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What new methods are under development to treat and prevent tooth decay?
Several new treatments are under development. One experimental technique uses fluorescent light to detect the development of cavities long before they can be detected by traditional means, such as x-rays or dental examination. In many cases, if cavities can be detected early, the decay process can be stopped or reversed. Researchers are also working on a "smart filling" to prevent further tooth decay by slowly releasing fluoride over time around fillings and in adjacent teeth. New means to prevent tooth decay are also being studied. A study has shown that a chewing gum that contains the sweetener xylitol temporarily retarded the growth of bacteria that cause tooth decay. In addition, several materials that slowly release fluoride over time, which will help prevent further decay, are being explored. These materials would be placed between teeth or in pits and fissures of teeth. Toothpaste and mouth rinses that can reverse and "heal" early cavities are also being studied.

What are dental sealants, who should get them, and how long do they last?
Sealants are a thin, plastic coating that are painted on the chewing surfaces of teeth -- usually the back teeth (the premolars, and molars) to prevent tooth decay. The painted on liquid sealant quickly bonds into the depressions and groves of the teeth forming a protective shield over the enamel of each tooth.

Typically, children should get sealants on their permanent molars and premolars as soon as these teeth come in. In this way, the dental sealants can protect the teeth through the cavity-prone years of ages 6 to 14. However, adults without decay or fillings in their molars can also benefit from sealants. Sealants can protect the teeth from decay for up to 10 years, but they need to be checked for chipping or wearing at regular dental checkups.

When will drill-less dentistry become a reality?
Drill-less dentistry, also called air abrasion and microabrasion, is being offered by some dentists now. Air abrasion can be used to remove tooth decay, to remove some old composite restorations, to prepare a tooth surface for bonding or sealants, and to remove superficial stains and discoloration. The air abrasion instrument works like a mini sandblaster to spray away the decay, stain, or to prepare the tooth surface for bonding or sealant application. With air abrasion, a fine stream of particles is aimed at the tooth surface. These particles are made of silica, aluminum oxide, or a baking soda mixture and are propelled toward the tooth surface by compressed air or a gas that runs through the dental handpiece. Small particles of decay, stain, etc, on the tooth surface are removed as the stream of particles strikes them. The remnant particles are then "suctioned" away.

What's the latest word on the safety of amalgam-type fillings?
Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that amalgams are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis?

Numerous public health agencies say amalgams are safe, and that any link between mercury-based fillings and disease is unfounded. The cause of autism, Alzheimer's disease, and multiple sclerosis remains unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.

March of 2002, the FDA reconfirmed the safety of amalgams. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. The National Institutes of Health has several large-scale studies currently under way to ultimately answer many of the questions raised about silver-colored amalgams. In addition, there has been concern over the release of a small amount of mercury vapor from these fillings, but according to the CDA, there is no scientific evidence that this small amount results in adverse health effects.

Is it possible to have an allergic reaction to amalgam?
It is possible, but fewer than 100 cases have ever been reported, according to the CDA. In these rare circumstances, mercury or one of the metals used in an amalgam restoration is thought to trigger the allergic response. Symptoms of amalgam allergy are similar to those experienced in a typical skin allergy and include skin rashes and itching. Patients who suffer amalgam allergies typically have a medical or family history of allergies to metals. Once an allergy is confirmed, another restorative material can be used.

What role are lasers playing in the field of dentistry?
Lasers have been used in dentistry since 1995 to treat a number of dental problems. But, despite FDA approval, no laser system has received the Canadian Dental Association's Seal of Acceptance, which assures dentists that the product or device meets CDA standards of safety and efficacy, among other things. The CDA, however, states that it is cautiously optimistic about the role of laser technology in the field of dentistry.

Still, some dentists are using lasers to treat:
Tooth Decay: Lasers are used to remove decay within a tooth and prepare the surrounding enamel for receipt of the filling. Lasers are also used to "cure" or harden a filling.
Gum Disease: Lasers are used to reshape gums and remove bacteria during root canal procedures.
Biopsy or Lesion Removal: Lasers can be used to remove a small piece of tissue (called a biopsy) and send it for testing to determine if it is cancerous; to remove lesions in the mouth; and relieve the pain of canker sores.
Teeth Whitening: Lasers are used to speed up the in-office teeth whitening procedures. A peroxide bleaching solution, applied to the tooth surface, is "activated" by laser energy, which speeds up of the whitening process

How do whitening toothpaste work and how effective are they at whitening teeth?
All toothpaste help remove surface stains through the action of mild abrasives. Some whitening toothpaste contains gentle polishing or chemical agents that provide additional stain removal effectiveness. Whitening toothpaste can help remove surface stains only and do not contain bleach; over-the-counter and professional whitening products contain hydrogen peroxide (a bleaching substance) that helps remove stains on the tooth surface as well as stains deep in the tooth. None of the home use whitening toothpaste can come even close to producing the bleaching effect you get from your dentist's office through chairside bleaching or power bleaching. Whitening toothpaste can lighten your tooth's color by about one shade. In contrast, light-activated whitening conducted in your dentist's office can make your teeth three to eight shades lighter.

What about whitening strips and whitening gels? What's the opinion on these products?
Both of these products contain peroxide in a concentration that is much lower than the peroxide-based products that are used in your dentist's office. Although some teeth lightening will be achieved, the degree of whitening is much lower than results achieved with in-office or dentist-supervised whitening systems. Additionally, use of over-the-counter products do not benefit from the close supervision of your dentist. On the positive, the over-the-counter gels and strips are considerably less expense (ranging from $10 to about $55) than the top-of-the line in-office whitening procedures, which can cost nearly $800.

Beyond simply changing the color of my teeth, I am interested in changing the shape of my teeth. What options are available?
Several different options are available to change the shape of teeth, make teeth look longer, close spaces between teeth or repair chipped or cracked teeth. Among the options are bonding, crowns, veneers, and recontouring. Dental bonding is a procedure in which a tooth-colored resin material (a durable plastic material) is applied to the tooth surface and hardened with a special light, which ultimately "bonds" the material to the tooth. A dental crown is a tooth-shaped "cap" that is placed over a tooth. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line. Veneers (also sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials that are designed to cover the front surface of teeth. These shells are bonded to the front of the teeth. Recontouring or reshaping of the teeth (also called odontoplasty, enameloplasty, stripping or slenderizing) is a procedure in which small amounts of tooth enamel are removed to change a tooth's length, shape or surface. Each of these options differ with regard to cost, durability, "chair time" necessary to complete the procedure, stain resistant qualities, and best cosmetic approach to resolving a specific problem.

I have a terrible fear of going to the dentist yet I recognize the importance of seeing the dentist to maintain good oral health. What should I do?
If you fear going to the dentist, you are not alone. Between 9% and 15% of Canadians state they avoid going to the dentist because of anxiety or fear. The first thing you should do is talk with your dentist. In fact, if your dentist doesn't take your fear seriously, find another dentist. The key to coping with dental anxiety is to discuss your fears with your dentist. Once your dentist knows what your fears are, he or she will be better able to work with you to determine the best ways to make you less anxious and more comfortable.

The good news is that today there are a number of strategies that can be tailored to the individual to reduce fear, anxiety, and pain. These strategies include use of medications (to either numb the treatment area or sedatives or anesthesia to help you relax), use of lasers instead of the traditional drill for removing decay, application of a variety of mind/body pain and anxiety-reducing techniques (such as guided imagery, biofeedback and deep breathing, acupuncture, mental health therapies), and perhaps even visits to a dentophobia clinic or a support group.

I've been a cigarette smoker for a number of years and am concerned about the possibility of developing oral cancer. What are the signs and symptoms of oral cancer?
First, it's important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally. To answer your question, the following are the common signs and symptoms of oral cancer:

- Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums or other areas inside the mouth.
- The development of velvety white, red, or speckled (white and red) patches in the mouth.
- Unexplained bleeding in the mouth.
- Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck.
- Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks.
- A soreness or feeling that something is caught in the back of the throat.
- Difficulty chewing or swallowing, speaking, or moving the jaw or tongue.
- Hoarseness, chronic sore throat, or changes in the voice.
- Ear pain.
- A change in the way your teeth or dentures fit together - a change in your "bite".
- Dramatic weight loss.

If you notice any of these changes, contact your dentist immediately for a professional examination.

With so many toothpaste in the marketplace today, can you offer any tips to help make a wise choice?
Here's some advice. First, when purchasing a toothpaste for you or your child, select one that contains fluoride. Fluoride-containing toothpaste has been shown to prevent cavities. One word of caution: check the manufacturer's label; some toothpaste is not recommended in children under age 6. This is because young children swallow toothpaste and swallowing too much fluoride can lead to tooth discolouration in permanent teeth.

Next, when considering other properties of toothpaste such as whitening toothpaste, tartar-control, gum care, desensitizing, etc…, the best advice for selecting among these products may be to simply ask your dental hygienist or dentist what the greatest concerns are for your mouth. Also, be aware that your needs will likely change as you get older. After consulting with your dentist or hygienist about your oral health's greatest needs, look for products within that category (for example, within the tartar control brands or within the desensitizing toothpaste brands) that have received the CDA Seal of Acceptance.

Finally, some degree of personal preference comes into play. Choose the toothpaste that tastes and feels best. Gel or paste, wintergreen or spearmint all work alike. If you find that certain ingredients are irritating to your teeth, cheeks or lips, or if your teeth have become more sensitive, or if your mouth is irritated after brushing, try changing toothpaste. If the problem continues, see your dentist.

Since the introduction of fluoride and other advances in dental care and dental products, is it still necessary to visit the dentist twice a year?

The standard recommendation still is to visit your dentist twice a year for checkups and cleanings. The three best arguments that can still be made to support the twice-yearly visitation schedule are:

- So that your dentist can check for problems that you may not see or feel.
- To allow your dentist to find early signs of decay (decay doesn't become visible or cause pain until it reaches more advanced stages).
- To treat any other oral health problems found (generally, the earlier a problem is found, the more manageable it is).

That being said, however, people who have taken great care of their teeth and gums and have gone years without any problems whatsoever may choose to lengthen the time between visits. Ask your dentist what visitation schedule works best for your state of dental health.

At the other extreme, it should be kept in mind that some people such as some people with gum disease, a genetic predisposition for plaque buildup or cavities, or a weakened immune system may need to visit the dentist even more frequently than twice a year for optimal care.

I recently moved and am in need of finding a new dentist. How should I go about this task?

- Ask family, friends, neighbors or coworkers for their recommendations.
- Ask your family physician or local pharmacist.
- If you're moving, your current dentist may be able to make a recommendation.

What should I look for when choosing a dentist?

You and your dentist will be long-term oral health care partners; therefore you need to find someone you can be comfortable with. To find a suitable dentist to meet your needs, consider asking the following questions as a starting point.

- What are the office hours? Are they convenient to meet your schedule?
- Is the office easy to get to from work or home?
- Where was the dentist educated and trained?
- What's the dentist's approach to preventive dentistry?
- How often does the dentist attend conferences and continuing education workshops?
- What type of anesthesia is the dentist certified to administer to help you relax and feel more comfortable during any necessary dental treatment?
- What arrangements are made for handling emergencies outside of office hours?
- Is information provided about all fees and payment plans before treatment is scheduled? If you are comparison shopping, ask for estimates on some common procedures such as full-mouth x-rays, oral exam and cleaning, and filling a cavity.
- Does the dentist participate in your dental health plan?
- What is the dentist's office policy on missed appointments?

How safe are dental x-rays?
Exposure to all sources of radiation including the sun, minerals in the soil, appliances in your home, and dental x-rays can damage the body's tissues and cells and can lead to the development of cancer in some instances. Fortunately, the dose of radiation you are exposed to during the taking of x-rays is extremely small.

Advances in dentistry over the years have lead to the low radiation levels emitted by today's x-rays. Some of the improvements are new x-ray machines that limit the radiation beam to the small area being x-rayed, higher speed x-ray films that require shorter exposure time compared with older film speeds to get the same results, and the use of film holders that keep the film in place in the mouth (which prevents the film from slipping and the need for repeat x-rays and additional radiation exposure). Also, the use of lead-lined, full-body aprons protects the body from stray radiation (though this is almost nonexistent with the modern dental x-ray machines). In addition, federal law requires that x-ray machines be checked for accuracy and safety every 2 years, with some states requiring more frequent checks.

Even with these advancements in safety, it should be kept in mind, however, that the effects of radiation are added together over a lifetime. So every little bit of radiation you receive from all sources counts.

Are women more prone to oral health problems?
Yes. Women have an increased sensitivity to oral health problems because of the unique hormonal changes they experience. These hormonal changes not only affect the blood supply to the gum tissue, but also the body's responses to the toxins that result from plaque build up. As a result of these changes, women are more prone to the development of periodontal disease at certain stages of their lives as well as to other oral health problems. The five situations in a women's life during which hormone fluctuations make them more susceptible to oral health problems are during puberty, the monthly menstruation cycle, when using oral contraceptives, during pregnancy, and at menopause.
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