FAQ

Our patients often have questions about their dental care. Dr. Christiane Trigueros has provided answers to some of the most frequently asked dental questions. If you have more questions, and to make your appointment with our dentist in Santa Maria, California, please call us at (805) 928-3928.

What should I do if I have bad breath?

Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

Bad breath may be caused by:

• Morning time—Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods—Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream and they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits—Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease—Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances—May also contribute to bad breath.
• Dry mouth (Xerostomia) —May be caused by certain medications, salivary gland problems or continuous mouth breathing.
• Tobacco products—Dry the mouth, causing bad breath.
• Dieting—Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals—Drinking water and chewing food increases saliva flow and washes bacteria away. 
• Certain medical conditions and illnesses—Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries or illnesses with your dentist.

You can prevent bad breath by:

• Practice good oral hygiene—Brush at least twice a day with an American Dental Association®-approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every two to three months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly—Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco —Ask your dentist what they recommend to help break the habit.
• Stay hydrated—Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses—Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

How often should I brush and floss?

Brush your teeth at last twice a day—especially before going to bed at night—and floss daily. We also recommend rinsing your mouth with water after brushing. You can also speak with our dentist about which over-the-counter mouthwash may be most appropriate for you.

Brushing your teeth:

• Brush at a 45-degree angle to the gums gently, using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Are amalgam (silver) fillings safe?

Over the years there has been some concern as to the safety of amalgam (silver) fillings. An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury. Dentists have used this blended metal to fill teeth for more than 100 years. The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association®, up to 76% of dentists use silver containing mercury to fill teeth. The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The consensus is that amalgam (silver) fillings are safe. Along with the ADA’s position, the Center for Disease Control, the World Health Organization, the FDA and others support the use of silver fillings as safe, durable and cost effective. The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling. The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels. For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them. However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain and gold fillings. We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

How often should I have a dental exam and cleaning? 

You should visit the dentist for a dental exam and cleaning at least twice each year. Our dentist may recommend more frequent visits depending on your dental condition.

How can I tell if I have gingivitis or periodontitis (gum disease)?
Symptoms of periodontal disease may include:

• Red and puffy gums—Gums should never be red or swollen.
• Bleeding gums—Gums should never bleed, even when you brush vigorously or use dental floss.
• Persistent bad breath—Caused by bacteria in the mouth.
• New spacing between teeth—Caused by bone loss.
• Loose teeth—Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
• Pus around the teeth and gums—Sign that there is an infection present.
• Receding gum—Loss of gum around a tooth.
• Tenderness or discomfort—Plaque, calculus and bacteria irritate the gums and teeth.

Please contact our office and make an appointment with our dentist if you notice any signs of gum disease.

Why is flossing important?

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth. Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

How can cosmetic dentistry help improve the appearance of my smile?

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health. This includes dental prevention and having a healthier, whiter more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile. Depending on your needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth makeover. Ask our dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

What are porcelain veneers and how can they improve my smile?

Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

• Severely discolored or stained teeth
• Unwanted or uneven spaces
• Worn or chipped teeth
• Slight tooth crowding
• Misshapen teeth
• Teeth that are too small or large

Call our office today for more information on dental veneers and to schedule a consultation with our dentist.

What can I do about stained or discolored teeth?

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile. Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association®.

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade. The color of our teeth also comes from the inside of the tooth, which may become darker over time. Smoking or drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull. Sometimes teeth can become discolored from taking certain medications as a child, such as tetracycline. Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching. Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains. Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

What are my options if I have missing teeth?

If your teeth are missing, it is important to replace them as soon as possible to avoid dental problems in the future, such as bone loss, shifting teeth, decay, gum disease, and TMJ problems.

Options for replacing your teeth include:

• Removable dental bridges
• Fixed dental bridges
• Dentures
• Dental Implants

If you are missing teeth, call our office to schedule your consultation with our dentist today.

What can be done about old, unattractive, or discolored fillings?

Most of us have fillings in our mouths that date back many years and some may have even been placed during our childhood. These fillings may now be old, dark and unattractive, making us feel self-conscious when we smile, laugh and talk. Old fillings are not only unattractive—they may also be defective. When a filling is old, the margins (space between the tooth and filling) may eventually open and allow bacteria and food debris to enter, potentially causing dental decay.

Your dentist can check your fillings and evaluate if they are defective and need replacement. Also, if you simply want to replace fillings that are unattractive, you and your dentist can decide which ones should be replaced first and what replacement options would best suit you. There are many state-of-the-art dental filling materials and procedures available today that are quick, painless and cost effective for replacing old, unattractive or defective fillings.

What do heart disease and other medical conditions have to do with periodontal disease?

Many people are unaware that having periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) can affect your overall health. Periodontal disease is one of the most common infections—often more prevalent than the common cold! Periodontal disease is not only the number one reason people lose teeth; it can also affect the health of your body!

Periodontal disease is a bacterial infection, and in its earliest stages, it’s called gingivitis. It starts when an accumulation of plaque (a colony of bacteria, food debris and saliva) is NOT regularly removed from the gums and teeth. The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jawbone that supports the teeth. When periodontal disease is not treated, it can eventually lead to tooth loss.

There are numerous studies that have investigated the correlation between gum disease and major medical conditions. These studies suggest people with periodontal disease are at a greater risk of systemic disease and indicate that periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs and begin new infections. Research suggests that periodontal bacteria in the blood stream may:

• Contribute to the development of heart disease
• Increase the risk of stroke
• Compromise the health of those that have diabetes or respiratory diseases
• Increase a woman’s risk of having a pre-term baby with low birth weight

Researchers conclude there is still much research to be done to understand the link between periodontal disease and systemic diseases, but enough research has been done to support that infections in the mouth can play havoc elsewhere in the body.

To ensure a healthy, disease-free mouth, we recommend the importance of regular dental check-ups and cleanings, which include a periodontal evaluation. Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.

Remember the mouth-body connection! Taking care of your oral health may contribute to your overall medical health!

When are dental sealants recommended?

Dental sealants are recommended for:

• Children and teenagers— as soon as the six-year molars (the first permanent teeth) appear, or at any time between age six-16.
• Infants—Baby teeth are occasionally sealed if the teeth have deep grooves or the child is prone to cavities.
• Adults—Tooth surfaces without decay that have deep grooves or depressions, making them difficult to clean.

What should I do if a tooth is knocked out?

We are all at risk for having a tooth knocked out. More than five million teeth are knocked out every year! If we know how to handle this emergency, we may be able to save the tooth. Teeth that are knocked out may be possibly re-implanted if we act quickly yet calmly, and follow these simple steps:

• 1. Locate the tooth and handle it only by the crown (chewing part of the tooth), NOT by the roots.
• 2. DO NOT scrub or use soap or chemicals to clean the tooth. If it has dirt or debris on it, rinse it gently with your own saliva or whole milk. If that is not possible, rinse it very gently with water.
• 3. Get to a dentist within 30 minutes. The longer you wait, the less chance there is for successful reimplantation.

Ways to transport the tooth:

• Try to replace the tooth back in its socket immediately. Gently bite down on gauze, a wet tea bag or on your own teeth to keep the tooth in place. Apply a cold compress to the mouth for pain and swelling as needed.
• If the tooth cannot be placed back into the socket, place the tooth in a container and cover with a small amount of your saliva or whole milk. You can also place the tooth under your tongue or between your lower lip and gums. Keep the tooth moist at all times. Do not transport the tooth in a tissue or cloth.
• Consider buying a “Save-A-Tooth” storage container and keeping it as part of your home first aid kit. The kit is available in many pharmacies and contains a travel case and fluid solution for easy tooth transport.
• The sooner the tooth is replaced back into the socket, the greater the likelihood it will survive and possibly last for many years. So be prepared and remember these simple steps for saving a knocked-out tooth.

You can prevent broken or knocked-out teeth by:

• Wearing a mouth guard when playing sports
• Always wearing your seatbelt
• Avoiding fights
• Avoid chewing hard items such as ice, popcorn kernels, hard breads, etc.

Why straighten teeth?

Straighter teeth perform chewing, biting and speaking functions more effectively than crooked teeth. In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments, including gum disease, TMJ disorders, tooth injuries and uneven wear. There are several types of malocclusion including overbite, underbite, crossbite and overcrowding. Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.

Teeth can be straightened using either orthodontic braces or customized aligning trays. Please speak with our dentist or with an orthodontist for more information.

Tobacco Use

Tobacco use is one of the leading causes of death in society. Fortunately, it is also among the most preventable. Aside from being a socially undesirable habit, smoking can result in oral cancer, reduce smelling and tasting abilities, compromise recovery after oral surgery, stain the teeth and increase the risk of contracting periodontal disease. The American Dental Association® and all pediatric dentists encourage children, adolescents and adults to abstain from all forms of tobacco use.

Almost all adult smokers have tried smoking before the age of nineteen. It is likely that an individual who abstains from smoking throughout the teenage years will never pick up the habit. Therefore, it is essential that parents strongly discourage pre-adolescent and adolescent tobacco use.

Is smokeless tobacco less dangerous for teens?

Tobacco use in any form brings the oral region into direct contact with carcinogens (cancer-causing agents). These carcinogens and other harmful chemicals cause irreparable damage to the child’s oral health.

Parents and teens often mistakenly evaluate smokeless tobacco as the “safer” option. In fact, smokeless tobacco has been proven to deliver a greater concentration of harmful agents into the body, and to be far more addictive. One snuff of tobacco has approximately the same nicotine content as sixty regular cigarettes. In addition, smokeless tobacco causes leukoplakia in the mouth, which are dangerous pre-cancerous lesions.

What are the signs of oral cancer?

Oral cancer can be difficult to detect without the aid of the dentist. In some cases, oral cancer is not noticeable or even painful until its later stages. Parents of tobacco users must be aware of the following symptoms:

• Changes in the way the teeth fit together.
• Difficulty moving the jaw.
• Mouth sores that don’t heal.
• Numbness or tenderness.
• Red or white spots on the cheek, lip or tongue.

Oral cancer is treatable if caught early. Disfiguring surgery can be avoided by having the child abstain from tobacco use and getting regular preventive dental checkups.

How can I stop my child from using tobacco?

There are several ways to discourage children and adolescents from using tobacco products. First, talking to the child personally about the dangers of tobacco use (or asking the dentist to talk to the child) has proven an effective preventative strategy. Second, parents should lead by example. According to research studies, children of non-smokers are less likely to pick up this dangerous habit. Third, monitor the child closely. If the child will not cooperate, screenings for tobacco can be requested at the dental office.

If you have questions or concerns about your childhood tobacco use, please contact your pediatric dentist.

Tongue Piercing

There has been an upsurge in the number of teenagers getting tongue piercings. Teenagers often view these piercings as a harmless expression of their growing individuality. Oftentimes, parents allow teens to pierce their tongues because the metal bar is impermanent. In addition, tongue bars are not as visually apparent as a tattoo or eyebrow piercing might be.

Unfortunately, tongue piercings can have a serious (even deadly) impact on health. Pediatric dentists routinely advise adolescents to avoid intraoral or perioral piercings for several good reasons.

Why is tongue piercing harmful?

First, there are a growing number of unlicensed piercing parlors in throughout the country. Such parlors have been recognized as potential transmission vectors for tetanus, tuberculosis, and most commonly, hepatitis. Second, a great number of painful conditions can result from getting a tongue piercing even in a licensed parlor. These conditions include:

• Bacterial infections
• Blood clots
• Blood poisoning
• Brain abscess
• Chronic pain
• Damaged nerves (trigeminal neuralgia)
• Fractured/cracked teeth
• Heart infections
• Hypersensitivity reactions (to the metal bar)
• Periodontal disease/gum recession
• Problems enunciating
• Scarring

What are the most common tongue piercing problems?

To pierce a tongue, the body piercer must first hold it steady with a clamp. Next, a hollowed, pointed metal needle is driven through the tongue. Finally, the piercer attaches the tongue bar to the bottom end of the needle, and then drags it upwards through the tongue. Two metal screw-on balls are then used to secure the tongue bar.

Most commonly, severe pain and swelling are experienced for several days after the piercing episode. Moreover, the new holes in the tongue are especially infection-prone, because the oral cavity is home to many bacteria colonies. In the medium term, saliva production may increase as the body responds to a completely unnatural entity in the mouth.

Are there long-term problems associated with tongue piercing?

Long-term problems with tongue piercings are very common. The screw-on balls constantly scrape against tooth enamel, making teeth susceptible to decay and gums susceptible to periodontal disease. Soft tissue can also become infected in specific areas, as the tongue bar continues to rub against it.

If the tongue bar is inappropriately long, it can get tangled around the tongue or teeth. In a similar way to an earring getting ripped out of the ear, a tongue bar can be ripped out of the tongue. This is extremely painful, as well as difficult to repair.

The American Dental Association® advises against any type of oral piercing and so do pediatric dentists.

If you are a concerned parent or would like the pediatric dentist to speak with your teen about tongue piercing, please contact our office.