Frequently Asked Questions

how can i have a cavity if nothing hurts

Answer: A cavity, also known as a carious lesion, or decay in a tooth sometimes will never hurt at all. That does not mean decay is not present. But if you wait until a tooth hurts to have it taken care of, oftentimes it is too late and the tooth will need root canal therapy. The best time to clean out a decayed tooth is when it is not hurting. This means that the nerve may not have been affected yet and a simple filling can be placed. Cleaning out a cavity when there are no symptoms yet and the decay is far away from the nerve lessens the chances of needing root canal therapy.

what is the difference between plaque and tartar

Answer: Plaque is soft white material that can easily be brushed and flossed away. If plaque is left behind, it hardens into little grains of sand on the tooth or under the gumline on the root and this is called tartar. Once tartar forms it cannot be removed by brushing or flossing. It needs to be scraped off with a dental instrument. When tartar builds up, it forms a rough surface, thus attracting even more plaque to form and stick and subsequently harden on the tooth and under the gumline on the root. This build- up of plaque and tartar eventually causes the gum to become inflamed and infected and it can cause the gum to recede or to form what is known as a pocket, which is a precursor to losing bone from around the tooth and its root. This is called periodontal disease.

what is the purpose of regular cleaning appointments if my teeth do not feel “dirty.”

Answer: When plaque and tartar form, it might only be present under the gumline and not noticeable by the patient. But the tartar still needs to be cleaned off of the teeth, especially under the gumline. However, it is also important that the gum be cleaned as well as the teeth. During plaque formation, the bacteria from the plaque and tartar invades the inside of the gumline, causing a mild inflammation or "mini" infection in the gumline. If there is no professional dental cleaning done for a long time, the gum can become very inflamed and infected and this can cause the gum to start to separate away from around the tooth. When the gum separates away from the tooth, the bone beneath it, that is, the bone which supports your tooth in your jaw begins to dissolve away or resorb. This is periodontal disease and most often it does not cause any pain for a long time. You can be unaware for years that anything is wrong with your tooth or your gum. But eventually, the tooth will start to feel loose and eventually an abscess forms and by then the tooth needs to be extracted. The worst thing about this process is that nothing hurts until the abscess forms and by then it is too late. But regular cleaning appointments can help to prevent this scenario.

what exactly happens at the cleaning appointment

Answer: In Dr. Chass's office, a numbing gel is applied along the entire gumline to desensitize the gum at every routine dental cleaning. During the cleaning appointment, the tartar is scraped off of the tooth and in addition, the infected gum sloughs off along with the bacteria that invaded it. This is why most people have some bleeding occur during a professional dental cleaning. After the gum is cleaned, there is a wound, of course, but it is a clean wound free of bacteria and the gum heals in about a day and should go back to its normal tightness around the tooth. But sure enough, the plaque begins to form again, most times right away and bacteria again begins to invade the gum, starting the inflammation process all over again.

Every patient's gum is different and so a customized plan for professional dental cleanings is very important. Some people need their teeth and gums cleaned more frequently than every six months. For some people it is because they are not flossing or brushing correctly or because they are not brushing long enough each time and for others, genetics can be a factor in how often a cleaning is needed in order to prevent periodontal disease.

what is the difference between bonding and porcelain veneers

Answer: Bonding is a term used to describe the way a filling or veneer is glued to a tooth. There are basically two ways to use bonding to make your smile look better. Direct Resin Bonding is actually a soft white filling material that comes out of a tube and is placed and shaped on the tooth after a special type of glue is brushed on. There are many different shades of tooth-colored direct resin bonding material and most often there needs to be a combination of a few shades in order to make the bonded teeth look natural. The filling material is hardened and bonded onto the tooth with a special light, after which more shaping and polishing is done.

A Porcelain Veneer is made in a dental laboratory from an impression of the tooth or teeth taken by the dentist. The color of the tooth is matched using a special shade guide that the laboratory is familiar with. The veneer itself is a very strong piece of porcelain shaped to look exactly like the tooth needs to look and it is bonded to the tooth with a special glue. Porcelain Veneers need two appointments because they are sent to and constructed in a dental laboratory and then sent back to the dentist. The main differences are: a Porcelain Veneer looks more natural than Direct Resin Bonding. Porcelain Veneers are shiny and smooth. They do not pick up stain and do not need to be polished. Direct Resin Bonded teeth are not as shiny as Porcelain Veneers. They can pick up stain and need to be polished periodically. Porcelain Veneers are more expensive than Direct Resin Bonding procedures.

Porcelain Veneers and Direct Resin bonding are similar in that in both cases, some tooth enamel has to be drilled off to make room for the addition of a Porcelain Veneer or Direct Resin Bonding. They are also similar in that both procedures are irreversible, that is, if you change your mind afterwards, you cannot have your tooth enamel put back, so make sure you really understand the process and you really want it done.

what is a root canal

Answer: Dentists call it root canal therapy and it basically means removal of the nerve of the tooth. There is a canal which starts in the center of the tooth and extends down the center of the root of each tooth. Some teeth have 2 or 3 roots branching out, thus 2 or 3 canals.

When the nerve of the tooth starts to feel decay coming near it, it can sometimes start to hurt. While the decay is being cleaned out, if it is found to have already invaded the canal in the center of the tooth, the nerve needs to be removed because it has been infected by the decay.

However, even if the decay did not invade the nerve and is cleaned out and a filling is placed, the nerve could still have been affected and can start to hurt a day, a week, a month or even a few years afterwards. The only way to stop the tooth from hurting at this point is to remove the nerve.

It is good to go to a root canal specialist for this procedure, the reasons being that the root canal specialist, called the endodontist, performs root canal therapy all day, every day, and gets the job done very quickly, sometimes in as little as one hour. Most of the horror stories people hear about having root canal therapy is because that person waited until the last minute and the nerve became "hot" or acutely inflamed or infected. It is very difficult to numb the nerve when it is very inflamed and so there can be pain in this situation that is why people are afraid of root canal therapy. The way to avoid this is to call the general dentist as soon as any pain or sensitivity begins so the tooth can be evaluated and treated early on, long before the nerve becomes "hot" or inflamed or badly infected. If the tooth is evaluated to need a root canal, it should be done as soon as possible and pain can be avoided.

why do i need a crown or an onlay after a root canal is done

Answer: The tooth is nourished by the nerve so when the nerve is removed, the tooth dries out and becomes brittle and can fracture. A crown or onlay helps to protect the tooth from fracturing due to brittleness. If a tooth with root canal therapy is not protected, and if the tooth fractures vertically down the root, the tooth usually needs to be extracted. So if you invest time and money into root canal therapy to save your tooth, you should also be prepared to invest in protecting the tooth with a crown or onlay soon after the root canal therapy is finished.

what is an implant

Answer: Many years ago during wartime, surgeons found that titanium metal rods which were used for repair of broken legs, fooled the bone into fusing with the titanium rod. We now call this osseointegration and use a titanium pin to act as a new root in the mouth so that we can place a crown onto that new root, thus replacing a completely missing tooth!

So if you have lost a tooth, an oral surgeon or periodontist will prepare a place in the jawbone where the tooth was lost and insert a specially constructed titanium pin, which the bone starts to fuse to within several months, thus resulting in a new root, a titanium root in the jaw. After the fusing or osseointegration is deemed successful, the general dentist will place a crown onto the new titanium root.