Michael A. Conrad

Like many of the questions posted on this site, the answer is "It all depends." So many factors are involved. Do you have many dental restorations - fillings, crowns, root canals, implants? Do you tend to build up plaque and tartar? Do you smoke? Do you regularly drink soda or alcohol? What type of diet do you have? How is your overall health? Are you diabetic? Heart problems? Any other serious health issues? If the answers to all of these questions are "no," then you may safely extend the time between cleanings. In fact, I have many patients who can go longer than 6 months between cleanings because their mouths are healthy and immaculate.

If the answer to any of those questions is "yes," then your cleanings should be on a regular schedule. But remember, while the cleaning is a major part of the recall appointment, it is not the most important. What is most important is the examination, which may include X-rays. Without a professional examination, a longer time between recall visits may result in undiagnosed developing problems like caries (cavities), fractures, loose restorations, periodontal (gum) disease, and even oral cancer. Even if a full cleaning is not affordable, the examination is vital.

Some patients postpone recall visits because of finances, schedules, and other reasons. Often, they are surprised that there is more intense and expensive work needed when they finally return.Many patients say they will wait until something bothers them, until it hurts That is often too late. Remember, just because there is no pain, it doesn't mean that there is nothing wrong. It all depends!

Yes, that is a possibility. Implants have a great track record and a high chance of success over a long time. But things happen. If your oral hygiene habits decline, you will not only be more susceptible to tooth decay and gum disease, but any implants could be threatened as well. Certain foods could damage implants if they are lodged beneath the implant crowns (popcorn!), and a change in overall health can affect implants' longevity as well. High blood sugars (uncontrolled diabetes) can affect all of the body and lead to implant loss. And smoking is a definite no-no. The jury is still out regarding vaping, but I wouldn't risk it. It has definite overall health effects. Anything that abuses your body in general can certainly be bad for implants. Often, people need implants to correct tooth loss that occurred because of neglect. If those habits remain or resurface, implants will be jeopardized. Let's face it. Nothing is permanent. We aren't permanent. But with good care, implants can last a long time, often, a lifetime.

Michael A. Conrad, DDS, PC

Under ideal circumstances, your gum may be sore for 7 to 10 days. After that it should feel better, but it can easily be injured and become painful again if you eat hard and crunchy food in the area.


Dr. Conrad

Not too sure about recovery from TMJ surgery. Best guess is 4-6 weeks till back to limited function. But it could be up to 6+months till you feel "normal" again. It's difficult to say because everyone heals differently. And it's all related to what type of surgery you're having. Some minor corrections may be fine in a few weeks. Others may require longer healing and even splinting the jaws together to prevent movement. Remember, it could be compared to a broken bone in any other part of the body. I'd certainly need more information regarding the type of surgery to make a more accurate determination, but perhaps the best answer is... it depends.

Dentu-Creme is best. Regular toothpaste has abrasive particles to remove stain from natural teeth, but that can cause wear of acrylic dentures. The key to cleaning dentures is to brush them thoroughly and safely - even soap and water work very well. Denture cleaning tablets work well, but the secret to using them successfully is to brush the dentures first. If you don't, any plaque that is not removed by them will quickly harden into tartar in a short time. Then it will need to be removed professionally.

Hate to say it, but it all depends - on how many roots and the way it may have been done each time. And, what is the reason for having it done multiple times? If it is necessary because of recurring infections, then each time the surrounding bone is affected and possibly weakened. Older methods of treatment were more invasive and often removed more tooth and root structure than today's more conservative methods do. Multi-rooted teeth inherently have thinner roots than most single-rooted teeth. Each time a tooth is treated with root canal (endodontic) therapy, there is a chance that the structure of the tooth is weakened further. Due to the physical nature of treatment and also the fact that there is no longer a blood supply in the tooth, root canal teeth are physically weaker and more susceptible to fracture. Teeth with prior large restorations almost certainly require crowns to prevent the chewing part of the tooth from breakage, but even so, there is a chance for root fracture in the future. Often when a properly-performed root canal needs retreatment, it is an indication of root fracture, which is most likely the end of the line for the tooth. That is why I always tell my patients the pros and cons of root canal therapy versus implants. Though I have personally seen poorly-treated root canal teeth last in excess of 45 years, that is not too common. Implants have a higher success rate over that amount of time. In the short run, root canal treatment with a crown is less costly than an implant, but not dramatically so, and the longevity is often less. Each time retreatment is necessary, the odds of long-term survival drop substantially.

Michael A. Conrad, DDS, PC

It all depends on the size of the tooth, the health of the tooth, and the ease of extraction. If the root system is much larger than the largest implant, it is best to graft the socket, allow it to heal for around 3 months, then place the implant. If the tooth is infected, many dentists and surgeons feel more comfortable with a graft before implant placement. If, for some reason, the extraction is complicated and there is more bone removed as a result, a graft would be necessary. But in the instance where the tooth is not infected, the extraction is uneventful and the socket is acceptable for an implant, then the process can be done the same day.

Emax is a ceramic and so is porcelain. It is much more durable than the standard porcelain of years ago and gives the patient a beautiful and strong result.

Over-the-counter tooth whitening works, but the one-size-fits-all trays that come with those often allow the bleach solution to irritate the gums. Professionally made bleach trays are designed to keep the bleach away from the gums. They also generally come with a much stronger solution for quicker results. Bleaching will not permanently harm your enamel. There are studies of people that bleach regularly for a year with no ill effects. That is not usually necessary. After bleaching your enamel will be slightly porous, but the minerals in your saliva will correct that in a few days. That's why we tell our patients not to smoke or drink dark liquids during and immediately after bleaching, because the porous teeth will be temporarily more likely to stain in spots. But don't worry about harming your enamel. As long as you follow the directions, everything should be fine.

As usual with questions like this, it depends on a few factors. If the wisdom teeth are impacted and under the bone, there is more of a chance for severe swelling and pain. Often, the patient needs 5-7 days of a narcotic to help with the pain. Increasingly though, dentists are trying to avoid opioids and will, in fact, prescribe higher doses of NSAIDs like ibuprofen. They work well for most pain, and have the added benefit of helping to reduce swelling and inflammation. In cases of severe pain, sometimes dentists alternate the ibuprofen with a milder
narcotic, or they may have to simply prescribe a stronger one for a short while. But the goal is to limit the use, or at least the duration, of any narcotic. If your wisdom teeth are not impacted in the bone, but are either partially below the gum or through the gum, ibuprofen should be fine. Even aspirin will be quite effective. Plain Tylenol or acetaminophen may not be as effective.

Generally speaking, the more complicated the surgery, the greater the chance for needing any narcotic prescription. In any case, if you have a higher or lower tolerance for pain, that will also help determine what is most effective for you. You certainly won't be required to use opioids.

Michael A. Conrad, DDS, PC

Rarely is this a problem. Tooth grinding in adults can be tied to stress. In children, it is often related to a changing bite, especially when all the teeth are not fully erupted, or there is what we call a "mixed dentition." That is when some baby teeth remain and all of the permanent teeth have not come in yet, leaving a bite that just doesn't line up properly. Often, when the child is asleep, the brain registers that the bite is not even and grinding occurs to "even things out." In adults, we can make mouth guards to be worn when sleeping to prevent night grinding and damaging teeth. But in children, we would have to make many mouth guards throughout each year of growth. That would be necessary to accommodate the constant growth of the jaws and the shifting of the bite. If that were not done, a mouth guard would stunt the child's jaw growth. Generally, such grinding in children subsides as the permanent teeth come in completely and the bite begins to stabilize. But it is often very stressful for parents to hear the loud sounds when their children are sleeping. That can make them grind their own teeth in frustration!

It probably is normal. Remember, we base our teething estimates on averages, and not everyone fits into the same growth pattern. Certainly, if there is a problem, there is nothing that we can do to make the teeth come in earlier. We just have to periodically evaluate the child and keep checking. And be patient.

Michael A. Conrad, DDS, PC

Every 6 months is ideal. Lots of problems can crop up at that age, because they don't brush as well as an adult can or should because of limited dexterity and motivation, and often it is hard for parents to do a terrific job as well. It's a small, moving target and cooperation is not always the best with kids of that age.

See one of the previous questions and my answer. But even though she can brush on her own, you must take charge and check her every time and correct any problems.

Certain juice can definitely cause stain, especially grape juice and apple juice. Also know that, while they are made from fruit, juices are acidic and sweet,, so they can cause cavities just about as easily as soda. There are also some medical problems that can lead to tooth discoloration as well as the use of certain medicines. Check with your dentist and pediatrician.

It depends if they are surface stains or stains within the tooth. Those developmental stains can occur from medicines, fevers, trauma to the teeth and other sources. Ask you dentist what type of stains they are, and then you can decide if more frequent cleanings can help your situation.

There might be residual infection. Have you been taking antibiotics? If so, sometimes they can work on the problem area and leave the whole body out of sync for awhile. If you haven't been taking them, maybe it is time to start. But remember, having an infected tooth removed is like having a major bone broken. It is very traumatic for the body, and some people need more time to recover from the shock to their system. Too often we say. "it's just a tooth," but you had a body part removed and you need to recover. If you had the same problem in your leg, you probably wouldn't walk properly for awhile. If it persists after 2 to 3 weeks, please check with your physician to make sure that there is not another underlying cause.

She needs to start brushing on her own, but you must check her and go over her teeth again at least until age 5 or 6. Kids just don't have the dexterity and concentration to do the job that they need to do. that's why we put sealants on their 6 year molars. Those first permanent teeth are highly susceptible to cavities on the chewing surface because of their deep grooves. Kids just don't always get them as clean as they need to be. Ask your dentist or hygienist for some disclosing tablets. After she's brushed as well as she can, have her chew up the small red tablet, swish it around her mouth and then rinse and spit. Every spot that she's missed will stain pink, so you can easily see the areas that need more attention. Just be careful not to have her do that before she needs to go somewhere important, because it will make the lips and tongue a bright pink!

Dry mouth can be caused by many things. Do you take any prescription medicines? If so, there are many that cause dry mouth. Sometimes it takes a while for dry mouth symptoms to appear, but when they do, the patient is suddenly aware of an uncomfortable problem.

As we age, some people notice a decrease in saliva production. Unfortunately, aging and age-related issues can happen to anyone. Treatment is usually limited to topical rinses and gels to make the patient more comfortable. I have no idea how old you are.

Systemic diseases can cause the same problem. Some are related to a decrease in tear production as well. They are often auto-immune problems, where, for some reason, the body begins to attack itself, affecting the cells that produce saliva and tears. That requires a medical diagnosis and treatment, but often can only be treated with the rinses and gels.

Finally, a systemic disease that often causes dry mouth is diabetes. If you are diabetic, or have recently transitioned to that condition, dry mouth is a warning sign of elevated glucose levels.

So, if you're on medications for anything, check with your doctor or pharmacist to see if dry mouth is related to any meds. If not, check with your physician and dentist to see if any of the other possible causes are affecting you. It could be nothing but a bothersome condition, but it could be a sign of a more serious, underlying problem.

If it is a film with stain, it is probably removable by a dentist. It may have been caused by some inadequate cleaning on your part, and if plaque had been there for more than a few days, it is more likely to stain and be impossible to remove without the proper tools. For a 34 year old patient, a color change is usually only on the surface and can be corrected. But please be aware that numerous factors contribute to staining: smoking, chewing tobacco, red wine, dark sodas, excessive garlic, blueberries, certain medications, and, in general, any dark food or drink. In addition, if you have any tooth-colored fillings on your front teeth, all of those stain producers can darken the fillings. They may need to be replaced. If you haven't been to a dentist for a cleaning and examination in a while, it is now time.