Birth To 18 Months: No Toothpaste Required!

Like most dentists, we believe that oral care is important for everyone—no matter their age. Children’s teeth should be cleaned as soon as they begin to come in. For babies under 18 months, the best way to clean their is with a wet cloth or guaze without toothpaste. Place the cloth over your finger tip and gently rub your child’s teeth and gums. Along with nursing and drinking water, this is all the oral hygiene that your child needs at this young stage. Once a more “full set” of teeth has come in, use a small, soft toothbrush to brush your child’s teeth with water.

When To Start Toothpaste? 18 Months

As a general rule, children should not use toothpaste until they are at least 18 months old—and when they do start using toothpaste, make sure it is a safe “children’s toothpaste” made especially for their young teeth. Because of the difference between the dental needs of kids and grownups, children’s toothpaste is made differently than ours.

What To Look For In A Children’s Toothpaste:

• SAFE TO SWALLOW: Kids love to swallow their toothpaste instead of spitting it out when they first start brushing so we recommend that your children’s toothpaste is formulated with this in mind.
• CONSIDER LOW-FLUORIDE CHILDREN’S TOOTHPASTE: As adults, we’re used to find fluoride-rich toothpaste as it is an important element of keeping teeth healthy and strong, but too much fluoride can be harmful for young children. Several varieties of children’s toothpaste have lower amounts of fluoride or are fluoride-free.
• FUN FLAVORS: Whether or not a child will enjoy brushing their teeth depends largely on how much they like the flavor of their toothpaste—so try some different flavors and see what your child likes. Some children, especially at the toddler stage, are very picky about flavors and might be reluctant to use a certain flavor of toothpaste so be prepared to buy a few different varieties till you have a winner.
• USE ONLY A PEA-SIZED AMOUNT: Children don’t need very much toothpaste for it to be effective so just squeeze a small pea-size amount onto the toothbrush—you don’t want your child to swallow more than they have to.

When can children use adult toothpastes?

Once your child is able to spit out most of their toothpaste after brushing they are ready for an adult toothpaste with fluoride. Typically, this happens around age 4-6. However, make sure they are still only using a “pea-size” amount.

REMEMBER: Brushing your child’s teeth is a crucial part of parenting. By taking the time to clean your child’s teeth twice a day with a specially-formulated children’s toothpaste, you will be helping to create a lifetime of healthy dental habits and happy smiles!

Why should you use an electric toothbrush instead of a normal toothbrush? The answer is simple. A great deal of clinical research has proven that electric toothbrushes are simply far superior to manual toothbrushes when it comes to getting rid of dental plague and preventing gum disease.

An electric toothbrush is designed to vibrate at a high speed, producing much more brush strokes per minute than manual toothbrushes. They also come with special unique features like different cleaning modes, brush timers, whitening polishers, gum massagers and pressure sensors, amongst many other capabilities. All of these factors help you ensure that you maintain an optimum level of oral hygiene and dental health.

In short, electric toothbrushes will improve your dental health, prevent gum disease, make your teeth look whiter and help you cultivate good oral hygiene habits. They are also useful for individuals with physical disabilities and older folks who do not have the arm strength to brush their teeth thoroughly.

On the rest of this page you’ll find a detailed buyer’s guide with tips on choosing the right electric toothbrush. I highly recommend that you read the entire buying guide but if you prefer to skip it and jump straight to my personal list of the top 3 electric toothbrushes in the market now.

What Types of Electric Toothbrushes Are There?

If you’re overwhelmed by the sheer number of electric toothbrushes available, don’t worry. I’ll help you make sense of it all. While you may notice a huge variety of electric toothbrushes online or in your local store, they can all be divided into two different types. Yes, that’s right. Just two types. They are as follows:

1. Normal Power Electric Toothbrush. These are low-end electric toothbrushes which can produce 3,000 to 7,500 brush strokes in a minute. They usually have rotary brush heads which spin in a circular motion or pulsating brush heads which vibrate in a horizontal forward-and-back motion. Many power electric toothbrushes do not have additional features like pressure sensors, quadrant timers and other cleaning modes. Their price range is from $15 to $100.

2. Sonic Electric Toothbrush. The sonic toothbrush is similar to the power toothbrush except for one key difference: brush speed and power. The best sonic toothbrush produces 30,000 to 40,000 brush strokes in a minute, significantly higher than normal electric toothbrush. Essentially a super high speed device for cleaning your teeth, sonic toothbrushes can generate sound waves and vibrating water molecules which are more effective in cleaning the teeth and gums. Their prices range from $100 to $170.

Clinical comparative research has proven that sonic toothbrushes are more effective at removing plaque than normal electric toothbrushes. These sonic toothbrushes usually come equipped with all the latest toothbrush technology like pressure sensors, timers, self-cleaning UV sanitizers and other features.

Now let’s move on and look the points you keep in mind when looking at the different electric toothbrushes out there. Understanding these factors will help you make a better electric toothbrush comparison so you can choose the best toothbrush for your needs.

Five Factors to Consider When Buying Electric Toothbrushes

A vintage 1940s advertisement for the electric toothbrush.

Now that you know the two main types of electric toothbrushes, let’s look at the 5 key factors to consider when you’re choosing an electric toothbrush. While there are many excellent electric toothbrushes on the market, all of them should be measured by the following criteria when making a buying decision:

1. Power Levels and Brush Stroke Speed – How powerful and effective is the electric toothbrush? The number of brush strokes makes a difference. Tests show that sonic toothbrushes clean your teeth more effectively than normal power toothbrushes. Electric toothbrushes with selectable brushing modes and power levels are recommended over toothbrushes with only one on/off mode. If you are new to electric toothbrushes, you may not be accustomed to its vibrations, so always remember to start at a lower rate of vibration.
2. Type of Brush Head – What brush heads can be used on the electric toothbrush? Pulsating rotary toothbrushes are suitable for people who like bigger brush heads because they are similar to manual toothbrushes. If you are looking for precision cleaning for hard-to-reach areas, a smaller rotary brush head is a better choice. Or you can get a brush head with both pulsating and rotary capabilities. There are also brush heads and bristles designed for specific purposes such as whitening, flossing, sensitive teeth and braces. Pick the right one that suits your specific needs. Just remember that electric toothbrush heads should be changed every 2-3 months.
3. Size of the Electric Toothbrush – Who is using the electric toothbrush? The toothbrush you choose should depend on the age of the user. For youths and children aged 4 to 12 years old, you should consider buying a kids electric toothbrush or a light-weight electric toothbrush because they are easier to hold. Alternatively, you can buy a normal toothbrush but get a smaller brush-head because it will be easier to maneuver for younger or older folks. For traveling purposes, its best to get a slim and lightweight electric toothbrush.
4. Warranties and Guarantees – Warranties and guarantees can significantly reduce the risk involved in buying electric toothbrushes. Most quality and high-priced electric toothbrushes will definitely be backed by a warranty of at least 12 months or more. Depending on the company or brand, you may also have money back guarantees of 14 days to 30 days. So take advantage of the guarantee to try out your new electric toothbrush. If you are not happy with it in any way, simply refund or exchange it for another model.
5. Battery Type and Life-Span – Does the electric toothbrush use rechargeable batteries or disposable batteries? How long can it hold a charge? The best electric toothbrush is a rechargeable toothbrush with a long battery life. Be sure to choose electric toothbrushes with rechargeable batteries: you don’t want to keep buying disposable batteries. The charge for an excellent rechargeable electric toothbrush usually lasts for a week, which is great for short holidays. I recommend choosing rechargeable electric toothbrushes with battery life indicators that tell you when its due to be recharged.

Advanced Features of the Best Electric Toothbrushes

The best electric toothbrush for your needs should not only have sufficient brushing power but it should have other features which complement your daily oral care routine. Consider choosing toothbrushes with the following extra capabilities as they can greatly improve your oral hygiene everyday:

• Pressure Sensors – A main problem that many people have is that they brush too hard. Too much pressure on your teeth will not ruin your teeth enamel, but will also lead to oversensitive gums. Gums can bleed when too much force is applied during brushing. To counteract this problem, some electric toothbrushes have built-in pressure sensors that that will tell you when you are brushing too hard.
• Built-in Two Minute Timer – Dental health care professionals all agree that you need to brush your teeth for the minimum duration of two minutes in order to effectively get rid of plaque and bacteria. This is hard to manage with manual toothbrushes. However, electric toothbrushes have a 2-minute timer which automatically starts when the toothbrush is turned on. It will then pulse or vibrate after 2 minutes. This helps to eliminate the problem of under brushing and is a very important feature to have a electric toothbrush.
• Quadrant Timers – For cleaning purposes, your mouth can be split into four sections. Dentists recommend that you spend at least 30 seconds on one quadrant before moving to the next. Some toothbrushes have quadrant timers that beep or buzz in 30 second intervals to tell you to move on to another part of your mouth. Unlike the 2-minute timer, this is a special feature that is often only found in high-end electric toothbrushes.
• UV Sanitizer – A UV sanitizer produces UV light which shines on your toothbrush heads, killing any existing bacteria or germs that may grow on your brush head while its sitting in your wet bathroom. They are highly recommended for hygiene purposes, especially if you live in messy/crowded areas where dirt and germs from the environment and other people can accumulate on your toothbrush head.

All of the features above are often included in high-end sonic electric toothbrushes. Some low-end power toothbrushes may have one feature or two but never all four of them at once. Just something to keep in mind when you’re shopping for electric toothbrushes.

Final Word: Which Electric Toothbrush Should I Buy?

Now that you’ve read my entire buyer’s guide to electric toothbrushes, you should have a pretty good idea of what electric toothbrushes you want. If you still need more guidance, here is my personal advice on buying electric toothbrushes. These tips are the result of many years of personal experience in buying electric toothbrushes for myself and loved ones.

First things first: Let’s talk about the cost involved. While I think its important to not over-spend, I cannot emphasize how important it is to ignore price as a main factor when choosing electric toothbrushes. I know some of you may be on a budget but hear me out: there is a reason to my madness. Why do I say price is not a relevant factor? Here are two main reasons:

Electric toothbrushes are long term investments. I have used some electric toothbrushes everyday for at least 3 years without them breaking down. They work just as fine as day one, the only thing that depreciates is the battery life, but that is unavoidable. My point is simple: A good high quality electric toothbrush can last you many years. When you divide the cost of a $160 sonic toothbrush over 2 years, it only comes to around $6 a month, which is really a LOW price to pay for great looking teeth and fantastic oral health. Don’t make the mistake of buying inferior toothbrushes just because you want to save money. It’s just not worth it in the long run.

Dental health is important. Extremely important. An electric toothbrush is NOT a frivolous fashion item that doesn’t add much value to your life. It’s a product that’s critical for your dental health and overall well-being. Choosing a great electric toothbrush with all the extra features can make a huge difference to your oral health over the years. It can literally maintain your teeth in perfect form so you never have to visit the dentist for fillings and cavity removals. Dentists are expensive. While you cannot avoid a yearly check-up, you can avoid major dental intervention by having a perfect dental hygiene plan through the use of a high quality electric toothbrush.

HOT TIP – If you really want to save money and there is more than one person in a household, consider buying a high-end sonic toothbrush and sharing it. Don’t worry, it’s hygienic. You just need to get multiple brush heads and label each one with the name of the person using it. Attach the relevant brush-head when its your turn to brush. A downside of this method is that sometimes the toothbrush will have low battery power because it’s used multiple times a day. You should also be fine with sharing the toothbrush handle. Some people may not be open to this idea and find it a hassle to share. Check first!

Now let’s decide on the type of electric toothbrush. Should you choose a sonic toothbrush or a normal power electric toothbrush? Personally, I highly recommend buying a sonic toothbrush instead of just a normal electric toothbrush. Sonic toothbrushes are just more effective when it comes to removing plague and keeping your teeth clean. Many clinical studies have proven that sonic toothbrushes perform better.

From personal experience, I just feel cleaner and fresher when I’m using an sonic toothbrush. I especially like the very slight ticklish feeling of sonic toothbrushes when I brush my teeth: it’s a great sensation. Nothing like deep cleaning my teeth and massaging my gums everyday. From what I’ve seen in the mirror, sonic toothbrushes do clean away food particles and coffee/tea stains much better than normal electric toothbrushes. So in short, go with a sonic toothbrush instead of a normal power toothbrush.

Here are my top recommendations for the best electric toothbrushes. If you’re short of time and don’t want to read many toothbrush reviews, just go with the ones listed below. They are the best-selling and most popular electric toothbrushes on the market right now so you can’t go wrong with choosing any of them.

Best Rated Electric Toothbrush – My Top Recommendations

Philips Sonicare FlexCare Plus Rechargeable Toothbrush. This is by far the best electric toothbrush on the market. It’s got all the advanced features you’ll find in a 21st century toothbrush. A high speed ultrasonic toothbrush, it has a built-in 2 minute timer, a quadrant timer, an illuminated LCD panel and even a UV sanitizer to keep germs away from your brush-heads. It also has many useful brushing modes: you can choose between 5 different brushing modes like cleaning, gum care, quick refresh, sensitive teeth and massage. Best of all, it works marvelously. I’ve been using this toothbrush for a year or so and it works just as well as the first day I bought it. Excellent design and high quality build. I really like the fact that it comes with a built-in UV sanitizer because you usually have to buy it separately. If you only can buy ONE electric toothbrush, this is the one you should choose. No doubts about that.

Oral B Professional Care Smart Series 5000 Toothbrush. Known as Oral B’s most technologically advanced electric toothbrush, the Professional Smart Series 5000 is an awesome toothbrush that’s packed with many great features. It has a 2-minute timer with 30-second quadrant intervals, pressure sensors, 5 brushing modes (Clean, Sensitive, Whitening, Massage, Deep Clean) and a battery charge display. It also comes with an additional Smart Guide which is a small digital clock with a quadrant display. While I didn’t find the Smart Guide to be very helpful, the toothbrush itself is fantastic. It’s comfortable to hold and isn’t too heavy at all. The recharging base isn’t too big as well and has a small footprint. Excellent product although it would be more perfect if it came with a UV sanitizer like the Philips

Oral-B 3000 Professional Electric Toothbrush. The newest electric toothbrush released by Oral B in 2010, this is a less feature packed and more affordable version of the Oral-B Smart Series 5000. It’s a great basic electric toothbrush that’s well designed. It has a 2-minute timer with 30 second intervals, pressure sensors and 3 brushing modes (Clean, Sensitive teeth, Polish). I particularly like the small round toothbrush head which makes it easy to cover the whole tooth and clean hard-to-reach areas like the teeth in the back of your mouth. While I personally prefer the Philips Sonicare Flexcare Plus and Oral B Smart Series 5000, my sister likes this one a bit more than the rest. She uses this on a daily basis after I gave it to her and loves it. Recommended for being a great basic electric toothbrush that’s no-frills and does its job well.

Best Electric Toothbrush for Kids

Philips Sonicare for Kids HX6311/02 Rechargeable Toothbrush. This is an excellent toothbrush for children with special features that you won’t find anywhere else. While its a sonic toothbrush, it has child-friendly power modes which can be adjusted so it won’t be too harsh for your kid. Designed with a kid-timer that automatically increases brushing time gradually over 90 days, it helps children to reach the eventual goal of a 2 minute brushing session. In my opinion, that’s a very thoughtful and fantastic feature to have. It also has rubber over-molds for the brush-heads, fun sound effects to tell kids to switch to another region in the mouth and different brush heads for kids from 4 to 7 as well as from 7 years onwards. This means this toothbrush can remain useful for a minimum of 6 to 7 years. This alone makes it great value-for-money. Philips even offers a 28 days money back guarantee whereby you’ll get a full refund within 28 days if you decide that you don’t like it. Highly recommended!

• Have a high degree of fear of having dental treatment completed
• Are embarrassed about their mouth
• Hate needles
• Have a difficult time getting numb or gag easily
• Have very sensitive mouths
• Need to have their treatment completed in as few appointments as possible
• Just don’t like coming to the dentist

The most commonly asked questions and answers:

Do I have to have a needle in my arm to be sedated?
No

Am I unconscious?
No but you are sedated and you will be very relaxed

Do I feel pain?
You will be able to communicate with us but will be so relaxed you will have a higher threshold before you are aware anything is bothering you. Many times you remember very little of what we do for you because you are not paying attention to us.

Will you need to use shots inside my mouth to deaden my mouth if we do this?
Today with some of the technology we have available to us we do not use as much anaesthesia as we used to. But we still use local anaesthesia when it is expected to be needed.

How long will I be sedated?
That depends on the amount of work you will be having completed. Normally from 2 to 6 hours is enough.

What are the benefits?
You take a pill 30 minutes before treatment and bring the others with you. You do not have to have an IV started in your arm to give you the medication.

You can have treatment completed in fewer appointments. Some treatment plans that normally take 8 to 9 appointments can be completed in 1 to 2 appointments.

You are closely monitored with a heart rate monitor and pulse oximeter. These help us to very accurately know how you are doing at all times during your appointment. Someone will be with you all the time during your treatment.

The precise technology driven dentistry of today can be much more predictably and efficiently done when you are quiet and still.

What is the process?

• You have someone accompany you to your appointment.
• We give you the medication upon arrival
• 30 minutes before your treatment you take the 1st pill – this will relax you well
• Your critical vital signs will be monitored
• We supplement you with oxygen and nitrous oxide as needed
• Your dental treatment will be completed while you are relaxed
• When your treatment is completed you will be driven home where you can relax.

Experts share tips to help you overcome your fear of the dental chair.

By Richard Sine
Reviewed by Louise Chang, MD

John Gamba was 9 years old when a dentist failed to anesthetize a back molar properly and hit a nerve dead-on. The result was a lifelong fear of dentists that reached a peak in his 20s, when he stopped going to the dentist entirely. “I couldn’t even drive by a dentist’s office without getting stressed out,” he tells WebMD.

Gamba was 38 when a chipped back molar began to decay, putting him in constant pain. “I was paralyzed. I couldn’t even consider going [to the dentist's office],” says Gamba, an Internet entrepreneur from Naples, Fla. “It was much easier to accept the pain, sick as that sounds.”

Few people look forward to a spell in the dentist’s chair. But serious anxiety prevents millions of Americans from seeking proper preventative care. The consequences of this problem may go far beyond dental pain or lost teeth. Gum disease is a serious infection that can affect other parts of the body. Studies now link it to illnesses including heart disease, stroke, and diabetes.

Fortunately, many dentists are specially trained in handling fearful patients; a variety of methods and treatments are available to reduce pain and alleviate fear in the dentist’s chair.

The ‘Root’ Causes

Between 5% and 8% of Americans avoid dentists out of fear, estimates Peter Milgrom, DDS, director of the Dental Fears Research Clinic at the University of Washington in Seattle and author of Treating Fearful Dental Patients. A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary, Milgrom tells WebMD.

Milgrom’s dental practice specializes in fearful patients. About two-thirds of them relate their fear to a bad experience in the dentist’s office, Milgrom says. Another third have other issues for which fear of dentists can be an unpleasant side effect, such as various mood or anxiety disorders, substance abuse, or posttraumatic stress experienced by war veterans, victims of domestic violence, and victims of childhood sexual abuse.

Fear of dentists stems not so much from the experience of pain as from the lack of control that patients experience in the dentist’s chair, says Ellen Rodino, PhD, a psychologist in Santa Monica, Calif., who has studied dental fear. “You’re lying prone, a dentist is hovering above you, and he’s putting you in a situation where you can hardly talk or respond. That creates a lot of anxiety for some people because they don’t feel in control.”

Still, many dentists create unnecessary anxiety in patients because they assume that all patients have similar pain thresholds and will handle dental procedures in the same way, Milgrom says. “If all dentists were a lot more careful about pain control, took the time to be sure patients were comfortable, and didn’t go ahead if they weren’t [comfortable], then we would create fewer phobics.”

Fearful patients need to be more assertive about their needs, Milgrom says. Patients should say to their dentists, “I want to talk about what can be done to make me more comfortable. I don’t want someone to tell me something doesn’t hurt me.”

Treating Fear of Dentists

Some dentists who specialize in treating fearful patients go out of their way to create a nonthreatening environment. The place where Jack Bynes, DMD, works in Coventry, Conn., is barely recognizable as a dentist’s office. It’s housed in a renovated historic gristmill, with a treatment room that overlooks a waterfall. The waiting room contains a fireplace and soothing photography; it’s free of posters depicting the horrors of gum disease. Bynes himself fancies bow ties rather than scrubs. Many “people have a fight-or-flight reaction” to the sights, sounds, and smells of a dental office, and taking away these cues has a calming effect, Bynes explains. And Bynes should know. He specializes in fearful patients today because he himself had to overcome his own medical phobias as he trained to become a dentist.

Bynes first talks with patients in his office, rather than in the dental chair. “I tell them they can leave anytime they want,” he says. “Only one has done it in 40 years. It’s so they know they have control.”

The best dentists use simple methods to enhance that feeling of control, Milgrom says:

• They gently explain what the patient will soon feel, and for about how long.
• They frequently ask the patient for permission to continue.
• They give the patient the opportunity to stop the procedure at any time the patient feels uncomfortable. (“I give them a cue,” Bynes says. “If for any reason they need to stop, raise your left hand.”)
• They make time for breaks as requested.

Many dentists lack the patience to treat fearful patients with the care they deserve, Bynes says. Even those who advertise that they “cater to cowards” may not do a good job of it. If you’re looking for a new dentist, Bynes suggests being honest about your fears from the first call. Ask to speak to the dentist about your fears before you come in. If the receptionist seems dismissive, or the dentist never returns your call, don’t go, he says. “That’s not the right office for you.”

Taking Charge

Chances are, visiting a dentist won’t be nearly as painful as you expect. Surveys of patients before and after the most dreaded procedures — such as a root canal or wisdom tooth extraction — have found that they anticipated much more discomfort than they actually experienced, Milgrom says.

The root canal in particular gets a “bad rap” because it is typically preceded by painful toothaches, Milgrom says. The procedure itself relieves this pain, often in just a single visit. Wisdom tooth extractions get a bad name because of occasional jaw pain experienced several days afterwards, which can be treated with pills.

Still, even if your mind tells you you’ll be just fine, your body may still fear that dentist’s chair. Here are a few tips that may help you overcome your fear of the dentist:

• Go to that first visit with someone you trust, such as a close relative who has no fear of dentists, Bynes suggests. Bynes even encourages friends and relatives to sit with the patient during treatment.
• Seek distraction while in the dentist’s chair. Listen to your own music on headphones –”a new CD, not one you’ve heard a lot, so you’ll be a little more interested in it,” Milgrom suggests. Or find a dentist with a TV or other distractions available in the treatment room.
• Try relaxation techniques. Milgrom suggests controlled breathing — taking a big breath, holding it, and letting it out very slowly, like you are a leaky tire. This will slow your heartbeat and relax your muscles. Another technique is progressive muscle relaxation, which involves tensing and relaxing different muscle groups in turn.
• Review with your dentist which sedatives are available or appropriate. Options include local anesthetic, nitrous oxide (“laughing gas”), oral sedatives, and intravenous sedation. While oversedation can be dangerous, too many dentists are uncomfortable using any oral sedation, Milgrom says. And only some dentists are qualified to perform IV sedation.
• If you can’t bring yourself to go to any dentist, you might want to try seeing a psychologist first, says Ronald Kleinknecht, PhD, a clinical psychologist at Western Washington University and co-author of Treating Fearful Dental Patients. The most “tried and true approach” to treating dental phobia (and other phobias) is what Kleinknecht calls “direct therapeutic exposure.” It involves introducing the patient to feared items — say, a needle — in a gradual and controlled manner.

As the pain from Gamba’s back molar intensified, he found support online through a forum for people with dental fear. He also found a dentist, Fred Eck, DDS, of Bonita Springs, Fla., who advertises his skill with fearful patients. Before going, Gamba says, “I convinced myself that I wasn’t going to have any procedure, that I was just going to talk with the dentist.” But Eck put him so at ease that he agreed to the extraction of the back molar on the first visit. And it was painless, he says.

Comfortable with his new dentist, Gamba finally got some much-needed dental work done. He spoke to WebMD just an hour before an appointment to get his final wisdom tooth removed. “It’s been miraculous,” he says. “I’ve gained such strength, hope, and courage by getting through these experiences.”

Patients howled too, about the high cost of dental work, and the feeling that they’ve encountered dentists who don’t have their best interests at heart. Here’s a typical letter: “My wife saw a dentist who quoted her $750. Then halfway through the job, when she was numb and had a big hole in her mouth, he told her he misquoted the price and it was going to be $1,500. She could not exactly argue.” Another reader wrote of going to two different dentists and getting two completely different opinions about what his mouth needs and when it needs it. Who do you trust?

I heard from people who work in dental labs that charge the dentists $125 for a high-end crown, so why the tenfold markup? One dentist in Grand Rapids, Michigan, offered to do my husband’s work for him for $1,395, or 40% of what he was quoted by his guy. All we would have to do was get him from Pennsylvania to Grand Rapids. (We passed.) Another dentist criticized my “gummy smile.” Others wrote of the hours of pro bono work they do and how that’s never noticed.

Two dentists, Dr. M. in upstate New York and Dr. W. near Indianapolis, agreed to be interviewed. They spoke to me at length about why fees are what they are. Here’s what I learned about why dental work is so expensive.

Dental care is not a commodity. It’s not laundry detergent or breakfast cereal or wireless minutes. Dentistry is a professional service that’s both art and a science. Yes, there are excellent dentists and not-so-great dentists. Often, you get what you pay for. Yet even great dentists have bad days. “I consider myself an awesome dentist,” Dr. W. told me. “And I’ve had failures.”

Overhead costs are huge. Anywhere from 60% to 80% of what a patient pays goes toward the expense of running a modern dental practice. Dentists pay for rent or mortgage payments on their office space, payroll for hygienists, office managers and receptionists, health insurance, taxes, supplies, business insurance and technology — just to name a few. “A lot of people would be surprised to know how tight the profit margins are,” Dr. W. says. And many dentists are still paying student loans from dental school.

Labs differ in the quality of the products they produce. We all want our dentists to be using high-quality labs for things like crowns and dentures. Should we have to ask about the labs? No. We should trust our dentists to select a good one. “In my view, you always want to use a good lab,” Dr. M. said, “because if the crown breaks, I’m the one stuck redoing the thing for another hour and a half for free. It’s important to make sure I’m putting good stuff in people’s mouths, because the last thing anyone wants to deal with is a redo. It doesn’t make me look good, the patients get angry, insurance doesn’t cover it, and it’s a waste of time. You want to do a good job.” Dr. M. has invested in a $100,000 machine that lets him make the crowns himself and cement them in one visit. He says patients love it and it allows him to control the process and do a better job. His fee, however, is higher than many in the area.

Insurance isn’t really insurance. Dental insurance, the dentists told me, is nothing like health insurance or auto insurance. It’s a maintenance plan that will cover cleanings and x-rays, maybe half the cost of a crown. It will not protect you if you need a lot of work done. The maximum annual benefits, $1,000 to $1,500, haven’t changed in the 50 years since dental insurance became available. “It’s a minor cost assistance, and there’s a widening divide between patients’ expectations of their dental insurance coverage and the actual coverage that’s provided,” says Dr. W.

Dental insurance drives docs nuts and they wish they didn’t have to use it. “The number one most complicated aspect of running a dental office, bar none, is dealing with dental insurance. You wouldn’t believe how long it takes to get through to a rep, make sure the patient does have benefits, calculate a copay,” says Dr. M. And the largest insurance plans in the country discount most dentists’ fees by 10% to 20%. If you’re paying out of pocket, ask for a discount. (You might discover the dentist is giving you one already.)

Dentists wish patients would value their teeth more. Teeth are a crucial part of health and appearance. Untreated gum disease, for instance, is linked to heart disease. (Would you choose a cardiologist based on price?) “With time, you will come to realize that shopping price is a minor concern when it comes to your health,” says Dr. W. “Any minor cost differences amortized out over a lifetime will become insignificant. You will get the best results and have the most long-term satisfaction getting care from someone you trust.”

So if you’re convinced dentists are worth their fees, how do you find a good one? The dentists had some suggestions:

• Ask if he or she uses specialists. Who does your root canals? If the person on the phone says, “We do everything here, that would scare me,” Dr. M. says. Especially orthodontia.
• Ask your primary care physician which dentist she uses. Ask your lawyer. Ask your boss. In other words, ask professional people whom they trust with their mouths.
• Ask a dental specialist, like an endodontist. One specialist wrote to tell me, “The best way to find a good dentist is to find a specialist who sees everyone’s patients on a referral basis. He or she will know who is good and who isn’t. Trust me, as a specialist, I know who is doing what, because I see their work every day.”
• If a dentist doesn’t take insurance, because he or she doesn’t need to, that will be a pretty good dentist. Those pros can book you for longer, and they don’t have to work under the constraints of insurance companies. Be prepared to pay higher fees.
• Look and look some more. Interview dentists, if they’ll let you. Take the view that your teeth are a lifetime investment.

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Begin by gently wiping his gums with a clean, wet washcloth or gauze after he has a feeding. Infants are very focused on their mouths, so he should enjoy this touching. As he starts to sprout teeth, the feeling of the wet washcloth on his itchy, irritated gums will be very soothing. Wiping his gums will help eliminate decay-causing bacteria and will help him get used to having his teeth brushed later on.

Once he has a tooth, between 6 and 12 months, you can introduce an infant toothbrush. Make sure it has soft, rounded bristles so it won’t scratch his gums. Brushing with just water is fine, but if your dentist recommends toothpaste, use a very small amount, about the size of a pea. Babies usually enjoy the flavor of toothpaste and often swallow it, and ingestion of fluoride can cause problems over time.

Brush his teeth after every feeding, and again at bedtime. By now he should enjoy the feeling of having his gums massaged and his teeth cleaned!

Keeping your baby’s teeth clean is more important than you may realize. Baby teeth have thinner enamel than adult teeth and are more vulnerable to the bacteria that cause decay. Decay in a baby’s tooth is swift and destructive; it quickly penetrates the enamel, then the dentin, and then infects the nerve.

Baby teeth eventually fall out, so why should it matter if they are lost early? Most dentists believe that baby teeth should remain in the mouth as long as possible, to serve as placeholders for the adult tooth that will follow. When baby teeth are lost early, the surrounding teeth often tilt and move toward the empty space. This can cause the permanent teeth to come in crooked.

Infant Tooth Care

As soon as your child gets his first tooth, you should begin cleaning his teeth and gums after feedings with a moist gauze pad or washcloth.

Infant/Child Tooth Brushing

When your child is comfortable with a toothbrush, brush his teeth twice a day with a special, extra soft infant toothbrush. Use a small dab of toothpaste if your child likes it and if you’re sure he won’t swallow it. Otherwise it’s fine to brush without toothpaste. It’s a good idea to keep some disclosing tablets on hand. The dye in these tablets will stain remaining plaque a bright red, making it easy to see and thus easy to remove.

Infant/Child Tooth Flossing

Gently floss your child’s teeth each day, and pay particular attention to areas where the teeth are close together. Regularly help your child brush and floss until he’s 7 to 10 years old and able to effectively keep the plaque off his teeth by himself. After that, check his efforts occasionally.

Infant/Child Milk Bottle Decay

The most serious dental problem for young children is called “bottle-mouth syndrome.” This is tooth decay caused by the constant presence of sugars from milk, formula, or fruit juice in a child’s mouth. It happens when a child takes a bottle to bed, or has a bottle for extended periods during the day. Use pacifiers or bottles of water at these times to prevent this severe decay of baby teeth, and always clean your child’s teeth and gums immediately after each feeding.

Infant/Child Learning

Children learn best by imitation, so let them watch you brush and floss your teeth. Regular praise of their homecare efforts, together with a positive example from you, will get your child started down the path of excellent oral hygiene.

What is fluorosis and how did my child get it? Is a pacifier safer for my child’s teeth than thumb sucking?

Fluorosis shows up as multiple snow-white specks or a brownish stain on permanent teeth. Your child may have ingested too much fluoride during the years when his teeth were forming. The excess can come from swallowing too much fluoride toothpaste (kids often like the way it tastes), drinking canned or bottled drinks that contain fluoridated water, and taking too many of the fluoride drops or tablets prescribed for infants.

Your water supply also may have contained high levels of fluoride, which added to the problem. As a precaution, have your water supply checked. To find out about at-home testing of your tap water, call 1-800-445-3386, or go to www.omniiproducts.com. Fluoride test kits from this vendor cost $16, including postage.

Is a pacifier safer for my child’s teeth than thumb sucking?

Both habits will often have an effect on the position of the front teeth. Pacifiers can actually have a greater effect than the thumb because it is a pliable object that will deform upon pressure and try to return to its natural shape. As a result, it’s actually exerting an active force against the teeth so that distortion of the normal tooth position will often be greater than with a thumb habit. While there are some controversies surrounding the advisability of taking a pacifier away from a child, from a purely dental standpoint, it is clearly the appropriate thing to do.

Negotiating with the child is not an effective way to bring the habit to a close. The most successful way to end the habit is by a unilateral parental decision not to make the pacifier available. This might take the form of simply “making it disappear” or informing (not discussing with) the child that the pacifier is going away.

My child has a toothache. What can I do before I get to the dentist?

Young children who complain of a toothache in a baby tooth often have a foreign object (such as a particle of food) lodged between the teeth. Even abscessed teeth are rarely cause for pain in baby teeth. The first thing to do is to have the child identify the exact location of the pain by having her touch the tooth that is hurting with a single finger. This will focus your attention on the offending area. Next, see if flossing between the teeth in the area will dislodge any debris. Often this will provide immediate relief. If not, basic pain medications, such as Tylenol, ibuprofen or other common children’s pain relievers will be helpful. Ultimately, these situations are best evaluated and treated by your dentist.

The Sugar Habit May Be Developing along with Your Child’s First Tooth

Plagued with a sweet tooth? If you are, it’s likely that this habit was formed long before you could walk into the kitchen to grab a soda or a candy bar.

The Academy of General Dentistry reports that a strong correlation has been established between sweetened drinks consumed during infancy and high sugar consumption in later years. Why? Because at the age a baby’s first tooth erupts, the types of foods that are introduced can influence eating habits for a lifetime. In other words, if a baby’s first “real” foods are pieces of dry, sweetened cereal, raisins, sweet fruit juice or worse yet, fruit “drinks” that are as little as 7 percent juice, a high-sugar habit may follow him into adulthood.

“Sugar is known to cause cavities throughout a lifetime, and the earlier an infant gets used to sugar, the easier it is to get hooked on high-sugar snacks as an adult,” says Heidi Hausauer, D.D.S., F.A.G.D., a spokesperson for the AGD. “The eating habits of adults are formed at weaning, so it’s important for the baby to develop good eating habits that will affect dental health.”

Bottle syndrome, or baby bottle tooth decay, is an all-too-frequent consequence when teeth are continually exposed to sugary fluids. Sugar feeds bacteria in the mouth, and in response, an acid is produced that decays the teeth. Even beverages labeled “100% juice” can have this effect, as they contain high levels of fructose, the form of sugar naturally found in fruit. Primary teeth (baby teeth) are much more susceptible to these acid attacks, as their protective outer enamel layer is thinner and more easily penetrated by the acid. To avoid bottle syndrome, parents are advised to:

• Limit beverages other than water to mealtimes only.
• Keep juice consumption down to 10 percent of your child’s total diet (as recommended by the AGD).
• Never put your child to bed with a bottle containing anything but water.
• Don’t flavor your child’s pacifier by dipping it in honey or any other sweet substance.
• Brush your child’s teeth after giving him any liquid medicine; many contain high amounts of sugar.

So in a nutshell, to maximize your child’s nutrition and dental health, and to encourage lifelong healthy eating habits, it’s important that you minimize his exposure to sweets of all kinds while he’s an infant.

Only the S. mutans bacteria has an enzyme called glucosyl transferase on its surface that is able to cause the polymerization of glucose on the sucrose with the release of the fructose.

The same enzyme continues to add many glucose molecules to each other to form dextran which is very similar in structure to amylose in starch. The dextran along with the bacteria adheres tightly to the tooth enamel and leads to the formation of plaque. This is just the first phase of cavity formation.

The graphic on the left is showing only a portion of this process which shows the release of the fructose. The glucose undergoes further polymerization as stated above.

In the next stage, the bacteria use the fructose in a metabolism process of glycolysis to get energy. The end product of glycolysis under anaerobic conditions is lactic acid. The lactic acid creates extra acidity to decrease the pH to the extent of dissolving the calcium phosphate in the tooth enamel leading to the start of a cavity.

Preventative measures include frequent brushing and flossing to prevent plaque build up. A diet rich in calcium and fluoride in the water lead to stronger tooth enamel. A diet of more complex carbon hydrates that are low in sugar and no sucrose snacks between meals is also a good preventative measure.

Whether in the form of one-hour bleaching sessions at your dentist’s office, or home-use bleaching kits purchased at your local drugstore, teeth whitening solutions abound. Yet only 15 percent of the population has tried the cosmetic procedure, and misinformation on the subject is rife.

The long and the short of it is that teeth whitening works. Virtually everyone who opts for this cosmetic treatment will see moderate to substantial improvement in the brightness and whiteness of their smile. However, teeth whitening is not a permanent solution and requires maintenance or “touch-ups” for a prolonged effect.

Bleaching vs. Whitening

According to the FDA, the term “bleaching” is permitted to be used only when the teeth can be whitened beyond their natural color. This applies strictly to products that contain bleach – typically hydrogen peroxide or carbamide peroxide.

The term “whitening,” on the other hand, refers to restoring a tooth’s surface color by removing dirt and debris. So any product that cleans (like a toothpaste) is considered a whitener. Of course, the term whitening sounds better than bleaching, so it is more frequently used – even when describing products that contain bleach.

Why Teeth Whitening? Examining Enamel

Most of us start out with sparkling white teeth, thanks to their porcelain-like enamel surface. Composed of microscopic crystalline rods, tooth enamel is designed to protect the teeth from the effects of chewing, gnashing, trauma and acid attacks caused by sugar. But over the years enamel is worn down, becoming more transparent and permitting the yellow color of dentin – the tooth’s core material – to show through.

During routine chewing, dentin remains intact while millions of micro-cracks occur in the enamel. It is these cracks, as well as the spaces between the crystalline enamel rods, that gradually fill up with stains and debris. As a result, the teeth eventually develop a dull, lackluster appearance.

Teeth whitening removes the stains and debris, leaving the enamel cracks open and exposed. Some of the cracks are quickly re-mineralized by saliva, while others are filled up again with organic debris.

Tooth Discoloration: The Two Types of Tooth Stains

There are two categories of staining as it relates to the teeth: extrinsic staining and intrinsic staining.

Extrinsic stains are those that appear on the surface of the teeth as a result of exposure to dark-colored beverages, foods and tobacco, and routine wear and tear. Superficial extrinsic stains are minor and can be removed with brushing and prophylactic dental cleaning. Stubborn extrinsic stains can be removed with more involved efforts, like teeth bleaching. Persistent extrinsic stains can penetrate into the dentin and become ingrained if they are not dealt with early.

Intrinsic stains are those that form on the interior of teeth. Intrinsic stains result from trauma, aging, exposure to minerals (like tetracycline) during tooth formation and/or excessive ingestion of fluoride. In the past, it was thought that intrinsic stains were too resistant to be corrected by bleaching. Today, cosmetic dentistry experts believe that even deep-set intrinsic stains can be removed with supervised take-home teeth whitening that is maintained over a matter of months or even a year.

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What Causes Tooth Staining?

Age: There is a direct correlation between tooth color and age. Over the years, teeth darken as a result of wear and tear and stain accumulation. Teenagers will likely experience immediate, dramatic results from whitening. In the twenties, as the teeth begin to show a yellow cast, teeth-whitening may require a little more effort. By the forties, the yellow gives way to brown and more maintenance may be called for. By the fifties, the teeth have absorbed a host of stubborn stains which can prove difficult (but not impossible) to remove.

Starting color: We are all equipped with an inborn tooth color that ranges from yellow-brownish to greenish-grey, and intensifies over time. Yellow-brown is generally more responsive to bleaching than green-grey.

Translucency and thinness: These are also genetic traits that become more pronounced with age. While all teeth show some translucency, those that are opaque and thick have an advantage: they appear lighter in color, show more sparkle and are responsive to bleaching. Teeth that are thinner and more transparent – most notably the front teeth – have less of the pigment that is necessary for bleaching. According to cosmetic dentists, transparency is the only condition that cannot be corrected by any form of teeth whitening.

Eating habits: The habitual consumption of red wine, coffee, tea, cola, carrots, oranges and other deeply-colored beverages and foods causes considerable staining over the years. In addition, acidic foods such as citrus fruits and vinegar contribute to enamel erosion. As a result, the surface becomes more transparent and more of the yellow-colored dentin shows through.

Smoking habits: Nicotine leaves brownish deposits which slowly soak into the tooth structure and cause intrinsic discoloration.

Drugs / chemicals: Tetracycline usage during tooth formation produces dark grey or brown ribbon stains which are very difficult to remove. Excessive consumption of fluoride causes fluorosis and associated areas of white mottling.

Grinding: Most frequently caused by stress, teeth grinding (gnashing, bruxing, etc.) can add to micro-cracking in the teeth and can cause the biting edges to darken.

Trauma: Falls and other injuries can produce sizable cracks in the teeth, which collect large amounts of stains and debris.

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Teeth Whitening Options

Three major teeth whitening options are available today. All three rely on varying concentrations of peroxide and varying application times.

In-Office Whitening

Significant color change in a short period of time is the major benefit of in-office whitening. This protocol involves the carefully controlled use of a relatively high-concentration peroxide gel, applied to the teeth by the dentist or trained technician after the gums have been protected with a paint-on rubber dam. Generally, the peroxide remains on the teeth for several 15 to 20 minute intervals that add up to an hour (at most). Those with particularly stubborn staining may be advised to return for one or more additional bleaching sessions, or may be asked to continue with a home-use whitening system.

In-office teeth whitening cost: $650 per visit (on average) nationwide. Our price is $350.

Professionally Dispensed Take-Home Whitening Kits

Many dentists are of the opinion that professionally dispensed take-home whitening kits can produce the best results over the long haul. Take-home kits incorporate an easy-to-use lower-concentration peroxide gel that remains on the teeth for an hour or longer (sometimes overnight). The lower the peroxide percentage, the longer it may safely remain on the teeth. The gel is applied to the teeth using custom-made bleaching trays that resemble mouth guards.

Take-home teeth whitening kit cost: $100 to $400.  Our price is around $70.

Over-the-Counter Teeth Whitening

The cheapest and most convenient of the teeth whitening options, over-the-counter bleaching involves the use of a store-bought whitening kit, featuring a bleaching gel with a concentration lower than that of the professionally dispensed take-home whiteners. The gel is applied to the teeth via one-size-fits-all trays, whitening strips or paint-on applicators. In many cases this may only whiten a few of the front teeth unlike custom trays that can whiten the entire smile.

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Over-the-counter teeth whitening cost: $20 to $100.

Hydrogen Peroxide vs. Carbamide Peroxide

The bleach preference for in-office whitening, where time is limited, is powerful and fast-acting hydrogen peroxide. When used in teeth bleaching, hydrogen peroxide concentrations range from approximately nine percent to 40 percent.

By contrast, the bleach of preference for at-home teeth whitening is slower acting carbamide peroxide, which breaks down into hydrogen peroxide. Carbamide peroxide has about a third of the strength of hydrogen peroxide. This means that a 15 percent solution of carbamide peroxide is the rough equivalent of a five percent solution of hydrogen peroxide.

How White Can You Go? A Matter of Esthetics

Teeth whitening results are subjective, varying considerably from person to person. Many are immediately delighted with their outcome, while others may be disappointed. Before you embark on any whitening treatment, ask your dentist for a realistic idea of the results you are likely to achieve and how long it should take to achieve them. Expectations play a major role in teeth whitening.

Teeth Whitening Shade Guides

In the dental office, before-and-after tooth color is typically measured with shade guides. These are hand-held displays of wide ranges of tooth colors. (Dentists also use them in choosing crown and other restoration shades.)

The standard-setter among them has long been the Vitapan Classic Shade Guide. This shade guide standard incorporates 16 shades, systematically arranged from light to dark into four color groups, and provides a universal tooth-color terminology.

While whitening can occasionally lighten tooth color by nine or more shades, most of those who bleach their teeth are likely to see a change of two to seven shades.

Teeth Whitening Risks

Teeth whitening treatments are considered to be safe when procedures are followed as directed. However, there are certain risks associated with bleaching that you should be aware of:

• Sensitivity: Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. This is likeliest to occur during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains (“zingers”) down the middle of their front teeth.Individuals at greatest risk for whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity and zingers.Whitening sensitivity lasts no longer than a day or two, but in some cases may persist up to a month. Some dentists recommend a toothpaste containing potassium nitrate for sensitive teeth.
• Gum irritation: Over half of those who use peroxide whiteners experience some degree of gum irritation resulting from the bleach concentration or from contact with the whitening trays. Such irritation typically lasts up to several days, dissipating after bleaching has stopped or the peroxide concentration lowered.
• Technicolor teeth: Restorations such as bonding, dental crowns or porcelain veneers are not affected by bleach and therefore maintain their default color while the surrounding teeth are whitened. This results in what is frequently called “technicolor teeth.”

Maintaining Your Teeth Whitening Results

To extend the longevity of newly whitened teeth, dentists are likely to recommend:

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• At-home follow-up or maintenance whitening – implemented immediately or performed as infrequently as once a year.
• Avoiding dark-colored foods and beverages for at least a week after whitening.
• Whenever possible, sipping dark-colored beverages with a straw.
• Practicing excellent oral hygiene – brushing and flossing after meals and at bedtime.

Caveats

In addition to the aforementioned risk factors, a number of caveats should be considered before undergoing teeth whitening:

• No amount of bleaching will yield “unnaturally” white teeth.
• Whitening results are not fully seen until approximately two weeks after bleaching. This is an important consideration if you are about to have ceramic restorations and want to be sure the color matches that of your newly bleached teeth.
• If cosmetic bonding, porcelain veneers or other restorations are part of your treatment plan, they should not be placed until a minimum of two weeks following bleaching to ensure proper adhesive bonding, function and shade matching.
• To avoid the technicolor effect, tooth-colored restorations will likely need replacement after bleaching.
• Recessed gums often reveal their yellowish root surfaces at the gum line. That yellow color has proven difficult to bleach.
• Pregnant or nursing women are advised to avoid teeth whitening. The potential impact of swallowed bleach on the fetus or baby is not yet known.

Has there ever been a time you went to the dentist to get a tooth extracted or for root canal therapy and you felt pain after the procedure?  Did you ask yourself, “Why did I even go to the dentist if I was going to feel pain after?” 

There are different reasons for different procedures people feel pain in dentistry.  There is pain after simple fillings and crown and bridge (restorations); pain after extractions; pain after root canal therapy; and pain after whitening.

Pain after restorations

Sometimes with restorations decay can travel deep, almost to the nerve.  If the restoration is not performed, the inevitable will occur, i.e. the decay will travel to the pulp, there will be significant pain and an extraction or root canal therapy will have to be performed.  This may occur over months or even years.  By doing the restorative procedure, the doctor hopes to head off the inevitable.  The problem is,  the process to remove the decay can be caustic to the tooth.  A high speed dental handpiece rotates up to 400,000 rpms and though it is cooled by water, it can still be hurtful to the tooth. 

After the decay has been removed from the tooth, the tooth has two paths it can take.  It can either return to normal, pain free or it can continue its inevitable course to necrosis (death).  If the tooth is on its path to recovery, it can still be sensitive but the sensitivity will start to recede over time.  This can take weeks, months and even up to a year, I have seen.  If the tooth is on the path to necrosis, it will be sensitive and it will begin to throb.  You will feel the throbbing when you watch TV or while you try to sleep.  The pain will be progressive.  When you eat or drink something cold, the pain will last longer than 10 or 15 seconds.  At this point, seek a dentist.

Pain after extraction

People go to the dentist to have a tooth extracted; hoping to the pain involved with the tooth will be gone, only after to have significant pain and possibly more than they had before.  There is little to fear by this.  The two main reasons people feel pain after extraction is because of infection and dry socket.  The timing is most important in this case.  There will be sensitivity immediately after the extraction but if the pain is noticeably significant within the first three days, it is most likely a dry socket.  This is due to the clot (scab) has been dislodged and has left exposed bone.  This can be treated easily by your dentist with a salve he/she can place directly on the extracted site.  After three days, and the third day is always the worst for healing, the pain should go away.  If the pain begins on the third day, it is often associated with infection.  See your doctor because you may need to change your antibiotics or treat for dry socket.  If pain persists for more than a week, x-ray should be taken of the area to make sure that no remnants of tooth were left.  Bone spicules also have a tendency to surface in areas of significant infection.  These often feel like little splinters.

Pain after root canal therapy

Root canal therapy is not like it used to be.  My mom remembers getting a root canal without any anesthesia.  This is probably where the adage comes from when comparing something you do not like, “I would rather have a root canal”.  At one time, this was probably the worst thing imaginable.  With current day technology, root canal therapy is no more painful than a simple filling, only requiring more time.  Some of the main reasons people feel pain after therapy is due to preexisting infection, injection site or cracked tooth.  If there was infection prior to the treatment, infection will still be there after.  Take antibiotics and the infection should dissolve over time.  The gums around the tooth worked on, will be tender due to anesthesia.  Rinse with warm salt water, take antibiotics and this will go away. 

Sometimes, after therapy, the tooth becomes fragile and the possibility of the tooth cracking increases, that is why a crown is necessary to add strength.  If cracked tooth is the result, then options are limited.  Depending where the crack is located will determine if extraction is necessary or not.

Pain after whitening

After whitening people’s teeth are often sensitive.  Sensitivity occurs due to whitening to the nerve endings in a tooth (dentinoenamel junction- where the dentin and enamel meet).  In addition, peroxide has been known to dehydrate the teeth.  Best options are to get desensitizing gel, prescription strength is preferable.

The first and in many instances the best way to replace a missing tooth is by titanium implant.  From my patients, I hear misinformation and fears about implants, i.e. implant failures, infections, pain, etc.  Much of these problems may have been partially true, ten or fifteen years ago, when implants had a 70% success rate, but today implants are 97% successful.  There is not a higher success rate for any procedure in dentistry. 

The advantage of an implant is that it feels and acts very similar to a real tooth.  The implant must have a higher standard of hygiene.  There tends to be gum and bone recession around an implant, more than regular teeth, so, one must pay particular attention to flossing and regular cleanings at the dentist.

Another advantage to an implant is that it preserves bone.  Without an implant in that space, after extraction, 40 to 60% of bone loss occurs in 2-3 years.  I have seen more and I have seen less than the statistics given.  If a bridge is placed immediately after extraction, this would leave cosmetic problems, especially up front.  With an implant, the bone would stay relatively at the same level.

Contraindications for implants are:

-          Insufficient bone – The lower jaw especially needs to have sufficient bone above “inferior alveolar nerve” which runs along the lower portion of your jaw.  If the implant impinges on this nerve, it could cause numbness temporarily or permanently.  In addition, if there is generally not enough bone, then an implant is not indicated.

-          Uncontrolled type II diabetes – If your diabetes has caused poor blood flow to the perifery limbs, this would not be an ideal situation for an implant.  The bone needs good blood flow and uncontrolled type II diabetes may prohibit this.

-          Bisphosphonate medication – Oral bisphosphonates have been shown to not have significant harm to implants but IV bisphosphonates have been shown to cause ‘bisphosphonate-associated osteonecrosis’, i.e. the bone dies around the implant.

-          Tooth clinching or grinding – Living teeth have thousands of tiny ligaments that attach it to the bone.  This is what you feel when you clinch your teeth and there is a slight give.  Implants integrate with bone and do not have this give.  Hence, if you clinch or grind your teeth significantly, it could cause an implant to fail.  Solution is to get a night guard.

-          Head/neck radiation – If you have had radiation in the head/neck region, the bone in this area has difficulty healing properly and could cause osteonecrosis.

The second best way to replace a missing tooth is with a fixed bridge.  The advantages of a bridge over an implant are:

-          Time – generally the time of turn-around for a bridge is about one to two weeks.  Depending on the conditions, the time it takes for an implant is between 2 wks and 1 year.  For most reliable results of an implant, ranges from 6 months to a year.  Not everybody has a year to wait to get a tooth.

-          Cost – Often the cost of a 3 unit bridge (a bridge with 3 teeth) is about the same as a one unit crown implant.  But if the teeth around the space to be filled need a crown, that would cost additional money on top of the cost for an implant.  By placing a bridge it would kill two birds with one stone.

-          Has ‘give’ – Because a bridge is essentially crowns on real teeth with a fake tooth in the middle connecting them, it has the cushion of real teeth.  This is good for a person grinds or clinches their teeth.

-          In the cases of osteonecrosis, a bridge would be a better fit to replace a missing tooth since there is no surgery needed.

-          No surgery needed – For those with a fear of dental surgery, a bridge is placed on the teeth next to the space needing the tooth and there is no need for surgery.

There are no real contraindications to a bridge but there are disadvantages.  One disadvantage is that the success rate is not as high as an implant.  Another disadvantage is if the proximal teeth are healthy and don’t need restoring, you do not want to put crowns on perfectly healthy teeth.  An additional disadvantage is that of aesthetics.  An implant can be made to look more like a tooth coming out of the gums than a bridge.  A bridge could get a gap by the gums.

A third and definitely least desirable way to replace a missing tooth is with a removable denture.  Two types of dentures are partial and complete.  To replace a missing tooth one would use a removable partial denture (RPD). 

The disadvantages of a RPD are too numerous to count but some are:

-          Eating – It’s harder to eat with an RPD

-          Speaking – It takes time to learn to speak with an RPD

-          Removable – It can be terribly embarrassing to have to take your ‘teeth’ out in front of company, or for your teeth to come out unexpectedly.   

A colleague of mine once put it best, ‘a denture is a good replacement for no teeth but is a terrible replacement for teeth.’  I rarely have seen a patient that is happy to have a denture of any type, but it is better than no teeth at all.

The only real advantage of a RPD is the cost.  If multiple teeth are missing and finances do not allow for implants or bridges, then an RPD is a viable alternative.

In summary, an implant is great substitution for a missing tooth, as long as the indications allow.  An implant has similar sensations as a real tooth.  If the indications do not allow, a bridge replaces a missing tooth nicely.  Disadvantages are present but it allows for a permanent replacement. A RPD is a poor alternative to the latter two, but if finances are a concern, it is an alternative.