Spring Complete Care Dentistry

In our professional opinion, mouthwash is at most an adjunct and should not be relied upon as a main oral hygiene tool. It can be a good short term cover for halitosis, or bad breath, but no more. WaterPik can be useful as an adjunct tool but it cannot and should not be used in place of brushing and flossing.

Interproximal brushes are small brushes that can be inserted in between teeth to clean these difficult-to-clean areas. They are not perfect substitutes but can do sufficient cleaning to prevent most problems.

They can also be used with kids although a Floss Pick is most likely a better tool for them at their age.

We recommend the flossing technique known as C-shaped flossing. Make sure the floss extends below the gum line slightly and the sides of both teeth cleansed by an up-and-down motion.

Flossing should be done once a day with a waxed floss.

Dental floss is the most effective way to clean the area between the teeth, known as the interproximal contacts. As we eat, food particles get trapped in the contact area and if not removed in time, can lead to what we call Class II/III decay, or cavities in between the teeth.

While brushing is a big part of oral hygiene, it alone cannot prevent all cavities. In order to truly protect yourself against dental cavities, you also need to use the dental floss.

Our office recommends the Bass Technique, which focuses mainly on cleaning the gum line area. The toothbrush bristles are held at 45 degrees to the gum line and the brush slightly “vibrated” by the hand, as if in a light paint-dabbing motion.

Make sure to do this for all areas.

https://youtu.be/EEN7g-4EgWw

We absolutely counsel against using toothbrushes with anything harder than soft bristles. In fact, if possible we recommend using extra soft bristles as present in Perio brushes. Using hard bristles can easily lead to gum damage when coupled with strong force and improper brushing technique. Over time this can lead to gum recession and/or tooth damage like abfraction.

Brushing should be done at least twice a day and for about 2-3 minutes each time. The easiest way I tell my patients to do this is to simply turn on their favorite song and brush for its duration. Care must be taken to cover all areas: Left and Right, Top and Bottom, Inside and Out, as well as Front and Back.

In cases where gum disease has been present for a long time and allowed to progress to an advanced stage, bone loss most likely will have made the teeth noticeably loose. In these cases, the teeth may no longer be savable and would need to be removed and replacements considered in the way of dental prostheses or implants.

Gum grafting is a very useful procedure to address gum recession and has a very high successful rate, provided that the situation is appropriate. In this procedure, a piece of gum tissue is harvested from the roof of the patients own mouth and then immediately transplanted to the site where recession has occurred. This donor gum tissue is then sutured in well and allowed to heal and “take” at the acceptor site. Success probability is very high. This procedure is used to address areas in of sensitivity or cosmetic concerns and usually works well unless considerable bone loss has occurred.

A deep cleaning is usually enough for the majority of cases of gum disease, but if the gum disease is too severe and the buildup too deep below the gum line, some surgical periodontal procedures would have to be considered. One such procedure is called pocket reduction. This is a minor surgical procedure aimed to access calculus buildup too deep for conventional deep cleanings.

After a deep cleaning takes place, the periodontium will heal because the inflammatory cause is now gone. The gum will become pink and healthy-looking again and shrink as the swelling is eliminated. However, this also means that some gum recession might occur as the swelling goes down. If bone loss has also occurred, some ‘black triangles’ may also pop up between the teeth. While the gum recession may be addressed with a procedure called “gum grafting,” (see below), bone loss is permanent and can’t be reversed. This is why we consider gum disease to be a ‘silent killer’ because by the time patients detect it, often substantial damage is already done.

There are various treatment modalities, but the most common treatment is Scaling/Root Planing, colloquially known as “deep cleaning.” This treatment involves removing not only the plaque/calculus that is visible, but also that which has accumulated below the gum line. This “invisible” buildup is actually the most dangerous and harmful part, as it is hard to remove and directly damages the periodontium. The deep cleaning involves using scalers to go deep below the gum line to remove all of this buildup. The process is a bit time consuming but usually produces no pain. In the scenario where the patient already has a lot of pain coming in, local anesthesia is more than enough to control and eliminate any discomfort present so that the procedure can be done.

When gingivitis is not treated, the calculus that forms eventually secretes enough bacterial toxins to cause gum and supporting bone to become inflamed for a long period of time. This prolonged inflammatory reaction (years usually) causes the supporting bone to become resorbed or lost and this is why people who have long-term gum disease usually have receding gum lines and gaps between teeth. Gum disease in this form in which bone loss is involved is called periodontitis.

The human mouth is a hotbed for bacterial activity and whenever we eat, food debris that is not cleansed away can combine with bacteria and natural mineral salts to form plaque, a soft, initially transparent layer of biofilm that sticks to teeth. This biofilm layer then grows in density and eventually becomes ‘mature plaque’ which is soft and whitish in appearance. Finally, if this is not cleaned away, it evolves to become calculus (a.k.a. tartar) that is extremely hard, often colored in appearance, and sticks to teeth extremely tightly. Once calculus forms, it normally cannot be removed by patients alone and would require a professional cleaning.

Gingivitis is the condition in which the gingiva, or gum tissue, becomes inflamed due to a constant, long-term build-up of plaque or calculus next to it, and especially if buildup happens below the gum line. Because of this presence of bacterial activity and the general unhealthful effects of debris, the gum tissue experiences a biological reaction in which the blood vessels become engorged with blood and the area swells due to a natural inflammatory reaction. This is why patients suffering from gingivitis most often has gum tissue that looks reddish-purplish and bleeds easily on brushing or touching.

The tissues surrounding and supporting teeth include both hard and soft components. The hard component is the alveolar bone or housing in which the teeth themselves are socketed. The soft component is the “gingiva” or gum tissue that is visible to the naked eye. Both of these components are critical to the long-term health and stability of teeth, just like the foundations for a house.

In general, we recommend waiting until all baby teeth are properly exfoliated before getting braces. However, in cases where skeletal disharmony is present or if certain baby teeth are not being lost properly, earlier intervention might be necessary through the use of headgears or other devices. Our office recommends having braces done during puberty to take advantage of the growth spurt so that any skeletal disharmony, if present, can be most easily corrected.

We recommend not to worry about crooked baby teeth, as it is unknown how their permanent teeth will look given uncertainly in growth and maturation. How teeth come out and how they are aligned is a balance between the amount of space available (arch growth), size of teeth coming in, and perhaps daily habits as well. In cases where crowding does take place or teeth are impacted, they can be easily rectified with modern dental technology from orthodontics, minor surgery, and time.

Yes, pediatric sedation is safe, provided that a pediatric dentist does it under an approved setting, preferably in a hospital. Doses must be given properly, and monitoring is mandatory as well. Our office works with a pediatric dentist who has hospital privileges in the Texas Children’s Hospital so that care done there is top-notch, safe, and monitored.

Generally, it has been our experience that for kids over the age of 5, the majority of them are able to sit through basic dental treatment through a combination of reasoning, tell-show-do, positive encouragment, and perhaps parental supervision. For those that are younger or for those with high anxiety, we would recommend them for specialist care with a pediatric dentist where sedation would be used. In our office, we do not sedate children as we do adults since we believe that children sedation requires more care and precaution, as their bodies are still developing and any drug allergies unknown. In cases where specialist care is needed, we highly recommend those using sedation and not the papoose board, as the latter tends to psychologically traumatize children and make it difficult for them to trust dentists as adults.

Dentistry in principle is virtually the same in children as in adults. For small cavities, we remove the decay and fill the voids with either silver (amalgam) or tooth-colored (composite) fillings. For decay that is too deep or has already compromised the nerves, we would remove the infected nerves and place a steel crown on the tooth. For teeth that are damaged beyond restoration, we simply take them out. Treatment is done under local anesthesia so no pain would be experienced by the patient.

In general, decay in teeth should always be addressed. However, in the case of baby teeth, if the teeth are very loose and on the verge of falling out, letting them fall out on their own without treatment might be an option as well. However, in this scenario, two prerequisites must be met: 1) The teeth are very loose and of virtual certainty to fall out, and 2) No acute infection or pain present. Otherwise, we always recommend addressing decay to avoid having the child suffer potential pain/infection from decay.

Aside from consuming too much sugar-containing foods, one of the most common and dangerous causes of decay in children is excessive use of baby bottles. In these scenarios, parents often leave baby bottles filled with milk in the toddlers’ mouths and let them fall to sleep. However, because milk also contains ample amounts of sugar, this leaves the baby teeth very vulnerable to decay in a phenomenon called “baby bottle caries,” characterized by severe decay especially in the top front teeth. Therefore, we always recommend parents to take particular caution to avoid having the child use baby bottles during sleep.

We recommend you schedule your child’s first appointment at around 6 months of age. At this age, the primary or “baby” teeth are just starting to emerge so monitoring can be started. Also, by exposing children to dental care early, they can become accustomed to dentists and very likely experience less anxiety later on in life, not to mention a greatly reduced likelihood of dental problems!

I have heard that Invisalign braces are not visible and much more comfortable to wear.

Invisalign is a modern approach to braces where no metal brackets or wires are used. Instead a series of sports-guard aligners are used to slowly push and align teeth to the desired position. Because no metal is used, there are no cosmetic concerns and patients are less worried in that area. However, Invisalign is appropriate in only mild and moderate cases and in severe cases where a lot of teeth movement is needed, the more traditional wires and bracket systems are still the desired and necessary system to achieve the desired result.

When braces are first put on or when wires are switched out, for the first few days of movement the teeth can feel quite “tight” and a bit sore from the movement that is taking place. However, for most people the discomfort can be well controlled with Advil/Tylenol and after a few days the soreness goes away for most people. Another source of common discomfort can come from the brackets scratching the gum/cheek tissues. This can be alleviated with wax pellets covering the metallic surfaces of orthodontic brackets or patients letting their soft tissues getting used to the devices though the formation of callous tissues.

Proper teeth alignment requires that the skeletal components (jaws) are in proper alignment as well. Sometimes, there is disharmony in this area and this leads to either crooked teeth or a poor bite. There are 3 classes of jaw relationship: Class I (Normal), Class II (Overbite), and Class III (Underbite). To correct the undesirable skeletal relationships in Class II and Class III patients, headgears are often necessary during the growth years while in adults orthognathic surgery would be necessary to reset/realign the jaw correctly.

Braces work by applying pressure to teeth to “push” them in the desired direction. This pushing motion dissolves bone in the direction being pushed and bone reforms behind the tooth from where it is being pushed. The result is that teeth are visibly shifted but bone level remains constant and in safe conditions. It is important to not have the teeth moved too aggressively or else root resorption might occur and lead to permanent damage for the teeth.

This can vary greatly among individuals depending on their case difficulty, growth differentials, and patient compliance. Usually, orthodontic treatment takes about 18-24 months to ensure proper and safe movement of teeth to the desired destination.

It seems like many more kids than adults get braces.

I am just wondering if as an adult I might stand out in the wrong way if I get braces.

While it is true that many more kids than “grown-ups” get braces, the truth is that anyone can get braces anytime provided that the teeth and supporting tissues are healthy enough to undergo the treatment. If appearance during treatment is a concern, there are white or porcelain brackets that can be used in lieu of the more traditional metal ones to allow for a more camouflaged appearance.

We absolutely welcome patients to ask questions either of the staff or Dr. Tan anytime during their care. We believe in complete transparency in the diagnosis, treatment, and after care process. Do not shy from asking if you have any uncertainties!

While antibiotics are useful as an adjunct in dental infections, by themselves they will not address the source of dental infections, which requires real dental treatment. Therefore, while we prescribe antibiotics in certain acute, notable infections, we generally recommend patients to avoid taking excessive doses of antibiotics and to seek real definitive treatment. In addition to possibly developing antibiotic resistance, excessive antibiotic taking can lead to other problems such as yeast infections in female patients, for example.

Dental anxiety is a very common occurrence and our office deals with it on a daily basis, for adults, we offer oral sedation whereby a sedative is administered under monitoring. The sedative is anxiolytic and makes people who otherwise would be racked with nervousness to become much more receptive to dental care; in many cases, people fall asleep under sedation, although this does not always happen. Our office offers this service free of charge as a courtesy for our patients, so I quite if you think you might need it.

Yes, with rare exceptions x-rays are a necessary component of any comprehensive and useful dental examination, the reason being that there are locations between the and in the bone that the human eye simply can’t see. While radiation should be avoided when possible, the amount of radiation used in a dental setting is minute and inconsequential compared to those performed in a Medical Doctor’s office. The chart below shows the relative intensity of radiation of dental radiography compared to some daily activities.

Our office recommends a regular interval of six months between exams and cleanings. Our experience shows that patients who stick to this interval rarely experience any serious dental problems and experience much better oral health than patients that do otherwise.

Absolutely not. Our clinic believes that dental care should be accessible to patients even when financials may be difficult on paper. Our fees are affordable to begin with, and we also offer payment options to patients such as CareCredit and DocPay. Please inquire about details if you think you need payment options.

While mouthwash is the most common way people deal with this condition, bad breath may actually be symptomatic of various causes. For example, periodontal (gum) disease can also cause bad breath, and so can a tongue with debris on the surface. In these cases, deep cleanings and tongue scrapers are better solutions, respectively. So if bad breath is present, consult with the dentist to find out what the underlying cause might be.

Yes, kids can get RCT as well, and as a matter of fact this happens often. When a child gets a deep cavity, to eliminate the cavity and the infection it has caused we often do an ‘abridged’ version of RCT whereby the tooth is opened and the pulpal chamber accessed. Nerves within the chamber are then removed while those in the root canals are left untouched; a filling is then placed afterwards to fill the access hole and the entire tooth covered with a stainless steel crown. This is commonly seen in children.

However, for permanent teeth it is generally a good idea to avoid doing true root canals in kids until about 2-3 years after the eruption of the tooth. This is because if the nerves and blood vessels in a root canal are prematurely removed prior to complete root formation, this may stunt the proper growth of the root and making it short artificially. So, while root canals are possible and in many some cases necessary in children, care must be taken to assess the root status before the undertaking.

There are alternatives to saving a tooth with RCT, but they are either not ideal, or would involve substantial expense. For example, one can always opt to extract and remove the tooth. While this option is cheaper than saving a tooth via RCT, it of course means that the tooth is lost forever and may lead to compromised chewing efficiency for the patient and/or cosmetic concerns. Over time, furthermore, the neighboring teeth can also drift and migrate into the empty space leading to a change in bite and periodontal stability. Another alternative in recent years is the dental implant. In this scenario, the infected tooth is removed, and a dental implant fixture is placed. After integration with the bone, a dental crown is placed in the implant and together this simulates the presence of a tooth. Currently, this is the most stable and state-of-the-art solution for tooth loss. Its drawback is that this option is expensive and time-consuming and the patient still needs to exercise good hygiene to keep the gum/bone healthy around the implant.

I have heard of people saying that several years after root canal their tooth broke or got reinfected.

Yes, without a doubt RCT does work, but its longetivity is dependent on several factors. First, the dentist has to be competent enough to find ALL of the canals in the tooth and do a good job at cleaning/disinfecting them. Secondly, a crown must be procured when indicated to help support and protect the weakened tooth. And finally, the patient must still exercise good home care for the tooth in terms of hygiene and cleaning. Just because a tooth got a root canal and no longer has nerves doesn’t mean that it no longer needs proper hygiene. If the tooth structure gets decayed, the tooth can still need additional treatment or need removal.

The reason why a crown is recommended for many root canal-treated teeth is that after a root canal, the tooth is hollowed out and always weaker than it’s original condition. The analogy I tell my patients is to think of a hollowed out tree. Because work and instrumentation was done inside the tooth, it is hollow and weaker and therefore prone to breakage and fracture if it does not receive some external support. Therefore, a crown is usually the instrument of choice to provide this support and it works very well in this regard. However, not every instance needs a crown and in some cases, particularly for anterior teeth, a buildup may be sufficient itself to provide this support. The proper treatment is always case-by-case.

Root canal treatment (RCT) is the specialized procedure dentists do to treat the interior of the tooth to eliminate infection in the pulp and root canal areas of a tooth. After anesthesia, the tooth is first excavated so that all of the causative insult like decay is removed and the pulpal chamber accessed; this is followed by the finding and identification of all canal present. The lengths of the canals are then determined and the canals thoroughly debriefed, Leander, and disinfected. Finally, the canals are filled with a rubbery, biocompatible material and the tooth sealed with a buildup, i.e. large filling.

The most common cause is dental decay. When dental caries are left untreated and extend sufficiently far inside a tooth to penetrate into the pulpal chamber, infection will result. Usually this is also accompanied by considerable pain/discomfort/sensitivity. Other causes can also result in the same condition. Physical trauma such as altercations or sporting accidents that knock a tooth hard can also result in damage to the interior of a tooth requiring root canal treatment. And gum problems like extensive gingivitis and periodontitis can also lead to endodontic issues in neighboring teeth.

A tooth becomes infected when an external insult (caries, physical damage, etc.) penetrates through the exterior housing of the tooth (enamel, dentin, or cementum) into the area where nerves and blood vessels exist. This brings harmful bacteria into contact with these tissues and hence an infection will result. Typically the infection runs the whole course of the root and causes an infectious buildup of materials we call a granuloma at the tip of the root. The physical pressure caused by this tissue, as well as the direct agitation of nerves inside the tooth, is what causes many people to suffer considerable pain. Often times, an abscess can also accompany the symptoms containing pus and exudates.

A tooth is composed of the coronal (visible) portion consisting of enamel and dentin, and its roots which extend into the bone to help anchor it to keep it in place. The coronal portion is a hollow casing which encloses the pulp, where the mass of the nerves and blood vessels of the tooth reside. The roots, however, also encase a slim, hollow space containing nerves and blood vessels as well. This space within the roots is what’s called the “root canal.” In a dental infection, not only the pulp but also the root canal spaces would become infected, and hence the “root canal” procedure would be necessary to disinfect the whole system.

As a matter of fact, there is. To forestall or minimize the bone loss, one can place dental implants at strategic locations in the residual bony ridge to help maintain the presence of bone and minimize the resorption with time. Bone loss may not be completely averted but the rate will at least be drastically reduced. The implants, just as importantly, can also serve as anchors to help tether the dentures to the ridge during wear. This is an extremely important benefit as it will help to keep the dentures in place and avoid any looseness or use of denture paste. In fact, implant-supported dentures are the current state-of-the-art technique for denture users and we highly recommend it. However, to do so requires a lot of money and time.

Yes, this is true of traditional complete dentures. With these dentures, the pressure from chewing over long periods of time, coupled with the absence of teeth, causes the residual bony ridge that the dentures sit on to eventually shrink and disappear over time. This process is usually very gradual and take place over decades, but can produce a noticeable ‘Popeye’ appearance given time where the patient’s top jaw seems to shrink, causing a pronounced lower jaw appearance. This is a result of the loss of the bony ridge and other supporting bony tissue over time. Appearance aside, the shrinkage and loss of the bony ridge also means wearing dentures become more and more difficult with time as it becomes progressively looser. Denture paste can usually counter this effectively but patients do notice a more difficult time functioning with bone loss.

In this case, complete denture would be the best option, unless the teeth are restorable and the patient is willing to spend a lot of time and money to do so. Here, all of the remaining compromised teeth would be removed and a complete denture fitted. However, before proceeding to such an option, a patient must be aware of the limitations of complete dentures (denture consent form); in general, patients must understand that complete dentures take considerable time to adapt to and there are certain functional aspects will remain forever compromised (chewing strength, taste ability, etc.). However, when fabricated well and with patient understanding, complete dentures can be an excellent alternative, both functionally and cosmetically.

Removable dental prostheses include both complete and partial dentures. These are devices used to replace a larger number of missing teeth or as a ‘cheaper’ option to missing teeth when patients cannot afford a FPD. Generally, when well-fabricated and well-cared for, removable prostheses are still excellent options. However, they can be a hassle in their use as they require insertion/removal and cosmetically, they may not be perfect. They also require good hygiene as well, as any decay to an anchor teeth or any remaining teeth present may necessitate a remake of the prosthesis.

Fixed dental prosthesis, or FPD in short, refers to a class of dental restorations colloquially known as dental ‘bridges.’ This option has been used for decades and is really useful at replacing one or a few missing teeth. The ‘bridge’ is done by using the teeth flanking the missing space as anchors and then placing crowns on these teeth, and then using these crowns as attachment points to hold a replacement tooth. Since the crowns on these anchor teeth are cemented permanently, the replacement tooth is also in place permanently. FPDs are therefore an excellent option to replace missing teeth while at the same time avoid the hassle of insertion/removal of a device, as well as offering excellent aesthetics. However, the drawback is that FPDs in general cannot replace more than 2 teeth, and home care is a MUST to avoid decay to ANY of the anchor teeth. If decay takes place in any of the anchor teeth, the bridge would need to be redone.

Dental prostheses come in two varieties, fixed and removable. The goal of both types is to restore function and form for patients who are missing teeth, either one or multiple. Most of the time when people discuss dental prostheses, they refer to the removable option and this form is generically referred to as ‘dentures.’

We recommend anyone getting veneers or crowns to also get a night guard to protect the investment. Nighttime grinding is very common in the population and the grinding forces often can either chip/damage the cosmetic restorations or in cases for veneers, pop them right off. Therefore, we heavily recommend folks to consider getting a nightguard to prevent this from happening and ensure a long, enjoyable lifespan for the crowns/veneers.

Yes, it can. However, it will require the usual home care we detailed in our hygiene page. Flossing is essential for both crowns and veneers and should be done daily to ensure proper cleanliness and avoid decay around the margins of the restoration. As for staining, porcelain restorations in principle do not stain. However, very slight surface discoloration may appear with time if the patient drinks a lot of coke, tea, coffee, or engages in activities like smoking or wine-drinking. Fortunately, these can be polished and cleaned off most of the time.

Yes, in our office we make sure that the crowns blend in with the patients natural teeth by doing “custom shading” whereby we have a professional lab take pictures and use shade guides to mimic the shade of the neighboring teeth. This ensures that the restorations will look perfectly natural and blend right in. We also work closely with the lab to establish the best ratios, symmetry, and shape of the teeth to optimize the aesthetics. There are general principles for this like the Golden Rule but for each person there are always variations and details that need to be individualized.

From our experience, cosmetic crowns tend to be better in terms of durability and retention. Although veneers are a bit more conservative and require the removal of less tooth structure, the tooth preparation is not all that different and still require the removal of most of the exterior surface of a tooth. But because veneers do not cover the whole tooth, they tend to ‘pop off’ easier, particularly in patients who grind their teeth at night. For this reason of retention, we recommend crowns over veneers for long term stability.

Many procedures can fall under the realm or have some relationship with it (such as bleaching or braces), but the most common purely cosmetic dental procedures are based upon veneers and crowns. Veneers, as the name suggests, are thin covers placed over the front surface of a tooth while crowns, on the other hand, are full “caps” placed over the entire body of the tooth. Both veneers and crowns are made of porcelain resembling tooth structure, thereby achieving the desired natural tooth look.

Cosmetic dentistry is a branch of dentistry that focuses on improving the appearance of teeth so that they look better. Often times there are no structural or health necessities, so the procedure is strictly cosmetic in nature and therefore considered elective.