Below is a list of some of the questions our patients most frequently ask. If you have a question that isn’t answered below, feel free to give us a call and our team at Ashley Ulmer, DDS will be happy to assist you.
Taking Care of Your Teeth and Gums
We recommend twice yearly visits for a dental examination and professional cleaning with a dental hygienist. It is important to evaluate the condition of your teeth, gums and other facial structures for conditions before they become a problem for you.
Most dental problems can be prevented with adequate daily removal of bacterial plaque from your teeth and gums. Care should be taken to disrupt the accumulation of bacteria 2 or 3 times a day. Brushing, flossing and rinsing with an antibacterial agent (like Listerine) will remove plaque and kill bacteria, minimizing the number of bacteria colonies that form on your teeth.
It is especially important to clean your teeth at nighttime because your oral cavity will tend to dry out more than in the day. Any food that is left on teeth and gums will feed the bacteria all night long.
We recommend supplementing your hygiene routine with extra fluoride- rinse, gel or paste- to help heal any cavities as they start on your teeth. If you are interested in a non-fluoride option to heal cavities, we can prescribe a special toothpaste for you.
Here are some recommendations for brushing correctly:
- Use the softest-bristled brush you can find. We used to think hard-bristled brushes were more effective for removing plaque, but now we have evidence to show how damaging scrubbing with a hard brush can be to your gums around your teeth. Overly aggressive brushing causes your gums to recede and expose the soft surface of your tooth roots which can get worn and damaged and sensitive over time.
- Angle your brush 45 degrees to your teeth at the gumline.
- Use small circular strokes to brush the entire surface of the teeth and gums. Work slowly to ensure every surface is cleaned before moving to the adjacent teeth.
- Brush all surfaces of each tooth: cheek, biting and tongue sides. Also, don’t forget to brush your tongue! The tongue can harbor a large amount of plaque that causes bad breath.
- Set a timer to brush for 2 minutes every time!
The best toothbrush you can buy is the one that you will use!!
Adequate brushing is focused more on your technique than the tool you choose to use.
We do recommend electric toothbrushes for a variety of reasons: the larger handle is more comfortable to hold, there is a timer built into the brush to help keep time, many brushes are engineered to stop working if too much pressure is used during brushing to reduce gum recession and they are REALLY COOL! Some parents find that it is easier to get kids to brush if they look forward to using a cool gadget.
It is important to know that brushing alone only cleans 60% of your tooth surfaces. If you are not flossing regularly, you are leaving bacteria on almost half of your tooth surfaces. Choose floss that fits comfortably between the teeth. We recommend a woven or tape-type floss that covers a larger surface area as you draw it up and down the teeth.
Here are some tips to improve your flossing game:
- Get the right length: 18 inches. Less makes it hard to hold the floss taught as you floss, more is just too much. Wind equal amounts around your middle finger on each hand. This allows you to hold the floss with your index finger and thumb to give you the most control as you floss. Wind and unwind the floss to get a fresh section as you move between the teeth.
- Remember flossing is essentially brushing the tooth surface between the teeth so make a slight C- shape to gently cup the tooth surface on either side of the contact between the 2 teeth. Floss up and down slowly and watch as plaque is removed from both surfaces.
- You might notice the floss can be gently pulled below the gum line. It is important to clean every surface the bacteria can cling to.
- Many people prefer to use floss holders or other implements to clean between their teeth. Any of these are fine, as long as they are working well to remove the plaque from your teeth. We will assess your methods at your next visit and recommend tips and tricks to help you if you need it.
Bacteria colonize and grow on all surfaces of our oral cavities. These colonies are a white film on the teeth, usually near the gum line that gets thicker as it grows. Plaque that is calcified by the minerals in your diet and saliva turns into the harder, rough, yellowish deposits of tarter you sometimes see on your teeth.
Periodontal (Gum) Disease
Periodontal disease is a progressive infection of the gums surrounding the teeth. In the earliest stages, the infection is limited to the gums right next to the crowns of the teeth. They get red and bleed easily when brushed or probed. This condition is called gingivitis and is readily treated by removing the irritating plaque and calculus from the teeth. Good home care and regular cleanings will limit the progression of gingivitis into periodontitis.
Periodontitis is similar to gingivitis. Often the gums are thick and red, bleed easily and plaque and calculus deposits are visible around the gum line. The difference is that the infection extends from the gum into the supporting bone structure as well. Pockets form in the gums and bone is lost around the roots of the teeth.
Once the bone is lost, there is no way to replace it. There are some surgical procedures to add some bone back to these areas, but the procedure is not always predictable. Initial periodontal therapy will work to stop the progression of the disease to keep as much bone as possible. Once the bacteria is removed and the gums start to heal to the root surface again, the gum pocketing is reduced and the gums seal off access of bacteria to the bone.
- Gums that bleed while brushing
- Red, swollen or tender gums
- Gums that have pulled away from the teeth
- Bad breath that doesn’t go away
- Pus between your teeth and gums
- Loose teeth
- A change in the way your teeth fit together when you bite A change in the fit of partial dentures
Periodontal disease is like a 3-legged stool. One leg is how well you remove the bacterial deposits on your teeth. How good is your home care? Are you brushing, flossing, and rinsing every day? Are there areas of your mouth you have difficulty cleaning or keeping clean? Poor oral hygiene leaves bacteria in contact with your tooth surfaces. The longer they stay the more complex their colonies become.
This leads to the second leg of the stool, which is the type of bacteria colonizing your teeth. Some periodontal bacteria are bad and some are very bad. The more of the very bad variety you have, the more disease you will display.
What makes some of these very bad bacteria so aggressive is the third leg of the stool, your immune response. Periodontal disease is not really a disease where bacteria attack your body. It is more of a disease where the bacteria colonize the surface of your teeth- just outside your body’s immune system, where they are never eliminated by your immune cells. They call to the immune cells by producing markers in their waste. These cells then begin to fight the bacterial infection but instead of killing the bacteria, they destroy the tissue and bone in the area near the bacteria. It’s like fighting a battle across a river. You can see the enemy is there but can’t accurately target them because you can’t reach them. The best you can do is blast the area— hoping you will hit something vital. Some people’s immune response is slow, it will tolerate a lot of stuff before it acts. Other people’s response is lightning fast- the slightest insult will cause a large response. In this case, these people are at a higher risk of developing periodontal disease because they have a hard time shutting down their immune response. We inherit our immune system from our parents so we always want to know what your family history of periodontal disease has been. Parents and grandparents that lost their teeth early from periodontal disease is a good predictor of how your disease process will likely progress.
All 3 parts play together to give us insight into your individual disease process. We schedule regular maintenance and follow up care to assess the disease progress and address how we can continue to stabilize your condition.
Yes. They are amazing! In addition to flushing out food and plaque from irregular surfaces that traditional floss really can’t touch, they really disrupt plaque deposits deep in periodontal pockets and deliver antibiotic rinses below the gum line. When you put an antimicrobial agent like Chlorhexidine into the water in the reservoir, it will soak into the pockets and sterilize the gums in that area for up to 30 minutes. It really inhibits the bacteria’s ability to reattach after you complete your oral hygiene routine.
Teeth are highly porous. Over time stain collects in the tubules on the surface of your teeth. Most whitening toothpaste relies on an abrasive component to remove layers of enamel, but most stains reside inside the teeth, not on the surface. The best option for lightening teeth is to use a chemical agent to soak into the tubules and remove the stain from inside the tooth.
These are three options we offer in our office:
This procedure is done in our office by applying a high-concentration peroxide gel on the teeth. The results can be seen in an hour. Custom whitening trays are included in the treatment to reapply periodically as needed.
Custom whitening trays are fabricated for you in our office. We give you instructions and the whitening solution to use on your own at home.
Over the Counter Whitening
Many pre-fabricated whitening kits are available from a variety of retailers. We often recommend starting with one of these solutions to see if it works for you.
We recommend reapplication of the whitening solution as often as you like but no more than once a month, one application only at a time.
There are studies that show the enamel will get thinner with daily exposure to whitening solution for an extended period of time.
Porcelain veneers are a minimally invasive restoration used to change the length, shape, and color of teeth.
Approximately half to 2/3 the thickness of enamel on the facial portion of your teeth.
Some people notice surface staining if they are not cleaning their teeth adequately or they consume foods and beverages that cause staining. Sometimes, the seal around the veneer can be compromised causing stain from leakage under the veneer. In these cases, the veneer will have to be replaced
For porcelain veneer it typically takes 2-3 weeks from start to delivery. Composite veneers can be completed in 1 day.
As many as it takes to address the concerns you have. We take a considerable amount of time listening to your concerns and planning your case to ensure we can deliver the esthetic restoration you expect.
This is largely dependent upon how much pressure these restorations will endure. If you are a heavy grinder and the veneers are to replace chipped and worn teeth, you will have to protect them from those forces working while you sleep. We recommend every patient wear a custom night guard every night to offer the best protection of your veneers.
Under ideal conditions, they are expected to last many years.
All About Dental Implants
Except for rare cases, implant restoration of missing teeth should be considered as a treatment plan option. Once you have a chance to hear all treatment options, we will guide you through the decision-making process to come up with the right plan for you. Dr. Ulmer will take as much time as you need to explain, in as much detail as you want how the treatment will go so you can make the right decision for your circumstance.
Both treatment options should always be considered. There are certain situations where one or the other option is not really available. When either bridges or implants are possible, patients often have to consider the cost and expected treatment time of either treatment.
Implants are ideal to replace multiple missing teeth. Often the stability of an implant-supported restoration is far superior to any other restoration. Whether used as abutments for implant bridges or as anchors for dentures, implants very closely mimic the function of real teeth.
The fees for dental implants are split into 2 parts: the fixture, which is the titanium implant body that is surgically implanted into the bone and then the restorative elements that are placed on top of the fixture. Even though they may cost more initially, they last longer than most other restorative procedures.
Dental implants are designed to last your entire lifetime. With regular hygiene visits and good home care we expect you will have few problems with your implant restorations.
We regularly refer the surgical portion of implant restorations to a specialist for placement. Most surgeons will spend considerable time scanning and planning the implant surgery to provide you with the information you need to proceed with treatment. Between CT scans and radiographs, the bone is measured and planned for augmentation as needed to ensure a predictable outcome.
We typically wait 3-6 months for the bone to mature after implant placement before fabricating the replacement tooth.
Yes. There are a couple of treatment options where teeth are removed and replaced in 1 day. It takes approximately 6 weeks to plan for the treatment, but the procedure usually takes 1 day.
We work with a surgeon to offer immediate implant and overdenture placement after the teeth are removed the same day.
Other Common Questions
Halitosis or bad breath is caused by a variety of factors. We will discuss your concerns at your initial examination. It will be helpful for you to bring a comprehensive list of medications and a food diary to evaluate the effect of different medications and foods on your salivary flow. We will also ask about your home care and how long it has been since you had a professional cleaning. Many bacteria produce foul-smelling waste and can proliferate in the semi-moist environment of dry mouth. It will be important during your exam to look at how much plaque is accumulated in your mouth and on your tongue.
What do you see when you look at your smile? Are you happy with the way you look? Do you look the way you feel inside?
There are a variety of ways to achieve the look you truly desire. Dr. Ulmer will evaluate the condition of your teeth and mouth at your initial visit and suggest options for addressing the concerns you have about your smile.
Whiten your teeth. It’s simple and forms the foundation for changing the shade of your teeth with restorations in the future.
Most people know composite resin fillings as “white” fillings. Composite resin is a putty-like material that can be shaped and and shaded to match the existing tooth structure as it is bonded to the surface of the tooth. In addition to being more esthetic, we are able to conserve more tooth structure as less tooth is removed to prepare for these restorations.
Dr. Ulmer will evaluate the condition of all the restorations in your mouth at your initial visit. She will recommend treatment based on her findings.
Silver/amalgam restorations are often the oldest restorations you have in your mouth and are expected to decay and leak after many years of service. It is not usually recommended to have these restorations replaced without visible decay, but we will discuss your options and plan the treatment that is right for you.
There are a number of options to replace defective restorations. Depending on the size of the restoration and the condition of the tooth under the restoration, we may need to consider a full-coverage crown or porcelain inlay restoration instead of replacing the filling. For small restorations, generally composite resin is a good replacement option to reseal the decayed portion of the tooth.