor of Dental Surgery) and DMD (Doctor of Dental Medicine) are the same degrees. The difference is a matter of semantics. The majority of dental schools award the DDS degree; however, some award a DMD degree. The education and degrees are the same.

Where can I get low-cost dental care or financial assistance for dental work?

Assistance programs vary from state to state, so you may want to contact the San Mateo County Dental Society to see if there are programs in your area. Patient Aid

Another possible source of lower-cost dental care is a dental school clinic. Generally, dental costs in school clinics are reduced and may include only partial payment for professional services covering the cost of materials and equipment. For locations and service details, go to Dental Care Assistance tab on this website.

How often should I replace my toothbrush?

Treat yourself to a new toothbrush every three to four months, or sooner if the bristles become worn, splayed or frayed. A hard, brittle brush can injure your gums. Children's brushes may need to be replaced more often, as they can wear them out more quickly.

How should I choose oral care products?

Even savvy shoppers can be baffled by the seemingly endless variety of dental care products. Choose products that carry the American Dental Association Seal of Acceptance - an important symbol of a dental product's safety and effectiveness. Oral care products that may carry the ADA Seal include toothpaste, manual and electric toothbrushes, floss and other interdental cleaning aids, mouthrinses and oral irrigators.

What does the ADA Seal of Acceptance mean?

The ADA Seal of Acceptance is a symbol that a product has shown that it meets ADA standards of safety and effectiveness. About 350 companies voluntarily submit research data to the ADA showing the safety and efficacy of their dental products. The data they submit undergo stringent review by independent consultants and the ADA before the Seal is awarded.

The ADA reviews all advertising claims for any product bearing the Seal. Only those claims that can be supported by appropriate clinical and/or laboratory studies and scientific data are allowed.

I've noticed that only some dental products have the ADA Seal of Acceptance. Why?

The Seal of Acceptance Program is strictly voluntary. Manufacturers may choose to have products evaluated; some choose not to. The ADA does not comment on why products do not carry the Seal or on the quality of non-Seal products. Data collected in our laboratories indicate that about 30 to 40 percent of consumer products fail to meet the standards required for the ADA Seal of Acceptance when they are first submitted. Manufacturers often make the required adjustments to their products and them resubmit them.

You may want to contact the manufacturer directly for more information on a particular product. A phone number is often available on the product packaging.

What ingredients are in toothpastes?

Toothpaste should contain fluoride to reduce tooth decay in children and adults. There are other ingredients that can be included. Tartar control toothpaste prevents tartar, above the gumline, from forming. The active ingredient of these toothpastes is based on the mechanism of action of a variety of pyrophosphates or zinc citrate. Desensitizing toothpaste can help block the pain of receding gums, which cause sensitivity to temperature extremes. The effective ingredient is potassium nitrate.

Toothpaste that contains triclosan, an antimicrobial, is proven to reduce gingivitis. Baking soda can act as a mild abrasive in high enough concentrations. An advantage of baking soda as an ingredient is that if you like the taste or feel of these toothpastes, you're likely to brush more often and thoroughly. Abrasives help remove stains and plaque and polish the teeth. All ADA-accepted toothpastes contain a mild abrasive that, along with your toothbrush, helps to remove plaque (a sticky film of bacteria). Usually the abrasives are a type of silica.

Other ingredients commonly found in toothpastes help to make brushing a pleasant experience. Flavoring agents such as artificial sweeteners, peppermint, cinnamon or wintergreen improve the taste. Humectants prevent water loss. A binding agent or thickener gives the toothpaste body and keeps it from separating into solid and liquid. Foaming agents may be added to promote cleaning of the teeth.

Can I get a copy of my dental records?

Talk with your dentist about getting a copy of your dental records and check your state law, if necessary. The ADA Principles of Ethics and Code of Professional Conduct states:

"A dentist has the ethical obligation on request of either the patient or the patient's new dentist to furnish, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental X-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient's account is paid in full."

How do I file a complaint against my dentist?

Even in the best dentist-patient relationship, a problem may occur. First, discuss any concerns you have with your dentist. Many times this will help clear up the matter. If you are still not pleased, contact SMCDS to register your complaint.

Local dental societies have established a dispute resolution system called Peer Review to help resolve the occasional disagreement about dental treatment. Peer Review provides an impartial and easily accessible means for resolving misunderstandings regarding the appropriateness or quality of care and, in certain instances, about the fees charged for dental treatment.

A Peer Review committee will attempt to mediate the problem. They may meet to discuss the case and may examine clinical records, talk to the dentist and patient and, when indicated, arrange for a clinical examination.

How to Brush

• While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.
• When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.
• To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue.
• Next you will clean the biting surfaces of your teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface.
• After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.
• If you have any pain while brushing or have any questions about how to brush properly, please be sure to call your doctor.

How to Floss

Periodontal disease usually appears between the teeth where your toothbrush cannnot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

• Start with a piece of floss (waxed is easier) about 18" long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

• To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gumline then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.
• To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.
• When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Caring for Sensitive Teeth

Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean the sensitivity will remain and could become more severe. If your teeth are especially sensitive consult with your dentist. They may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.

Choosing Oral Hygiene Products

There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Automatic and "high-tech" electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator.

Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with your dentist.

Fluoride toothpastes and mouth rinses if used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gumline so these products have not been proven to reduce the early stage of gum disease.

Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.

Your dental professional is the best person to help you select the right products that are best for you.

Professional Cleaning

Daily brushing and flossing will keep dental calculus to a minimum, but a professional cleaning will remove calculus in places your toothbrush and floss have missed. Visit your dentist, as he or she is an important part of your program to prevent gum disease. Keep your teeth for your lifetime.

Periodontal Diseases and Their Prevention

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.

Why is oral hygiene so important? Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.

Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gumline. Plaque constantly forms on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.

Periodontal diseases can be accelerated by a number of different factors. However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).

Periodontal Disease

Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.

Preventing Gum Disease

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Other important factors affecting the health of your gums include:

• Smoking
• Diabetes
• Stress
• Clenching and grinding teeth
• Medication
• Poor nutrition

What is a root canal?

A root canal is one of the most common dental procedures and well over 14 million are performed every year. This simple treatment can save your natural teeth and prevent the need for dental implants or bridges.

At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature, or pain in the tooth and gums.

How is a root canal performed?

If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident. Local anesthesia is used to eliminate discomfort. In addition, your doctor may provide nitrous oxide analgesia if indicated. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.

What happens after treatment?

When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, please contact your doctor. To prevent further decay, continue to practice good dental hygiene.

How much will it cost?  

The cost associated with this procedure can vary depending on factors such as the severity of damage to the affected tooth and which tooth is affected. In general, endodontic treatment is much less expensive than tooth removal and replacement with an artificial tooth.