Dental

CDR Robert J. Peters, DC, USN

In decades past, tooth decay was for most people, a common occurrence. But over the past fifty years, tooth decay has been reduced dramatically with the introduction of fluoride into community water supplies. The positive impact of fluoride on tooth decay is widely recognized as one of the greatest achievements in the history of public health.
What is fluoride and were does it come from? Fluoride comes from the element fluorine, which is the 17th most abundant element in the earth's crust. Fluorine exists only in combination with other elements as a fluoride compound. These fluoride compounds form part of the mineral make-up of rocks and soil. As water passes over these rock and soil formations, it dissolves the fluoride compounds that are present and creates fluoride ions. These ions account for the small amounts of soluble fluoride that is present in all natural water sources.
How does fluoride strengthen the tooth and reduce tooth decay? Researchers have discovered that there are several ways through which fluoride aids in reducing the incidence of tooth decay. When incorporated into the tooth's outer enamel layer, it acts to strengthen the tooth so that it is more resistant to the acids produced by bacteria. These acids are responsible for causing the break down of the outer enamel surface, which we commonly know as a cavity. Fluoride also exerts it's influence directly on the bacterial plaque film, reducing the ability of plaque microorganisms to produce acid. Fluoride also acts to repair, or remineralize, tooth surfaces that have been broken down by bacterial acids. This occurs through the uptake of fluoride to restore the mineral rich outer enamel layer. This remineralization process is important because it can reverse the early stages of tooth decay. Topical and systemic fluorides are the two types of fluoride that provide this beneficial effect.
What is the difference between topical and systemic fluoride? Fluoride is introduced into the human body in one of two ways, either topically or systemically. Sources of topical fluoride include toothpastes, mouth rinses and professionally applied fluoride gels and rinses. Topical fluoride application allows for the erupted teeth to be bathed in fluoride with the beneficial effect of fluoride being incorporated into the outer surface layer of the tooth. This fluoride-enriched surface gives the tooth a short termed added protection against future acid attacks. Systemic fluorides, on the other hand, are ingested into the body and become incorporated into the developing tooth structures. As this process occurs during the time of tooth development, fluoride is deposited throughout the entire outer surface, providing a longer lasting protection than those applied topically. Systemic fluorides also provide a topical effect, as the ingested fluoride is present in saliva and can become incorporated into the outer tooth surface. Sources of systemic fluoride include fluoridated municipal water supplies, fluoride supplements in the form of droplets or tablets, and fluoride that is present in some foods and beverages.
Are all sources of drinking water fluoridated? Community water fluoridation has been around for about 50 years and is a process whereby your local water company adjusts the fluoride content of tap water to the recommended level for optimal health. The recommended level is between 0.7 and 1.2 parts fluoride per million units of water. At these levels, fluoridated water has been proven to reduce tooth decay in both children and adults. If you do not know if your drinking water is fluoridated, call your local water company to find out. Also, most brands of bottled water do not contain fluoride. Make sure that you read the label of ingredients to see if fluoride has been added. If you have children between the ages of 6 months - 16 years and live in an area that does not have fluoridated water, dietary fluoride supplements in the form of drops or tablets are recommended. Your local dentist or physician can prescribe the correct dosage. And one final comment, fluoride is safe and effective when consumed properly. The Centers of Disease Control and Prevention recently released a comprehensive study on fluoride and confirmed that fluoride is a safe, effective and inexpensive method of reducing tooth decay.

LT Mathew J. Royal, DC USN

In today’s health and image conscious society, a higher priority has been placed on maintaining one’s teeth and oral health than in the past. Dental implants and root canal therapy are two options available to patients to help preserve overall oral health.
What is a dental implant? A dental implant is a titanium fixture or screw that is surgically placed into the bone of the jaw to substitute for a missing tooth. Many factors determine if a patient is a good candidate for an implant. Two of the most important criteria are overall health and the amount of existing bone in the area where the implant is to be placed. Smoking is also a very important factor determining if a patient is a good candidate for implants. Smokers often have a decreased immune response as their bodies are unable to fight off infection as well or heal as quickly from surgical procedures as compared to non-smokers. Consequently, oral surgeons and periodontists, the dental specialists who place implants, will usually not perform surgical implant placement unless the patient is smoke-free for at least 90-120 days. 
Implants do have advantages over other methods of replacing missing teeth such as bridges and removable partial or complete dentures. In order to place a bridge, the teeth on either side of the missing tooth or teeth must be prepared for crowns as part of the procedure. Crown preparation could lead to future problems for these teeth. When a tooth is removed, the bone in the area of the missing tooth will start to shrink, just like a muscle will start to atrophy when it is not used. A benefit to having an implant is that it helps to maintain bone levels and prevent further bone loss or shrinkage in these areas. 
What is a root canal? A root canal is a procedure where the tissue inside the tooth is removed and the space that it once occupied is cleaned, shaped and filled with a restorative material. The tooth is then often crowned or capped if it is towards the back of the mouth. The tooth is essentially “dead” and should not respond to hot or cold sensation, but should continue to function normally.
If tooth decay spreads close to or into the nerve of the tooth, then the tooth will often become symptomatic and usually require a root canal. Another situation where root canal therapy may be an option will include trauma to a tooth in which the nerve of the tooth has been damaged. If a tooth has had multiple dental procedures, the nerve of the tooth may become irritated or slowly start to die and eventually require a root canal. Also, a tooth can break down to the point where there is very little remaining tooth structure above the gum line. This tooth may require a root canal in order to place a post down into the root of the tooth to act as an anchor for a crown or a cap. 
So why would I have a root canal done instead of just getting the tooth pulled and an implant placed? There are several reasons why we want to save and maintain our natural teeth. Natural teeth have a ligament that surrounds the tooth and attaches it to the bone of the jaw. This ligament allows our body to judge how much force we require to bite down. Implants do not maintain this natural ligament and therefore we lose the ability to judge the force with which we bite down on the implant. Cosmetic or aesthetic concerns may be an issue as well. Our natural teeth are designed to be in harmonious contact and contour with the surrounding teeth and gum tissues. In some cases it might be difficult to establish these harmonious relationships with implants. 
Another major factor presently impacting one’s decision on treatment is cost and insurance. Currently, a majority of dental insurance will cover about 80-100% the cost of a root canal. Most dental insurance policies do not cover the cost of placing dental implants at this time. Yet another concern with implants is that they require a surgical procedure. The risks involved with any surgery apply such as infection, temporary or permanent nerve damage, and damage to the bone, jaw or gum tissues. Conventional or non-surgical root canal therapy does have some inherit risk involved, but not to the same degree as a surgical procedure.
Every tooth and every situation is different, many factors will determine the treatment that has the best chance for success. Therefore, when given the option of having a root canal or removing a tooth to have an implant placed, make sure your dentist provides you with the risks and benefits of both procedures so you will be able to make an informed decision. 

CAPT Gregory D. Naylor, DC, USN

Recurrent "canker sores" affect approximately 20 to 25% of the United States population. The proper terminology for a canker sore is recurrent aphthous stomatitis. The sores or ulcers are most commonly located on the moveable tissues of the mouth, like the tongue, the inside of the lips and cheeks, the floor of the mouth, or the soft palate.
Generally, the sores begin as small, red, oval swellings that become a shallow ulcer that has a whitish-yellow center surrounded by a red halo. The ulcers normally heal within a seven to ten day period. Canker sores can range in size from a half a centimeter to two centimeters or greater in the most severe cases. In the severe cases, the ulcer may leave a scar after healing is complete. Fever is not associated with the sores, but regional lymph nodes may be sore and tender in response to the ulcer. Patients may have one or more ulcers at the same time. The frequency of recurrences of ulcers varies considerably between patients. Some patients will have only one or two ulcers per year, while others may suffer from ulcers on a continuous basis.
The cause of canker sores is not fully understood, in fact there may be a number of causes. There does not appear to be a virus or bacteria responsible. Allergic reactions to certain foods have been implicated. Patients with stomach and intestinal ulcers may also be susceptible to oral ulcers. Female sex hormones may play a role in causing canker sores, since the ulcers occur in certain phases of the menstrual cycle. Most women experience improvement or remission of the ulcers during pregnancy. It is interesting that patients who smoke or use smokeless tobacco are not affected by canker sores. This, however, is not an indication to use tobacco products. Women seem to be affected more often then men, and studies show that the susceptibility to recurrences may be inherited.
Patients who have frequent recurrences of the ulcers should have blood and allergy tests to determine if there are nutritional deficiencies, allergies, or some other cause. Vitamins and other nutritional supplements may prevent or reduce the recurrences. Patients with food allergies can reduce recurrences by avoiding those foods that have been proven to cause the ulcers.
There are several treatments for reducing the pain and duration of canker sores for patients whose recurrences cannot be prevented. Anesthetic ointments, such as benzocaine, can reduce the pain. Steroid mouth-rinses or ointments can be prescribed in more painful cases. Patients with severe canker sores may need to take tablets of steroid or other immunosuppressant drugs. These drugs may cause undesirable side effects and should be used only under the supervision of a dentist.
If you have canker sores, avoid abrasive foods such as potato chips, which can stick to your cheek or gums and irritate the sores. Take care when brushing your teeth to avoid aggravating the sores, also avoid acidic and spicy foods that can be irritating. Finally, canker sores are not contagious, and you cannot transmit them to other people.
If you suffer from canker sores, treatment is available.

LCDR C. Zdanowitz - Periodontics Consultant

It is 8 AM, your mouth is open, overhead there is a light shining down on your face, you hear the scraping of a metal explorer gliding over what you hope are spotless - cavity free teeth. Obviously, you are in the dental office and you hear exactly what you want to hear – that you have no cavities! Unfortunately, that statement is followed by something that you do not quite understand - you have periodontal disease. Now you become a bit upset. First, because you are not quite sure what periodontal disease is; and secondly, because you brush your teeth every day and you feel fine.
Periodontal disease is a bacterial infection – often painless – of the gums and teeth. It is caused by a buildup of plaque (the film that forms on teeth both above and below the gum line). If left undisturbed, plaque can destroy the fibers and bone that anchor teeth in the jaw, leading to tooth loss.
The dentist tells you that the key to fighting periodontal disease is good oral hygiene habits – brushing and flossing daily. You recant, "But I brush my teeth every morning."
What most people fail to realize is that there are millions of bacteria which live in our mouths. They thrive off of the same foods and liquids that we place in our mouths on a daily basis. Briefly, these bacteria, their by-products, food debris, and different materials from our saliva all form the substance that collects on our teeth called plaque. If someone were to brush and floss their teeth at 7 AM and then have a cup of coffee with cream and sugar at 7:15 AM their teeth would have been clean for a total of fifteen minutes. For the next twenty-three hours and forty-five minutes their mouth would be a haven for plaque forming bacteria. Brushing your teeth once per day in the morning and/or brushing without flossing is like washing your right foot but not your left.
But this act of omission is not only hazardous to your gums and teeth. A growing body of evidence suggests that oral infections, particularly periodontal disease, may play a role in chronic medical problems, including our nations number one killer: heart disease. Furthermore, periodontal disease is increasingly being associated with a raised risk for stroke, diabetes, and pre-term and low-birth weight babies.
The major risk factors for coronary heart disease are well known. They include smoking, hypertension, and high cholesterol. In recent years, several studies have found evidence linking periodontal disease with an increased risk for atherosclerosis and thromboembolisms independent of other risk factors for these cardiovascular diseases. Researchers theorize that the bacteria associated with chronic periodontal infections may spread throughout the body via the blood stream to infect the vasculature and other end organ systems such as the heart.
Periodontal disease in pregnant women is receiving considerable attention as a potential independent risk factor for pre-term low-birth weight (PLBW) babies. Several studies have demonstrated an association between genitourinary infection and PLBW babies, and it is now widely held that PLBW caused by infections is probably initiated by the spreading of bacterial products associated with periodontal disease.
This brief article has highlighted some of the knowledge about periodontal disease itself and the link it may play with other systemic diseases. The goal of the dental professional is to help patients prevent not only periodontal disease, but to have good oral health.
Remember, the tennis ball is in your court 100% of the time! You must brush and floss daily and never, never, never go to bed or let your children or significant others go to bed without brushing and flossing.

CDR Cliff Zdanowicz, DC, USN - Staff Periodontist

Floss only the ones you want to keep. What does that mean? What is gingivitis? What is periodontitis? As a dentist I deal with patients on a daily basis whom are afflicted with a painless and chronic infection in their mouth. Quite often they are totally unaware of its existence, its cause, and its consequences. To exacerbate the situation while some are unaware of the most important oral hygiene habit that they can perform to prevent this disease, I would wager that most are just too plain lazy. What am I referring to? The disease process is periodontitis and the oral hygiene habit is quite clearly – FLOSSING! 
Let us begin with a brief anatomy lesson. When we smile we usually see some portion of our teeth and gums. Usually the portion of the tooth you see is the crown – a highly mineralized part of the tooth composed of enamel. The portion that you do not see is the root. Unless you have recession the root will be covered by your gum tissue - gingiva. The root is less mineralized than the crown (softer) and it is composed of cementum. The root of the tooth – the cementum – is anchored in bone. However, the cementum does not actually touch the bone. Instead, there is a connective tissue attachment between the two. That connective tissue attachment is referred to as the periodontal ligament. The attachment apparatus (the bone, the cementum and the periodontal ligament), which holds your teeth in your jaw, is much like the links of an anchor chain spanning between the anchor on the bottom and the ship on the surface. If the chain breaks the ship floats away. If the attachment apparatus fails – by a disease process called periodontitis - the tooth becomes loose and may fall out or need to be removed. 
Now let us revisit a question I posed but have not answered. What is gingivitis? The term gingivitis refers to inflammation (swelling) of the gingiva – the gum tissue. What causes this swelling? The answer – PLAQUE. What is plaque? We all have millions of living bacteria in our mouths. These bacteria thrive off of the same foods and liquids, which we place in our mouths. Plaque is a film that forms on our teeth and below our gum line. It is a film composed of bacteria, bacterial by-products, food debris, and also different agents from our saliva. 
Plaque also causes periodontitis. However, the huge difference between gingivitis and periodontitis is that in gingivitis the attachment apparatus – the cementum, the bone, and the periodontal ligament are left intact. Another huge difference between gingivitis and periodontitis is that the disease process of gingivitis is totally reversible. If your gums are swollen, perhaps red, maybe they even bleed if you touch them - you might have gingivitis caused by plaque. The solution to your problem: proper flossing and brushing. Any permanent damage to your attachment apparatus? NONE. However, if your gums are swollen, perhaps red, maybe even bleed if you touch them - you might have periodontitis caused by plaque. The solution to your problem: you need to visit a periodontist – a dentist who specializes in the treatment of the attachment apparatus referred to earlier. Any permanent damage to your attachment apparatus? YES. 
YIKES!! All this talk about bleeding gums, inflammation (swelling), permanent damage to my teeth. How can all of this go on in my mouth and not hurt? Unlike the common “tooth ache” which as its name implies – hurts; periodontitis and gingivitis are two disease processes which are often ignored because they are often painless. Unfortunately, some of us are unaware of the disease process until we discover a loose tooth in our mouth or a swelling on our gums – by this time it is often too late and a tooth or even several teeth have lost so much attachment that they have to be removed.
So how is all of this prevented? Proper brushing and flossing is the key. Not once a month. Not once a week. Not flossing one or two times per week and brushing daily. The solution is brushing and flossing every day. But that still may not be enough. The brushing and flossing must be after meals – after liquids as well. Many of us wake up in the morning and brush our teeth every day. Maybe a few of us floss as well one or two times per week. Then we begin our daily routine. So if I were to get out of bed, floss, brush, and have a cup of coffee twenty minutes later my teeth and gums would be free of plaque for those twenty minutes. If I do not revisit oral hygiene until the next morning my teeth and gums would be a plaque-infested arena for the next twenty-three hours and forty minutes. If I were to shove a splinter of wood into my thigh it would cause inflammation. If I were to remove it for 20 minutes every morning and then shove it back into my thigh the inflammation would not subside and the infection would spread. Plaque that is not removed daily and at the proper times of the day will also cause inflammation that will not subside – inflammation that will result in the disease processes of gingivitis and periodontitis which may culminate in tooth loss.
While we as dentists may be able to eradicate decay (cavity) within one appointment we cannot quickly eradicate years of neglect in the realm of oral hygiene. Do not end a 20 plus year career thinking that now (at almost 19 years plus or minus a few years) it is the time to be concerned with your oral heath. Quite frankly, if you have postponed this issue you have postponed it far too long.
When you visit your dentist, hygienist, or Navy prophy technician ask them to observe your oral hygiene habits. Demonstrate to them how you brush and floss. The ball is in your court 100% of the time. The ball is in our court to educate you, remove plaque by a prophy technician. However, if you also have calculus (also known as tartar) in addition to plaque you must be seen by a dentist, periodontist, or hygienist for its proper removal and evaluation of your disease state.

CDR Ben Hunter, DC, USN

Prosthodontics is the dental specialty related to the replacement and restoration of teeth. A Prosthodontist is a dentist who has completed 4 years of dental school and an additional 3 years in advance post graduate study in the creation of tooth replacements and the maintenance of a healthy smile. Prosthodontists are the architect of complex dental treatment, acting as the coordinator with other specialties and general dentists to provide solutions to your dental problems.
Our goal is providing dental care to improve or restore the appearance and function of teeth, and ultimately creating a healthy smile. If you think of your smile as a painting, then your face would be the frame, with your gums the canvas, and your teeth as the picture. These three parts should be in harmony to create a pleasing overall appearance. When they are not in harmony due to disease or trauma, a diagnosis based on a lot of information is required. A thorough exam, radiographs (x rays), photos, impressions of your teeth, and your dental and health history may all be needed. Additional consults with other specialists may be required as the complexity of your health or severity of your problems increase. Deciding what needs to be done and when it should be done can often be more important than how your problem is solved. The good news is that Prosthodontists have a big bag of tricks to correct most problems.
Cosmetic dentistry is at an all time high with a great appearance becoming tantamount in our culture. Bleaching techniques can change the color of teeth. Selective removal of parts of your teeth and placement of small tooth colored fillings can achieve excellent results. Another option may be placing porcelain veneers on your front teeth to correct minor defects, change color, close spaces, or realign slightly crooked teeth.
As more parts of your teeth are missing due to disease or trauma, more complex care and parts are required to restore your teeth. A crown (cap) may be needed if a significant amount of the tooth is missing, or regular fillings are inadequate to restore the tooth. If teeth are missing, a bridge may be used to connect the remaining teeth and fill the space. Removable partial dentures are used when more teeth are lost and supporting bone and gums have receded. Full dentures are used when all the teeth are missing.
Dental implants are one of the exciting innovations in Prosthodontics. Titanium dental implants act as root replacements for missing teeth. Special attachments can be used to help retain removable dentures and fixed bridges. If a single tooth is missing, crowns can be attached to the implants without affecting the adjacent teeth.
You can obtain more information atwww.prosthodontics.org. So with a little science, a little art, a bit of magic and a lot of patience, your smile can be restored too.

LT Nicholas J. Toscano, DC, USNR

Do you suffer from jaw pain? Do you wake up in the morning and your jaws feel stiff? Do you have neck pain and headaches? If you do you may fall into a population of people who suffer from Orofacial pain/TMD. Greater understanding of TMD has emphasized the need for a more thorough appreciation of the relationship between TMD and other pain disorders in the head and neck.
What is TMD?
TMD is a collective term that includes a number of clinical problems that involve the chewing muscles, theTemporomandibular Joint (TMJ) , or both.
According to the American Academy of Craniofacial Pain, health problems and the pain associated with disorders of the jaw joint (the TMJ) may seem to be mysterious and unexplainable to you. There are growing numbers of health care providers who are qualified to diagnose and treat Temporomandibular Joint Disorders (TMD). While no amount of printed information can replace a complete examination by a qualified practitioner, it is often comforting to have some of your questions answered before taking that major step and making an appointment to consult "an expert".
Some patients live with TMD for years before it becomes painful enough to cause them to seek help. Others contract the problem suddenly -- usually by some trauma or blow to the head, face and/or neck region. But both types of patient can have very similar symptoms.
Even though a headache can be a sign of many kinds of health problems, frequent headaches are the most common complaints of TMD sufferers. Other common complaints can include clicking or popping jaw joints, pain when chewing or yawning, grinding or clenching your teeth, neck/shoulder pain, worn teeth, your teeth do not touch when you bite, "stiffness" in your jaw joints that makes it difficult to open or to close your mouth. Again, only a qualified health care practitioner can tell you for certain if any of these problems are a direct result of TMD.
Methods for successful diagnosis and treatment of TMD vary from patient to patient and from office to office. Some problems may require a "team-approach" which means several different health care practitioners may be working with you together to help treat your problem. Treatment can take time and even the amount of time varies from patient to patient. Sometimes it even takes time to get an appointment with a qualified health care practitioner.
Treatment requires a whole body approach. The practitioner will look at factors that cause orofacial pain. Such factors include parafunctional habits. Parafunctional habits include daytime clenching and grinding of teeth, poor posture, and bruxism. Other factors which may contribute to orofacial pain include poor sleep, use of caffeine and nicotine, trauma, skeletal and occlusal relationships and psychosocial factors. Through a comprehensive exam a diagnosis and treatment plan is developed.
Treatment is done through the use of physical self-regulation exercises to eliminate parafunctional habits and calm the fatigued system down. Use of splints (night guards) and muscle relaxants are used as adjuncts to the physical self-regulation.
If you suffer from jaw pain, neck pain and headaches, treatment is available.

Captain Richard R. Schwab - Dental Corps, USN

Why? Why? Why? I’m often asked, “Why do I have to have my tooth removed (especially wisdom teeth) if it’s not bothering me?” I explain to my patients several reasons that this article will review and assure them that that if the teeth did not need to come out I would leave them in because I get paid the same salary either way! This usually convinces them along with explaining clinical findings. My technician tells me they only do it because I’m a Captain. I’ll never know the real reason. 
When a third molar (wisdom tooth) partially erupts through the gums, a mild-to-moderate inflammatory response may occur. This may develop into a severe infection requiring medical and surgical treatment. The independent duty corpsman or young dental officer, although well trained, do not have the surgical skills required to treat severe cases. It is best to practice preventative dentistry and remove most wisdom teeth prior to a deployment. In addition, a partially erupted third molar cannot be adequately cleaned, the impacted tooth as well as the adjacent molar has a greater chance for getting decayed or developing gum disease. Also most thirds with poor attachment of the gingival (gums) or teeth with “deep pockets” as measured by a periodontal probe are recommended for extraction. 
Teeth may also be extracted due to crowding thereby making it easier to clean. In addition, the dentist may recommend extraction to prevent a cyst or tumor, however, while this is a potential, it rarely occurs. Sometimes, impacted teethe are removed to prevent root resorption of adjacent teeth. Occasionally, the dentist wants an impacted tooth removed before constructing a fixed (bridge) or removable (denture) prostheses. 
Not all wisdom teeth need to be removed. Those that are fully erupted, not decayed, are easily to clean, and are surrounded by healthy gums most likely do not need to be removed. In addition, all surgeons consider the risk of surgery versus benefit. If patients have a good chance of nerve damage during surgery due to the location of the impacted tooth near the dental nerve then the dentist may elect not to extract. Likewise, if surgery would result in a post-surgical defect greater then the pre-surgical one, the decision may be to not extract. 
In conclusion, there are multiple factors used to determine whether to a tooth should be removed. At this time, we know healing after third molar surgery is best when the impacted tooth is removed before it becomes exposed in the mouth, before it resorbs bone on the backside of the tooth in front of it, and when the patient is as young as possible. Bottom line, if there is poor gum health, the tooth is difficult to clean, or damage to the adjacent tooth may occur, the tooth should be removed to allow the best healing to occur especially if the patient is less than 30 years old.

CAPT T L Brown - Operative Dentistry Consultant

Doctor, can my teeth be whitened or bleached? This is a frequently asked question in the dental office these days. The answer to this question depends on several factors that you should discuss with your dentist. Some types of discolorations are more easily corrected with whitening agents than others. Yellow stains usually bleach well but brownish-yellow teeth may not bleach as well and grayish or blue stains may not bleach well at all. Sometimes a combination of bleaching and porcelain veneers or bonding will aid these stained situations. Also if you have several tooth colored fillings or porcelain veneers or crowns these materials will not bleach so your teeth will be a different shade than these restorations after bleaching. If you are considering bleaching you may want to have the tooth colored restorations replaced after completion of the whitening procedure.
If you choose to have bleaching done, you and your dentist must decide whether to do an in-office or at-home procedure. Sometimes a combination of both procedures is done to maximize the effects of the whitening. The in-office bleaching procedure may require several visits of 30 minutes to one hour in duration. During the in-office procedure the dentist applies a rubber shield or protective gel barrier to the gums to protect the oral tissues. A bleaching agent is then applied to the teeth and a dental light may be used to enhance the action of the bleach. There are several products available for the at-home procedure. These products can either be dispensed by your dentist or purchased over-the-counter.
Bleaching products contain peroxide that bleaches the tooth enamel. The active ingredient is usually carbamide peroxide in concentrations that vary from 10% to 20% for at-home bleaching and higher concentrations for the in-office procedure. The bleaching agent is typically a gel that is placed in a custom mouth guard provided by your dentist or in strips that are applied to the teeth. The regimen usually calls for usage twice daily for two weeks or overnight use for one to two weeks. The most common side effects from the bleaching agent are tooth sensitivity or tissue irritation. Both of these effects are usually temporary and should go away once the treatment is completed. You should consult your dentist if you are concerned about side effects.
There are also several whitening toothpastes on the market. Toothpaste helps remove surface stains with mild abrasives and some toothpaste has special chemicals or polishes to provide additional stain removal. Toothpastes do not remove intrinsic stains that bleaches can remove.
Hopefully this article has answered some of your questions about bleaching procedures, agents and side effects. If you are considering tooth whitening or bleaching procedures you should consult with your dentist. For additional information or to ask questions about bleaching, email me at: tlbrown@us.med.navy.mil

CAPT T. L. Brown - Operative Dentistry Consultant

This is a frequently asked question by patients in the modern dental practice. The answer to this question depends on several factors that you should discuss with your dentist to determine what is the right filling material for your restorative situation. The durability, longevity and expense of dental fillings are influenced by several factors. Such factors as the chewing load on the tooth and filling, the components of the filling material, placement of the filling material and time required to properly place and finish the filling should be taken into consideration to select the proper filling material.
The advances in esthetic filling materials over the past several years have given dentists the ability to provide patients with fillings that create natural looking teeth. The introduction of these materials has not eliminated the usefulness of other more traditional materials such as dental amalgam fillings or what we usually refer to as silver fillings. The durability and strength of the traditional silver filling still make them useful where teeth must withstand heavy chewing forces especially in the back of the mouth.
Dental amalgam is a compound of mercury and other metals that set up into a solid form. It is the most researched and tested filling material in use today. Dental amalgam is very durable and resistant to wear, inexpensive compared to other materials and can withstand heavy chewing forces. Some disadvantages of silver fillings include possible sensitivity to hot and cold after placement, the silver color is not as esthetic and it requires more tooth structure removal than white fillings. Some questions have been raised about the mercury content of dental amalgam and its effect on our health. The mercury in dental amalgam chemically combines with other metals to make it stable and safe for fillings. Amalgam has over a 100-year history of safe and reliable use. Several scientific organizations such as the National Institutes of Health, the U. S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization through panels and studies have been satisfied that dental amalgam is safe and effective as a filling material.
Composite filling materials or what we refer to as tooth colored or white fillings are a mixture of acrylic resin and finely ground glass-like particles that give a tooth colored appearance. Composite fillings are durable in small to mid sized fillings and can withstand moderate chewing force. Some advantages of composites over amalgams are they require less tooth structure removal, they are adhesively held in the cavity by bonding agents allowing for conservation of tooth structure in many instances. Composites are moderately resistant to wear under heavy chewing loads but less so than amalgam fillings. The cost of composite filling materials is moderate but they require more time by the dentist to properly place and finish the restoration adding to the cost of the filling. Also the cavity must be kept clean and dry during the placement of a composite filling for proper bonding and placement and they will stain and discolor over time requiring replacement.
Hopefully this article has answered some questions about white verses silver fillings. So the next time you need a filling in a back tooth you can discuss the options better with your dentist to determine which filling materials are best suited for your restoration.

Suho Lee, LT, DC, USNR and Richard Schwab, CAPT, DC, USN

Your wisdom teeth (third molars) are the last teeth to emerge from your gums during your late teens, or "age of wisdom," which gives them their name. But wisdom teeth aren’t really so wise. They often become trapped (impacted) in the jawbone and gums and fail to erupt, or emerge, as straight and fully functioning teeth. Impacted wisdom teeth nearly always have to be removed.
Why do we have wisdom teeth at all if they have to be removed so often?
Very simply, because human beings once had tougher diets, and they needed larger jaws and more teeth to chew their food. But as time progressed, our diets became softer and more refined. Because we no longer needed large jaws for strenuous chewing, the jaw failed to develop, leaving little room for the third molars. Today, there are some adults who never develop wisdom teeth and perhaps in the distant future we won’t have to worry about them at all.
Wisdom teeth that aren’t painful seem harmless enough, but if they are not removed early, they often cause the following problems.
Infection(Pericornitis)- The mouth is full of bacteria that normally does not get past the protective layer of the gums. But when an impacted tooth breaks through the gum’s surface, bacteria can get in, causing an infection in the gum around the crown of the tooth. This infection can cause severe pain, swelling, stiffness of the jaws and even general illness.
Destruction of the next tooth- An impacted tooth may still try to grow where it has no room, eroding the tooth next to it. This is called resorption. Eventually this could lead to the loss of both teeth.
Pain- Infection in a decayed wisdom tooth or in the gum around an impacted tooth can cause pain. If a decayed wisdom tooth is not in a healthy position or if it is not restorable, your dentist may recommend its removal. An impacted tooth can also cause pain if it presses against a nerve or the next tooth.
Crowding- An impacted tooth can crowd nearby molars out of alignment. If you are undergoing orthodontic care, your orthodontist will probably recommend that your impacted wisdom teeth be removed.
Cysts- When a tooth is impacted, the sac around the crown remains in the bone. Occasionally, the sac fills with fluid, forming a cyst that can destroy the bone and endanger surrounding structures.
Another reason that we recommend early removal of wisdom teeth is that before you reach adulthood, the roots of your teeth are not totally formed and the surrounding bone is softer. Therefore, there is less chance of damaging nerves and other nearby structures during surgery. The operation itself also may be more difficult as you get older, when health risks are greater and healing is slower.
Removal of wisdom teeth is a very common procedure. Your dentist can analyze your x-rays and discuss the diagnosis with you. He/she can provide you with information about the surgical treatment of your impacted teeth as well as any possible alternatives to surgery.

CAPT Gregory D. Naylor, DC, USN

Dental X-rays or radiographs provide important information about your overall oral health. Radiographs allow the dentist to evaluate areas that can’t be seen with the naked eye, such as the underlying bone, the roots of the teeth, and unerupted teeth. In certain cases, radiographs can identify a condition at an early stage before you experience any signs and symptoms that something is wrong. Some patients have questions concerning the need for dental radiographs and whether there are any health risks associated with them. It is the purpose of this article to answer these questions.
X-radiation is a form of radiation that can penetrate many materials including bone and soft tissue. X-rays can expose photographic films, so by placing a film in the mouth and exposing the film to X-radiation shows the dentist the current condition of your teeth and bone. 
When a radiograph is taken more X-rays are absorbed by dense structures like teeth and bone, and less dense structures like the cheeks and gums absorb less radiation. The X-rays that pass through these structures create an image on the film. Dense structures like the teeth appear lighter because fewer X-rays reach the film; less dense structures like the gums appear darker because more X-rays pass through to the film.
Dental X-ray examinations involve very low doses of radiation, which makes the risk of harmful effects extremely small. Only a small part of the body is exposed to radiation during a dental X-ray examination. Limiting the size of the X-ray beam and using a lead apron are precautions employed to minimize the risk of X-ray exposure and increasing its safety. 
Many diseases of the teeth and surrounding structures can’t be seen when your dentist examines your mouth. The X-ray examination may reveal small areas of decay between the teeth, infections in the bone, developmental abnormalities, and sometimes, tumors that otherwise might not be seen.
The dentist will recommend dental radiographs after reviewing your dental history and possibly after examining your mouth. Based on this information, the dentist can determine which radiographs are needed. If you are a new patient, the dentist may recommend a full mouth series of radiographs to determine the status of the hidden areas of your mouth and to help analyze changes that may occur later. The need for radiographs on recall visits varies according to age, risk for disease, and signs and symptoms of disease. New films may be needed to identify new decay, assess the severity of gum disease, or evaluate the status of growth and development. Children may need radiographs more often than adults may because their oral structures are growing and changing, and it may be necessary to evaluate the growth, development, and eruption of the permanent teeth.
Pregnant females must tell the dentist that they are or possibly might be pregnant. Dental X-ray examinations are limited to the head and neck region and the dentist should discuss whether X-rays are necessary. Although it is most desirable to avoid all radiation during pregnancy, if dental treatment is necessary, radiographs may be needed to accurately diagnose and treat the patient.