Treating Sensitive Teeth

See your dentist if you have sensitive, painful teeth. Your dentist will examine your teeth, determine the cause of your tooth sensitivity, and recommend a proper treatment plan.

Your Dental Exam

Your dentist will check your teeth for sensitivity to cold, air, or heat. Let him or her know if you eat foods that are high in acid. Also, mention any stomach problems you may have that bring acid into your mouth. Your dentist will also look inside your mouth to check for decayed teeth, or teeth worn by improper brushing. If needed, x-rays are taken. You may also be checked for signs of teeth grinding or clenching. You may start out with a special oral hygiene program for home care. But your dentist may also suggest professional treatment.

Home Care

Your dentist may suggest that you follow an oral hygiene program at home. Use a toothbrush with soft bristles. If any roots are exposed, you may be asked to use a special toothpaste. This toothpaste makes teeth less sensitive. Your dentist may also suggest that you try a fluoride rinse or gel. Cleaning all parts of your teeth and mouth helps prevent tooth sensitivity and decay.

Professional Treatment

Depending on how sensitive your teeth are, your dentist may suggest professional treatment. He or she may:

• Apply special chemicals to the sensitive areas.

• Use a coating of resin to seal the dentin.

• Fill cavities or deep grooves in any exposed root.

• Apply a fluoride varnish to the root surface.

Know that your teeth can become sensitive again. Be sure to follow your home-care treatment plan. Also schedule regular dental examinations. By working with your dentist, you can help keep your teeth pain-free.

After a Tooth Extraction: Caring for Your Mouth

When you've had a tooth extracted (removed), you need to take care of your mouth. Doing certain things, even on the first day, may help you feel better and heal faster.

Control Bleeding

To help control bleeding, bite firmly on the gauze placed by your dentist. The pressure helps to form a blood clot in the tooth socket. If you have a lot of bleeding, bite on a regular tea bag. The tannic acid in the tea aids in forming a blood clot. Bite on the gauze or the tea bag until the bleeding stops. Slight oozing of blood on the first day is normal.

Minimize Pain

To lessen any pain, take prescribed medication as directed. Don't drive while taking any pain medication as you may feel drowsy. Ask your dentist if you may take over-the-counter medication, if needed.

Reduce Swelling

To reduce swelling, put an ice pack on your cheek near the extraction site. You can make an ice pack by putting ice in a plastic bag and wrapping it in a thin towel. Apply the ice pack to your cheek for 10 minutes. Then, remove it for 5 minutes. Repeat as needed. You may see some bruising on your face. This is normal and will go away on its own.

Get Enough Rest

Limit activities for the first 24 hours after an extraction. Rest during the day and go to bed early. When lying down, elevate your head slightly.

Do's

Below are some things to do to help your mouth heal.

Do eat a diet of soft, healthy foods and snacks. It may be easier for you to eat soft foods soon after your extraction. Also, drink plenty of liquids.

Do brush your teeth gently. Avoid brushing around the extraction. And don't use any toothpaste. Rinsing toothpaste from your mouth may dislodge the blood clot.

Do keep the extraction site clean. After 12 hours you may be able to gently rinse your mouth. Rinse 4 times a day with 1 teaspoon of salt in a glass of water. Check with your dentist first.

Don'ts

Below are some things to avoid while you're healing.

Don't drink with a straw. Sucking on a straw may dislodge the blood clot.

Don't drink hot liquids. Hot liquids may increase swelling. Limit your alcohol use. Excessive use of alcohol may slow healing.

Don't smoke. Smoking may break down the blood clot, causing a painful tooth socket.

What Is Scaling and Root Planing?

Scaling and root planing is a special type of cleaning done by a dental professional (general dentist, dental hygienist, or periodontist). This cleaning removes plaque and tartar from beneath the gums. It helps restore health to your gums and teeth.

Your Evaluation

Your dentist looks at your gums for color changes, bleeding, swelling, and recession. Your teeth are checked for looseness and sensitivity. Full mouth x-rays show if there is bone loss around your teeth.

The Procedure

Scaling and root planing removes plaque and tartar from below your gum line. This controls the growth of harmful bacteria. It also helps gums reattach firmly to the teeth. Because this procedure goes deeper than a regular cleaning, your mouth may be numbed. The cleaning may take 1 to 4 or more visits to complete.

Partial Dentures

A partial denture replaces missing teeth and restores your smile. With your new partial you should be able to chew more easily and with greater comfort. The partial will also help keep your remaining teeth from "drifting." Take good care of your partial to keep your mouth healthy and help your partial last.

Your Partial Denture

A partial denture is made up of one or more porcelain or plastic replacement teeth. Gum-colored plastic attaches these teeth to a metal framework. The partial is removable. It is held in your mouth with either metal clasps or precision attachments (attachments that fit into existing teeth, often hidden by crowns).

Tips to Help During Adjustment

Your dentist can make sure your partial fits properly. Follow the instructions that your dentist gives you to help your mouth adjust. This may take a few weeks. The tips below may help your mouth adjust faster and more easily.

• At first, eat soft foods and foods that have been cut into small pieces. Once you're used to eating with the partial, you can eat almost anything you like. However, avoid very sticky or hard foods.

• Practice reading out loud until you can talk comfortably with the partial in place.

• Practice putting the partial in and taking it out in front of a mirror. Never force it or bite down to try to get it into place.

Keeping Your Mouth Clean

Prevent tooth decay, gum disease, and mouth odor by taking good care of your natural teeth.

• Remove your partial and brush your teeth with fluoride toothpaste after each meal. Also brush your tongue.

• Floss between your teeth at least once a day.

• See your dentist for regular checkups and cleanings.

• Ask your dentist about using a fluoride rinse.

Your Fixed Bridge

A fixed bridge is one or more replacement teeth attached to the natural teeth next to them. Once it's in place, the bridge is not removed. A bridge can be made of metal, tooth-colored porcelain, or a combination of the two. Your dentist will suggest the best material for your mouth. There are two main types of bridges: conventional and resin-bonded.

What Happens After Tooth Loss?

Spaces left by missing teeth affect the rest of your teeth. These gaps can cause chewing problems. If even one tooth is missing, other teeth may slowly shift out of place. This changes the way your teeth fit together (your bite). A poor bite may make your jaw sore. Your teeth may become harder to clean, leading to tooth decay and gum disease. And shifting of teeth following tooth loss may change your smile. But a bridge replaces one or more missing teeth. A bridge makes it easier to chew, improves your appearance, and keeps your teeth, gums, and jaws healthy.

The Procedure

It will take two or more visits to prepare and fit your bridge.

Preparing Your Teeth

For a conventional bridge, the teeth on either side of the space to be filled must be reshaped to hold crowns that support the bridge. Limited reshaping is necessary with the resin-bonded bridge. For either bridge, impressions of your teeth are taken and used to make your bridge. This process takes several weeks.

Fitting Your Bridge

When it's ready, your dentist places the bridge on your teeth and adjusts it until it fits and feels right. The bridge is then cemented or bonded into place. If you have any problems over the next few days, call your dentist.

Caring for Your Bridge

Your bridge depends on the health of supporting teeth and gums. Always clean your bridge and the rest of your mouth carefully. Ask your dentist whether special cleaning aids for bridges would help you.

Brushing

Brush after each meal. Brush the surfaces and sides of your bridge just as you do your natural teeth. Use an interdental brush to clean between large spaces.

Flossing

Floss at least once a day to clean food and bacteria from between teeth and at the gum line. Special thick floss can help keep your bridge clean. Floss threaders help you thread floss under a fixed bridge.

Dental Visits

See your dentist at least twice a year for a cleaning and checkup. These dental visits help keep your teeth and gums in good condition. Your dentist can also check to be sure there are no problems with your bridge. If you do notice a problem, especially if your bridge is loose, call your dentist right away. Never try to fix your bridge yourself.

Living with Your New Bridge

Your new bridge can help make chewing comfortable again. It can also let you feel confident about your smile. Take the time to care for your teeth. Keep your mouth healthy and your teeth will stay looking and feeling good.

Periodontal Disease: Bone Replacement Graft

Teeth are held in place by surrounding gums, bone, and other tissues. But periodontal disease can cause the bone to break down. Certain techniques called regenerative procedures can be used to stimulate growth of new bone. This growth increases the height of the bone around the tooth, giving the tooth more support. Getting back even half the lost bone height extends the life of the tooth. One type of regenerative procedure is called a bone replacement graft.

Placing the graft

After the area heals

How a Bone Replacement Graft Works

A graft helps your body replace lost bone. The graft consists of your ownbone, synthetic material, or bone from a tissue bank. A gel containing growth factors may also be used to stimulate tissues to grow. This is how a graft is done:

• Placing the graft. First, a gum flap is created. Growth factors may then be applied to the root. Graft material is packed into the area where bone was lost. This material provides a platform for new bone to grow.

• Closing up. The gum is closed and sewn together. The growth factors stimulate tissue to grow.

• After the area heals.Stitches dissolve or are removed. Though the gum has healed, it takes a year or more for new bone growth to fill the space.

Understanding Root Canal: Overview

Most of us try to keep our teeth clean and looking nice. Butwe don't think much about what's inside our teeth-until something goes wrong. When problems develop insidea tooth, root canal therapy may be the only way to rescue it.

The Whole Tooth

The parts of a tooth include:

• The crown.This part of the tooth is above the gumline. It has a hard surface for biting and chewing.

• The root. Below the gumline, theroot anchors the tooth to the bone.

• The pulp. The middle of the tooth(the pulp chamber) contains the pulp. This soft tissue is made up mainly of blood vessels and nerves.

• The root canal. This is the pathway from the pulp chamber to the nerves and blood vessels in the jawbone.

Pulp Problems

Pulp problems most often occur when decay or an injury damages the tooth's crown, exposing the pulp. Once this happens, the pulp becomes inflamed. Bacteria in the mouth can infect and kill the pulp. The infection can then spread throughout the pulp chamber and the root canal. If it reaches the tip of the root, it can invade the bone and, in some cases, form an abscess (pocket of pus). If this process isn't stopped, it leads to bone and tooth loss.

Choosing Root Canal Therapy

Root canal therapy can save a tooth whose pulp has died. The earlier the tooth is treated, the less pain, trouble, and expenseyou'll face. And though many people believe that root canal therapy is painful, this is just a myth: The treatment rarely causes discomfort.

An Overview of Treatment

Root canal therapy consists of removing the inflamed or infected pulp. The first step is to make an opening in the crown. The dentist then cleans the pulp chamber and root canals. These spaces are later filled with a rubber-like substance called gutta-percha, which acts as a permanent bandage. Finally, restoring the crown of the tooth protects the tooth from further damage or infection. The goals of treatment are to:

• Relieve pain and other symptoms.

• Stop any infection and prevent its spread.

• Save the tooth from having to be extracted.

Understanding Root Canal Therapy

Root canal therapy is a way of removing dead or dying tissue from insidea tooth. This stops infection and prevents it from spreading further. Therapy is mostoften completed in one or two visits. Your dentist will tell you how long each visit is likely to last.Between visits,you'll need to take special care of the tooth until the crown (the part of the tooth above the gumline) can be restored.

The First Step: Cleaning Out Your Tooth

Root canal therapy is done under a local anesthetic. (It's the same kind that's used when you have a filling.)

• Cleaning and Shaping the Canal

  A dental dam (a thin sheet of rubber) is placed around the tooth to protect your mouth and throat. The crown of the tooth is then opened and the pulp (soft tissue in the middle of the tooth) is removed. Using small files, the dentist cleans, enlarges, and shapes the root canal (pathway from the pulp to the jawbone). Medications may be used to stop infection.

• Filling the Canal

  The root canal is filled with gutta-percha, a rubber-like substance that acts as a permanent bandage. This prevents bacteria or fluid from entering the tooth through the roots. Typically, the opening in the tooth is then closed with a temporary crown or filling.

Between Visits

In most cases, the tooth will be closed with a temporaryfilling. In rare cases the tooth may be left open for a short time to drain an infection. In either case, pain often can be controlled with over-the-counter medications. To protect the tooth between visits:

• Avoid crunchy, chewy, and sticky foods.

• Avoid chewing on the treated side of the mouth unless told you can.

• Brush and floss as instructed.

• Take antibiotics as prescribed.

The Second Step: Restoring Your Tooth

After root canal therapy, the crown of the tooth must be restored. In most cases, an artificial crown is needed. Therapy is not complete until a permanent filling is in place-so don'tdelay longer than your provider advises. After restoration, the treated tooth is much like your other teeth.

• A Permanent Seal

  The dentist removes the temporary filling. A permanent filling is then used to seal the tooth. If needed, an artificial crown is placedon top of the filling and around the remaining natural tooth. Crowns can be made of porcelain, gold alloy, or porcelain fused to metal.

• If a Post Is Needed

  If little is left of the natural crown, a metal or fiber post may be used to help support thepermanent filling. The artificial crown is then placed on top of the filling. Your dentist will take care to ensure that the post is not visible once the restoration is complete.

After Treatment Is Complete

Your dentist will check the tooth during a follow-up visit. With successful treatment,the tooth should function and look very much like your other teeth. You can eat whatever you want, including the hot and cold foods you may have been avoiding. Of course, you'll need to brush and floss daily to keep your mouth healthy.

Dental Treatment for Temporomandibular Disorders (TMD)

You have been diagnosed with temporomandibular disorder (TMD). This term describes a group of problems related to the temporomandibular joint (TMJ) and nearby muscles. The TMJ is located where the upper and lower jaws meet and is part of a structural system that includes the teeth. Because the joint and teeth work together, a problem with your teeth and bite can be linked to TMD. If you grind your teeth or if you have a bad bite, your dentist may be able to help. If your bite needs adjustment, you may be referred to an orthodontist.

If You Grind or Clench Your Teeth

Bruxism (teeth grinding) or clenching strains the TMJ. If you have these habits during the day, doing self-checks can help you stop. But it's hard to control these habits when you're asleep. That's when splinting can often help.

• How a Splint Works

  A splint is an appliance that fits in the mouth. It may also be called an orthotic or night guard. There are different kinds of splints for different kinds of needs. A splint can keep the upper and lower teeth apart. This helps protect tooth surfaces from grinding. A splint can also be made to reduce strain on the area.

• Wearing and Caring for Your Splint

  To make a splint, your dentist or orthodontist may take impressions of your teeth. Then a splint will be made to fit your mouth. A splint:

  • May be worn during the day or only at night. Be sure to ask when and how often you should wear your splint.

  • Should be cleaned before you put it in and after you take it out. Ask your dentist or orthodontist how to clean the splint.

  • Should be kept in a protective case, away from the reach of children and pets. This helps keep the splint from getting dirty or broken.

If Your Bite Is Incorrect

Malocclusionmeans the jaws or teeth don't fit together properly. This can result in pain and problems with jaw function. If your jaws or teeth are out of alignment, orthodontic treatment may help. If your bad bite is due to missing or damaged teeth, you may receive restorative treatment.

• Restorative Treatment

  A bad bite can be caused by missing or damaged teeth. A dentist can restore teeth in many ways:

  • A crownis a porcelain or metal cap. It is cemented in place to repair a broken or damaged tooth.

  • A bridgeis a false tooth fused between two crowns.

  • A dental implantis an artificial tooth root. It is attached to the jaw as a base for an artificial tooth.

• Orthodontic Treatment

  Sometimes the upper and lower jaws are out of alignment. Or teeth are out of line, turned, crowded, or spaced too far apart. Your orthodontist can align teeth with braces and other devices. This helps provide a more comfortable bite.

Wisdom Teeth: Removal

Wisdom teeth are often removed ina surgeon's office or in anoutpatient surgical center. Your experience depends on the position of the teeth, the number of teeth being removed, and other factors. Your surgeon may advise removing all of your wisdom teeth in a single procedure, even if they are not all causing problems. Or your surgeon may advise separate procedures for each side of the mouth.

The wisdom tooth is removed through an incision. The incision is closed with sutures.

Preparing for Surgery

Your surgeon can tell you how long the surgery is likelyto take. Including recovery from anesthesia, it may last between45minutes and2 hours. Before surgery, be sure to:

• Arrange time off from work or school.You'll need a day or more to rest and begin to heal.

• Tell your surgeon about any medications younormally take. Your surgeon may advise some medication changes.

• Follow your surgeon's instructions on eating and drinking before surgery. You may be asked not to eator drink anything after the midnight before surgery.

• Wear loose, comfortable clothing. Choose a shirt or blouse with short sleeves. This makes inserting anintravenous (IV) line easier.

• Arrange for a ride home. An adult family member or friend should drive you home after surgery. Don'tdrive yourself, and don't take public transportation! The person who drives you should wait in the reception area during surgery.

How Your Tooth May Be Removed

Methods of extraction can vary.Details of the procedure will depend on:

• The position of the tooth.

• Whether the tooth has erupted.

• How deeply the tooth is embedded in the bone.

• How close the roots of the toothare to the sinuses or certain nerves or blood vessels.

Removing the Tooth

An incision may bemade in the gum. This creates a flap of gum tissue that can be folded back to expose the bone and the tooth. In some cases, the surgeon may be able to loosen the tooth and extract it with forceps. The tooth may need to be sectioned (cut into pieces). Bone around the tooth may also need to be removed. In rare cases, only the crown of the tooth is removed (coronectomy). After the tooth has been removed, any incision that was made is closed with sutures.

Wisdom Teeth: Your Recovery

After surgery to remove your wisdom teeth, your mouth needs time to heal. Some bleeding is normal on the firstday after surgery. You may also see some bruising and swelling on your face for about the first week. To promote faster healing, get enough rest, eat and drink nutritious foods, and take care of the extraction site. Follow any special instructions from your surgeon.

A few hours after surgery, a blood clot develops to fill the socket.

About 3 weeks after surgery, repair tissue has filled the socket.

Within 3 to 6 months after surgery, the socket is filled with new bone.

The Healing Process

Healing after wisdom teeth removal takes a few months. First, a blood clot forms in the socket where the wisdom tooth wasremoved. Within a day or two, the socket starts filling with repair tissue. This lays the foundation for bone tissue to grow. When new bone tissue fills the socket, healing is complete.

After Surgery

During the first day or two after surgery:

• Control bleeding.Bite down on the gauze dressing over the extraction site. Use constant pressure. Bleeding should stop within2 hours. (Some oozing for a few days is normal.)

• Take medication as directed. Your surgeon may prescribe pain medication. Or he or she may suggest using over-the-counter medication instead. You may also be prescribed antibiotics to prevent infection.

• Reduce swelling. Apply an ice pack to your cheek for 10 minutes at a time. Take a break of at least5 minutes between applications. Don't drink hot liquids, since heat may increase swelling or bleeding.

• Get enough rest.Take it easy for at least24 hours after surgery. And go to bed early.

• Drink nutritious liquids.Once bleeding has stopped, try drinking vegetable juice, 100% fruit juice, protein drinks, or milk.

• Protect the extraction site. To avoid dislodging the blood clot, don't brush your teeth or rinse your mouth the first day. Don't smoke or drink through a straw, since suction can dislodge the clot.

Helping Your Mouth Heal

• Return gradually to your normal diet.Start with soft foods such as oatmeal, bananas, or mashed potatoes. You can eat solid food when you feel able to.

• Brush and floss your teeth gently.Wait until the day after surgery. Then, take care when cleaning around the healing site.

• Keep the extraction site clean.Starting the day after surgery, rinse your mouth after each meal for about a week. Use antiseptic as directed, or a mixture of 1 cup warm water and teaspoon salt.

Things to Avoid

• Don't drivewhile you're taking prescription pain medication.

• Don't drink alcoholfor as long as you're taking pain medication.

• Don't smokefor at least a week after surgery. This allows faster healing. The longer you keep from smoking, the better. Quitting permanently is best of all.

• Don't eat crunchy or sticky foods,such as popcorn or caramel, for at least2 weeks. Also, avoid drinking thick liquids (such as a milk shake) through a straw.

Wisdom Teeth: Your Treatment Plan

If one or more of your wisdom teeth are likely to cause problems,your surgeon may recommend removal. This can relieve your symptoms and protect your dental health. In some cases, you may be advised to wait or to try other treatments first.

Your surgeon will help you decide on a plan suited to your needs.

Early Removal Is Often Recommended

Your surgeon may advise removing the wisdom teeth now, even if you have no symptoms. This is becausewisdom teeth roots mature and become more firmly anchored to the bone as you age. This makes removal more difficult. It also increases the risk of complications. And people heal more slowly as they grow older.

Other Options May Be Possible

The position of wisdom teeth roots may make removalunwise. Or surgery may not be recommended because of another health problem. Other options include:

• Close follow-up. Regular exams and x-rays check for signs of complications.

• Medications.These can be used to control some symptoms and treat infections.

• Minor surgery. In some cases a procedure such as anoperculectomy (removal of gum tissue overlapping the tooth) may help.

Herbst Appliance

A Herbst appliance helps line up your top and bottom jaws. This helps improve the way your teeth fit together (your bite). The Herbst appliance moves the lower jaw forward while pushing the upper jaw backward.

How Your Appliance Works

Each rod slides up and down within a tube. If the rod and tube come apart, open your mouth wide. Then guide the rod back into the tube as you close your mouth.

It's important to know how your appliance works. Start by learning the parts that make up your Herbst appliance. This will help you talk to your doctor about any problems you may have with it.

What You Can Expect

Your Herbst appliance may take a few weeks to get used to. Your upper and lower teeth may not touch when you close your mouth. And your teeth or muscles in your jaws and cheek may feel tender. So, it may be hard for you to eat at first. But these problems will likely go away soon. Also, the rods and tubes in your appliance may come apart if you open your mouth too wide. If this happens, they can be reconnected. Your doctor will show you how to do it.

For Your Comfort

If the appliance makes your mouth tender, your doctor may suggest medicine to relieve the soreness. The appliance may rub against your cheeks or tongue. If this happens, roll a small piece of dental wax into a ball. Then press it against your appliance at the sore spots. If you get a small cut in your mouth, rinse it with a mixture of 1 teaspoon of salt and 1 cup of warm water. Don't swallow the salty water.

Foods to Avoid

Eating certain foods can break your appliance or pull it apart. Stay away from sticky, chewy, crunchy, or hard foods, such as candy, gum, ice, and popcorn. Slice raw carrotsand apples into thin pieces.

Brushing and Flossing

When wearing your appliance, you may find it harder to brush and floss your teeth. But make a special effort to keep your teeth clean.Carry a toothbrush and toothpaste with you. This way, you can brush your teeth after every meal or snack.

A Better Bite

When your jaws and teeth line up right, you'll have a better bite. And you'll look better, too. By working with your doctor, you can have a good bite and a great smile.

Treatment for Restoring Your Tooth: Crowns

Your smile is what lights up your face. But damaged teeth may make you feel too self-conscious to smile. If you have a single damaged tooth, your doctor may recommend a crown. Read on to learn more about this treatment option.

The crown is adjusted for fit. Then it is cemented into place.

What Is a Crown?

A crown is used to restore a damaged tooth to its normal size and shape. It may be made of gold, other metal, porcelain, or porcelain fused to metal. If your crown will be visible when you smile, your dentist will try to match it to the color of nearby teeth.

What to Expect During Treatment

Your treatment experience may be as follows:

• Preparing your tooth.A crown needs to be the same size as the original tooth. Your dentist will make the damaged tooth smaller for the crown to fit over. Then an impression of the prepared tooth and the opposing tooth will be taken.

• Between visits.It will take1-3 weeks for a lab to make your permanent crown. To protect the prepared tooth during that time, you may have a temporary crown. Keep your mouth extra clean during this time. To avoid pulling off the temporary, pull floss out sideways, not straight up or down. And avoid sticky foods. If the temporary does come off, ask your dentist whether you should secure it back in place with denture adhesive until you can visit the office.

• Fitting your crown. At your follow-up visit, your dentist removes the temporary crown and puts on the permanent crown. He or she checks the fit. After making adjustments, the dentist cements the crown into place. If you have any problems with the crown later, call your dentist.

Dental Implants: After Surgery

You just had dental implant surgery. Read on to learn what to expect after surgery and how to recover at home. Be sure to keep all follow-up appointments with your surgeon and dentist. Also, follow all mouth care instructions.

Help the healing process. Keep your teeth and gums clean.

After Surgery

When your surgery is over, you may rest awhile. But you can go home as soon as you feel able. Be aware that a certain amount of swelling and minor bleeding is normal. To speed your recovery, be sure to follow your surgeon's instructions. You may be told to:

• Drink only clear liquids for the rest of the day.

• Take pain medications and antibiotics.

• Avoid putting pressure on your jaw.

• Eat soft foods for the first few days as your mouth begins to heal.

• Avoid wearing your temporary prosthesis or denture for a certain amount of time.

Taking Care of Your Mouth

Much of the healing process depends on keeping your teeth and gums clean. If you don't take care of your mouth, you may get an infection. This could cause theimplants to fail. For best results:

• Use a soft toothbrush to clean your teeth and gums after every meal.

• Clean the areas near your incisions. But do not brush the incisions themselves.

• Use an antiseptic rinse if prescribed.

Follow-up Care

It often takes a few months for jawbone to firmly attach to implants. During that time, you'll have several follow-up visits with your surgeon. This is to see how well your jaw is healing. If you wear a denture, you may also visit your restorative dentist. He or she may put a new lining in your denture for greater comfort.

Dental Implants: Placing Abutments and Making Your Prosthesis

If you have one or more missing teeth, your dentist may recommend dental implants. A dental implant is an artificial tooth root. Your jawbone fuses with the implant to provide a secure platform for a prosthesis (artificial tooth). Abutments are connecting pieces that join the prosthesis to the implants. You may need an abutment and a prosthesis as part of your treatment.

The top of the abutment sticks out just above the gum line.

Understanding Abutments

In certain cases, abutments may be placed at the same time as implants. More often, though, surgery to place abutments is done after the jawbone has fused to the implants. This second surgery usually takes less time than the first. Depending on your dental needs, two kinds of abutments may be used. Healing abutments (also called healing cuffs) help gum tissue heal around the implant site. Once the gum has healed, final abutments are placed so the prosthesis can be joined with the implant.

How Abutments Are Placed

• Exposing the implant.If you have a second surgery to place abutments, a small incision is first made in the gum tissue.

• Placing healing abutments.In many cases, a healingabutment is temporarily secured to the implant.

• Placing final abutments.When gums have healed, the final abutment is placed.

After Abutments Are Placed

It usually takes4-6 weeks for gums to heal around abutments. During that time, follow your surgeon's advice about what kinds of foods to eat. You will also be given instructions for cleaning around the abutments. Proper cleaning prevents infection and promotes healing.

Making Your Prosthesis

When your gums have healed around the abutments, your restorative dentist will begin making your permanent prosthesis. Several office visits may be needed to make a precise model of your mouth. Then it may take a few weeks, or even months, to build your prosthesis.

• A custom fit.To custom-fit the prosthesis, your restorative dentist will make impressions (molds) of your jaws, teeth, and abutments. Bite registrations are also made to seehow your teeth fit together. These molds are used to create a model of your mouth. Your new prosthesis is then made from this model.

• Fitting your prosthesis.Once the prosthesis is ready, you'll have several fittings to see how it feels in your mouth. With a fixed prosthesis, this process may take a little longer. After any needed adjustments are made, the prosthesis is attached to the abutments. You may be told not to eat hard or crunchy foods for a few weeks after the prosthesis is attached.

Dental Implants: Your Surgical Experience

Your dentist has recommended dental implants for your missing teeth. A dental implant is an artificial tooth root. Surgery is used to place the implants in your jawbone. Most implant surgeries are performed in a dental office. Read on to learn more about what to expect with surgery.

Preparing for Surgery

To prepare for surgery, follow your surgeon's instructions. Also:

• Tell your doctor if you're taking any medications, herbs, or supplements.

• Wear comfortable clothes to the office.

• Take antibiotics as prescribed.

• If you will be sedated or asleep (under general anesthesia) during surgery, arrange for an adult to give you a ride home. Also, don't eat or drink for several hours before surgery.

During Surgery

The length of surgery depends on how many implants are placed. If you're awake, you may hear sounds or feel vibrations. But you shouldn't feel any pain.

• Upon arriving, you may be asked to rinse your mouth with an antiseptic.

• You may also be given medication to help you relax or to make you sleepy.

• Right before surgery, the jaw is numbed.

• The surgeon will make an incision in the gum to expose the jawbone. This allows the surgeon to prepare the bone.

• To prepare the bone, a precise hole is slowly and gently drilled into the jawbone. The size of the hole depends on the size of the implant.

• The implant is twisted or gently tapped into position.

• Then the incision is closed with stitches.

• In some cases, abutments are placed at the same time as implants. Abutments are connecting pieces that join artificial teeth (prostheses) to the implants.

Dental Implants: The Right Prosthesis for You

If you have one or more missing teeth, your dentist may recommend dental implants. A dental implant is an artificial tooth root. Your jawbone fuses with the implant to provide a secure platform for a prosthesis (artificial tooth). A dental prosthesis is secured to one or more implants. The prosthesis you have will depend on your dental needs. Your dentist will work with you to find the right prosthesis for you.

A single prosthesis may be used to replace a tooth that has been lost.

A Prosthesis to Fit Your Needs

Depending on how many teeth you're missing, you may have a single, partial, or complete prosthesis. The more teeth to be replaced, the more implants you will need. For most people, a permanent prosthesis won't be made until the jawbone has fused to the implants. Until then, a temporary prosthesis may be used.

• A single prosthesis is used to replace a missing tooth. One implant is all that's needed for support.

• A partial prosthesis replaces two or more teeth.Two orthree implants are used for support.

• A complete denture prosthesis replaces all the teeth in an upper or lower jaw, or both. The number of implants needed depends on whether a fixed or removable prosthesis is used.

If You Need a Complete Prosthesis

There are two types of complete denture prostheses: removable and fixed. Both can be used to replace a complete set of teeth. Removable means you'll be able to take it out of your mouth. Fixed means it can only be taken out by a dentist. You and your restorative dentist can discuss which type is best for you.

• Removable prosthesis:With a removable prosthesis, the new teeth are joined to the implants by a connecting device, such as a clip and bar. This allows you to take the prosthesis out for cleaning. For support, this type often uses 4 to 6 implants per jaw.

• Fixed prosthesis:With a fixed prosthesis, the new teeth are fitted to a frame that is secured to the implants.Five or more implants are placed along the contour of the jaw. In some cases, a fixed prosthesis offers more stability for chewing.

Flossing Crowns, Bridges, and Implants

Bacteria collects in every nook and cranny of your mouth. It can cause disease in teeth, gums, and bone. It can even decay teeth beneath restorations (dental treatments such as crowns, bridges, and implants). Brushing cleans bacteria from surfaces that are easy to reach. But to clean where a toothbrush can't reach, you need to floss.

Daily Flossing

Scrape the floss against the side of each tooth several times.

Flossing daily removes bacteria from between teeth and from pockets between teeth and gums. A water jet product can help.

• Clean all surfaces under and around a restoration just aswell as you would clean your natural teeth. The technique is also pretty much the same.

• Flossing is easiest with a floss holder or disposable flosstool. These let you floss with one hand. That way you can floss while doing other tasks, such as working atyour desk.

• To floss:

  • Take about18 inches of floss and wrap the ends around your middle fingers.

  • Gently slide the floss between your teeth. Scrape it against the side of each tooth several times.

A floss threader helps you get floss under a bridge.

Cleaning Aids

Special cleaning aids can make it easier to clean all surfaces of your teeth.

• Denture cleansersreach denture surfaces that brushing misses.

• Floss holders help you floss in hard-to-reach places.

• Interdental brushes clean inside spaces, such as under a bridge.

• Electric toothbrushes help you clean teeth with less effort.

Understanding Orthognathic Surgery

A jaw that's too small, too large, or crooked can cause problems with chewing, speaking, breathing, and even sleeping. The shape of your jaws also affects the way your face looks. Orthognathic surgery is treatment that reshapes the jaws to improve their form and function.

How Orthognathic Surgery Can Help

Some people are born with poorly aligned jaws. Others develop problems as the bones grow or as a result of an injury. Orthognathic surgery realigns facial bones, making jaws work together better. Surgery is only one part of the treatment process. In most cases, treatment to move and straighten the teeth (orthodontics) is needed before and after surgery. This combination of treatments can relieve problems caused by teeth and jaws that are out of alignment.

Your Treatment Plan

Orthognathic surgery and related treatments can take time, often over a year. Starting treatment and not completing it could leave you with more problems than you have now. So you need to commit to the process before treatment begins. Your plan will likely include a time frame for each stage of treatment. Typical stages and time frames are shown here:

If You Have Questions

Be sure you understand what each step involves, and what you can and can't expect from treatment. Keep in mind that treatment plans can differ depending on your jaw problem and factors such as your age and oral health. Your healthcare provider can answer your questions and address your concerns.

Preparing for Orthognathic Surgery

You have been scheduled for orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. During the months leading up to surgery, you'll work with your orthodontist. Your orthodontist will keep your surgeon updated on when your teeth are likely to be in the right positions for surgery. You'll be given plenty of time to get ready for surgery and plan your recovery.

Seeing Your Orthodontist

During this period, you'll see your orthodontist often. At these visits, he or she will check your progress. Your braces may be adjusted. More records may be taken. These are pictures, x-rays, and models that document the positions of the teeth and jaws. Your orthodontist will tell you if the timeline for your surgery needs to be revised, and will update your surgeon. Discuss any concerns about your bite with your orthodontist.

Meeting with Your Surgeon

Shortly before surgery you'll meet with your surgeon. He or she will evaluate your progress and finalize the surgical plan. You'll discuss factors that could affect surgery, such as medications and allergies. You'll also have an exam and blood tests to make sure you're healthy enough for surgery. Depending on various factors, you may also need other tests, such as a chest x-ray.

Before Surgery

Surgery takes place in a hospital or surgery center. A day or two before your surgery:

• Stock up on liquid foods you can eat without chewing. These include total-nutrition drinks, soup, and milk. Foods that are easy to liquify, such as bananas, are good, too.

• If you don't already have a blender, buy or borrow one.

• Arrange for an adult family member or friend to give you a ride home and stay with you after surgery.

• Don't eat or drink for at least8 hours before surgery. Ask the surgeon whetheryou shouldtake your regular medications during this period. If so, take them with small sips of water.

What You Can Do to Prepare

During the months before surgery, there's a lot you can do to make your treatment and recovery easier. For example:

• If you smoke, quit.Smoking increases the risk of complications during surgery. It slows healing after surgery. It can also cause or worsen gum disease. The sooner you quit, the better. Ask your primary healthcare provider to help you make a plan to quit smoking.

• Arrange for time off to recover.Planning in advance helps make your absence from school or work go smoothly. Ask your surgeon how long your home recovery is likely to take.

• Learn about your recovery. After surgery, you won't be able to chew at first. In some cases the jaw is held shut (immobilized) for about2 weeks. So you'll need to learn what to eat, how to eat, and how to stay comfortable.

• Make medication changes as directed.Be sure your surgeon knows about any medications, herbs, or supplements you take. You may be advised to stop taking certain ones a few weeks before surgery.

Orthognathic Surgery: Presurgical Orthodontics

You have been scheduled for orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. Before surgery, most people need to have orthodontic treatment to move and straighten the teeth. This allows the surgeon to place the jaws in the proper position. Dental work is also needed throughout the process. This presurgical phase is often the longest part of treatment.

Impressions (molds) of your teeth are taken to help plan for your braces.

Preparing Your Mouth for Braces

To support the teeth, the gums and underlying bone need to be healthy. So you'll need to keep up with routine dental care throughout the treatment process. All cavities should be filled before surgery. If you have periodontal (gum) disease, you'll see a periodontist or general dentist for treatment. Other dental problems may also need work. For example, if you have wisdom teeth, they will most likely need to be removed before you get braces. When your teeth and gums are ready, you'll go on to the next step.

Getting Your Braces

Braces help ensure that the placement of your teeth will work well with the position of your jaws after surgery. The braces use gentle pressure to slowly shift teeth into their new positions. Modern orthodontic treatment uses very mild pressure to reduce the discomfort. Also, modern braces are less noticeable than old-fashioned braces. While you have braces, you'll need to avoid certain hard or sticky foods. You'll also need to be extra careful about brushing and flossing your teeth. Your orthodontist will tell you more about taking care of your braces and your teeth.

Orthognathic Surgery: Recovering at Home

You just had orthognathic surgery.This istreatment that reshapes the jaws to improve their form and function. Your job now is to keep yourself comfortable and help your body heal quickly. Make sure to get plenty of calories and protein. Get up and move around, but avoid strenuous activity. Be sure to get lots of rest. Keep your mouth and teeth cleanto help the incisions heal.

Controlling Swelling and Pain

For the first few days, swelling will likely increase. It should then start to ease. To reduce swelling and pain:

• Sit or lie with your head and shoulders higher than your heart.

• Apply an ice pack to your face for10minutes at a time, with breaks of at least5 minutes in between. Keep a thin cloth between the cold source and your skin.

• Use pain medications as directed.

Nutrition and Fluids

You will need to get enough nutrition, which may be harder while you're not able to chew. You also need fluids to help prevent dehydration and nausea. For calories, protein, and fluids, try total-nutrition drinks, protein powders, soups, milk shakes, and other blended foods. Don't use a straw, since the suction can stress the incisions in your mouth. Instead, use a glass or a "sippy cup" designed for young children. Once you can chew again, eat soft foods that can be cut with a spoon or fork.As you heal,you'll gradually return to your normal eating habits.

Keeping Your Mouth and Teeth Clean

To keep your teeth as clean as possible:

• If you can't open your jaws, brush the front surfaces of your teeth with a baby toothbrush.

• If a fluoride toothpaste or mouth rinse is prescribed, use it as directed.

• If your surgeon advises it, start using an oral irrigator about10 days after surgery.

• Aim to get back to brushing and flossing normally as soon as you can.

Orthognathic Surgery: Your Surgical Experience

You have been scheduled for orthognathic surgery.This istreatment that reshapes the jaws to improve their form and function. Surgery takes place in a hospital or surgery center. The procedure lasts several hours. You will likely stay in the hospital for1-2 days. In some cases it may be possible to leave the same day. In either case, hospital staff will keep you comfortable and help you recover until you're ready to go home.

The Day of Surgery

• When you arrive at the hospital, you'll change into a hospital gown. Staff will then prepare you for surgery.

• An IV line will be started to provide you with fluids and medications.

• You'll meet with an anesthesiologist or nurse anesthetist. This is to discuss the medication (general anesthesia) used to keep you asleep and free of pain during surgery.

• Once you're under anesthesia, the surgery will be performed.

• To help stabilize the bite, a plastic splint may be placed between the chewing surfaces of your teeth. In some cases, elastic bands or wires are attached to the braces to hold the jaws firmly shut. In other cases, looser elastic bands called "guiding elastics" are used. Sometimes, no wires or bands are needed.

Right After Surgery

• After surgery you'll awake in a recovery room.

• Your IV will remain in place.

• You'll most likely have a device to give you oxygen.

• Ice packs will be applied to your face to control swelling.

• Your face will most likely be numb, but you'll be given medication if you feel any pain.

• Nurses will monitor you to make sure you're recovering well from anesthesia.

• You'll then be taken to a regular hospital room.

Recovering in the Hospital

• You'll be urged to get up and walk as soon as possible after surgery. This helps you recover from anesthesia. It also helps prevent complications.

• Sometime late in the day, you'll likely be started on liquids.

• Using facial muscles helps reduce swelling, so try to talk if you can.

• It's common to have some nausea the first day. Vomiting when you can't open your jaws can be scary, but don't panic. Since you fasted before surgery and you're now taking only liquids, the vomit will be liquid. Just lean over and spit it out. If you have any concerns about how nausea may affect you, talk to your surgeon ahead of time.

Going Home

• You will most likely stay in the hospital overnight, or for up to2 days. You can go home when you're up and around, you have no signs of complications, and any nausea is under control.

• Before you leave you'll be told how to reduce pain, swelling, and nausea at home.

• You'll also be given prescriptions for medications to help control these problems.

Treatment for Restoring Your Tooth: Partial Dentures

Your smile is what lights up your face. But missing teeth may make you feel too self-conscious to smile. If you have one or more missing teeth, your doctor may recommend partial dentures. Read on to learn more about this treatment option.

Clasps are the standard way to attach partial dentures.

What Are Partial Dentures?

A removable partial denture is one or more replacement teeth supported by a metal or plastic frame. It does not attach as securely in your mouth as other kinds of restorations, so it will take time to get used to. You will need to have your dentist regularly adjust its fit.

Types of Attachments

Most partial dentures are attached or held in place by metal clasps. These clip onto the teeth on each side of the gap. In some cases, though, your dentist may suggest a "precision attachment." With this method, a connector fits into a slot prepared in the crowned supporting tooth.

What to Expect During Treatment

Your treatment experience may be as follows:

• Preparing your mouth.Before getting a partial, you may need some other dental work. Teeth may need to be removed or reshaped. Bone may need to be built up. Then your dentist will take an impression of your gums and remaining teeth. Your partial will be made from this impression. You may wear a temporary partial while the lab makes your final one. If so, your dentist will advise you about when and how to take it out and clean it.

• Fitting your partial.Once your final partial is made, your dentist will make the first of many adjustments to it. He or she will check for pressure spots on your gums and make sure the look and bite are good. You will learn how to put it in and when to take it out. Plan to visit your dentist twice a year to have your partial checked and adjusted if needed.

Getting Used to a Partial

Your partial will feel awkward for a few weeks. It is likely to affect your speech and your mouth may water a lot at first. Keep wearing the denture. That way you will get used to it sooner. Here are some tips:

• Practice reading out loud until your tongue adjusts to the feel of the denture.

• Practice putting the denture in and taking it out. Never force it into position by biting down. That could bend or break the clasps.

• Eat soft foods at first. Avoid sticky or hard foods. Cut all foods into small pieces.

Care Over the Years

Your mouth naturally changes shape over time. To keep up with those changes, your denture must be adjusted. If it's not, it will feel less comfortable. Worse, it may irritate your gums and speed up bone loss in your jaw. To get the best results with a partial:

• See your dentist as instructed to have the partial checked and adjusted. Never adjust or repair it yourself.

• Take it out at bedtime to let your gums rest.

• Avoid gum problems and decay by keeping the support teeth especially clean. When cleaning the partial, hold it over water or a towel so it won't get damaged if you drop it.

Periodontal Disease: Soft Tissue Graft

When you look in the mirror, doesyour gumline look uneven?Or do you see too little gum? These are common effects of periodontal disease. A type of gum surgery called gingival surgery can lower or even out the gumline. And if more of the tooth needs to be exposed, gingival surgery can fix that, too. One type of gingival surgery is called a soft tissue graft.

Before surgery

After surgery

How a Soft Tissue Graft Works

When the gum isn't supported by bone, the gum can start to pull away. A graft can be used to fill in an area where the gum hasreceded. The graft tissue may be taken from the roof of the mouth or from a tissue bank.

• Before surgery. A gumline that has receded can expose the root. This can lead to tooth sensitivity and cavities in the root. The uneven gumline may also be visible when you smile.

• After surgery.Graft tissue covers part or all of the exposed root. This protects the root and prevents the gum from receding further. It can also improve your appearance.

Periodontal Disease: If You Need Surgery

If you have periodontal disease, you may need surgery to save one or more teeth. Surgery can helpreduce the size of pockets that form between tooth and gum. It can also help regenerate bone and other tissue, or adjust the gumline. In addition, surgery can be used to reach tartar that can't be removed with other techniques.

Your Surgical Experience

Periodontal surgery takes place in the dentist's office. You will go home soon after it is completed. To control pain you'll be given local anesthesia.You may also have a sedative (medication to help you relax). Be sure to arrange in advance for a ride home.

After Surgery

Your instructions right after surgery may include:

• Resting for a day or two

• Taking medication to control pain or prevent infection

• Using ice or medication to control swelling

• Not smoking

• Special instructions for cleaning teeth

• Caring for the surgical area or dressing

You'll have a follow-up visit in1-3 weeks to check how you're healing. This is when stitchesand any dressing (protective covering) are removed.

Risks and Complications

These vary depending on the surgery. In general, risks and complications of periodontal surgery may include any of the following:

• Pain or discomfort

• Increased tooth mobility or sensitivity(often temporary)

• Swelling and bruising of the cheek

• Numbness or tingling, due to temporary or permanent damage to nearby nerves

• Exposure of more crown or root

Periodontal Disease: Crown Lengthening

When you look in the mirror, doesyour gumline look uneven?Or do you see too little gum? These are common effects of periodontal disease. A type of gum surgery called gingival surgery can lower or even out the gumline. And if more of the tooth needs to be exposed, gingival surgery can fix that, too. One type of gingival surgery is called crown lengthening.

Functional crown lengthening: Gum and bone are removed. The remaining portion of the tooth can now support a replacement crown.

Cosmetic crown lengthening: Removing gum can create a more attractive smile.

How Crown Lengthening Works

Surgery to expose more of the crown (the part of the tooth you can see) includes:

• Functional lengthening. In some cases, a restoration (artificial crown) is needed. Gum and bone are removed to expose enough tooth to anchor the new crown. This also helps prevent future damage to gum and bone near the restoration.

• Cosmetic lengthening. This is done to remove an overgrowth of gum tissue that causes a "gummy" smile. It can improve appearance and may make teeth easier to keep clean.

Periodontal Disease: Guided Tissue Regeneration (GTR)

Teeth are held in place by surrounding gums, bone, and other tissues. But periodontal disease can cause the bone to break down. Certain techniques called regenerative procedures can be used to stimulate growth of new bone. This growth increases the height of the bone around the tooth, giving the tooth more support. Getting back even half the lost bone height extends the life of the tooth. One type of regenerative procedure is called guided tissue regeneration (GTR).

Surgery on gum and bone

How GTR Works

A special membrane is placed between gum and bone. This prevents gum tissue, which grows quickly, from filling the space where bone was lost. That way, new bone has time to grow where it's needed. This is how GTR is done:

• Surgery on gum and bone. The gum is opened. Then a membrane is placed over the damaged bone.

• Separating tissues.Once in place between bone and gum, the membrane allows space for bone to heal.

• After healing.The stitches and membrane dissolve or are removed. In about a year, bone forms to support the tooth.

After healing