Dental care is more than brushing and flossing every day, visiting the dentist at least twice a year and occasionally having a problem treated. To get the most out of your care, we need to consider the “big picture” of risk management: identifying where your oral health is most at risk and tailoring your treatment approach accordingly. With that in mind, here are the 4 main risk areas we should address for your long-term dental health. Support structures. Healthy gums and bone support healthy teeth. The loss of these support structures from dental disease puts your teeth at higher risk of loss. The focus then is keeping the gums and bone healthy through dedicated oral hygiene, regular checkups and office cleanings, lifestyle changes (like refraining from tobacco use), nutrition and early, proactive disease treatment. Tooth health. Your teeth also need to be healthy and sound. When compromised by decay, erosion or injury, your risk for losing them increases. To manage that risk, we need to identify, treat or minimize the root causes of unhealthy teeth like disease-causing bacteria, high acid levels in the mouth or restricted saliva flow. It’s also important to repair damaged teeth as soon as possible through fillings, crowns or root canal treatments to give teeth a better chance of survival — and to know when a tooth is beyond salvage and should be replaced with an appropriate restoration. Mouth function. Your teeth, muscles and jaw joints work like an intricate mechanism to help you eat, speak and even smile. When they don’t function properly, though, it can lead to significant dental problems. Tooth grinding habits, poor bites (malocclusions) or temporomandibular (jaw) joint issues can cause pain, compromised function, and even excessive tooth wear that may compromise dental health and affect appearance. It’s necessary to treat these underlying functional problems through conservative TMD treatments, night guards or lifestyle changes before attempting dental restoration or the damage will continue. Smile appearance. Although subjective, how you feel about your smile is extremely important, and can have a profound effect on your self-image and relationships. Blemished, misaligned, or missing teeth pose a personal and social risk and deserve attention. While you should have realistic expectations about both your overall mouth condition and your financial ability, there are many options for improving your teeth’s appearance and ultimately your smile. If you would like more information on comprehensive dental care, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Successful Dental Treatment.”

Managing pain is an important part of dental care — alleviating pain caused by disease or trauma and reducing discomfort during and after treatments. In many of these instances we can do this effectively with mild, over-the-counter drugs like ibuprofen or aspirin. These Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are safer and have fewer side effects than stronger prescription pain drugs, and have proven effective after extensive studies. Nevertheless, they can cause problems if not taken properly. NSAIDs work by blocking prostaglandins, substances released by diseased or damaged tissues that have become inflamed (swollen). Inhibiting prostaglandins reduces inflammation that in turn eases pain. This differs from steroids that reduce inflammation by suppressing the immune system or narcotics like morphine or codeine that act on the brain to reduce pain. Both steroids and narcotics are strong, prescription medications used only for severe pain, and can be addictive if abused. While NSAIDs aren’t as habit-forming and have milder side effects, they can cause significant health problems if overused. The most common is their tendency to act as a blood thinner, which decreases the blood’s ability to clot. This can lead to serious complications: over-extended use of aspirin, for example, can damage stomach lining and give rise to ulcers or dangerous bleeding; ibuprofen can damage the kidneys. An estimated 100,000 Americans are hospitalized each year due to ulcers or gastrointestinal bleeding linked to chronic NSAID use for pain relief. They’re not recommended for patients who are pregnant, have preexisting stomach problems or heart disease. In short, NSAIDs are best used for only brief periods to alleviate short-term discomfort. Unless otherwise directed by a physician, a single dose of 400-600 milligrams is safe and normally sufficient for about five hours of mild to moderate pain relief; daily dosages shouldn’t exceed 2400 milligrams. NSAIDs remain the best approach for alleviating most dental pain and discomfort. Taken properly, they can help you cope with pain until you’re back on your feet again. If you would like more information on managing pain associated with dental care, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Pain with Ibuprofen.”

There are many different removable appliances — from dentures to retainers — that help people enjoy better mouth function and a more attractive smile. But like many things we use, they can wear out. Because they’re also spending a lot of time in the mouth they can become an attractive home for disease-causing bacteria. You can extend your appliance’s life through regular cleaning and maintenance. Here are 4 tips to help you do it properly. Use detergent — not toothpaste or bleach — for cleaning. Your appliance may look like teeth or gums, but it isn’t made of living tissue and shouldn’t be cleaned the same way. The abrasives in toothpaste can cause microscopic scratches in appliance materials that could harbor bacteria. Bleach is also a no-no — while it kills bacteria it also breaks down the composition of many appliance plastics. Ordinary household soaps like dish detergent work just fine. Use warm — not hot or boiling — water. Boiling water also kills bacteria, but it and even hot tap water can soften many dental plastics and distort your appliance’s precise fit. Warm soapy water is sufficient for keeping your appliance clean. Be sure also to use a separate brush from your regular toothbrush, ideally one designed to clean appliances. Consider using an ultrasonic cleaner. No matter how thorough you are, you won’t be able to fully access tiny crevices in your appliance with a brush. If you have a permanent appliance like a denture or retainer, consider purchasing an ultrasonic cleaner, a device that emits high frequency sound vibrations to loosen plaque in those hard to reach places. Protect your appliance while it’s out of your mouth. Place a towel in the sink while you’re cleaning your appliance — an accidental drop onto a soft towel is less likely to damage it than on a hard porcelain or metal basin. Unless otherwise directed, it’s also best to remove your appliance while you sleep to help cut down on bacterial growth. But don’t leave it lying anywhere — pets or even young children may find it a fascinating “toy.” Be sure to store it in its case or in cleaning solution in a high place. If you would like more information on taking care of an oral appliance, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “10 Tips for Cleaning Your Oral Appliance.”

Think braces and you may conjure up the image of a teenager undergoing what is for many adolescents a rite of passage. But while correcting poor bites (malocclusions) is usually optimal between pre-adolescence and early adulthood, it’s just as viable an option for older adults. Still, many people in their later years with malocclusions think orthodontics isn’t worth the bother — it’s simply too late for them or they don’t want the “embarrassment” of wearing metal braces at their age. But even if you’re older, it’s worth reconsidering treating that bad bite. Here are 3 reasons why. Misaligned teeth can affect your oral health. If your teeth are out of position, then they will be much harder to keep clean, and may wear down at a higher rate than normally aligned teeth. You may also find chewing your food becomes easier with a straighter bite, which can improve your overall nutrition. A More Aesthetic Option to Metal Braces. One of the biggest concerns for many older adults is the thought of wearing metal braces for an extended time. Clear aligners are a more attractive alternative. They are a series of computer-generated incremental clear plastic trays: each tray is worn for about two weeks moving teeth a small distance before changing to the next tray in the sequence until the end of treatment. Not only are they much less noticeable than metal braces, they can be removed for easier oral hygiene, or even for a rare special occasion. Age Really isn’t a Factor. Not everyone is a good candidate for orthodontics. A person’s level of bone volume is a major consideration: if they have significant bone loss successful tooth movement may not be possible. Systemic conditions like diabetes, severe heart-valve disease or leukemia, or drugs for arthritis or osteoporosis can also make treatment difficult if not out of the question. But, if you’re in reasonably good health with adequate bone support, there’s no reason you can’t undergo orthodontics — at any age. If you would like more information on orthodontic treatment at any age, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Orthodontics for the Older Adult.”

It’s easy to view your child’s primary (“baby”) teeth as less important than the permanent teeth replacing them. They’re temporary — the last of them will give way around ages 10 to 13 — so why go to extraordinary lengths to save them if they’re decayed? Although relatively short in life, primary teeth are indeed important. They, of course, provide young children a means to speak and eat. But they’re also pivotal to your child’s mouth and facial development. A primary tooth lost early can lead to adverse effects in the permanent teeth and bite later. A primary tooth holds open the space in the jaw for the permanent tooth as it develops below the gums. When it’s ready to come in, the roots of the primary tooth dissolves (resorbs), allowing it to be lost. If they are lost too early, though, it can disrupt this spacing, especially for a back tooth. If this happens, adjacent teeth can move or “drift” naturally into the open space, greatly increasing the chances of a bad bite (malocclusion). The permanent tooth may then come in the wrong position or perhaps not at all, setting up the need for costly future orthodontic treatment. That’s why it’s better to save the tooth if we can, even employing a modified root canal treatment for deep decay if necessary. If, however, the primary tooth is lost prematurely due to disease or trauma, we can still attempt to preserve the space left behind. One way is to install a “space maintainer,” a metal orthodontic device that prevents adjacent teeth from moving into the space. This will still require constant monitoring and extra care to prevent the device from dislodging. The best strategy for preserving primary teeth is, of course, prevention. By establishing daily brushing when the first teeth appear in the mouth, coupled with regular dental cleanings and checkups twice a year and a diet low in sugar-added foods, you can reduce the risk of dental disease. Further prevention with sealants or topical fluoride can also strengthen young teeth. Keeping primary teeth healthy will help ensure they’ll continue until they’ve served their purpose. In the end they’ll set the stage for a lifetime of healthy teeth. If you would like more information on caring for your child’s primary teeth, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Importance of Baby Teeth.”

There are definite links between smoking tobacco and several major health problems. While we’re all familiar with its relationship to cancer or heart disease, smoking can also adversely affect your dental health, particularly the long-term survival of dental implants. Smoking can affect your mouth in two ways: first, the inhaled smoke can slowly “cook” gum tissue to form a thickened top layer of cells and damage salivary glands, which reduces saliva flow causing mouth dryness. Second, the nicotine in tobacco may cause the mouth’s blood vessels to constrict and inhibit blood flow, which can weaken the body’s defenses and healing ability. Put all these outcomes together and you increase your risk of periodontal (gum) disease that can cause the loss of supporting gum tissue and bone. Bone loss especially can have an adverse effect on implant stability, which relies on adequate bone for anchorage. Slower mouth healing caused by smoking also lowers the chances of a successful outcome to implant surgery. Over time, bone in the jaw grows and attaches to the imbedded titanium implant, which will increase the implant’s strength and durability. With a weakened healing mechanism, however, this process known as osseo-integration may fail to develop fully. As a result, the implant won’t be as strong and stable as it could be and may fail when it encounters normal biting forces. This scenario is borne out in a number of research studies. Although dental implants have a very high success rate, about 5% fail. Twice as many of those failures occurred in smokers compared to non-smokers. Although an implant isn’t destined to fail if you’re a smoker, your risks are much higher. You can reduce that risk by trying to quit smoking a few weeks before implant surgery, or at the very least try not smoking a week before and two weeks after the procedure, and follow good oral hygiene practices to prevent gum disease. And, be sure to see us on a regular basis for checkups and implant maintenance. Dental implants are a highly successful tooth replacement option that can give you decades of service. Don’t allow smoking to short-circuit that success. If you would like more information on the impact of smoking and other lifestyle issues on dental implants, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants & Smoking.”

Moving teeth through orthodontics is more than a “smile makeover” — it’s also an investment in yours or a family member’s future oral health. Normally aligned teeth function better and are easier to keep clean and healthy. Ironically, though, the same appliance that helps enhance future oral health can also make it harder to keep the mouth healthy in the here and now. This is because fixed orthodontic hardware like braces can impede a patient’s ability to reach tooth surfaces while brushing or flossing to remove plaque. This thin biofilm of food remnant and bacteria can build up on tooth surfaces and cause tooth decay or periodontal (gum) disease. It’s therefore not uncommon for people wearing braces to have two to three times the plaque on their teeth. This is especially problematic for younger patients whose newly erupted permanent teeth don’t have the resistance of older teeth to the acid that causes tooth decay. While maintaining effective hygiene during braces is difficult, it isn’t impossible. There are a number of things that can be done to improve plaque removal. When brushing use a soft bristle, multi-tufted brush, which is more flexible for reaching around hardware. Be sure to take the time to brush above and below each braces wire all the way around, then on the inside of the teeth and the biting surfaces. If there’s difficulty reaching between teeth with regular flossing techniques, consider using a special floss holder or invest in a “water” flosser that sprays water under a pulsing pressure to remove plaque between teeth. It’s also a good practice to eat a diet rich in fresh fruits, vegetables and dairy products and low on snacks with added sugar, a prime food source for bacteria. Use fluoride toothpastes and antibacterial mouth rinses to help strengthen enamel and reduce bacteria. Continue regular visits to the family dentist for dental cleanings to remove hard to reach plaque and calculus (hardened deposits) and monitor for disease. It may take a little extra time and the aid of a few new tools, but your efforts will make a difference. You or your loved one will be taking care of their teeth now, while the braces take care of their health and smile tomorrow. If you would like more information on hygiene practices during orthodontic treatment, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Caring for Teeth During Orthodontic Treatment.”

When fighting periodontal (gum) disease, it’s often necessary to go deep into “enemy” territory — below the gum line — to remove bacterial plaque, a thin film of built up food remnant that fuels the infection. This often requires gum surgery to access these deep areas of infection. As gum disease advances, the slight natural gap between the gums and teeth can widen to form voids called periodontal pockets that can fill with infection. Pockets that extend more than 4 millimeters below the gum line can’t be reached effectively with oral hygiene techniques like brushing and flossing. As the pockets become deeper, even dentists and hygienists have difficulty with conventional hand instruments called scalers to effectively remove plaque and calculus (hardened plaque deposits). As the pockets deepen, surgical procedures are often needed to reach these areas. That allows the dentist to remove all of the plaque and calculus as well as smoothing the root surface free of contaminants. Then, the gums are placed closer to the bone so that gum tissue pockets are removed and become easier to clean. Surgical lasers offer a new alternative to scalpel surgery. The laser’s narrow beam of light only removes diseased gum tissue without incisions and with minimal disruption of healthy tissue. Because of the color of its light, the laser energy passes through normal gum tissue like sunlight through a glass pane, but heats and vaporizes the much darker diseased cells. Scalers are then used in the open space it creates to remove plaque from the tooth surface. Besides precisely targeting and destroying diseased tissue, the laser’s pulsating energy also limits excessive heat buildup that can also damage healthy tissue. The laser also limits bleeding by cauterizing the area as it passes through. As a result, there’s less tissue disruption and damage, less bleeding and no need for suturing afterward. But is it as effective as the conventional procedure? A number of studies have indicated similar success rates as with conventional surgery. And, patients with laser treatment indicate less pain and discomfort afterward with quicker recovery times. While this treatment is still new, recent findings are encouraging. Lasers may soon become the standard and with fewer complications for patients dealing with this aggressive and debilitating condition. If you would like more information on treating gum disease including with lasers, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Gum Disease with Lasers.”

You’ve probably heard a lot of great things about dental implants as a replacement for missing teeth. But there’s one aspect about implants that may cause you hesitation about choosing them: the cost. If you have multiple teeth to be replaced, the expense of implants may seem even further beyond your means. But before you decide against what’s widely considered the premier tooth replacement option, it would be beneficial for you to look at their cost from a long-term perspective. You may find implants are actually a cost-effective investment in both your oral health and your smile. So, what sets the dental implant apart from other options? One of its most important attributes is its life-like appearance. Not only does the visible crown resemble the color, shape and texture of natural teeth, the implant’s placement can so precisely mimic the appearance of natural teeth emerging from the gums, it’s indistinguishable from the real thing. They’re not just attractive, but also durable. This is due in large part to titanium, the most common metal used in implants, which has the unique quality of being osseophilic, or “bone-loving.” Bone cells naturally attract to titanium and over time will grow and adhere to the implant in a process known as osseointegration. As a result, the implant’s attachment in the jaw becomes strong and secure. This durability gives implants a greater longevity on average than most other replacement options. If you thus compare the total costs for an implant (including maintenance) over its projected life with the costs of other options like dentures or fixed bridges, you’ll find implants may actually cost less over time. That may sound affordable for one or two missing teeth — but what about several? Replacing multiple teeth individually with implants can be quite high; but implants are also versatile — just a few strategically placed implants can support a fixed bridge or overdenture. This “hybrid” solution combines the affordability of these other options with the stability of implants. Before weighing your options, you should first undergo a complete dental examination to see if you’re a candidate for implants. From there we can help you decide whether implants are the right investment for your health and your smile. If you would like more information on dental implants, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants 101.”

Think you’re too old to have your teeth straightened? In reality, healthy teeth can be moved at any age to better positions. For the many adults who have some form of malocclusion (bad bite), orthodontics is still a viable option even in later years. As important as it is to self-image and confidence, treating misaligned teeth can benefit you more than just improving your smile. Misaligned teeth may be harder to keep clean, setting up a mouth environment advantageous to the development of tooth decay or periodontal (gum) disease, the risks of both rising with age. And normally aligned teeth are easier to chew with than those misaligned. Age isn’t the determining factor for whether you’re a good candidate for orthodontics — but your dental health is. Gum disease in particular can cause supporting bone loss, which can complicate orthodontic treatment. It’s important then that we first perform a complete oral examination and attempt to treat problems such as decay or gum disease first before attempting tooth movement. What type of orthodontic treatment you’ll need will depend on the type of malocclusion you have and its relationship to the way your jaws fit together. Because your adult jaws have fully developed you may need orthognathic (“jaw straightening”) surgery to address certain advanced forms of malocclusion. If your bite problems aren’t that severe (the majority of situations) they can be treated with braces or, an increasingly popular alternative, clear aligners. These customized clear plastic trays are nearly invisible compared to metal braces and are effective for most patients. Following the completion of tooth movement and other bite procedures, you will most likely need to wear a retainer to help prevent the teeth from reverting to their older positions. You may need to wear the retainer for a longer period than a younger patient, or perhaps indefinitely. Even with this mild inconvenience, though, you’ll still experience the positive effects of healthier and better functioning teeth and a great new smile. If you would like more information on orthodontic treatment, please contact Dr. Cindy Sumarauw at 801-281-3500 to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Orthodontics for the Older Adult.”