Frequently Asked Questions

How often should I see a dentist?

There is no standardized answer to this. However, we recommend most people to visit the dentist twice per year.  Prevention must play a great role in the oral health care of the individual.  Fixing a defect, or cavity early on prevents further pain and complication down the road.  Another important reason we recommend frequent dental visits is because most cavities, restorative defects, gum disease, and even oral cancers are silent in the beginning.

What kind of toothbrush should I use?

We recommend our patient use only soft or ultra-soft toothbrushes. When it comes to effective cleaning of your teeth, the stiffness of the bristles of a toothbrush is not as important as the proper brushing technique.   In fact, medium and hard bristles can damage the lining of the gums and cause recession, and even damage the root surface at the gumline.  we don’t recommend the use of medium or hard toothbrushes for anyone.  But speak to your dentist about this important topic prior to switching or investing in a toothbrush. We understand ultra-soft brushes are not easy to find on the supermarket shelves, so we provide them for our patients twice per year after their cleaning appointments.

What is the best electric toothbrush?

The assortment of toothbrushes is sometimes a blessing, and sometimes a source of confusion.  I recommend you look for the ADA seal on the product whether it is a manual brush, or electric. It is true that if used properly, an electric toothbrush can be very effective in removing plaque.  An electric brush can be of great help specially for those of us who have diminished fine motor skills, and reduced hand dexterity.

But which one should you get? All the brushes I see with ADA seal on them can and will do the job if you brush properly. Use gentle, circular, light handed movement on all surfaces. This movement is awkward. But from what we have observed, it tends to put less pressure on the gums, and wearing of the thin enamel at gumline is also greatly reduced. Try to avoid brushing back and forth in straight liens. They will all do the job just fine as long as you brush gently, thoroughly, and with a light hand pressure.

What are some tips for proper brushing of teeth?

Manual toothbrush- use circular motion to move the brush tip gently over an area several times prior to moving on to the next spot.  Do not apply heavy hand, but just enough pressure to remove the soft film on your teeth.  Do not brush in a straight line.  This seems to be the default mode of brushing for most, but we don’t recommend this technique.  Spend 30 seconds on each quadrant.  30 seconds upper right, 30 seconds upper left, 30 seconds lower left, and 30 seconds lower right. 

Electric toothbrush- circular movement just as in the case of a manual toothbrush, but much slower in movement speed, and with reduced hand pressure.  Allow the moving brush head to do the job. The bristles of an electric brush may be medium or hard.  Therefore, do not press hard or use vigorous movement with these brushes. 

Why is it important to floss?

Our teeth have 5 sides; cheek side, tongue side, top of the tooth, front, and back.  Brushing can only get to the tongue side, cheek side, and top of the tooth.  We are not able to brush front or back side of the tooth in most cases because they are blocked by other teeth.  The food caught between the teeth and the plaque that accumulates causes gums to inflame, causing gum bleeding.  Food debris caught between the teeth causes cavities to form on these surfaces.  Floss once or twice per day.

What is the proper way to floss?

Place the floss between the teeth, then wrap the floss around one of the teeth making a C-shape around the tooth.  Move the floss up, and out.  Place the floss in the same spot, and wrap it around the other tooth like a C, and move up and out. Repeat this with each contact area. 

What is causing my tooth sensitivity?

When speaking of sensitivity, we are often referring to temperature sensitivity.  There are many factors that causes a tooth to react to temperature.  These are some of the commons causes of tooth sensitivity:

  • Receding gumline- This exposes the root surfaces, which have less insulation against temperature than top of the tooth.
  • Fracture lines or cracked enamel- enamel acts like a physical protective barrier over the dentin. Dentin is the inner layer of the tooth and is the sensitive part of the tooth. Without enamel, dentin will react to sweets, cold and hot temperature changes. 
  • Grinding and clenching- This common phenomenon will cause wearing away of enamel, and in some cases fracture of enamel. Areas where enamel is thin, or missing will experience temperature sensitivity.  The effect of grinding is often noted at the gumline, facing the cheeks. 
  • Leaky fillings- This may happen when a filling is cracked, or the edges of filling are pealing off which allow temperature to reach dentin, the sensitive inner layer.
  • Cavities- a lot of the time cavities present no symptoms. But because they damage tooth structure which insulate a tooth, they can make the tooth sensitive to cold, hot, or sweets. 
  • Deep fillings- when treating a cavity that is deep, and close to the nerve, the newly placed filling may cause sensitivity to cold, or hot temperatures. This typically can last days to even months.  Although this condition typically will improve over time, it is important to notify the dentist of any changes.
  • Acid attack- acid reflux, or high acidic diet will eventually cause thinning of enamel in certain spots and this will lead to tooth sensitivity.
What are some remedies for bad breath?

Bad breath, which is also known as halitosis is usually the result of microbial deposits on the tongue, and around teeth which break down food debris and sugars and create compounds causing the bad breath.  Not all forms of bad breath are a sign of pathology, but some are.  Morning bad breath that dissipates as the day goes by are caused by the normal oral flora.  Due to reduced saliva flow at nights, the byproduct of bacterial decomposition does not get washed away and it accumulates causing bad breath.  As salivary flow increases throughout the morning, bad breath also decreases.  In these cases, use antimicrobial mouthwash after brushing and flossing in the mornings.  Since the tongue is a large depository for bacteria, make sure the top of the tongue is brushed also.  Other sources of bad breath that linger may be more serious.  This may indicate the presence of gum disease or periodontitis.  This condition must be evaluated by a dentist and proper cleaning prescribed to treat it correctly.  There may also be a localized or generalized infection in the gums.  This is not going to go away with mouthwash.   Sometimes, the source of chronic bad breath may be a faulty restoration such as a decayed filling, or crown.  This will require replacement or repair of the affected teeth. 

How to treat tooth sensitivity at home?

There are many factors which may make a tooth sensitive. The question is formulated in this list as such because I’m aware of how it is normally asked over the internet.  But in my opinion, the real question is “should I treat my tooth sensitivity at home?”  It is not a good idea. Because to treat a tooth sensitivity properly, it is important to find the reason for the sensitivity first.  This can be a challenge even for dentists.  Self-diagnosis at home is not recommended. Depending on the reason, the treatment will be different. Sometimes the treatment may be changing a toothpaste.  At times, if there is a physical defect, it may mean restorative approach.  Do not self-diagnose this condition.  There are over the counter products that could address very specific reasons behind a tooth sensitivity.  But may not be adequate or even appropriate for many other reasons for tooth sensitivity.  I strongly suggest speaking to a dentist in person about this, as this could be a sign of an underlying condition which may worsen if not treated.  Sometimes the reason for sensitivity is simple.  We may simply advise the patient to use over the counter toothpastes containing potassium nitrate, an inorganic salt which is shown to reduce tooth sensitivity.  We then advise them to reduce the intake of acidic foods and drinks.  At times, this is all that is needed to reduce or eliminate tooth sensitivity.  But this only works, if the underlying conditions are properly diagnosed.  There are more serious conditions that give rise to these same symptoms, and cannot be treated by the use of a simple toothpaste.

Is there anything I can do for my dental anxiety?

Dental anxiety is very common.  The importance of addressing this issue may mean the difference between a healthy oral cavity, and down right neglect of oral health by the anxious patient due to fear.  The best remedy for this condition is complex and multifactorial.  Before resorting to medication, dentist must take his or her time addressing the source of anxiety in a patient.  Getting to know the patient, and allowing the patient time to get to know the dentist, and their oral conditions.  Conservative approach to treatment is a tremendous relief to an anxious patient, in our experience.  Explaining the areas that need treatment, and explaining the nature of treatment in a simple manner is very helpful.  Starting with a simple and short procedure to help the patient be familiar with the dentist and the style of dentistry, and employing a light-handed approach with a gentle demeanor are a must.  If it is noted that more needs to be done to ease the patient’s anxiety, certain drugs are available, including nitrous oxide.

How do I get my teeth whiter?

First, speak to your dentist about this important topic prior to whitening your teeth.  You may have fillings or crowns on your front teeth that will not get whiter with bleaching.  If you know for sure you don’t have visible fillings, or crowns on your front teeth, and you have no history of sensitivity, then over the counter whitening kits are a good option.  Limiting some foods that tend to increase staining is important as well.  Foods such as red wine, sodas, coffee may stain your teeth.  You may also use whitening toothpaste which may help remove some of the stains on your teeth that are causing your teeth to look darker. But as always, we ask that you discuss this with your dentist.  Sometimes the shade of a tooth has less to do with surface stains, and more to do with internal structure of the tooth.  Intrinsic stains do not respond to external whitening.  Generally, teeth with a gray shade will respond poorly to bleaching.  In cases which staining is internal, or due to aged restoration, it may be necessary to use composites, or porcelains to improve the shade of your teeth.  At our office we use take home whitening kits.  These kits have been effective and affords the patient more flexibility in the process. 

At what age should I take my child to the dentist?

We recommend that your child see a dentist as soon as the first teeth erupt.  Now, this does not mean they will need X-rays, or dental work.  But it slowly and gently introduces the child to his or her dentist and familiarizes them with that environment helping to alleviate future fears and anxieties.  Also, early detection of problems is the best way to ensure a healthy oral cavity for your child, and generally less dental work as they grow.

When do the baby teeth fall out?

Usually baby teeth will begin this process around the ages of 6-8.  They will usually fall out in the same order as they erupted.

Why is it important to replace missing teeth, and what options do I have to replace missing teeth?

It is important to replace missing teeth not only to restore function, but also esthetic. Another reason for replacement is to prevent future complications with bite, and shifting of the teeth.  Over time, due to available spacing caused by missing teeth, the remaining teeth may drift and this will cause gaps between teeth.  This will also increase the risk of gum problems.  We have noted that often times when one or more teeth are missing, patients will favor the side of the mouth with less gaps between teeth for chewing.  This increased workload can cause further deterioration of the teeth on the side that patient uses more often.

Options to replace missing teeth:

  • Implants- in most cases this is by far the best option. It may not be the option for every single case.  Implants act like natural teeth.  They can be flossed like a natural tooth.  They do not move or shift.  They last a long time, and restore function and esthetics very well.  But there are certain bone conditions, and underlying health conditions which may not make this option ideal.  Speak to your dentist about implants.
  • Bridge- a bridge is like a crown, but with multiple crowns fused together back to back. A bridge is a fixed prosthesis that is cemented in place like a crown and does not move.  However, they require flossing under the bridge to remove debris, and it requires prepping of abutment (supporting) teeth in order to fit properly.
  • Dentures- these are removable prosthetics that replace one or all teeth using the same appliance. They are more economical, and have helped patients for decades.  But due to their movable, unfixed nature, they are not ideal treatment for everyone.

Leaving the space open/nor replacing the missing tooth is certainly an option.  But as we discussed, this can lead to shifting of teeth, gaps between teeth, gum problems, and possible premature wear of existing teeth.

What are some of the symptoms of early dental problems?
  • Mouth ulcers, or sores
  • Pain in the facial muscles, jaw, teeth, gums.
  • Swelling of face or gums.
  • Bleeding gums
  • Chronic bad breath
  • Dry mouth
  • Tooth sensitivity to temperature
  • Tooth pain when chewing, or pressure
  • White spots, or red lesions in the mouth
  • Sudden shade change noted on one tooth

Please note, many of other oral conditions do not have any symptoms. This is why it is important to see a dentist regularly.

Are dental X-rays safe, and why we need them?
This is one of the most common concerns of patients that we encounter regularly.  Why do we need X-rays? Without X-rays, we simply cannot see every aspect of the tooth, and certainly not the roots.  By looking at a tooth we cannot see the contact areas of the tooth.  We also would not be able to examine the deep structures under the gums. But how safe are they? A dental radiograph by itself, requires only a small amount of radiation.  8 radiographs taken once per year, do not expose the patient to high radiation amounts.  But we should not think of dental X-rays in isolation from other sources of radiation.  We must consider if patient has been exposed to other forms of radiation that year.  Have they undergone medical scans or therapy which have exposed them to larger than usual amounts of radiation? If so, we have to find a way to reduce dental radiation, and be selective with areas to be radiographed.  And at times, we have to postpone X-rays all together for some time.
Can pregnancy affect my teeth?

This topic is a complicated topic because not only can pregnancy affect the teeth, but bad oral health can affect the pregnancy as well. Due to acid reflux during later stages of pregnancy, acid erosion of enamel is common.  This can lead to severe sensitivity and require restorative intervention to repair the affected enamel.  Many women also experience inflammation of the gums during pregnancy which is commonly known as pregnancy gingivitis.  This can advance into a more advanced form of gum disease called periodontitis.  This is where gum infection affects the bone and attachment fibers under the gums, causing more bleeding, swelling, redness of the gums, and even pain.

How can periodontitis affect the pregnancy?

Periodontitis has been shown to be a risk factor for preterm birth.  According to the results of the studies, it is recommended that periodontitis be brought under control by the dentist and periodontist prior to and during pregnancy.  This requires good communication between dentist and patient so that appropriate evaluation and treatment plan can be designed and implemented.

What do you do if your tooth gets knocked out?
  • Do not scrub the tooth, the tissue on the root is important in the success of re-implantation
  • Rinse the tooth with lukewarm water gently.
  • Place the tooth in the mouth between your cheek and gum.
  • Place in milk, if placement in the mouth is not possible.
  • See a dentist promptly. The chance of successful re-implantation decreases with time. Your goal should be 30 minutes, but do not panic if this is unrealistic due to traffic or car trouble.
  • The dentist will evaluate the surface, clean the socket gently, and place the tooth back in. Once in place, the dentist will splint the tooth to the neighboring teeth to stabilize it. 
  • Splinting will need to stay for at least 4-6 weeks.
  • Usually the successfully re-implanted tooth will need a root canal after it is healed.
If I have no pain, does this mean I have no cavities?

The presence of cavities does not cause pain, at least in the beginning.  Most cavities occur between teeth where they can’t be visualized or felt. This is why a full exam using X-rays is vital.  If cavities are detected early enough, when they are still on the outer part of the enamel, they may be treated by means other than fillings.  Fluoride use at home, good brushing and flossing, and restricting sugar and acidic food intake can help these spots remineralize.  We employ this approach at our office routinely.  We don’t always get the results we hope for, but we have seen many small cavities mineralize this way.  For this strategy to work, early detection is very important.  For this, X-rays are needed. 

Are silver/amalgam fillings bad for your health?

These fillings contain a mixture of metals, including mercury.  The mercury is bound in the metal alloy and only small amounts of vapor is released if the filling is intact.  Studies have shown amalgam to be safe, but this is an area of ongoing research.  The presence of mercury vapor is a concern and for this reason we only recommend tooth-colored fillings.  Removal of silver fillings will release more vapor and must be done under controlled parameters. 

Over the last few decades, we have seen great improvements made to the properties of the tooth-colored filling material. Even though tooth-colored materials still need more improvements, we no longer see a justification for the use of silver fillings at our office.

 

Why is one of my teeth turning gray?

Most often, when one tooth turns gray, or discolors, and this is not attributable to staining, trauma is suspected.  Past traumatic injuries to face which involve the front teeth may have caused irreversible damage to the pulp tissue inside the tooth.  These teeth may display no symptoms for months or even years after the incident. Typically, once verified by clinical examination and radiographic examination that the pulp tissue is dead, these teeth are treatment planned for root canal to remove the dead tissue inside the tooth and subsequent placement of a tooth colored crown to restore esthetics.  Other times, extraction followed by implant restoration or bridge restoration may be more appropriate.

ttings.

Dr. Edwin Y. Josephs, DDS

Phone

(209) 529-6995

Email

josephsdentistry@gmail.com

Address

1213 Coffee Road, Suite J
Modesto, CA 95355
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Hours

Mon - Wed: 7:00am - 4:30pm
Thu - Fri: 7:00am - 2:00pm