I have been thinking about getting my teeth whitened for quite some time and now I am ready to make a move. The procedure that seems the quickest and the best is the in-office type that is done by a dentist. I have also seen it done on television makeover shows and the results seem phenomenal. Is it safe, will it work for anyone, and how long do you think it will last? Please provide any information about the process that may help me in my decision. – Donna in Belle River

I believe that you are talking about the same in-office chair-side tooth whitening system that we now perform in our practice. It is quick, convenient and inexpensive. It is a tooth bleaching process that lightens discoloration of tooth enamel and dentin, the layer beneath the enamel. More people than ever are now whitening their teeth and a bright, sparkling smile can make a big difference for anyone and is usually a great esteem booster.
There are many causes of tooth discoloration. Besides aging, the worst culprits are staining substances including but not limited to tea, coffee, red wine and smoking. We also see striped, spotted and discolored teeth from excessive fluoride or certain antibiotics that were taken by individuals during tooth formation. These cases can be improved also.
Almost anyone with natural teeth and limited previous cosmetic dental restorations on their front teeth can benefit from this type of amazing treatment. Keep in mind though that some people will get better results than others for various reasons. If your dentist offers this kind of procedure, he or she will be able to determine whether you are a good candidate or not, through a consultation or comprehensive dental examination and shade assessment.
Research has concluded that whitening teeth under the supervision of a dentist is safe. It may even be the safest cosmetic dental procedure available. However, this treatment is not recommended for children under the age of thirteen or for lactating mothers.
As far as results go, by following the simple post-treatment instructions, your teeth should always stay lighter than before. You must floss daily, brush twice a day and do the occasional touch-up at home with the whitening gel given to you after treatment by your dental professional. Whitening toothpaste may even help you maintain your whiter smile.
Over-the-counter whitening products such as strips, brush-on gels, and toothpastes take a considerably longer amount of time to work and the results are not nearly as dramatic as with the in-office treatment of a dental professional. The chair side method commonly lightens three to six shades lighter than these store bought products.
The best system currently in use is light-activated. This light is utilized in conjunction with a light-activated gel whose active ingredient is hydrogen peroxide. As the hydrogen peroxide gel is broken down, oxygen enters the enamel and dentin, bleaching colored substance while the structure of the tooth is unchanged. The light actually aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth. The use of the light has been found to increase the effectiveness of the peroxide gel by approximately thirty-three percent.
During the procedure, you will find that it is very relaxing. You can listen to music or watch television. You may experience some mild sensitivity to cold during the treatment, but these symptoms usually disappear one to three days after the treatment is completed.
The complete procedure takes between one and two hours. It begins with a preparation and isolation period followed by one hour of actual bleaching. A five minute fluoride treatment completes the procedure. It is important to know that a dental cleaning by your dentist or hygienist is required prior in-office tooth whitening.
After completion, your dentist will advise you to stay away from certain tooth staining beverages and foods, especially during the first forty-eight hours, and then to use some whitening gel for a few nights in a pair of custom fabricated trays, to finish things off. You will be amazed by the results, and I think you are on the right track if you are considering this technologically-advanced form of cosmetic dental treatment.

Dear Dr.: My gums are bleeding a lot when I brush my teeth and I’ve heard people talking quite a bit about gum disease. How do I know if I have it, and if I do what can be done about it?-James in Tecumseh

Dear James: If your gums are bleeding when you brush, there is a good chance that you are at some stage of gum (periodontal) disease. It does affect approximately nine out of ten adults at some point in their lives and it may not even hurt or you may not even be aware that you have it until a more advanced stage. If you notice any of the following warning signs, see your dentist ASAP:
*Bleeding gums
*Red or swollen gums
*Gums that look like they have pulled away from the teeth
*Pus between the gums and teeth
*loose teeth or ones that have changed position (can make your bite feel different)
*constant bad breath

In terms of treatment, it depends on the severity of the problem. The first step after a comprehensive exam is usually to remove plaque and tartar (calculus) deposits from above and below the gum line (scaling). The root surfaces may also be smoothed (planning) to decrease the chance of future plaque attachment and also to facilitate healing and reattachment of gum tissue to the teeth. In more advanced stages of the disease deep pockets can form between your teeth and gums that may even make it difficult for your dentist to do a thorough job. In this case, and possibly before, you may be referred to a Periodontist (gum specialist) for evaluation. If you have had any of the warning signs, don’t let it go any further. Allow your dentist to treat it, educate you about it and how to control it, and put you on a proper maintenance schedule. The longer you wait, the worse it will get!

Dear Dr Mady: I have so many unanswered questions when it comes to choosing oral care products like toothbrushes and toothpaste. What do you think?-a faithful reader.
Dear faithful reader: When shopping for oral care products it is extremely common for one to become confused with the great variety available on the market today. A good place to start is with recognition of a dental association seal such as ADA, ODA or CDA, on packages. Products that carry one or more of these seals include toothbrushes, toothpastes, mouthwashes, flosses, inter-dental cleaners and the list can go on.
With respect to your tooth brush, it should be replaced approximately every 3 months or sooner if the bristles appear frayed or severely worn. Always purchase a soft or ultra-soft bristle brush as the medium or hard bristle type may cause unnecessary damage or wear to both your teeth and gums. The bristles on your brush should be polished when they are made so that they are gentle on tissues. Use a size and shape that allows you to clean all surfaces of your teeth comfortably. Children may wear out their toothbrushes quicker than adults.
Shopping for floss and other related items can be even more frustrating. When it comes to floss, choose a type, whether waxed or un-waxed, that adapts the best to your teeth and gums. Waxed flosses seem to be more gentle for the most part and they are available now in thick or thin versions. As far as mouthwashes go, ones that contain antibacterial qualities are best for rinsing and gargling. Other oral cleaning devices and stimulators may be prescribed by your own dentist specifically to suit your own dental needs. Ask your dentist or hygienist what they think.

If you need any other information or have any dental questions, please e-mail Dr. Mady at drmady@drmady.com

I am a twenty-one year old who has a great love for baseball. I was recently advised by my dentist that I should be wearing a mouth guard for this and all sports. Is a mouth guard really necessary?-Shaun in LaSalle

Absolutely!! Do not allow yourself to become a victim of preventable sports injury. Listen to your dentist and wear a mouth guard. I do realize that they are not mandatory as a part of attire or equipment for any sport but their worth is non-arguable.

As a dentist I have seen many injuries that could have been prevented if only a mouth guard was worn. They not only limit damage to teeth but help protect the cheeks, lips, gums, tongues and even assist in stopping concussions. Any type of blow that an athlete may take in the head or neck area can be cushioned by a mouth guard.

Taking all of this into consideration, it is important to realize that there is not only one type of mouth guard. Available kinds include custom-made, mouth-formed, or ready-made. The custom type is fabricated by your dentist on a plaster model or your exact mouth and jaws for complete coverage. They usually are very comfortable and will not interfere with breathing. These offer the best protection and fit although they are more costly than other types.

Mouth-formed mouth guards are the type that have to be boiled in water and have to be softened up. Even though your dentist can assist you in fitting these they are an inferior choice due to the fact that they will not work well on patients who wear braces, they do not cover all the anatomy that they should for full protection and they usually become brittle with time and ultimately useless.

The third type, cheapest and least user friendly are the ready-made mouth guards. These are formed out of polyvinyl or rubber. They are the least effective and could cause more damage during trauma in some cases. I won’t even explain what they’re all about except to tell you that I do not recommend their use.

So teach yourself or ask your dentist about the most common oral injuries associated with the sports that you play and protect yourself by wearing a mouth guard. Use the custom-made type fitted by your dentist, especially if you wear braces or other oral appliances. Never wear removable partial dentures or any removable dental devices for that matter during sports or exercise. Whatever your sport or age, mouth guards are an excellent form of safety. You are only given one set of permanent teeth so do whatever you can to protect them, your smile and also to preserve your health.

Dear Dr. Mady: I have been experiencing problems with extremely bad breath for the past four months. My dentist said my teeth are not the cause of the problem. As a matter of fact, he said that my oral hygiene is superb. Can bad breath come from somewhere other than my teeth?-Joe B. in Monotonic

Dear Joe: Items like mouthwashes, toothpastes, breath mints, breath strips and gum are a multi-billion-dollar a year business, especially in North America. This is mainly because bad breath is bad news for business, relationships and self-confidence. The first impression is often an important one and bad breath leaves a bad impression. What does concern me is the fact that bad breath can also be a sign of poor health.
Bad breath can be a sign of problems in the mouth, sinuses, lungs, airways, stomach or even kidneys. If someone has persistent bad breath, their physician should entertain the fact that there may be other causative factors. I have seen infections in the lungs that cause halitosis (bad breath).
The reason bad breath is so devastating, is due to the embarrassment that it causes. In ancient times it was known as a disease and sometimes evens a curse. For many, it just means it is time to floss and brush your teeth. For others it is a chronic problem caused by an underlying sickness or for no known reason.
It is a common belief that someone with halitosis does not brush their teeth and that they have poor oral health. This is actually false. Most individuals with bad breath have impeccable oral hygiene. The culprits of bad breath are bacteria that function in an oxygen-deprived environment in our mouths. These bacteria ingest protein particles and metabolize them and in the process they produce sulfur gases. These sulfur gases have a rotten egg-like smell that causes halitosis.
Gum disease starts with a plaque build-up on teeth and gums. These bacteria are oxygen-loving and they too create sulfur gases. This is why people with periodontal disease have bad breath. For those with a chronic problem unrelated to oral bacteria, they must seek the help of their physician to ?dig a little deeper? to try and diagnose the real underlying cause.
The fact is that low-crab diets do cause bad breath, because the large protein intake is very desirable to anaerobic bacteria that cause bad breath. As the body burns fat, keenest are released b through the breath and the urine and these ketenes smell. So if you are on a low-crab diet, drink lots of water and this will lessen the chances of bead breath.
Another fact is that your tongue is a rug-like haven for bacteria to metabolize into sulfur gases. Tongue scraping is one of the absolute best ways to decrease bad breath in addition to brushing your tongue when brushing your teeth.
It is a myth that if you have a bad taste in your mouth, that you will have halitosis. You could have a bad taste in your mouth and no odor whatsoever in your breath. On the other hand, if you have no taste in your mouth, you could have very bad breath. Sometimes you can even get used to the smell and not even notice it yourself, but others surely can.
While performing oral hygiene at home, always include flossing, because floss gets in between teeth where your brush can not and removes food debris and bacteria that fester into halitosis. The bottom line is that if you understand all these facts and are performing good and proper home dental care and are still experiencing long-lasting bad breath, you need to act now. Ask your dentist or hygienist to review your hygiene practices and ask if they have a toothpaste and mouth rinse containing chlorine dioxide. If that doesn?t help, call your physician and I am sure that with warranted diagnostic testing that you will increase your chances of a cure for this ?disease?

I have been wearing braces for the past two and a half years and I will be getting them off in four weeks. My doctor said that I will need to wear some type of retainers to keep the teeth straight. Is this really necessary and what types are available?-Paulina in Las Vegas

When it is finally time for your braces to come off, your teeth will be straight and beautiful at last, but you won’t be finished yet. Most individuals need something to help retain the teeth in their new and proper position. The?something? that I am talking about is called retainers.
Impressions will be taken for study models and working models for your new retainers. Retainers are designed to hold your teeth in place while they settle into their new and final position. Depending on your case, your dentist or orthodontist will make recommendations on which type of retainers you will require, how long you will need to wear them each day and for how many months or years. In some situations, they will need to be worn for life. Orthodontic retaining appliances resist the natural tendency of teeth to return to their pre-treatment positions under the influence of periodontal, occlusal (biting) and soft tissue forces, and continuing dent facial growth.
Your doctor will fill out a prescription slip for his lab technician with instructions for the type of retainer and the specific design that they want the lab technician to follow when making your appliances. Some doctors have a technician in their office but in most cases your retainers will be sent out to an orthodontic laboratory to be fabricated.
These orthodontic dental retainers are appliances that are most commonly made of plastic and stainless steel wire (Hawley type), clear vacuum formed plastic or can be a custom wire permanently bonded in the mouth. While the orthodontic retainer is holding the teeth in their new position, the surrounding bone and gums adjust around them to compensate for the previous movement. If the appliance is removable, the length of time that it must be worn will vary, but most teenagers will be advised to wear their orthodontic retainer at least until their early twenties. I personally feel that they should be worm indefinitely. Immediately after braces are removed, the retainers should be worn at all times except eating during the first one to four weeks and then at least twelve hours per day for the first year. Some individuals wear them twenty-four hours a day except while eating. It all depends on what your doctor prescribes for your specific case.
The plastic/acrylic and stainless wire or Hawley type of retention appliance is the most common and has been used in orthodontics for many years. It is utilized mostly for retention in the upper arch but can be used on the lower as well. In addition to retaining tooth positioning, it can also be used for additional minor tooth movements or even for space maintenance prior to orthodontic treatment.
The Hawley appliance is made of acrylic which can hold various wire attachments. In general, a Hawley constructed for the upper arch will cover most of the palate or roof of the mouth, and the lower Hawley will be shaped like a horseshoe. The wire attachments may include certain types of clasps and rests to help stabilize the position of the retainer. Small springs may also be attached to achieve tooth movement if desired. These springs will require activation by the dentist at certain time intervals to achieve the desired results if movement is needed.
The clear retainer is vacuum formed over models of the straight teeth when one desires not to have a straight wire showing on the top or bottom. This retainer is see-through, and can sometimes be used with tooth whitener gels. It better esthetically than the holly type and is more cost efficient to replace if it gets damaged or lost in a napkin at a restaurant.
The “bonded lower retainer” for the lower teeth is actually simple. There is a small diameter wire bonded to the back of each tooth between and including the lower cupids. It is also called a “bonded 3 to 3″ in orthodontic terminology. This is a retainer which will hold the lower six front teeth in perfect position as long as the retainer remains in place. It can sometimes be used for upper front teeth also. I tell my patients that it is “forever”, or as long as you want your teeth to remain perfect. In reality, the wire is unseen and unnoticed after the first few days. You have to thread floss under the “bonded retainer” to keep it clean, or else it can become a plaque trap. That is about the only negative aspect of this fixed type.
The rationalization behind lower permanent retainers is prevention of a naturally occurring process that tends to crowd the lower front teeth as one ages. In the late teen years, the mandible or lower jaw will normally grow forward a bit, at the end of growth, crowding the bottom teeth against the inside of the upper front teeth. As long as the bonded retainer is in the lower, the teeth will stay straight and not move.
Ask your dentist or orthodontist to show you samples of the different types of retainers that are recommended for you specifically. A decision can be made after taking cost and esthetics into consideration. Good Luck!
If you want more information about orthodontics and cosmetic dental procedures, go to www.drmady.com and click ?articles? and then type a search topic in the search box on the left and simply select ?go?. There is an abundance of interesting and educational information in all of these articles.

Dear Dr. Mady: The first time I went to my dentist for an examination, five years ago, he had x-rays taken of all of my teeth. I go now about every six months for cleanings and check-ups and he has the hygienist take a couple of x-rays about every second visit. Sometimes they find cavities and other times they do not. What are the benefits of dental x-rays, how do they work and how often should they be taken?-Heather from Naples, Florida via e-mail

Dear Heather: Every time you go to visit your dentist and he looks in your mouth, many diseases that may exist in the teeth and in the tissues around them cannot be seen. However a dental x-ray is an excellent aid with respect to diagnosis of any anomalies or of good oral health.
Individuals who do not floss often get cavities in between their teeth just below where the teeth contact each other. A visual exam often is not sufficient to correctly diagnose these interproximal cavities, along with recurrent decay that may be growing underneath existing restorations that you have. Failing to diagnose these may ultimately lead to the need for root canal treatment or even extraction.
Also infections, abscesses or cysts in the jaw bone surrounding teeth can be easily seen on dental radiographs. These often exist for various reasons and you may not even be aware of them. There may also be other dental abnormalities existing that cannot be visualized with the naked eye.
Gum disease or periodontal disease ultimately destroys the supporting structures of your teeth, including bone. Loss of this bone and the extent in all areas can easily be seen with x-rays and gives your dentist a better idea of which direction to go in as far as your dental treatment plan goes.
Basically the way that dental x-rays work is that a small amount of radiation passes through a selected area of your mouth and conveys an image of this area on a small dental film (intra-oral). There are larger films that are used to take an x-ray of a larger area and these films are used outside of the mouth (exta-oral). Examples of these are the anorexia and the cephelogram.
In the process, more of the rays are absorbed by the denser tissues like teeth and bone than by the gums and cheeks, before these rays reach and hit the film. This is how the image is created. The reason that the teeth seem lighter is because fewer rays penetrate (are not absorbed as much). Infections, bone changes, ligaments that surround teeth and cavities appear darker on the x-ray because more rays penetrate these less dense areas. Existing fillings will show lighter or darker depending on the dental restorative material that was used in their placement.
Frequency of x-ray taking on dental patients is situation-specific. In simple terms, this means that it depends on the oral health needs of each individual patient. Every patient is different and the need for radiographs will be different and individualized for each. Your dentist will decide whether they are warranted and when, based on present signs and symptoms oral conditions, previous history of decay, age and risk of dental disease.
If it is your first visit and complete exam, your dentist usually will want more x-rays so that everything can be completely examined at that starting point. If there is no disease present or a possible problem starting, these radiographs can later be used as a vehicle to compare future changes with past conditions. If you have recently had x-rays taken at another dental office, forwarding these to your dentist or new dentist is a common practice. On the other hand if a referral to a dental specialist is later required for you, your dentist can simply send the radiographs there and omit the need for new ones to be taken.
Children may require dental x-rays more often than adults because their teeth and jaws are constantly developing and they are more likely to be affected by tooth decay than adults. Also the tracking of exiting baby teeth and entering permanent teeth is important. If you are an individual that has new cavities diagnosed every time you visit your dentist, x-rays will be taken more often so nothing gets missed.
Finding and treating dental problems at an early stage can save money, time, pain and unnecessary aggravation later on. They can detect damage to structures that are not evident during a visual oral exam and ones that exist but are asymptomatic. If you have a hidden tumor, dental x-rays may even help save your life!

I have been a high school teacher for the past twenty-five years and I have to say that I see more tobacco use among teenagers now than ever before. Please address how damaging this is, at least as it relates to the mouth and teeth. I feel it is important for teens to grasp some understanding of the negative side of this addictive substance. -a concerned educator

I have been a high school teacher for the past twenty-five years and I have to say that I see more tobacco use among teenagers now than ever before. Please address how damaging this is, at least as it relates to the mouth and teeth. I feel it is important for teens to grasp some understanding of the negative side of this addictive substance. -a concerned educator

Dear concerned educator: Thank you for your interest in this subject. I know from my own practice that the problem of teenage tobacco use is becoming rampant in our society. It may begin at school or anywhere, from social pressure or from other variables. The bottom line is that you are right. Tobacco use is very unhealthy and oral health is affected primarily even before the respiratory system and other organs.
What young people do not realize is that smoking and using smokeless tobacco increases your chance of developing oral cancer by four times. This is especially true for females, more than males. Teens think that older adults are the only ones who get cancer, if they think about it at all.
There is a great number of other, less drastic side effects associated with excessive tobacco use. Many of these are not life threatening but however have unpleasant consequences associated with them. They include but are not limited to leukoplakia, dry mouth, bad breath, stained teeth, increased mucous formation, decrease in taste and smelling senses, mouth sores, and promotion of destructive gum disease.
Leukoplakia is a white irritation often created by smoking and it does have the potential to turn cancerous like other mouth sores. Tobacco use in combination with alcohol is an even much more potent and damaging cocktail than people realize with respect to forming oral and throat cancers. If cancer develops or progresses into the esophagus, diagnosis is often not until the later stages and treatment is extremely challenging if at all possible at that point.
Gum disease, as we know, is basically the destruction process of the supporting structures of our teeth. These structures include mainly our gums, bone and periodontal ligaments surrounding the roots of our teeth. These tissues are very susceptible to tobacco use and if gum disease is already inherent, the situation only worsens when attacked by tobacco and it’s dangerous ingredients.
Youngsters who think it is ?cool? to use smokeless chewing tobacco or snuff are in for a rude awakening if they don’t quit! If they think it is safer than smoking, they are in for a big surprise and should understand the risks. They do not understand how many different chemicals are being released into their bodies from smokeless tobacco and it is these exact toxins that are putting them at serious risk of illness. Just like tobacco that is smoked, snuff can cause dry and cracking, oral soft tissues and mouth sores that can lead to cancers in the throat, mouth and lips.
The main reason that tobacco is so destructive is because it contains known toxins that destroy our cells and tissues in our bodies. It also causes vasoconstriction of blood vessels, in the mouth especially. This is a narrowing of the small and large arteries and veins that our blood flows through and if there is constriction, there is less blood flow and circulation. We all know that increases blood flow means more healing and healthier tissues and organs in the area of more circulation. It only makes sense that in areas of decreased circulation, tissues will be more exposed to inflammation, disease and other unhealthy situations. The defense and immune systems of our body are affected in a negative way also if we use tobacco and eventually it shows on the outside even through your skin and eyes.
There are presently studies being performed that even may prove that second hand smoke not only causes cancer but may even cause periodontal or gum disease. Basically remember that tobacco and a healthy mouth don’t go well together.
APRIL IS DENTAL HEALTH MONTH. LETS ALL CELEBRATE THE SMILE!!
If you want more information about any of the above topics or about cosmetic dental procedures, go to www.drmady.com and click ?articles? and then type a search topic in the search box on the left and simply select ?go?. There is an abundance of interesting and educational information in all of these articles.

I am now seventy years old and have been wearing a full upper denture for twenty years. I recently went to see my dentist to inquire about getting a new one made and I told him that I wanted a much whiter smile than what I presently have. He tried to talk me out of it because he said that my natural lower teeth have yellowed with time and that if I whitened the tops, it would look unpleasant. I still want a whiter smile and was thinking of just having the lowers pulled and making a full set of false teeth. What can I do?-John D. in Cleveland.

I understand exactly what you are up against. I see similar cases on a regular basis in my own practice. I cannot blame you for wanting a healthier, younger looking smile. After all, the mouth is one the first things that anyone sees when communicating with another individual face to face.
It seems that our society today has become almost obsessed with having whiter and more sparkling teeth. It could be partially due to a never ending bombardment of gleaming, perfect smiles from many sources including magazines, television and numerous types of advertising. It is almost like a nice smile eludes a healthy appearance and there is really nothing wrong with this. What we all have to keep in mind is that not everyone has the same teeth, mouth, skin color and facial features, and options that work for some don’t always work for others.
When we look at a great smile we must realize that the lips have something to do with it also. When we look at the lips, we must see that the rest of the face relates to their shape and the way that they appear with the teeth.
As a denture wearer, your pursuit of a more perfect appearance is just as normal and important as someone who has all of their natural teeth. Actually it may even be easier, quicker and less costly for denture wearers to change or enhance their dental appearance. If you have a new upper (maxillary) denture fabricated, you will have the ability to choose the shape, color and arrangement of your teeth in the new prosthesis. If you like the old denture exactly the way it is with respect to shape and size of teeth, but wish it was brighter, your dentists job becomes much easier. Instructions to the lab technician may even request for denture duplication with whiter teeth.
As time goes on, I see more patients like you who are requesting lighter shades of teeth for their dentures. This can make denture wearers feel younger, healthier and make their smile much more glamorous. It can however make the job of keeping things looking more natural, difficult. This is especially true with patients in their eighties who desire a perfect ?bleach white? smile that gleams every time they open their mouth. Although it may look beautiful, in reality it does not reflect great health due to the fact that it would be obvious to everyone that this person is wearing a denture.
The problem that you are describing about your lower remaining natural teeth appearing darker is not uncommon. With the technology that dentists have today, there are options for you to exercise prior to new upper denture fabrication. It could be as simple as a home or in-office tooth whitening procedure on your lower teeth. The different dosages of peroxide used in these procedures can often create dramatic results, no matter how old the patient is.
The cost for these procedures has become relatively inexpensive. Even the cost of the in-office instant whitening has decreased considerably from a few years back. A whitening procedure is the simplest, most economical and least time consuming treatment option that I would entertain first.
If the results from whitening your lower teeth are not to your satisfaction, you may consider cosmetic bonding with resin, porcelain veneers (facings) or full coverage ceramic porcelain crowns (caps). With one of these procedures, you and your dentist will have the ability to create the most natural and attractive shade for your teeth and later or simultaneously fabricate your upper denture to match exactly with the lowers. Many patients even like to have the lower teeth or the cupids (eye teeth or canines) ever so slightly darker for a more natural look. Natural teeth often appear like this when they are formed.
When exercising your treatment options, don’t ever contemplate extraction of your natural lower teeth unless they are severely decayed or have lost so much periodontal support that they are not salvageable. If you go the extraction route you will unpleasantly discover the fact that a lower denture is much more difficult to adapt to and wear than a upper, like so many others have realized. Remember, once your natural teeth are gone they won’t grow back. Keeping them, no matter what the esthetics, is always the best option!
If you want more information about whitening and other cosmetic dental procedures, go to www.drmady.com and click ?articles? and then type a search topic in the search box on the left and simply select ?go?. There is an abundance of interesting and educational information in all of these articles.

I have been experiencing sinus congestion off and on for the past month and now my upper back teeth are very sensitive and I have some pain on both sides when biting. I believe it all started with a cold but now I am wondering if my teeth are the root the problem. What do you think could be wrong and what is your advice?-Donna in Chatham

Dear Donna: From what you are describing, I have to say that it appears that you may be suffering from a sinus infection or sinusitis. Sinusitis simply means that your sinuses are infected and/or inflamed. Although sounding simple, this condition can cause much agony and pain.
Sinusitis actually refers to inflammation of the lining of one or more of your sinuses. Dentists and physicians typically classify these sinus infections according to the sinuses involved. If the maxillary sinus in the mid-face is involved, we call the condition maxillary sinusitis. We also indicate which side is involved because these infections are often unilateral (one sided) in nature, but can be bilateral.
We have four of these hollow air spaces in our heads. If the sinusitis is affecting all four at one time, then we refer to it as pan sinusitis. The four sinuses are the the maxillary, frontal, ethnocide, and sphenoid sinuses.
The maxillary sinuses are inside each cheekbone. The frontal are over the eyes in the brow area. The ethnocide are located immediately posterior to or behind the bridge of the nose, between the eyes and lastly the sphenoid sinuses are behind the ethmoids in the upper area of the nose and behind the eyes.
Sinusitis is also classified by its duration and frequency. ?Acute? sinusitis is the term used when the infection lasts less than six to eight weeks and occurs less than four times per year. ?Chronic? sinusitis however is when the problem is persistent for more than eight weeks or occurs more than four times per year. Each is different and as a result is usually treated differently.
Each sinus has an opening into the nasal cavity for exchanging of air and for the release of mucus. If there is a swelling in the nose or anything similar to that, as in the case of the common cold, this can cause air and mucus to become trapped inside the sinuses. Pressure on the sinus wall is the end result and it is this pressure that elicits the pain, pain that may refer to other areas. The common cold is often a precursor to acute sinusitis, especially when the cold lasts more than ten to fourteen days. The presence of headache or facial pain can suggest that the sinusitis is beginning. Facial pressure, especially under the eyes is very common.
With chronic sinusitis, the most usual symptom is postnasal drip. With this there is usually a constant flow of mucus into the back of the nose or throat. It can trigger a cough at times if it drips down into the vocal cord, windpipe or bronchial tube area. In this case the cough will be worse in the morning.
Toothaches and tooth sensitivity in the upper back teeth is an often apparent sinus infection symptom. The main reason for this is that in most human’s anatomy, the roots of the upper molars and sometimes the premolars or bicuspids in front of them, sit right in the maxillary sinuses. Pressure in the maxillary sinus can irritate the nerves and surroundings of these teeth and cause many symptoms. Sensitivity is most often the first symptom, but as pressure builds up in the sinuses the teeth are actually being pushed outward and then biting pain occurs. This is because even if these teeth are a micron more into occlusion (bite) from sinus pressure, they will take more biting forces than any of the other teeth in the mouth during chewing. In addition to irritating the teeth more, the chewing may also irritate the maxillary sinus where they originate from.
In my practice I often see individuals present with these symptoms and sometimes you can even see the white fluid filled sinus on the dental x-ray. Tapping the teeth may cause pain and is another diagnostic test that can be performed. Molars on one side or both may be affected.
Patients often refuse to agree with a diagnosis that their dental pain may be from a sinus infection, even if the pain extends over the roof of the mouth. I have accepted patients that have previously had extensive dental treatment on their upper teeth to help alleviate sinusitis symptoms, with no change in their condition. Some people have even gone to the extreme of having teeth extracted unnecessarily from sinusitis.
My best advice to you at this point is to start with the simplest form of treatment. Seek assistance from your physician or dentist and if they feel that sinusitis is the problem, it may be as simple as a regimen of a good upper respiratory antibiotic for ten days. If that does not work, they can ?dig a little deeper? and if the problem really becomes chronic to the point where it is affecting your quality of life, your physician may choose to refer you to an ear, nose and throat specialist for evaluation. In the meantime see your pharmacist immediately for a good antihistamine/decongestant that will work for you and not interfere with any other medications that you may be taking. This will help carry you until you see your health care professional and it may even be a good idea to take it in conjunction with an antibiotic, if one is prescribed. After being assessed you will be treated accordingly. I hope this helped.
Good Luck.

My 3 year old daughter visited our dentist for fillings and would not let him near her. She is very afraid and I explained my concern that she may fear dentists for the rest of her life. Because of this he recommended a pediatric dentist. What exactly do they do differently and do you think it will help her get over her fear?
-Manal in Central Windsor

It sounds like your dentist is giving you good sound advice. If a Child is apprehensive and uncooperative and treatment is forced on them at a young age, it could lead to a dental phobia. I see it very often, but children and parents from this era do have other options.

Pediatric dental specialists treat children from infancy to adolescence just like a pediatrician. They are dedicated to the oral health of children. They also focus on mentally and developmentally handicapped or compromised children. They have an additional two to three years of specialized education related to pediatric treatment and they focus only on these aspects of dentistry. This specialization allows them to provide the most up-to-date thorough child dentistry for a wide variety of children’s dental problems.

If required, they can use different types of sedation to make treatment possible and hospital dentistry may be offered to you, depending on the specific needs of your child and amount of treatment required.

Pediatric dentists communicate with your child in a special way that assists them with behavior modification and establishes more trust. Once this trust exists, acceptance of treatment becomes a much more attainable goal. They can provide excellent dental care for your daughter in a caring and sometimes exciting environment.
Children, in reality, are like ?small grownups? But they have totally different physical and emotion needs. When they have fear or apprehensiveness about something, they react differently than adults, and we cannot expect anything but this. The pediatric dentist places your child in an environment specifically suited to them and the stage of life that they are in.
During your child?s first visit to the pediatric dentist, you can get all of your questions answered and if needed, your daughter can just meet and talk to the doctor and staff. Depending on the situation and level of comfort, she may have a cleaning and fluoride treatment completed, with x-rays, if they were not taken prior to then. A treatment plan will be made after that and presented to you.

The staff members in these specialty clinics are programmed to put your child at ease. They often have lots of nice books, video games and movies to keep your child occupied and in a comfort zone. If they request that you are not present during treatment, accept this unless the separation anxiety during the first visit or two interferes with treatment.

I know you probably think your family dentist is fabulous, but keep in mind that your three year old daughter is looking at everything through three year old eyes, and perceives everything differently than you do. The normal treatment that you are used to may just frighten the daylights out of your daughter. If dental visits are more relaxing and enjoyable for your child, it may be the beginning of a lifelong trusting relationship with ?the dentist?.