FAQ (Frequently Asked Questions)

Why are my teeth sensitive?



Tooth sensitivity can affect one or more teeth. It’s most common when you eat or drink something hot, cold, sweet or sour. Sometimes a breath of cold air can set it off. Sensitive teeth often come from the fact that your gums have slightly receded over time. This recession of the gum line allows the underlying dentin to show through which allows water and food easier access to the sensitive nerve. To manage this, there are a number of toothpastes, gels and even some dental procedures that can be applied. Speak to us in more detail if you have very sensitive teeth.


What is tooth decay and how to prevent tooth decay?

Tooth decay is damage that occurs when bacteria in the mouth make acids that eat away at the enamel of a tooth. This can cause a hole in the tooth called a cavity. If it isn’t treated, tooth decay can cause infection, pain and loss of the tooth. Great teeth and gum care start at home. Brushing and flossing on a daily basis is the best way to take care of your teeth and gums on a continual basis.   By keeping to a daily routine you will greatly minimize the risk of gingivitis or tooth decay as you age.


What is gingivitis and how do I prevent it?

Gingivitis is a condition caused when bacteria surrounds the teeth and enters the gums.  The gums can become irritated, inflamed and often bleed.  In order to prevent the condition from worsening, regular hygiene visits are highly recommended.  During your visit, our team will teach you the proper flossing techniques and oral hygiene protocol for home care, which will help prevent the periodontal disease.


What is periodontal disease?

Periodontal Disease is a quiet disease that begins with little or no symptoms.  When gingivitis is not treated, it can advance to periodontitis (inflammation around the tooth). In periodontitis, gums pull away from the teeth and form spaces called pockets that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not properly treated, the condition worsens.  Noticeable symptoms listed below may appear:

  • Tooth Pain
  • Bad Breath
  • Gum Recession
  • Gum Sensitivity to Acidic Foods
  • Abscesses
  • Tooth Loss

How do you treat periodontal disease?

Periodontal Disease is a chronic condition that needs immediate attention.  The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the periodontal disease. Any type of treatment requires that the patient keeps up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.


Deep Cleaning (Scaling and Root Planing)

The dentist removes the plaque through a deep cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line, and root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.


Will I need any medications?

Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist may still suggest surgical treatment.


What is the difference between white and silver fillings?

Dental amalgam is a mixture of metals, consisting of liquid mercury and a powdered alloy composed of silver, tin and copper. Approximately 50% of dental amalgam is elemental mercury by weight. Dental amalgam fillings are also known as silver fillings because of their silver-like appearance. Silver fillings have been around for decades and are the best restoration for fillings because metal expands and contracts with the heat and cold places in the mouth, which may lead to cracks in the teeth.

White fillings, also known as composites, are often made of plastic or glass polymers. These cosmetic fillings allow us to fill a cavity with a substance that will look and feel just like your existing tooth structure.  This restoration is created with a resin material which bonds into a tooth to prevent decay.  Rather than a gray or silver material in your mouth, the composite color will match the tooth color.


How can I improve my smile?

There are several ways to enhance your smile such as:

  • Tooth Whitening
  • Bonding
  • Porcelain Veneers
  • Porcelain Crowns
  • Invisalign

Our office has the expertise and state of the art technology and materials to perform each technique and procedure. Please contact our office to arrange a time to conduct a thorough evaluation of your concerns and develop an individualized treatment plan. A short summary of each procedure is provided in the patient FAQs section.


What is whitening?

Whitening your teeth is a cost effective and safe procedure to create a beautiful and healthy smile.  The whitening gel’s active ingredient is hydrogen peroxide. As the hydrogen peroxide is broken down, oxygen enters the enamel and dentin, bleaching colored substances while leaving the structure of the tooth unchanged. The zoom-in office whitening lamp helps to activate the hydrogen peroxide and penetrate the surface of the tooth.

Over the years fluoride has been added to the whitening product as well, reducing the risk of tooth and gum sensitivity. The whitening process must be monitored by the dentist and only done after a comprehensive exam and hygiene cleaning. This procedure can last for a number of years if maintained properly.  Beverages such as coffee, tea, cola and wine will reduce the lasting effect.  Remember, if it could stain a white dress, it will stain your smile!


What is bonding?

Bonding is a cost effective procedure used to fill gaps in front teeth and to change a tooth’s color.  The immediate results are amazing.  Within a few hours, you will have a great smile!  Bonding, like tooth whitening, may change color over time due to coffee, tea, cola and wine.


What are porcelain veneers?

Porcelain veneers are thin pieces of porcelain that go directly on your natural teeth. This entire procedure can take as few visits.  Veneers change the size, shape and color of a patient’s teeth. 

This procedure is used to repair fractured teeth, teeth darkened by age or medication, or a crooked smile.

Veneers can be an excellent way of improving the appearance of teeth. The dentist uses a thin tooth-colored shell in order to cover the natural tooth. If your tooth is chipped, cracked, stained or uneven you should consider having veneers. They can also be used to close large gaps between the teeth. Veneers look great especially if done correctly and patients ask for porcelain veneers to simply feel and look younger with a straighter whiter smile, but this should only be done after careful consideration of all options since it will permanently change your smile.

There are two main types of veneers: composite resin and porcelain veneers. A porcelain veneer is generally the most sought after because it will outlast composite resin varieties. Porcelain veneers are usually the perfect choice because these are stain resistant, and they typically last much longer and do a much better job matching the teeth’s natural color. The veneers are typically produced by one of our trusted and professional dental laboratories. You may get temporary veneers while waiting for the permanent one. Resin veneers are less resistant to stain, but they may be the better option in some cases as they are less expensive and usually created inside the dental office, and so, may be applied sooner.

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What are dental crowns?

A crown is a cap that is shaped like a tooth and placed over your own existing tooth or teeth to cover and restore its size and shape, improve its overall look and to make your tooth stronger. When we cement the crown into place it will fully encase the whole visible portion of your tooth that lies at or above the gum line.  This can help protect a damaged tooth, bring back its beauty and give you the confidence to smile again.


Why may a crown be needed?

  • To protect a weak tooth from breaking and tooth decay.
  • To restore a broken and worn tooth or address “cracked tooth syndrome”.
  • To provide support and to cover teeth with large fillings.
  • To hold a dental bridge into place.
  • To hide or cover discolored or misshapen teeth.
  • To cover a dental implant.

Can crowns be placed in children?

For most children a dental crown can be used on primary baby teeth to:

  • Save a damaged tooth, and then hold the space so the permanent tooth can erupt.
  • Protect the child’s teeth if they are at high risk of tooth decay, especially if the child is experiencing difficulty in keeping up a good oral hygiene.

What are different types of crowns?

  • Permanent crowns – this type of crown can be made from different materials like stainless steel, ceramic, porcelain-fused-to-metal (PFM crown or cast crowns), metals like gold or some other alloy.
  • Temporary crowns – temporary crowns are usually made from different materials like stainless steel or acrylic. This can be used as a temporary tooth restoration.

What are bridges?

Bridges literally bridge the gap that is created by your missing teeth and are one of the most common types of treatments to improve your smile. A bridge is actually made up of 2 crowns for your teeth on the gap’s either side.  Bridges can correct the alignment of your teeth and may reduce the stress on surrounding teeth.


When are Bridges Required?

There are a variety of situations that may require you to have a dental bridge. This may be due to clinical or cosmetic reasons including:

  • Allowing you to speak and chew properly.
  • Maintaining the natural shape of your face.
  • Preventing your remaining teeth from drifting out of alignment.
  • Overall improvement of your beautiful smile.

What are the different types of bridges?

Bridges are made from different materials including metal and porcelain, as well as some stronger materials including alumina and zirconia. The three mostly used bridges these days include the following:

  • Traditional Bridge – This is considered as the most popular type of

    bridge that is mostly made from ceramics, or porcelain, and fused metal.

  • Maryland Bonded Bridges – also known as a Maryland Bridge of resin-bonded bridge, these

    are made of plastic gums and teeth, which are supported by a metal framework.

  • Cantilever bridges – these are used once there are teeth that are adjacent on just one side

    of the loss tooth/teeth.


What is an endodontic treatment or root canal treatment?

Endodontic treatment may be necessary when underlying layers of the tooth become inflamed or infected, and left untreated, pain or an abscess may result, but in order to understand endodontic treatment, it helps to know something about the anatomy of a tooth. A tooth has several layers. The outside layer of a tooth is composed of a hard layer called enamel and beneath the enamel is an inner layer called dentin, which has at its center a soft tissue known as the pulp. The pulp contains blood vessels, nerves, and connective tissue, and it creates the surrounding hard tissues of the tooth during development. The pulp receives its nourishment supply from vessels that enter the tooth at the end of the root. It is this layer that becomes inflamed and/or infected. Although the pulp is important during the development of the tooth, it is not necessary for the functioning of the tooth. A tooth continues to be nourished by the tissues surrounding it, even after the pulp is removed. Simply put, endodontic treatments can save natural tooth structure by removing this pulp instead of the entire tooth.

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Why would I need endodontic treatment?

Endodontic treatment is necessary when the pulp becomes inflamed and/or infected. The most common causes include deep cavities (cavities or decay), repeated dental procedures and cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the to an abscess. Common indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, tenderness upon biting or chewing and swelling of adjacent gums. Sometimes there are no symptoms but may be discovered during an exam.


Will I feel pain during or after a root canal procedure?

Toothache pain is the main reason that patients seek endodontic treatment. Fortunately, modern anesthetics can make a root canal treatment procedure comfortable. Seeking treatment early makes the procedure more comfortable as well, so don’t wait! When caught early, treatment should feel no different than having a regular filling. For the first few days after a root canal treatment, expect some sensitivity to biting pressure, especially if there was pain or infection prior to the procedure. Sometimes over-the-counter anti-inflammatory medications (such as Advil) are recommended for a day or two. Dr. Punaji can prescribe other medications, but they are rarely required.

What are the reasons for tooth extraction?

There are several reasons for extracting a tooth. These include:

  • Severe Tooth Damage/Trauma: Some teeth have such extensive decay and damage (broken or cracked) that repair is not possible.
  • Malpositioned/Nonfunctioning Teeth:To avoid possible complications that may result

    in an eventual, negative impact on oral health, your dentist may recommend removing

    teeth that are malaligned and/or essentially useless (teeth that have no opposing teeth

    to bite against).

  • Orthodontic Treatment:Orthodontic treatment, such as braces, may require tooth

    extraction to make needed space for improved teeth alignment.

  • Extra Teeth:Also referred to as supernumerary teeth, extra teeth may block other teeth from erupting.
  • Radiation:Head and neck radiation therapy may require the extraction of teeth in the field of radiation in order to help avoid possible complications, such as infection.
  • Chemotherapy: Chemotherapy weakens the immune system, increasing the risk of tooth infections, heightening the risk of extraction.
  • Organ Transplant:Immunosuppressive medications prescribed after organ transplantation can increase the likelihood of tooth infection. As such, some teeth require removal prior to an organ transplant.

What are the types of tooth extractions?

There are two types of tooth extractions:

  • Simple Extractions:These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are usually done under a local anesthetic with or without anti-anxiety medications or sedation.
  • Surgical Extractions:These involve teeth that cannot easily be seen or reached in the mouth because they have broken off at the gum line, or they have not fully erupted. Performed by dentists or oral surgeons surgical extractions require some type of surgical procedure, such as bone removal, removing and/or lifting and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be done with local anesthesia and/or conscious sedation. Patients with special medical conditions and young children may receive general anesthesia after consultation with the doctor.

What should I expect during a tooth extraction?

At the extraction appointment your dentist will numb or anesthetize the tooth to be extracted, as well as the jawbone and gums surrounding it. Typically, a local anesthetic such as novocaine or lidocaine is injected to eliminate discomfort.


What happens after a tooth extraction?

Since bleeding is normal after an extraction, your dentist will have you bite on a piece of gauze for about 45 minutes to put pressure on the area and allow the blood to clot. Some swelling and discomfort are normal after a tooth extraction. Cold compresses or ice packs can help decrease the swelling. If your jaw is sore and stiff after the swelling dissipates apply warm compresses. Sleeping with your head face upward to relieve pressure on the jaw and keeping your head elevated with extra pillows also may also help. In addition, your dentist may recommend you take an OTC pain reliever such as ibuprofen (Motrin or Advil) for several days. With surgical extractions, which generally cause more pain afterwards, your dentist may prescribe a prescription pain medication. Other aftercare tips include:

  • Do not rinse your mouth for the first 24 hours immediately following a tooth extraction.
  • Stick to a soft or liquid diet (milk, ice cream, mashed potatoes, pudding) the day of and the day after a tooth extraction, gradually progressing to eating other easy-to-chew foods. Chew with teeth that are far from the extraction site, as well.
  • Brush and floss the other teeth as usual, but avoid the teeth and gum next to the extraction socket.
  • After the first 24 hours, and then for at least five days after extraction, gently rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and before bed.

In addition to the aftercare considerations above, tooth extraction aftercare also involves avoiding certain foods and activities:

  • Avoid anything that might dislodge the blood clot and delay or prevent normal healing.
  • Do not smoke, vigorously rinse or spit, engage in strenuous activities, or drink through a straw for at least two days after an extraction.
  • Stay away from hot liquids, foods that are crunchy or contain seeds or small grains, alcohol, and carbonated soft drinks for two to three days after tooth extractions.
  • Do not brush your gums or use an OTC mouth rinse (you can use homemade water and salt washes).

Healing from a tooth extraction takes about five to seven days. The gum area should be fully healed in three to four weeks.


What is dry socket?

Dry socket, a common complication after a tooth extraction, occurs when a blood clot has failed toform in the socket, or the blood clot that did form has been dislodged. This leaves the underlying bone and nerves exposed to air and food. Often quite painful, dry socket typically appears two to five days after extraction and can cause pain and a bad odor or taste. In most cases, if you develop dry socket, the dentist will place a medicated dressing into the socket to soothe the pain and encourage healing. The dressing is replaced every 24 hours until the symptoms of dry socket lessen (about five to seven days).


What is a dental implant?

A Dental Implant is a man-made replacement for a missing tooth or tooth root.  Made from titanium, this screw-like object is inserted under the gum and directly into the upper or lower jaw bone.  There is usually minimal discomfort involved with this procedure.  After a period of a few months the dental implant and the bone fuse together, creating an anchor for the new tooth to be placed onto the dental implant.


What are the benefits of dental implants?

Dental implants look and function like your natural tooth and are a permanent solution for missing teeth. They decrease the possibility of bone loss, periodontal disease, misalignment of other teeth and further tooth loss, and replace the need for a removable full or partial denture. Dental implants focus only on the tooth or teeth that missing. A traditional bridge would involve the two or more adjacent teeth being compromised to create a false tooth in between. The implants are maintained by routine hygiene visits to your dentist.


Who is a candidate for dental implants?

With major advancements in dentistry and dental implants, most people are candidates for dental implants.  There may be exceptions due to chronic illness, heart disease and severe osteoporosis.


What does the dental implant procedure involve?

The average dental implant procedure takes 3 – 4 visits.  The first visit is to x-ray the area and take an impression for a surgical guide and a temporary prosthesis to cover the implant. The next visit is to place the implant. A local anesthesia is applied to the area (any additional sedation is no longer necessary unless deemed by the dentist). The dentist will then make a minor incision to place the implant. The implant is placed into the jaw bone and the area will then be covered with sutures.  The procedure is usually completed with minor pain. The next appointment will be approximately 3 – 6 months to begin creating the porcelain crown to place over the implant.


How long does a dental implant last?

With routine dental hygiene scheduled and proper home care, A Dental Implant can last approximately 30 years to a lifetime.


What are removable dentures?

Full or partial tooth loss, if left untreated, doesn’t just affect a person’s self-image, it can also increase the risk of developing nutritional problems and other systemic health disorders. Fortunately, there’s a reliable and time-tested method for treating this condition: full or partial dentures. Dentures are just one option for replacing missing teeth. Some of the others include fixed bridgework and dental implants. Each method has its particular pluses and minuses, which should be carefully considered. There are also several varieties of dentures available to address specific issues, from partial dentures to implant-supported overdentures. During a consultation, we can explain the available options and help determine which is best for you.


How do removable dentures work?

faq3 Full or partial dentures consist of a gum-colored base made of plastic resin, which fits over the remaining alveolar (bone) ridge that formerly held the teeth. The prosthetic teeth projecting from the base are designed to look and function just like your natural teeth. Dentures are held in place primarily by the suctioning effect of their close fit against the alveolar ridges — that’s why it’s so important that they are fitted properly. The upper denture also gets extra support from the large surface area of the roof of the mouth (palate), which generally makes it extremely stable. At first, wearing dentures may require some getting used to in terms of talking and eating, as the dentures become “balanced” in the space formerly occupied by the teeth. But over time, the muscles, nerves and ligaments of the mouth learn to work in new ways, which allows these functions to occur normally. Dentures also help support the facial skeleton and the soft tissues of the lips and cheeks, which can help create a more youthful appearance.

Types of Full Dentures

Immediate Dentures: These are usually a temporary means of helping you transition to successful denture wearing. Because of the muscular readjustment required, as well as the natural shrinkage of gums, the dentures, which are placed immediately after tooth extraction, won’t fit as well as permanent dentures made when the healing is complete. They do, however, provide you with new teeth right away, and give you time to adjust.

Conventional Full Dentures: After a period of time, we can fabricate permanent dentures that conform to your mouth with near-perfect accuracy. These are carefully crafted to look as much like your own natural teeth as possible, and are able to function properly in your mouth for a long time.

Implant-Supported Overdentures: To increase the stability of a lower or upper denture, it’s possible for it to be securely anchored using two or more dental implants. The upper jaw requires more implants (generally three or more) than the lower jaw due to a lesser bone density. Many people find this option offers a great balance of comfort, functionality and value.

Types of Partial Dentures

Transitional Partial Dentures: These relatively inexpensive removable plastic dentures serve as a temporary tooth replacement and space maintainer as you wait for your mouth to heal from tooth extraction, for example. Once the healing process is complete, dental implants can be placed.

Removable Partial Dentures (RPDs):Usually made of cast vitallium, these well-constructed, metal-based removable partial dentures are much lighter and less obtrusive than those made of plastic. They are a little more expensive than plastic dentures but will fit better and not expensive than implants or fixed bridgework.


How Dentures Are Made and Fitted

faq4Making quality dentures is a blend of science and art. First, an accurate impression (mold) is made of the alveolar ridges on the top and bottom of your mouth. The base of the denture is made from this mold in a dental laboratory. Working together, the dentist and lab technician choose from among many different sizes and shapes of prosthetic teeth to re-create a natural-looking smile. When everyone is satisfied with the result, the temporary dentures are made in permanent form. To enable normal speech and eating it’s crucial to balance your bite. This means that the upper and lower dentures come together and properly stabilize each other. We carefully check the form and function of the dentures to ensure that they are working and fitting properly.


What should I expect after getting my dentures?

If you’ve recently lost your teeth and received an immediate/temporary denture, it’s normal to find some tissue shrinkage and bone loss occurring. Therefore, in several months you may find that your immediate dentures no longer fit well. You will have two choices at this point: have the immediate (temporary) dentures re-lined (this means that material is added under the denture’s base to better conform to the new contours of your alveolar ridge), or move to a set of conventional full dentures, which will last longer and fit better. With proper care, dentures offer a functional, aesthetic and economical solution to the problem of tooth loss.


How do I take care of my dentures?

Dentures need to be treated with care. If taken care of properly they will continue to feel comfortable in your mouth and keep you smiling day a