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FAMILY & GENERAL DENTISTRY - FAQ's Dr. Gates answers some of your questions about General and Family Dentistry Click on a link below to read about each topic. Click the  to return to the top of the page.Caps, crowns, inlays, onlays... What's the difference? Are white fillings as good as silver What's a root canal? Are silver amalgam fillings bad for your health? How long does it take to fix a chipped front tooth? (It doesn't hurt, but it doesn't look very good.) How long do crowns last? How often do I need to see my hygienist? How do I know if I have gum disease? How do I prevent cavities? How should I choose oral care products? How often should I replace my toothbrush? What is the proper way to brush my teeth? How do I clean between teeth? What can I do for bad breath? What are oral irrigating devices? I have braces. How should I brush my teeth? Some questions about wisdom teeth, Snoring, and a child's first visit. Why are wisdom teeth removed even if they don't hurt? What can you do about snoring? How old should a child be when he visits the dentist for the first time? What do you do to ensure patient safety? Do you accept my insurance? Will I be charged if I miss an appointment? What are some of the different billing and payment options you provide? Do you have other questions? A list of some of the most common procedures. Caps, crowns, inlays, onlays… What's the difference?
These are all ways to fix or ‘restore’ a tooth that has been damaged by decay or fracture. Caps and crowns are two names for the same thing. Cap is an older term, and Crown is the more recent name for it. Generally, fillings are used to treat smaller decay, and crowns are used when the decay is larger, or the tooth is cracked or fractured. A crown fits perfectly over a tooth, like, say, a helmet, while inlays, and onlays fit into the tooth, sort of like a puzzle piece fitting into a very specific shaped hole. They are all made in a laboratory. This means that they are made from impressions taken of the tooth. To place these ‘restorations’, two visits are needed. At the first visit, the tooth is reshaped to provide room for the metal or porcelain that will cover the tooth, (we call this ‘preparing’ the tooth), the impression is taken, and a temporary restoration is made and placed over, on or in the tooth. This temporary ‘restoration’, is a plastic version of the final crown, which will insulate, and protect the tooth while the laboratory makes the final crown. Approximately 2 weeks later, at the second visit, the temporary is removed and the permanent restoration is placed.Which one of these restorations is used depends on how much of the tooth has been damaged and needs to be replaced. If the cavity is small, a filling works fine. Because we are a cosmetic practice, we use exclusively white fillings. Dr. Gates has not used silver fillings for almost 15 years. For cavities that are a little larger, the walls of the remaining tooth become too thin and weak, and risk further fracture. For that reason, an inlay, or a crown, which is made outside the mouth and cemented in place, will work better and last longer. If part of the remaining tooth structure is weak, then the metal or porcelain can be made to wrap around that part. (This is called ‘shoeing the cusp’.) This supports the weak section and prevents it from breaking. If only part of the tooth needs to be protected, then it is called an onlay. If the entire tooth needs to be covered, it is a crown. 
Crowns, inlays and onlays can be made from white material or gold. The white materials look beautiful. In fact, they are often invisible in the mouth; they look just like natural teeth.
Another technology available today allows the dentist to produce an inlay or onlay right in his office, without a technician, but rather with a computerized machine that mills a cube of porcelain into the desired shape. The advantage of this crown is that it requires only one visit, rather than two. We purchased this technology a number of years ago,  but found them less esthetic and satisfactory than the traditional gorgeous crowns our patients were used to, and we discontinued this service. Some other dentists love this procedure, but we simply didn’t feel it satisfied the needs of our patients.Under normal conditions, the healing process can take as little as 6 weeks. After this time, a crown, bridge, or denture is secured to the implant. We generally approach implants very conservatively, waiting a number of months for healing to take place in the bone before putting a crown in place. However, certain ideal situations lend themselves to placing the crown after a much shorter period of time. 
Are white fillings as good as silver?Yes. In some instances, they are even better. Silver fillings just fill the hole in the tooth. If the hole (cavity) is large or near an edge of the tooth, the walls that are left can be thin and weak. With repeated use, thin and weak parts of teeth will crack and break. White filings do more than just fill the hole. They actually bond to the tooth structure. In this way, they make the tooth stronger. These bonded fillings can prevent teeth from cracking, and if they already have cracks starting, can prevent them from getting worse. We are optimistic at this time that white fillings will last as long as silver fillings. The materials we now use have wear characteristics almost equal to silver. We have been using the current generation of white filling materials for many years, and they are doing beautifully. What's a root canal?Sounds scary doesn’t it? Well, it’s not. Of all the procedures in dentistry, perhaps none has been more maligned than root canal therapy. Maybe this is because someone always knows someone who had a bad experience. Yet, most of the time, when this procedure was uncomfortable, it was on a patient who had waited a long time to come to the dentist, and the condition was already very serious, and painful. Yet, root canal therapy is one of the best ways to save an infected tooth. It's the only alternative to taking out the tooth. In order to be more specific, it's necessary to understand a little about the structure of a tooth. Let’s give it a go. 
Every tooth has a hollow space inside. That space runs inside the tooth (the chamber) along its length right to the tip of the root (the canal). Inside that space is soft tissue (nerves, blood vessels, and other tissue) called the pulp, but often referred to as "the nerve". This tissue has a very limited ability to heal itself. When injured, either from trauma or from infection, the pulp usually dies. Tooth decay is a bacterial infection of the tooth, and when the decay gets close to the pulp, bacteria can enter the pulp chamber and infect that tissue inside. Did you follow that at all? 
Root canal therapy cleans that space, disinfects it, and fills it with a specific material used only in root canals. Following root canal therapy, as long as the tooth is properly restored, the tooth should last as long as any other tooth in the mouth.
Are silver amalgam fillings bad for your health?No, they are not. There are some people who think that silver fillings cause a variety of health problems. However, there have been a number of well-done studies over the years, looking at large groups of people. There are, after all, hundreds of millions of people who have silver fillings in their teeth. No link between silver fillings and health problems has ever been demonstrated in a well done, controlled study. A very small percentage of people are allergic to the material, and react to silver fillings much the same as people who can't wear certain kinds of jewelry or eat certain foods. In fact, most anything on this earth will produce an allergy in somebody –peanut butter, roses, cement, --I even know a fellow is allergic to sunlight. Bummer! What has been alleged is that silver fillings cause a variety of health ailments. This has never been shown to be true. I am sure that someone, somewhere, is allergic to silver fillings. I just have personally never seen or met one. Someday I hope to. I don’t recommend replacing fillings for health reasons because there is no real health benefit. If you don't like the way they look, or if you need a filling replaced for other reasons, there are really gorgeous alternatives to silver fillings. In fact, we use tooth colored fillings frequently because they work better than silver fillings in many situations and look so much more natural. I haven’t used silver filling material in about 15 years. If you have any questions or would like to discuss this issue further, feel free to speak to any of us.
How long does it take to fix a chipped front tooth? It doesn't hurt, but it doesn't look very good. 
You are correct to be worried about your chipped tooth. Even though you are not experiencing any pain, a chipped tooth can lead to significant health problems including infections and the possible loss of the tooth. The larger the chip, the more problems it causes.
How long do crowns last? 
Tough question. Crowns can last a very long time, depending on how well their owners treat them. I’ve seen crowns that were done in the 60s, and still looking pretty good. A few years ago, an 80 year old lady came to our office with a 60 year old gold inlay. Looked pretty good. Remember that a crown covers a living tooth. This means that the tooth is still susceptible to decay. Plaque can form at the bottom of the crown and decay can work its way under the crown. Gum disease can just worsen this problem. You gotta take good care of this dental work. The way to keep your crown as long as possible is to carefully brush and floss around the neck of the tooth at the gumline where the rim or edge of the crown meets the tooth. Getting periodic checkups helps make sure the crown, tooth and gum tissue around it stay in good shape, too. Insurance companies think they should last 5 years, since they’ll often help pay for a new one after those 5 years are up. Many people have crowns that have lasted 3 or 4 times that long.
How often do I need to see my hygienist?
Listen carefully to this. Of all the preventative things you can do, to keep your mouth in good condition, there is almost no preventative measure that you can take which is as effective and beneficial as your visit with the hygienist. It’s true! One of the best studies--a double blind study completed in 1987-- showed that effective maintenance against periodontal disease and decay required quarterly professional cleanings. A quarterly hygiene appointment for patients who have chronic periodontal problems is very common and highly recommended. 
But wait! Quarterly you say? Yes, but for patients with more stable periodontal health, cleanings every six months are recommended. Brush, and floss as often and thoroughly as you can. Yes, use the Sonicare toothbrush, and get rid of the sodas. Of course we recommend all of this. But even if you neglect these from time to time, DON’T neglect the one that makes the most difference. The hygienist getting the areas that you simply can’t get to yourself. With the previous information as a guideline, at the Center for Cosmetic and Family Dentistry, we recognize that each person is unique and we will let you know if your particular situation requires being seen on a different schedule. Usually we take x-rays once a year, and I personally examine your teeth. This includes examining your teeth, and gums, reading your x-rays, doing an oral cancer screening, and evaluating your general oral condition.
How do I know if I have gum disease?Gum disease is present in over 75% of adults. The classic signs of gum disease are red, tender, puffy, or bleeding gums, or bad breath. Healthy gums do not bleed when you brush your teeth, even at the gumline. Smokers are often fooled because the nicotine in cigarettes significantly reduces blood flow, and the absence of bleeding is mistaken for a healthy condition. Gum disease is treatable and preventable, but the worse it gets before treatment begins, the harder it is to treat and the greater the likelihood it will result in tooth loss. The best plan of action is regular professional tooth cleanings and examinations.
How do I prevent cavities?You can help prevent cavities by following these tips: 
How should I choose oral care products?We recommend two products in particular. One is Oxyfresh mouth rinse. We don’t much recommend the mouth rinses on the market. Oxyfresh has a magic ingredient called chlorine dioxide, which is much more gentle, and frankly much more effective in reducing bad breath, and in keeping your mouth very clean. It’s available at our office. The other product we strongly recommend is a Sonicare toothbrush. We’ve looked closely at most of those available, and Sonicare distinguishes itself, because it has the ability to get deeper below the gums than any other power toothbrush. These are also available in our office.
How often should I replace my toothbrush?
Treat yourself to a new toothbrush every three to four months, or sooner if the bristles become worn, splayed or frayed. Most toothbrushes that are sold today are medium or soft bristled. This prevents the bristles from irritating the gums. A hard, brittle brush can injure your gums. Children's brushes may need to be replaced more often, as they can wear them out more quickly because they seem to chew on them. . If you are using the Sonicare Tooth brush, which we recommend, you should be changing the head about every six months. New heads are available in our office when you come in for your hygiene appointment.
What is the proper way to brush my teeth? Thorough brushing twice a day, and cleaning between the teeth daily with floss or other interdental cleaners, removes plaque. Keep these tips in mind when brushing your teeth.
How do I clean between teeth?
Floss and other interdental cleaners remove plaque from between the teeth and under the gumline, areas where the toothbrush can't reach. If you haven't been in the habit, it's never too late to start.
What can you do for bad breath?Chronic bad breath is a problem for over 90 million people. Typically, halitosis is caused by poor oral hygiene that leaves decaying food particles and bacteria in the mouth. Or, it may be due to gum disease and tooth decay. In either case, decay and debris produce sulfur compounds just like the kind found in rotten eggs, resulting in foul-smelling breath. Although many people try breath mints, over-the-counter mouth rinses or sugar-free gum as a means of controlling bad breath, these products only temporarily relieve the symptoms without treating the cause. Instead, the first step in controlling bad breath is to practice good oral hygiene: twice daily brushing, daily flossing, and tongue cleaning. We’ll review your home care to make sure that all sources of bacteria are controlled, from brushing and flossing techniques In fact, a plastic tool called a tongue scraper will actually allow you to clean away bacterial build-up on your tongue and significantly alleviate odor. Even better is to use the Sonicare toothbrush, right on the tongue, to vibrate away all the bacteria. And good hygiene must include regular dental check-ups, since professional cleanings do a much more thorough job of eliminating bacteria and plaque build-up. A second step to note, is that if you have dentures or a removable retainer or mouth-guard, you must also practice excellent hygiene each time you remove the appliance, cleaning it thoroughly and according to proper instructions. Third is making sure your mouth is free from infection (decay and gum disease are infections). Periodontal disease will certainly create a bad smell but is much more serious than just the smell because periodontal disease breaks down and eventually erodes the bone. Less commonly, bad breath may result from a systemic problem such as a sinus infection, digestive disorder, diabetes, kidney failure, or liver malfunction. In these cases, we’ll refer you for a medical consultation. Radiation treatment for cancer may produce a dry mouth that leads to halitosis, as well. And several simple, non-medical conditions can occasionally have a temporarily negative effect on your breath: stress, dieting, snoring, advancing age, and hormonal changes. Regardless of the source, it's important to realize that bad breath is treatable and take steps to correct it. We do see some few people who have bad breath for none of these reasons. In those cases, it's the type of bacteria that normally reside in their mouth that is producing the odor. For those patients, there Oxyfresh, a rinse we have available at the office, to neutralize the compounds that you smell.
What are oral irrigating devices?
Oral irrigating devices use a stream of water or a stream of water with special ingredients in it, to remove food particles from around the teeth. They are meant to be used as an aid and not to replace regular brushing or cleaning between the teeth with floss or interdental cleaners. Oral irrigators are helpful for people who have braces or fixed partial dentures.
I have braces. How should I brush my teeth?
Wearing braces means you must care for your teeth better than ever before. Due to their design, braces trap food particles on your teeth where plaque can start building. Cleaning those small, tight areas under and around your braces means brushing and flossing carefully after every meal. After you’re done, carefully check your braces and teeth in a mirror to make sure they are clean.We recommend that patients with braces use additional brushing aids such as a ‘power flosser’ and a waterpik. Your orthodontist will also work carefully with you to instruct you on maintenance of your teeth while in braces. Our hygienists will take care of you very diligently while you’re wearing braces.
Why are wisdom teeth removed even if they don't hurt?Many times there are no symptoms of wisdom tooth trouble. But x-rays may show us that there is the potential for a serious problem, or that other teeth in your mouth may be at risk for damage. Look at it this way. Suppose your wisdom teeth are putting the 2nd molars (the teeth right in front of the wisdom teeth) at risk for decay. It would be a real shame for the 2nd molars to be jeopardized because of the wisdom teeth, which are quite a bit less valuable than the 2nd molars. About 28 percent of wisdom teeth are impacted because the jaw is not big enough to accommodate them. Here’s another problem. These impacted wisdom teeth may grow sideways, break part way through the gum, or remain trapped beneath the gum and bone. Bacteria and food can lodge under the flap of gum over the partially erupted tooth, causing infection in the gum. A cyst can form around the crown of the tooth and destroy the surrounding bone or neighboring teeth. Because of their position, wisdom teeth are difficult to clean and are often victims of decay. The results of extensive orthodontic treatment can be ruined if your wisdom teeth crowd adjacent teeth, causing them to shift position. Again, we’d rather let them go than have them wreck something else in the mouth. If we spot a potential problem, we may recommend removing the wisdom tooth, even before it is fully developed. It is easier to remove wisdom teeth at an early stage because the roots are not fully formed or strongly planted in the jaw. This means that the sooner your wisdom teeth are removed, the easier the procedure and the smaller your risk of complications. Maybe you already know that you have a problem. Perhaps the area behind your last tooth is sore from time to time. Please let us know right away if you have any obvious problems with your wisdom teeth. But you can rely on our expertise to diagnose existing or potential problems caused by your wisdom teeth, whether you have symptoms or not. You can be sure that we won’t recommend tying a string around it, and tying the end of the string to the door handle.
What can you do about snoring?Quite a bit, actually. There are dental devices that can help reduce or eliminate snoring. Here’s basically how the snoring problem works. When you sleep, your muscles relax. When the tongue relaxes, it can drop back very near the back wall of the throat. This is the space air passes through when you breathe. During inhalation, the air is drawn past that narrowed passageway. Just like the air that rushes out of a balloon when you let it go, the back of the tongue and the soft palate will vibrate. This vibration causes the sound we call snoring. If the tongue gets very close to the back of the throat or actually touches it, the suction caused when you inhale will suck the airway closed; no air can get by. Breathing stops. After several seconds, an alarm goes off in the brain and you are aroused from deep sleep, which restores the muscle tone, and the tongue is pulled forward, opening the airway. There is usually a gasp with the first breath, then a relaxation back to sleep. The sleeper is unaware of what happened. This is called obstructive sleep apnea or OSA. This is a very dangerous condition. There have been numerous studies linking OSA with serious medical conditions such as stroke, high blood pressure, heart attacks, and others. 
There are specific dental devices that can help snoring and OSA. They are worn in the mouth like a mouthguard or night guard. When you bite into it, the appliance causes the lower jaw to be positioned forward. This causes the tongue to come forward, away from the back of the throat, thereby opening the airway. This is so much simpler than the alternative treatments that involve a facemask-like device, and a tube to a machine with pressurized airflow, and a whole lot simpler than surgery to the tongue, throat, or palate. Good grief.
How old should a child be when he visits the dentist for the first time? Your child's first visit to the dentist should be made after the first teeth erupt and before the first birthday. Tooth decay may appear as soon as just after the eruption of the very first tooth. We recommend that parents bring their children to their own hygiene visit, and the child can watch as the hygienist cleans their teeth. Then they become familiar with the mirror, the water spray, and the camera that shows the teeth. We’ll let them ride in the chair, and hold the various tools and instruments. Soon, they’ll want to have their own teeth cleaned too. This will also give us a chance to peek into their mouths, and see if everything looks okay. As parents you should prepare your child before the dental visit to understand what will happen there. It is important that you do not transfer your anxieties or ANY anxieties about the dentist to your child. It is unfortunate that often, the parents in their desire to protect their children, will be the vary source of causing their children anxiety, by talking about ‘hurt’ ‘pain’ ‘shot’. These discussions are very counterproductive, since most experiences at the dentist will actually be happy, good tasting, and fun for a child. We promise not to make them anxious about being there, if you won’t. During this early visit your dentist will:
What do you to ensure patient safety?We employ rigorous sterilization and patient protection procedures. We comply with all the government and professional agencies and organizations that regulate this area. We not only meet these recommendations and requirements, but we take that extra step. We always wear gloves, we use disposable supplies whenever possible, and steam/heat sterilize (autoclave) all instruments and handpieces. We take advantage of continuing education courses and professional publications to stay up-to-date in this ever-changing field. This is consistent with our goal of maintaining a 'state-of-the-art' dental practice in all regards. Our primary concern is the health and safety of our patients and staff. If you have any questions or concerns, please feel free to discuss them with any member of our staff. We’ll even give you a tour of our sterilization area, and you can see the procedures in action. Sounds exciting, right?
Do you accept my insurance?Regarding insurance plans, there are three levels of participation. 
On the other hand, if your plan has a list, but gives you the option of seeing a dentist not on the list, then there will certainly be a benefit for any treatment we perform for you. The level of benefit will depend on the specifics of the plan. We can provide you with that information if you tell us the name of the plan. If you have a traditional insurance plan where there is no list, then the benefits will be spelled out in your plan documents. We can help you determine what the benefit is for any course of treatment. As special service, we will also, send in for your insurance, to get you the maximum benefit possible. The terms of these contracts determine whether or not it makes sense for us to sign on. An indication of the quality of the plan is the number of offices on the list. We cannot provide the quality of care that we dedicate ourselves to within the constraints of many insurance plans. We are very selective as to the plans we contract with. Regardless of your plan or the level of coverage, you can be sure we will do our very best for you. We have only one level of care. If you are not yet a patient, give us a call and we can help you determine the level of insurance benefit you can obtain for treatment we perform. Come in and meet us, and see why many of our patients stay with us even if they might have less out of pocket expense somewhere else.
Will I be charged if I miss an appointment?Appointment time is reserved just for you. We don’t overbook, and with the exception of patients who call us with emergencies, we schedule each individual patient to have our undivided attention. Missed appointments or last minute cancellations leave us with insufficient notice to offer that time to a patient who has been waiting to see us. However, we do realize that things happen. People get sick, cars break down, situations arise that interfere with your ability to keep your appointment. This should happen rarely, however. We do have a quick call service for those who have difficulty determining, in advance, when they might be available for dental appointments. We do not charge for missed appointments, but we will not continue to reappoint patients who frequently fail to keep their appointments. We don’t run late very often, and we will be very respectful of your time. We recognize that you could go to any number of dentists for your treatment and we very much appreciate you choosing our office. Many of our patients tell us the treatment is so exquisite, the esthetics so beautiful, and the service so superior to their previous experiences, that they wouldn’t go anywhere else. We think you’ll agree. So, we’ll be very respectful of your time, and we ask that you be very respectful of ours.
What are some of the different billing and payment options you provide?
We do request that patients pay their fee at the time of service unless prior arrangements have been made with our Kim, financial coordinator. For your convenience, we do accept Master Card, Visa, American Express, and Discover credit cards, as well as cash and personal checks.If you have a large treatment plan and wish to make monthly payments, we do offer a payment plan. Kim, will be happy to discuss the details with you. If you have dental insurance and wish the benefits to be sent to this office, please bring insurance information (card, form, or other identification) with you to your first appointment. We can now estimate, in advance, what the anticipated insurance benefit will be. We will process and submit all insurance forms and accept assignment of benefits directly from those insurance companies who offer that option. When this assignment applies, patients are only requested to pay their deductible and co-pay at the time of service.
Do you have other questions?If you have other dental questions, please e-mail me at atlantisdds@lvcm.com and I’ll answer any of your other questions. In fact, if you have other questions you think should be on our website, let me know, and I’ll add them in.
Here is list of some of the most common procedures we perform for you:New Patients
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