Dental Solutions

Since 1985 CEREC by Sirona has remained the preferred CAD/CAM technology of dentists worldwide for the fabrication of all-ceramic dental restorations in a single treatment appointment. CEREC is proven by hundreds of clinical studies and is offered by thousands of dentists to millions of patients around the world each year. It also has the broadest restorative range of any dental CAD/CAM system on the market. Proven performance, unrivalled success, and unequalled capabilities have made CEREC the number one dental CAD/CAM choice for over 28 years.

Why are thousands of people world wide choosing the CEREC restorative technique for their dental needs?

Single Appointment Dental Care

Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, get another injection, have the temporary pried off (if it hasn't fallen off already), and have a permanent restoration put on. With CEREC, the procedure is done in a single appointment, start to finish. No temporary restorations.

Finest Dental Materials

A CEREC tooth restoration isn't just convenient, it is also healthy. Many years ago, dentists had few options to repair decayed and damaged teeth other than amalgam, gold, and other metals. With CEREC, your dentist can use strong, tooth coloured ceramic materials to restore your teeth to their natural strength, beauty, and function. These materials closely match the composition of natural tooth structure. The materials are chemically bonded to your tooth, so your dentist can save as much healthy tooth tissue as possible while providing you with a dental restoration that strengthens your tooth. Using metal free materials that are the closest to your natural enamel, CEREC gives you the highest quality restorative care.

Smile Enhancement

We use CEREC for more than just crowns. CEREC is capable of producing any single tooth restoration. Chipped or discolored front teeth can be repaired with beautiful CEREC porcelain anterior crowns or veneers. Your smile makes a lasting first impression. Enhance it with CEREC.

Your dentist is in complete control of the final result

Since the crown, inlay, onlay or veneer is designed and fabricated from start to finish by your dentist, he has total control over how it will look and fit. A crown made in a laboratory is under the control of the technician and assistants who work of plaster models and hasn't even seen the patient.

No temporary restorations

With Cerec your restorations are placed in a single appointment. If you have lab made veneers you would require temporary veneers during the wait whilst your new teeth are being made by the technician. These have been known to fall off and cause problems. This step is eliminated with CEREC restorations.

In certain circumstances it may be necessary to customize your restorations to blend in with your natural neighboring teeth. This is accomplished by adding colouring stains to your restoration and firing it in an oven before the final glazing is done.

Glazing gives the restoration a very smooth and shiny surface texture, enhancing optimum oral hygiene. It also strengthens the crown.

Microscope Enhanced Dentistry has become a standard feature in advanced dental clinics. With the use of a microscope, diagnosis and treatment attains unparalleled heights of precision. With the high magnification, we are able to see detail that is simply impossible to visualize with the naked eye.

The microscope can be used to magnify almost all the procedures which are done routinely by dentists. This is a revolution in the dental world - dental treatment done under magnification with the use of the microscope, is significantly improved.

The key factors to successful endodontic surgery -vision and precision - are now readily attainable. With the microscope you will recognize even the finest detail in the tooth structure. You will also be able to find a 4th canal and see existing isthmuses with amazing clarity. The chances of failure of root canal treatment become much smaller.

Doing complicated procedures like failed RCT and removal of broken files deep inside the roots of teeth, are challenges which demand the use of a microscope. Teeth with failed RCT's can be re-treated with a second RCT and successfully saved, when done very carefully, and the chances of success are much higher when done under the microscope.

Poorly treated root canal, decay and restoration overhangs easily detected with digital x-rays.

Clinical intra-oral photography shows cracked restoration and tooth, poor contact points and decay.

The use of digital x-rays and intra- oral photography are excellent tools that enhance the diagnostic capabilities of the clinician. X-rays can be manipulated by enlargement, highlighting and colour changes, to name only a few advantages. The digital dental X-ray system is more sensitive than dental X-ray film systems. Your exposure to X-rays is reduced by as much as 90%.

With intra-oral photography, images are recorded which can be reviewed with precision and can be referred back to for accurate diagnoses, once the patient has left the surgery. The camera does not lie. You get a clear view of the state of your teeth, restorations and surrounding oral structures. A true view of your present oral health is displayed.

Extra-oral photography is mostly used for smile design and orthodontic planning. The facial features, profile view and appearance of smile and teeth are recorded for examination and treatment planning.

Radiosurgery is one of the most important and versatile instruments in dentistry today. Its numerous uses range from performing surgical incisions to establishing haemostasis. The radiosurgical instrument uses a high frequency radio signal to perform the incisions.

The radio signal produces a finer, micro smooth sterile incision with immediate haemostasis and minimum tissue alteration. It offers the advantage of a safe, fast, and efficient incision with a better field of visibility. The patient receives a pressure less cut with a minimal amount of bleeding which often requires no suturing.

Most common use in dental cosmetic surgery is to sculpt the gum tissue around front teeth to give it an even height and form, and to elongate the clinical crown (gingivectomies). Also used to reduce "gummy smiles" in conjunction with bone alteration (crown lengthening) and lip repositioning procedures. Other indications are: sterilizing root canals, troughing of sulcus around crown preparations to enhance optical and normal impressions and to facilitate bonded placement of restorations, removal of overgrown gum soft tissue.

The ability to vary the wave form of the radio signal, together with the combination of the different active and passive electrodes which are self- sterilizing, offers numerous advantages. It prevents seeding of bacteria into the incision site and eliminates scar tissue formation. Healing time is reduced significantly.

In contouring nothing is added to the tooth - only taken away. Small imperfections on the outer borders of your tooth are removed by sanding, to create a better looking shape for the tooth.

It is a quick, inexpensive procedure with phenomenal results. Only very small amounts of tooth are removed to prevent post operative sensitivity.

When bigger alterations to the shape and size of the tooth are needed, crowns or veneers will be the treatment of choice.

Dr Hugo Lemmen uses CEREC cad/cam for the fabrication of porcelain veneers, inlays and onlays.
It is important to note that the size of a cavity, the position of the tooth in the mouth and the amount of biting force exhibited on the restored tooth will determine the suitable material to be used for the restoration. This can be either porcelain or composite.

Dental bonding is a technique that has been used in cosmetic dentistry for many years and can transform your smile in just a single visit. The process involves the skillful and artistic use of the correct amount and colour of dental composite, which is a moldable material with a paste like consistency made from acrylic resins and a variety of filler, depending on the type used.

At the Perfect Smile dental studio the porcelain restorations are milled from solid blocks of porcelain, which have been scanned with x-rays to make sure they have no imperfections. Your dentist will determine what type of porcelain will be suited best for your restoration. All is done in a single visit.

Porcelain and composite bonding is used for a variety of cosmetic dental procedures including:

• Filling dental cavities - "white fillings"
• Replacing metal or amalgam fillings
• Repairing broken and chipped teeth
• Closing gaps between teeth (diastema)
• Reshaping teeth
• Smile makeovers - composite veneers, although porcelain veneers are the better option for this

Can composite bonding be used for all cavities?

Composite is not suitable if you have large cavities in your teeth, as the material does not have a strong structure over large areas. Composite is ideal for small fillings that are not exposed to great forces. With recent advances in dental technology, many dentists are turning to the use of CEREC CAD/CAM technology to produce ceramic fillings (inlays and overlays), which have the advantages of both strength and aesthetics, and can be fitted in the same visit within an hour. Some practices may have their dental technicians to fabricate a ceramic filling which can take 2-3 weeks.

What are the disadvantages to composite bonding?

The main drawback of bonding is that it doesn't have the strength of other restorative materials such as ceramic or porcelain. It has a greater tendency to stain than your surrounding natural teeth. Due to polymerization shrinkage (crimping when hardened) and expansion with heat, they are often sensitive after placement.

Can any dentist carry out bonding?

Yes - however, you must note that bonding requires a high level of artistic skill and not all dentists are equally skilled. Some cosmetic dentists will have undertaken extensive postgraduate training in the field of dental bonding. Be sure to ask your dentist what experience they have in this area and also if you can see photos of some of their previous work

Perfect Smile dental studio makes use of Cerec CAD/CAM for all porcelain crowns, veneers and restorations.

Porcelain crowns are restorations that protect damaged, cracked or broken down teeth. A crown strengthens your existing damaged tooth and preserves its functionality.

Why May I needs Crowns?

• If your tooth has undergone significant decay, and there is not enough tooth structure remaining to support a filling or an inlay to maintain functionality and strength.
• If a large portion of your tooth has fractured and it cannot be built up using traditional composite bonding techniques.
• If you have had a dental implant to replace a missing tooth, a crown will be fitted to the abutment of the titanium implant.
• Following root canal treatment a crown is often needed to strengthen the tooth.
• If you grind your teeth and have a poor diet, acid erosion may reduce your teeth to a point where the only option available is to crown them.
• For cosmetic reasons to improve the aesthetics of your smile, all porcelain cosmetic crowns may be the best solution.

Are dental crowns always the best option?

Crowns should not be the first treatment of choice just to improve the aesthetics of your teeth, because a significant portion of the original tooth needs to be removed to facilitate placement of a crown. Less invasive alternatives include veneers, composite bonding or orthodontic correction. Crowns are required when the strength of the tooth supporting the restoration is compromised, since veneers and dental bonding restorations are only as strong as the supporting tooth , or when major changes in the size and form of a tooth is needed for aesthetic reasons.

What materials can crowns be made from?

In modern day dentistry there is a wide variety of dental materials to choose from. Some crowns are made from full gold, where as others are made from an alloy of metals fused to a porcelain outer shell. After time, crowns that are made from a combination of metal fused to porcelain can begin to show dark gum lines that are not aesthetically attractive. All porcelain or ceramic crowns are the best choice for a natural cosmetic look. There are many different brands and types of porcelain crowns and the variation between the costs of dental crowns at different dental practices may well reflect the quality of the materials used. Perfect Smile dental studio uses CEREC cad/cam for fabrication of all porcelain crowns.

How long do crowns last?

This will depend largely on how well you look after your teeth. Dental crowns require the same and often a higher level of care and attention than your natural teeth. Provided you have a good oral hygiene program and attend regular check ups at your dentist, and do not suffer from teeth grinding, maintain a tooth kind diet and do not do things like open beer bottles with your teeth, then a high quality dental crown can last 10-15 years.

How much do crowns cost?

The price varies between dental practices. The price will depend on the skill of the dentist, the quality of the crown and the materials used.

A veneer is a thin covering made of porcelain, ceramic or composite which is placed over the front, visible part of a tooth to enhance its appearance. They are often used in smile makeovers.

Veneers are used on teeth when minor changes in the size and shape of teeth are needed. Veneers can be placed on front teeth that are poorly shaped, slightly crooked, chipped or worn. Veneers may also be used to lighten teeth that cannot be whitened by bleaching or to close gaps between front teeth.

Because they are very thin and bonded directly onto the enamel, the underlying tooth structure should be sound and healthy.

What are dental bridges?

Dental bridges are false teeth that are permanently anchored on neighboring teeth, in order to replace one or more missing teeth. The false tooth is known as a pontic and is fused between two crowns that serve as anchors by attaching to the teeth on each side of the false tooth, thereby bridging them together.

If the proposed anchor teeth are healthy, aesthetically pleasing teeth with no restorations or imperfections, an implant might be a better solution to replace the missing teeth.

When are dental bridges needed?

Bridges are recommended when there are one or more teeth missing that affect your

• Smile and appearance
• Bite as a result of adjacent teeth leaning into the space and altering the way the upper and lower teeth bite together.
• Speech
• Shape of your face
• Gum disease and tooth decay as a result of food accumulation in the gap

What are bridges made of?

• Porcelain fused to Zirconium ( all tooth coloured )
• Porcelain fused to metal.
• All metal dental bridges (Gold)

How long will dental bridges last?

This will depend largely on how well you look after your teeth. Dental bridges require a higher level of care and attention than your natural teeth. You need to follow a specialized oral hygiene program and attend regular check ups at your dentist. Combined with a tooth kind diet, a high quality dental bridge can last 10-15 years.

How to take care of your dental bridges?

Practice optimum dental hygiene:

• Clean the dental bridge at least twice daily to prevent tooth decay, bad breath and gum disease
• Clean thoroughly under the pontic ( false tooth)
• Keep the anchor teeth healthy as these serve as the foundation for the dental bridge

Brushing and flossing:

• Brush and floss at least twice daily
• To floss under the pontic use a bridge floss threader (a flexible piece of plastic with a loop at one end to thread the floss), or superfloss from oral-b.
• Thread one end of a 20 - 25 cm piece of dental floss through the loop, making sure to leave one side about half as long as the other
• Insert the end of the floss threader without the hole in between the bridge and the gum line.
• Hold onto the longer piece of floss, gently bring it up and pull the pointed end all the way through.
• Superfloss can easily be threaded under the bridge without a threader using the more rigid end.
• Floss using both your hands, moving the floss back and forth under the bridge
• Floss the bridge completely from one end to the other

Diet and eating habits:

• Eat soft foods or cut food into smaller pieces until you get accustomed to the dental bridge
• Eat a balanced and nutritious diet for good general and dental health

What are the advantages of dental bridges?

• They have a natural tooth appearance if designed and placed correctly
• They generally require only two appointments with the dentist
• They have a good life period, lasting for 10-15 years, provided that you maintain good dental hygiene
• They improve your appearance, bite issues as well as speech problems that can occur as a result of missing teeth

What are the disadvantages of dental bridges?

• Teeth become mildly sensitive to extreme temperatures for a few weeks
• They require healthy tooth tissue from neighboring teeth to be removed
• Your teeth and gums are vulnerable to infection if proper hygiene is not maintained.

Endodontic treatment is required when the nerve of the tooth has been injured or became necrotic and causes an abscess with accompanied toothache. The only alternative treatment is extraction.

In the modern era of dentistry the use of a microscope during endodontic treatment is almost compulsory to effectively treat a tooth.

With a microscope detection of additional canals in multi-rooted teeth is greatly enhanced.

Quite often the treated canal can be inspected from crown to apex, ensuring all debris are cleaned and that the canal is properly shaped for sealing.
The use of an apex locator that precisely determine the correct length of the root, which is often not detected with x-rays alone, is compulsory to effectively do root canal treatment.

The introduction of nickel-titanium rotary instrumentation in conjunction with very precise electrical motors and hand-pieces has revolutionized the success of endodontic treatment. These files can curve around sharp bends and create a tapered canal shape which can be properly cleaned and sealed.

Ideally your upper lip should rest at the level where your gums meet your two front teeth when smiling. The correct diagnoses for the reason of the gummy smile and the amount of gum showing, has a mayor influence on the corrective treatment used and the final result. The visible length of incisor teeth at rest or with slight opening of the mouth is a telltale sign of the underlying problem.

There are basically three treatment options available to reduce the amount of gum shown when smiling, depending on the severity of the problem. Often combinations of treatments are used.

a. Orthognatic surgery

If more than 8/10 of the front teeth or even gum tissue is visible, and lips are apart at rest, chances are you have vertical maxillary excess (vertical overgrowth of the maxillary bone)

Best results are obtained with orthognatic surgery done by a maxillofacial surgeon. In this procedure the maxilla is positioned upward to correct a malocclusion and is used in conjunction with orthodontic treatment. The cosmetic bonus is lip closure at rest and reduced gum tissue shown when smiling. It should very seldom be considered for pure cosmetic improvement.

b. Lip repositioning

When the correct length of tooth (less than 3/10) is visible at rest, excessive elevation of the upper lip probably causes the gummy smile. This can successfully be treated with a lip repositioning procedure by your cosmetic dentist, periodontist or oral surgeon. It will generally correct a problem if the lip needs to be repositioned 10mm or less. This procedure is almost always used in conjunction with crown lengthening. A small portion of the tissue on the inside of your upper lip is removed and the lip is sutured to the gums. This limits the muscles that raise your lip from showing too much gum tissue.

c. Crown lengthening

This procedure is commonly used to re-contour the gum tissue for symmetry on the front teeth. When only gum tissue is removed above the teeth to give it a longer appearance, it is called a gingivectomy. In some cases a portion of the bone need to be sculpted to increase the crown length. This is called crown lengthening. A part of the root will be exposed and you will need crowns or veneers to cover them.

Dr. Lemmen has advanced training in both the surgical and restorative aspect of implant dentistry. Having a dentist with combined knowledge in both areas offers patients an advantage for correct planning and placement of implants and successful functional and aesthetic reconstruction.

People lose teeth all the time, either through trauma when teeth are knocked out (athletes such as rugby players & boxers commonly experience this), or due to decay, gum disease or old age. Whatever the reason for loosing your teeth, they need to be replaced both for aesthetic and functional reasons. The most common treatments for missing teeth are either a denture or a fixed bridge. However, dental implants are now becoming a more popular treatment to replace missing teeth as they provide a longer-term solution, slow down bone loss and preserve nearby healthy tooth tissue.

What is a dental Implant?

A dental implant is a titanium "screw" designed to artificially substitute / replace the root portion of an absent natural tooth. It is anchored into a pre-drilled socket in your jaw-bone to support a crown, a bridge or secure a denture firmly in place. Implants are made from titanium, a material that is well tolerated by bone and integrates easily with bone tissue. During the placement of a dental implant, the goal is to achieve a close contact between the outer surface of the implant and the surrounding bone tissue so they can "fuse" together (osseointegration) creating a stable support for the new teeth.

The Procedure

Implant treatment is prostetically driven. This means that the desired position of the final crown or bridge must be planned before implants are placed. This will ensure that implants are placed in the correct position and height to ensure the best aesthetic and functional outcome, especially in the front of the mouth where aesthetics play a crucial role.

Before any implants are placed, it is important for your dentist to assess the health of your teeth and gums. If there are any signs of gum disease or decay, these must be treated first. After this your treatment will be planned following several x-rays, photographs and study models and in some cases a CT scan, to assess the bone quality and volume and check for nearby anatomical structures to avoid, before any drilling. The procedure is usually carried out under local anesthesia but sometimes general anesthetic is needed, depending on severity of surgical procedures.

The gum where the implant is to be placed is cut and lifted and a small hole is drilled in the jawbone at the precise location of the intended implant. The titanium implant is tightly fitted into this socket and the gum is stitched back over the implant. If there is insufficient bone material to accommodate the implant a bone graft may be required or alternatively the dentist may use smaller sized mini implants if suitable.

Once the implant has been placed it is left to heal and integrate with the jawbone for between 6 weeks to 6 months. The bone tissue will grow and anchor itself into the microscopic rough surface of the implant.

During this "healing period" patients are given temporary teeth (bridges) or continue to wear dentures. It is important that any temporary teeth do not exert any forces on the healing implant. After the healing period the gum is lifted again and a post is attached to the implant with a temporary crown or healing abutment. Four to six weeks later, when the surrounding gum tissue has matured the final permanent restoration can be fitted to the implant.

What are the advantages of dental implants over dentures and bridges?

• Reduced bone loss
  Normally, the bone tissue surrounding the root of your tooth is maintained by your body's natural renewal process. However, if you loose a tooth, you will be left with a hole where your tooth root used to be, and the bone around this area will slowly begin to disappear (atrophy) and may change the shape of your jaw. A dental implant placed in that area can actually stimulate bone growth and production, preventing loss of valuable bone structure. In some patients where bone loss is substantial a bone graft may be required before placing a dental implant. Bone loss is a problem for people who have dentures, and as the shape of the jaw slowly changes the dentures need to be adjusted or re-made to fit the new shape of the jaw. Bone loss can also make a person look older since the area around the mouth can sag as bone is lost
• Improved function
  Once dental implants are fully integrated into you jaw, they function just as well as your own natural teeth, and you can eat the foods you want and speak with complete confidence. With dentures, eating hard foods such as an apple can be a problem. Either the dentures come loose or patients cannot withstand the hard biting forces as they cause pain in the gums. Irritation and inflammation of the gums is a common problem amongst denture patients.
• Improved dental hygiene
  Unlike bridges and dentures, which require special cleaning instructions and extra attention, single unit dental implants just need regular brushing, flossing and dental hygiene appointments just like your natural teeth.
• No need to drill or remove any healthy tooth structure
  When replacing missing teeth with dental bridges, the teeth adjacent to the gap need to be prepared. Healthy tooth structure is removed to accommodate a crown or bridge abutment to fit over the top of the tooth. In the future, if one of the supporting teeth is damaged the entire bridge restoration will also be compromised, whereas with an implant the restoration is independent of any of your other teeth. By replacing lost teeth with an implant, no support is required of the adjacent teeth, and hence your natural teeth do not need to be prepared or altered in any way.
• Better aesthetics
  If done correctly, a dental implant should be indistinguishable from your surrounding natural teeth. This is important in the anterior aesthetic region. Dentures can come loose and look un-natural if they do not blend with your gums. Some dentures have unsightly metal clasps to hold them in place. Dental implants provide a much better cosmetic and functional end result.

How many teeth can a dental implant support?

Traditionally an implant placed into your bone supports a single crown. This is known as a "single tooth implant". However, if you have several missing teeth you do not necessarily need an implant for every missing tooth. One implant can support several teeth via a bridge or a denture. The number of implants required depends on the volume and density of bone tissue available at each implant site.

In the case of full mouth reconstructions, where an arch of several teeth (10+) needs to be supported in either the upper or lower jaw, a minimum of 6 implants in each jaw would be required. The exact number of implants needed would depend on the individual case. Your implant surgeon would be able to advise you on the best solution after a thorough examination and assessment.

Am I a suitable candidate for dental implants?

Dental Implants can be placed in patients of any age (with fully developed jawbones), provided that they have sufficient quality and quantity of bone tissue available. Most healthy individuals that maintain a good oral hygiene program are suitable candidates for dental implants. Circumstances where implants may not be suitable or situations that have an increased risk of implant failure include:

• Heavy smoking - this slows down and hinders the healing process
• Excessive alcohol intake - disrupts healing of the gums
• Periodontal gum disease - all active gum disease must be treated prior to any implant procedure to ensure long term success of any treatment. Periodontal disease is a major cause of bone loss, which would hinder the success of any implant procedure.
• Immuno-compromised individuals (steroids, auto-immune disease, patients undergoing radiation treatment).
• Teeth grinders (bruxism) - a night time splint can be given to treat this.

How will I know if I have enough bone for implants?

Using a combination of dental X-rays and sometimes a CT scan or cone beam technology, your bone density and volume can be assessed, as well as information about nearby anatomical structures to avoid

What if I don't have enough bone for dental implants?

The alternative options for replacing missing teeth include dentures and bridges. However, there are various bone grafting and tissue regeneration procedures that can be carried out to enable treatment with dental implants:

Sinus augmentation - if you need to replace missing teeth at the back of the upper jaw, a sinus augmentation, whereby new bone in the sinus is created, can increase the height of the bone available for the placement of implants in this area.

Onlay Grafting - this is where a piece of bone from somewhere else is taken and it is secured over an area that is deficient in bone. Over time the newly placed bone will fuse with the underlying bone creating a better environment for an implant to be placed.

Where can bone be taken from for the graft?

The best source of bone for your graft is your own bone tissue from elsewhere in your body. Areas that can be used for bone grafts include the chin, back of the lower jaw, the hip and tibia. Bone taken from your own body offers the most viable and faster healing time when compared to alternatives. In many cases a combination of artificial bone substitutes and your natural bone is used. In any bone grafting procedure the grafted bone provides an anchor and stimulus for the existing bone to grow onto, eventually providing an environment suitable for the placement of implants.

How long do dental implants last?

Dental implants have been used for over 30 years to replace missing teeth and they can last a lifetime depending upon how you look after them. Like any other restoration, your implant-supported teeth can still be damaged by trauma and affected by gum disease and poor oral hygiene.

How much do dental implants cost?

The price of dental implants tends to vary considerably and depends on several factors including the level of skill of the surgeon, the type / quality / brand of implant used, the clinic where the treatment is carried out, the level of aftercare service provided and obviously the amount of work required (i.e. bone grafting) and number of implants required.

Content provided by www.cosmeticdentistryguide.co.uk

In the blossoming world of cosmetic dentistry, teeth whitening reigns supreme. Universally valued by men and women alike, whitening (or bleaching) treatments are available to satisfy every budget, time frame and temperament.

The long and the short of it is that teeth whitening works. Virtually everyone who opts for this cosmetic treatment will see moderate to substantial improvement in the brightness and whiteness of their smile. However, teeth whitening is not a permanent solution and requires maintenance or "touch-ups" for a prolonged effect.

Why Teeth Whitening?

Most of us start out with sparkling white teeth, thanks to their porcelain-like enamel surface. Composed of microscopic crystalline rods, tooth enamel is designed to protect the teeth from the effects of chewing, gnashing, trauma and acid attacks caused by sugar. Over the years enamel is worn down, becoming more transparent and permitting the yellow colour of dentin - the tooth's core material - to show through.

During routine chewing, dentin remains intact while millions of micro-cracks occur in the enamel. It is these cracks, as well as the spaces between the crystalline enamel rods, that gradually fill up with stains and debris. As a result, the teeth eventually develop a dull, lackluster appearance.

Teeth whitening remove the stains and debris, leaving the enamel cracks open and exposed. Some of the cracks are quickly re-mineralized by saliva, while others are filled up again with organic debris.

Tooth Discolouration: The Two Types of Tooth Stains

There are two categories of staining as it relates to the teeth: extrinsic staining and intrinsic staining.

Extrinsic stains are those that appear on the surface of the teeth as a result of exposure to dark-coloured beverages, foods and tobacco, and routine wear and tear. Superficial extrinsic stains are minor and can be removed with brushing and prophylactic dental cleaning. Stubborn extrinsic stains can be removed with more involved efforts, like teeth bleaching. Persistent extrinsic stains can penetrate into the dentin and become ingrained if they are not dealt with early.

Intrinsic stains are those that form on the interior of teeth. Intrinsic stains result from trauma, aging, exposure to minerals (like tetracycline) during tooth formation and/or excessive ingestion of fluoride. In the past, it was thought that intrinsic stains were too resistant to be corrected by bleaching. Today, cosmetic dentistry experts believe that even deep-set intrinsic stains can be removed with supervised take-home teeth whitening that is maintained over a matter of months or even a year.

What Causes Tooth Staining?

Age: There is a direct correlation between tooth colour and age. Over the years, teeth darken as a result of wear and tear and stain accumulation. Teenagers will likely experience immediate, dramatic results from whitening. In the twenties, as the teeth begin to show a yellow cast, teeth-whitening may require a little more effort. By the forties, the yellow gives way to brown and more maintenance may be called for. By the fifties, the teeth have absorbed a host of stubborn stains which can prove difficult (but not impossible) to remove.

Starting colour: We are all equipped with an inborn tooth colour that ranges from yellow-brownish to greenish-grey, and intensifies over time. Yellow-brown is generally more responsive to bleaching than green-grey.

Translucency and thinness: These are also genetic traits that become more pronounced with age. While all teeth show some translucency, those that are opaque and thick have an advantage: they appear lighter in colour, show more sparkle and are responsive to bleaching. Teeth that are thinner and more transparent — most notably the front teeth — have less of the pigment that is necessary for bleaching. According to cosmetic dentists, transparency is the only condition that cannot be corrected by any form of teeth whitening.

Eating habits: The habitual consumption of red wine, coffee, tea, cola, carrots, oranges and other deeply-coloured beverages and foods causes considerable staining over the years. In addition, acidic foods such as citrus fruits and vinegar contribute to enamel erosion. As a result, the surface becomes more transparent and more of the yellow-coloured dentin shows through.

Smoking habits: Nicotine leaves brownish deposits which slowly soak into the tooth structure and cause intrinsic discolouration.

Drugs / chemicals: Tetracycline usage during tooth formation produces dark grey or brown ribbon stains which are very difficult to remove. Excessive consumption of fluoride causes fluorosis and associated areas of white mottling.

Grinding: Most frequently caused by stress, teeth grinding (gnashing, bruxing, etc.) can add to micro-cracking in the teeth and can cause the biting edges to darken.

Trauma: Falls and other injuries can produce sizable cracks in the teeth, which collect large amounts of stains and debris. This can also cause nerve damage and subsequent internal discolouration.

Teeth Whitening options

Two professional teeth whitening options are available today. Both rely on varying concentrations of peroxide and varying application times.

1. In-Office Whitening
Significant colour change in a short period of time is the major benefit of in-office whitening. This protocol involves the carefully controlled use of a relatively high-concentration peroxide gel, applied to the teeth by the dentist or trained technician after the gums have been protected with a paint-on rubber dam. Generally, the peroxide remains on the teeth for several 15 to 20 minute intervals that add up to an hour (at most). Those with particularly stubborn staining may be advised to return for one or more additional bleaching sessions, or may be asked to continue with a home-use whitening system.

Disadvantages of In-Office Whitening

• In-office bleaching is more expensive than take-home alternatives.
• Results can be unpredictable, depending on factors such as age, heredity and the type of staining that is present.
• In-office bleaching is not a permanent solution. Shortly after treatment is completed, the teeth resume accumulating stains. Many dentists therefore recommend home maintenance follow-up with a lower-percentage bleach that can be kept on the teeth for longer periods of time.
• Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. This is likeliest to occur during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains ("zingers") down the middle of their front teeth.

2. Professionally Dispensed Take-Home Whitening Kits
Many dentists are of the opinion that professionally dispensed take-home whitening kits can produce the best results over the long haul. Take-home kits incorporate an easy-to-use lower-concentration peroxide gel that remains on the teeth for 6-8 hours daily (sometimes overnight) for 10-14 days. The lower the peroxide percentage, the longer it may safely remain on the teeth. The gel is applied to the teeth using custom-made bleaching trays that resemble mouth guards.

Hydrogen Peroxide vs. Carbamide Peroxide

The bleach preference for in-office whitening, where time is limited, is powerful and fast-acting hydrogen peroxide. When used in teeth bleaching, hydrogen peroxide concentrations range from approximately 9% to 40 %.

By contrast, the bleach of preference for at-home teeth whitening is slower acting carbamide peroxide, which breaks down into hydrogen peroxide. Carbamide peroxide has about a third of the strength of hydrogen peroxide. This means that a 15 % solution of carbamide peroxide is the rough equivalent of a 5 % solution of hydrogen peroxide.

Teeth Whitening Risks

Teeth whitening treatments are considered to be safe when procedures are followed as directed. However, there are certain risks associated with bleaching that you should be aware of:

• Sensitivity: Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. This is likeliest to occur during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains ("zingers") down the middle of their front teeth. Individuals at greatest risk for whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity and zingers. Whitening sensitivity lasts no longer than a day or two, but in some cases may persist up to a month. Some dentists recommend a toothpaste containing potassium nitrate for sensitive teeth.
• Gum irritation: Over half of those who use peroxide whiteners experience some degree of gum irritation resulting from the bleach concentration or from contact with the whitening trays. Such irritation typically lasts up to several days, dissipating after bleaching has stopped or the peroxide concentration lowered.
• Technicolour teeth: Restorations such as bonding, dental crowns or porcelain veneers are not affected by bleach and therefore maintain their default colour while the surrounding teeth are whitened. This results in what is frequently called "technicolour teeth."

Maintaining Your Whiter Smile

To extend the longevity of newly whitened teeth, dentists are likely to recommend:

• At-home follow-up or maintenance whitening - implemented immediately or performed as infrequently as once a year.
• Avoiding dark-coloured foods and beverages for at least a week after whitening.
• Whenever possible, sipping dark-coloured beverages with a straw.
• Practicing excellent oral hygiene - brushing and flossing after meals and at bedtime.

Caveats

In addition to the aforementioned risk factors, a number of caveats should be considered before undergoing teeth whitening:

• No amount of bleaching will yield "unnaturally" white teeth.
• Whitening results are not fully seen until approximately two to four weeks after bleaching. This is an important consideration if you are about to have ceramic restorations and want to be sure the colour matches that of your newly bleached teeth.
• To avoid the technicolour effect, tooth-coloured restorations will likely need replacement after bleaching.
• Recessed gums often reveal their yellowish root surfaces at the gum line. That yellow colour has proven difficult to bleach.
• Pregnant or nursing women are advised to avoid teeth whitening. The potential impact of swallowed bleach on the fetus or baby is not yet known.

For me, orthodontic treatment starts with the face. The hard tissue (teeth and bone) support the soft tissue ( lips , cheeks and chin) to give a well balanced profile and facial appearance. Too often after orthodontic treatment we see teeth that perfectly fit together , but a lower jaw and/or chin that is too short causing a severe convex profile , or flattened lips due to incorrect retraction of front teeth , or an upper jaw that is vertically too long showing a lot of gum tissue when smiling.

The two most common reasons for malocclusion are teeth that have moved into the wrong position in the bony arch ( dental) or abnormal relationships between upper and lower jaws (skeletal) , or combinations of both. Correctly diagnosing and treating the reason for malocclusion is very important to maintain support of the soft tissue. In certain cases where the skeletal discrepancy is small , attempts can be made to treat the malocclusion with pure tooth movement. This is called dental camouflage.

If however there is a huge skeletal discrepancy, a combination of orthodontic treatment and orthognatic surgery should be used to ensure a desirable result with long-term stability. Orthognatic surgery should only be considered to correct malocclusions, and not for pure cosmetic change. (an exception is chin reduction or advancement to improve profile)

Extractions should only be considered if there is a lack of space in the dental arch to accommodate the teeth present in the correct position and angulation. Most common reasons for extraction are:

• Bimaxillary protrusion (front teeth are angled severely forward with all back teeth in contact on a good arch form and width)
• Macrodontia (big teeth on relative small bony arches)
• Mesial drift of posterior teeth (back teeth moved forward taking up space of pre-molars or canines. There will be an impacted or blocked out tooth elsewhere in the dental arch)

At the Perfect Smile dental studio we offer the following surgical procedures

1. Removal of impacted teeth
2. Frenectomy
3. Surgical orthodontic exposure for mechanical eruption of teeth
4. Gingivoplasty and gingivectomy to sculpt gum tissue
5. Bone augmentation and sinus lift procedures to facilitate implant placement
6. Crown lengthening procedures
7. Lip repositioning for gummy smiles.

Temporomandibular disorder (TMJ, TMJD or TMD) affects the temporomandibular joint, an area that includes the hinge jaw joint (the bridge for the lower jaw or mandible) and the temporal bone of the skull located in front of each ear, the muscles surrounding the jaw and the jaw itself.

This area of the face contributes to chewing, bite (occlusion) and jaw movement. Therefore, TMJ disorder compromises jaw flexibility and may cause pain at rest or during common movements such as talking, chewing and yawning.

The pain and discomfort caused by TMJ disorder may be severe, can be either intermittent or constant and may last for many years.

Causes of TMJ Disorder

TMJ disorder has often been portrayed as psycho-stress related, but in truth there are many different types of TMJ, any one of which may result from multiple causes.

The most common factor contributing to TMJ is a bite problem affecting the joint itself. Interferences in the structure of individual teeth may force displacement of the lower jaw, leading the muscles to position the joints out of their sockets to force the upper and lower teeth to fit together. Anatomical factors within the joint or surrounding muscles (such as the presence of scar tissue) may also interfere with the bite and cause TMJ disorder.

In other cases, TMJ may result from a jolting injury to the head or face. Also, wear and tear on the teeth due to aging or tooth grinding and clenching may cause uneven surfaces on the teeth, leading to interferences in the bite and improper jaw closure.

TMJ Symptoms and Diagnosis

The onset of TMJ symptoms is typically the first step toward diagnosis. Pain is TMJ disorder's most common symptom. People with TMJ may experience severe pain and discomfort in the face, jaw joint, neck and shoulders. During a dental consultation to evaluate TMJ, your dentist will evaluate pain with a "clench test." If any one tooth, all teeth, or the jaw are in pain when you bite down during a clench test, your pain is probably related to a bad bite.

TMJ sufferers often experience jaw clicking, popping or locking during movement. In some cases, chewing is difficult, or the bite may not align properly (malocclusion). You may also experience swelling on the side of the face, toothaches, headaches, neck aches, earaches and hearing problems.

A dentist suspecting TMJ disorder will first evaluate your bite (occlusion). To study your jaw-to-bite relationship as well as the position and condition of the temporomandibular joint, your dentist will make mould impressions of your bite and mount them on an instrument called an articulator, a device that mimics the jaw's movement and joint closure. During this study, your dentist will determine if a structural disorder exists within the joint itself or if deflective interferences in the bite such as uneven teeth are affecting the joint's ability to close properly, thus causing the TMJ.

Temporomandibular Joint Disorder Treatments

TMJ Treatment Cautions
"Conservative" is the key word in TMJ treatment. TMJ treatment should be determined through consultation with a dental professional highly experienced in TMJ disorder. Ideally, your dentist would have expertise in evaluating jaw-to-bite relationships and in proper treatment procedures such as occlusal equilibration. Ironically, a TMJ diagnosis can be confirmed when the TMJ-associated pain is eliminated through proper procedures such as occlusal equilibration and intra-oral appliances

Temporary TMJ Symptom Relief
Many self-help remedies have been suggested to treat TMJ symptoms, but be aware that these remedies do not treat the cause. In fact, TMJ treatment through the right dentist may be less costly, less time intensive and can produce a fully satisfactory result.

Although the following self-help remedies do not treat TMJ long-term, temporary relief may be found:

Heat and Cold Packs: Heat and cold packs applied to the side of the face and temple for 10 minute intervals may reduce the intensity of the pain affecting the muscles and surrounding area of the jaw.

Limit Jaw Movement: It is important to avoid large movement of the jaw such as singing and wide yawning. Also, do not apply pressure with your hand against your jaw for an extended time period during sleep. Limit the pressure you apply with a phone receiver.

Diet: Choose soft food and stay away from foods requiring repetitive chewing or the mouth to open wide. In particular, avoid chewing gum, taffy, pretzels and raw carrots.

Dental Treatment: Continue to receive dental treatment for any teeth requiring restoration. Tooth decay may affect the bite, a contributing factor to TMJ.

Physical Therapy, Biofeedback, and Massage: In some cases, physical therapy, biofeedback and massage provide temporary relief from TMJ.

Medications: Some doctors or dentists may prescribe non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen), muscle relaxants, anti-anxiety medications and in some cases anti-depressants. The choice of medication depends on the intensity of the disorder and your medical history. However, the need for medication is greatly reduced when treatment is received by an experienced TMJ dental professional.

Dental Appliances: Your dentist may prescribe a dental appliance such as a mouth guard or splint to reduce the effects of tooth grinding and clenching. Such appliances may also help improve your bite and the ability for the lower jaw to fall properly into the temporomandibular joint socket.

TMJ Basics

Only a small percentage of TMJ cases require surgical intervention. Many bite corrections simply require orthodontics or restorations.

If your dentist determines that no structural disorder exists in the joint but that there are deflective interferences on the teeth affecting the bite resulting in improper jaw closure, you may undergo occlusal equilibration or your dentist may elect to correct the bite with an appliance.

Occlusal equilibration, which involves reshaping the biting surfaces of the teeth, is often the best choice for eliminating deflective interferences so that the jaw can close properly. A careful examination of both the joints and the occlusion is a critical step before a specific treatment is selected.

Once the lower jaw is able to close properly into position within the temporomandibular socket, you may find that your pain is relieved immediately. If your pain is not relieved, then the dentist may fit you for an occlusal appliance to cover the deflective interferences affecting the bite and allow for the lower jaw to be repositioned into the socket properly. If this relieves the pain, it is likely that your bite was causing the problem.

Many TMJ cases can be corrected with occlusal equilibration, particularly when performed by a dentist experienced in TMJ diagnosis.

Treatment for a Structural Disorder

If your dentist suspects a structural disorder within the joint itself and your pain is not resolved through the aforementioned treatment options, a panoramic X-ray may be ordered. In some cases, an MRI (magnetic resonance imaging) may help your dentist view the soft tissue area surrounding the disc joint. A CT scan to evaluate the bony areas of the jaw and hinge joint may also be ordered. Depending on what these images reveal, your dentist may recommend an intra-oral appliance, orthodontia or maxillofacial surgery. You may be referred to an oral and maxillofacial surgeon who will further evaluate and treat TMJ.

Surgical Treatment

Surgery is considered usually after you have tried all other treatment options. All TMJ-related surgery is performed under general anesthesia.

Alternative Medical Treatment for TMJ

Alternative medical treatment for TMJ is considered less conservative and not necessary if you initially receive proper diagnosis and treatment. Alternative treatments include transcutaneous electrical nerve stimulation (TENS), ultrasound, trigger-point injections and radio wave therapy. TENS and radio wave therapy send low levels of electrical or radio waves of energy to the affected area in order to stimulate blood flow to the joint and surrounding area. However, these options do not treat the causes of TMJ and may provide only limited, temporary symptomatic relief.

It is important to have your teeth professionally cleaned by your dentist or oral hygienist at least twice a year. If you suffered from previously treated periodontal disease, have your teeth cleaned professionally every three months.

The main cause of periodontal disease and tooth decay is bacterial plaque. Plaque forms continuously on your teeth and is a sticky colourless film. It can be made more visible with the use of "disclosant" dyes. By removing plaque daily, you can prevent the damage associated with periodontal disease and decay.

Daily plaque control is very important! Periodontal disease is the major cause of adult tooth loss. It affects three out of every four adults. Replacing lost teeth is the most expensive form of dental treatment. By making an investment of time into your daily plaque removal, you may be able to avoid thousands of rands of replacement dentistry. Usually only ten to fifteen minutes a day is required to fully cleanse your mouth of these harmful bacteria.

Proper Brushing

Proper brushing helps minimize the risk of tooth decay and gum disease, the major causes of tooth loss. Use a soft-bristle brush and fluoride toothpaste to remove plaque and food particles. Replace your brush every three months.

On outer and inner surfaces, brush at a 45-degree angle in short, half-tooth-wide strokes against the gumline. Then gently wipe bristles from gum towards tip of tooth


On chewing surfaces, hold the brush flat and brush back and forth.

On inside surfaces of front teeth, tilt brush vertically and use gentle left to right strokes with toe of brush, then pull bristles towards tip of tooth.


Brush the tongue in a back-to-front sweeping motion to remove food particles and freshen your mouth.

Brush your tongue, removing the bacteria that cause bad breath, will freshen your breath. Use a tongue scraper if you do not feel comfortable cleaning your tongue with your toothbrush. If you have a bad breath problem, brushing the roof of your mouth might also help.

• When you brush your teeth, you remove most of the plaque-causing bacteria. But some stay behind. These bacteria can set up a colony and begin damaging your teeth within 24 hours--which is why dentists recommend brushing twice a day to consistently interrupt their growth.
• After finishing brushing your teeth, you can check if you have effectively removed dental plaque by using disclosing tablets.
• Avoid the use of hard toothbrushes. Do not use too much force while brushing teeth. In both cases you could cause abrasions to the tooth enamel or dentin, that could lead to tooth sensitivity problems.
• A correct brushing must have a duration of 4 to 5 minutes.
• After brushing teeth use the dental floss to complete your dental hygiene

The Best Toothbrush For You

In order to choose the best toothbrush that provides you with adequate teeth cleaning, you should know that a modern toothbrush must have:

• A head size and design that feels comfortable in your mouth and allows you to easily reach all the teeth in your mouth.
• Anatomic grip to help you make the correct tooth brushing moves
• Nylon bristles (natural bristles wear out easier and allow the growth of bacteria).
• Rounded end of bristles to avoid damaging the gums.
• Your dentist will advise you for the right toothbrush hardness (soft or medium) and type, according to your specific needs, mouth shape and dental problems. In general, the safest choice is a soft toothbrush

The use of a electrical toothbrush can be beneficial in certain circumstances. Ask your dentist or oral hygienist for more information.

Kids Toothbrushes

Special care must be taken when choosing an infant toothbrush, because kids have more tender gums that are easily injured.
Kids toothbrushes should have:

• Small head size to fit in the small mouth of the infant
• Soft bristles to protect the child's teeth and tender gums
• Large and anatomic grip for easier handling
• Flexible neck material to absorb excessive brushing pressure
• Attractive design and colours to make tooth brushing a pleasure for the kid.
• For kids under the age of two, you could use a special type of infant toothbrush that fits over your finger (without handle) to clean their teeth
• Ask a dentist before buying one of the infant electric toothbrushes for your kid.

When To Change Your Toothbrush

The bristles of the toothbrush wear out during brushing. After some time they don't provide adequate cleaning and may injure the gums. To always have the best results from brushing you must change the toothbrush:

• Every 3-4 months
• Immediately after the bristles start to loose their natural position on the head of the toothbrush
• After a cold or flue
• Children toothbrushes have to be changed more often since they wear out easier.
• A toothbrush is a strictly personal item, do not share it with anyone else.

How to Store Your Toothbrush

The right way of storing your toothbrush will allow you to keep it in good shape for a longer period. To achieve it, after every brushing:

• Wash and rinse the toothbrush well to remove any remaining toothpaste, food debris and bacteria.
• Store it in upright position in a well ventilated area to help drying
• Do not cover the toothbrush head or put it in a closet, at least not before it dries completely. The moisture that remains on the toothbrush may help the growth of bacteria.
• If your toothbrush is stored in the same holder with another person's tooth brush, keep them separated to avoid cross contamination.

Toothpaste

Toothpastes vary widely in their ingredients and their effectiveness. If you look at the selection in any dental section, you will soon be very confused. The most basic concept to remember is that there are specific pastes for specific goals. There are whiteners, tartar controls, cavity fighting, and breath freshening products. Stay away from abrasive toothpastes.

FLOSSING

The most vulnerable area of the gum to periodontal disease resides between the teeth. Even the best brush designs cannot clean this area. There are many different types of dental floss. Flossing is the most effective way to reach these areas.

Different types of Dental Floss

• Today there are many different types of dental floss commercially available:
  - Waxed and Unwaxed dental floss
  - Thread/String and Tape dental floss
  - Flavored and Unflavored dental floss
  - Teflon dental floss
• Waxed and teflon made dental flosses that slide more easily between the teeth. The best dental floss for you is the one you find easiest to use.
• If you find it difficult to floss, you can use a flossing aid, such as a dental floss holder, flossing handle, or an electric or pre-threaded flosser. A dental floss threader can make it easier to floss when wearing fixed orthodontic braces, under bridges, implants and between connected crowns.

Dental Flossing information and tips

• The main benefits of flossing are the mechanical removal of food residuals and dental plaque bacteria from teeth and gums. Use of dental floss should be an indispensable part of your daily oral hygiene routine.
• Although it is suggested -as for tooth brushing- that you floss after each meal, using dental floss even only once a day could be enough to keep you in good oral health, assuming of course that you do it thoroughly and effectively using proper flossing methods. If you use dental floss only once per day, prefer flossing teeth at night before you go to bed.
• Regarding the duration of flossing, the answer is simple : 'as long as it takes' (depending on your dexterity and expertise on how to use dental floss).
• It is normal to have some gum bleeding when flossing. Do not suspend flossing. On the contrary, gum bleeding is a sign that your oral hygiene is not perfect and you should be more persistent in brushing and flossing teeth.
• After flossing use disclosing tablets to check if dental plaque has been removed.

How to use DENTAL FLOSS - Dental Flossing techniques

Most people floss only once a day, many even less often. It is very important that you use the correct way to floss, in order to remove as much dental plaque as possible. The recommended flossing methods are described here :

THE CORRECT WAY TO FLOSS

• Break off about 45-50 cm of floss and wind most of it (~30 cm) around one of your middle fingers.
• Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty.
• Hold the floss tightly between your thumbs and forefingers, leaving ~3cm of floss between your hands.
• Guide the dental floss to the space between your teeth using a gentle rubbing motion. Never snap the floss into the gums to avoid injuries.
• When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.
• Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.
• Repeat this method on the rest of your teeth. Don't forget the back side of your last tooth.
• It is important that you wash your mouth with water or mouthwash after flossing your teeth, so the debris you have loosened up is rinsed out of your mouth.
• If the dental floss starts to get stuck in a spot where it didn't in the past, you should visit your dentist as it could be a sign of tooth decay.

You should also introduce your children to dental floss early so that they become accustomed to the correct way of flossing teeth.

PROPER FLOSSING
Flossing daily removes plaque and food particles between teeth and below the gumline.

Wrap an 40 cm strand around your middle fingers and hold a 3cm section tightly.

Ease floss between teeth. Clean up and down several times while curving around teeth at the gumline.


Always floss behind the last tooth. Unwind clean floss as you proceed.


Floss around the abutment teeth of a bridge and under artificial teeth using a floss threader or superfloss.

You may experience sore or bleeding gums for the first several days you floss. If bleeding continues after the first week of flossing, call your dental professional. If you have trouble handling floss, ask your dentist about the use of a floss holder, or other types of interdental cleaning aids.

Be sure to follow the special home care instructions provided by your dental professional.

Interdental brushes-Occasionally you will be instructed to use a small, conical shaped brush for additional cleaning between your teeth. These are particularly advantageous when there are larger spaces between your teeth. They are very helpful for cleaning around orthodontic braces. These should also be used twice a day.

Rinsing- Rinse vigorously for as long as the manufacturer advises to dislodge plaque and food particles that have been loosened by the brushing and flossing. There are several brands of rinses. Ones containing fluoride are most beneficial for daily use.

Irrigators- Oral irrigation devices are particularly helpful in removing food particles after meals, especially from around bridgework and other hard to clean areas. Additional clinical benefits can be accomplished with irrigation devices if a diluted, commercially available rinse is used instead of plain water.

Tongue Scrapers- The top surface of the tongue is a haven for plaque! Brushing the tongue is helpful, but using tongue scrapers is far more effective. Do this every night! You'll be surprised how much plaque you remove.