Back

Services

Dr. John Sulak works constantly to keep up-to-date with the latest advancements in dental care.

Dr. Sulak uses the latest techniques and remains deeply committed to developing new and better ways to protect your teeth and gums.

Take a moment to learn more about the exciting new services we offer our patients.

Please call our office at (209) 524-4000 with any additional questions or comments you may have.

Back

Bonding

Bonding is among the easiest and least expensive of cosmetic dental procedures.

The composite resin used in bonding can be shaped and polished to match the surrounding teeth.

Most often, bonding is used for cosmetic purposes:
- To improve the appearance of a discolored or chipped tooth
- To close slight spaces between teeth
- To make teeth look longer
- Or to change the shape or color of teeth

Back

Crown Aesthetics

If your smile is in need of a makeover, crowns can provide predictable results. Crowns can give an unattractive tooth back its beautiful shape and color. For smaller or worn down teeth, a crown can restore the natural size of the old tooth. A crown can replace either part of or the tooth's entire structure. For procedures requiring only the areas visible from the outside, a veneer may be an alternative option.

Back

Crown Procedure

A crown is sometimes termed a "cap" or "jacket." A crown will restore a large filling or a cracked tooth to its original size, shape and tooth color. A crown may be recommended after root canal therapy has been completed, as the tooth tends to become brittle and is more likely to fracture. A crown can strengthen and protect the remaining tooth structure and improves the appearance of your teeth. With the advances in technology, we now have the ability to make ceramic crowns with no metal.

To place a crown, your dentist must reduce 1-2 mm of the tooth to make room for it. Your dentist will then use a piece of thread or cord or use a laser to push the gum down around the tooth, to take an impression of the tooth. The impressions are sent to the lab where the crown is made. During that time, you will have a temporary crown. These crowns are usually made of plastic and are made in your dentist's office on the day of your visit. They are not meant to last. If a temporary crown is left in the mouth, the cement eventually washes out and the tooth can decay. At a second visit, your dentist will remove the temporary crown and test the permanent one. Sometimes crowns need additional polishing, glaze or some other adjustment before they are placed. Once the crown is ready, it's cemented to your tooth.

Back

Gold Crown

The 'gold' standard. Dental gold is about 60% gold alloy which is meant to match the hardness of the enamel of opposing teeth so both wear about evenly, an important trait.Gold does not tarnish or corrode and has some bacterial inhibiting quality. Gold crowns are strong and will not break. However, gold crowns obviously are not considered esthetic; they are gold colored. So usually gold crowns are used for lower back molars because they don't show there.

Back

Home Whitening

Whitening your teeth at home often involves using a custom fitted mouth guard into which a whitening solution is placed. These custom fitted mouth guards will help protect your gums from irritation that occurs while using ill-fitted over-the-counter whitening mouth pieces. After the solution is placed in the mouth guard, it is placed over the teeth and left on for a few hours or overnight depending on the type of whitening solution. Ask Dr. Sulak if home whitening is right for you.

Back

Opalescence Boost

Opalescence Boost features a unique, chemically activated formula that allows your dentist to whiten your teeth without the bothersome heat or ultraviolet rays of a light. Opalescence Boost also contains potassium nitrate and fluoride, which help to improve oral health by strengthening enamel, decreasing sensitivity, and offering increased cavity prevention.

Back

Opalescence Take Home Whitening

Opalescence Take Home Whitening Gels are only available from your dentist, who will supervise your treatment from initial consultation through completion. The sticky, viscous gel won’t migrate to gums and most formulations include Potassium Fluoride (PF), which helps to improve oral health by strengthening enamel, decreasing sensitivity and offering increased cavity prevention.

Back

Porcelain Fused To Metal Crown (PFM)

The most common type of crown and has a proven track record. PFM crowns are fairly aesthetic and they look like real teeth. However, the margins or borders may appear dark because PFM crowns have a metal substructure with layers of porcelain fired over the substructure. Porcelain is very hard, much harder than natural enamel and may cause excessive wear of the enamel of opposing teeth. Porcelain may break with extreme biting forces.

Back

Dental Veneers

Back

Replacing Old Fillings

There is now new technology that allows you to replace old silver and gold fillings with a more natural looking, composite filling. Composite fillings are bonded to the tooth and research has proven them to be about 90% as strong and healthy as natural tooth material.

Other Benefits:
- Beautiful in appearance
- Completed in a single visit
- No filling leaks
- Less chance of tooth cracking

Back

Single Visit Whitening

Single visit whitening uses a special light that is able to activate a higher concentration of whitening solution in order to produce quicker and more dramatic results. Our technicians protect your mouth very carefully and the whole process takes around an hour.

Back

Teeth Whitening

One of the most requested procedures asked of a dental office is tooth whitening. This is a procedure that will assist in removing stains and discoloration from teeth while lightening them.

Tooth whitening can only be completed once cavities are treated in order to prevent the whitening solution from reaching the inner tooth and causing sensitivity. Also keep in mind that tooth whitening is unable to lighten exposed tooth roots and tooth replacements such as crowns and veneers.

Back

Tooth Colored Fillings

In order to make a filling appear almost invisible to the naked eye, composite fillings are often used. These fillings are designed to match your natural tooth color and are bonded to your teeth, which makes them less likely to fall out. These fillings are used to replace older fillings made of silver or gold. Tooth colored fillings have a more aesthetic appearance, can be completed in one visit, form a strong seal and are less likely to crack a tooth.

Back

ZOOM Whitening

The Zoom Whitening System has been featured in numerous publications and has been featured on some popular television shows. This system is available in our office for anyone who is looking to lighten their smile by up to an average of nine shades in about an hour. Anyone who wants to brighten their smile can use this system to enhance their smile, even those who have severe stains on their teeth.

Back

Denture Instructions

It is sometimes difficult to get used to your newly placed dentures. They can feel bulky, loose and awkward. In order to make your adjustment period smoother, here are a few guidelines to follow:

- Wear your dentures all the time after you first receive them.
- Never use adhesives on your dentures unless instructed to by your doctor.
- When you go to sleep, remember to always remove your dentures.
- Always brush your dentures after removal and store them in a bowl of water. You can soak your dentures in a denture cleaner as well, but only after you have brushed them.
- If you experience any sore spots, looseness or discomfort please let your doctor know so they can help.

Never try to adjust your dentures on your own, each individual will have a different adjustment period and it will take time for you to become comfortable with your new teeth.

Back

Denture Resorption

Approximately 40% of your jawbone structure will be gone after wearing your dentures for just six months. You will begin to notice that your dentures aren't fitting the way they used to after a few years of wearing them as well. This is because over the years, the structure of your jawbone becomes unable to support your denture. The same thing happens even if you are wearing a partial denture.

Once the structure of your jawbone is gone, your options for tooth replacement become very limited. Dental implants can stop bone loss and provide your mouth with natural looking teeth before the jawbone structure is completely lost.

Back

Flexible Partial Dentures

Flexible partials are very comfortable. They are made from the latest technology in thermoplastic resins.

Depending upon your condition, flexible partials may be all thermoplastic or they may be combined with Vitallium biocompatible metal for increased strength.

Back

Full Arch Dentures

At times, it is necessary for all teeth to be removed due to extensive periodontal disease and/or due to decay. An alternative for the replacement of all the teeth is a complete upper and/or lower denture. These dentures require support from your gum pad and many times require the use of dental adhesive. Throughout life, the dentures require constant adjustment and refitting and can cause the jaw bone to melt away making the dentures loose and once again requiring continuous adjustment.

Back

Immediate Dentures

An Immediate Denture is designed to be placed in the mouth immediately after the extraction of your natural teeth. An Immediate Denture eliminates the embarrassment of having to go without teeth, while the gums are healing.

An Immediate denture is designed to fit your mouth at the time impressions are taken; however, after a few months your gums will change drastically due to "gum resorption." It's possible that the denture will rub against the gums when it is first placed, which may be very sore until it can be adjusted. Gums shrink the most within the first year of having teeth extracted. Most patients will require relines within a few months, to restore the fit of their dentures. Expect that the first year of wearing dentures will also be the most difficult and costly.

Since an Immediate Denture covers over the surgical site and the tooth sockets, it helps keep that tender surgical area from becoming irritated, much as a bandage would. Do not remove your denture by yourself, even for just a few minutes, until your dentist tells you it's all right. The gum tissue underneath the denture has a tendency to swell. If you take the denture out for very long, you may never get it back in again.

Back

Over Denture

An over denture fits on-top of natural teeth or dental implants. Many patients suffer with ill fitting and loose dentures that move or even fall out when speaking or eating. One way of solving this problem is to construct a dental plate that goes over and attaches to something underneath it. Keeping a few natural teeth or placing dental implants in the bone under the denture also helps keep the jaw bone healthy. This avoids much of the natural jaw bone loss often seen after teeth are removed. Traditional over dentures go over natural teeth. A denture can be made that goes over and attaches to one or both cuspids.

Implants supported over dentures fit on top of dental implants. A retainer bar or retention balls are placed on the implants and special attachments are inserted into the denture to grab onto these retention devices. A new method using mini implant dentures is becoming increasingly popular. Mini implants are very thin, long titanium implants that screw into the jaw bone. They can be placed and old dentures can often be retrofitted to the implant.

Back

Partial Dentures

Partial Dentures are used to replace missing teeth. Partials have metal hooks that grab onto the neighboring teeth for support. Unfortunately, the hooks have a tendency to loosen up the teeth and partial dentures have the tendency to get loose and require multiple adjustments throughout the years. On the upper, there is a large piece of metal that goes across the roof of the mouth which can interfere with taste sensation and/or have food collected under it. Additionally, the partial plate can press into the gum tissue and cause sores. The partial dental plate must be taken in and out each day for cleaning. It is certainly not an ideal alternative.

Back

Precision Partials

Precision partial dentures are retained in the mouth by interlocking components. A specially shaped extension of the partial fits snugly into or onto a receiving area or projection of a natural tooth that has been crowned. This makes for anti-slip dentures that won't move or come out when you speak or chew.

Back

Snap In Dentures

Implants allow you to wear full dentures and partial dentures without fear that they will slip or fall out. A "snap-in" denture is an implant supported, removable denture. The snap-in feature is available for upper or lower dentures. Having implant supported dentures allows for the base of the denture to be made much smaller and more comfortable. Implant supported dentures enhance chewing and speaking. Never again will you have to worry about your teeth falling out when you eat, laugh or speak. You will regain chewing function and enjoy some forgotten foods.

Back

Soft Dentures

Soft dentures are a flexible alternative to more common hard dentures crafted out of acrylic. These dentures don't require adhesives and adjust to the shape of the gums for greater comfort. Soft dentures are only called that because the inner lining is soft. They're otherwise similar to ordinary dentures, which can be altered to have flexible linings.

Back

Suction Cup Denture

Suction cup dentures make use of small suction cups made with a soft rubber that attaches gently inside the mouth with no irritation. This type of denture can be used for various types of tooth replacement in patients with flat ridges. Almost any existing denture can be changed into a suction cup denture easily.

Back

Temporary Partials

Temporary or interim appliances serve many useful purposes and are often an integral part of a prosthetic treatment plan. These appliances can be designed to be either fixed or removable. This simple appliance is excellent for temporary replacement of front teeth while the patient is waiting for a permanent bridge, a partial, or implants. This removable interim bridge is made of a clear vacuum-formed material. The appliance simply snaps into place.

Back

Post and Crown

When there is not enough tooth structure remaining after trauma, decay or a root canal procedure, then a post and crown will be utilized to restore the tooth to full form and function. A crown buildup is either composed of a bonded composite material or possibly an amalgam material. If a crown is placed on an unstable tooth foundation you will have a higher risk of having that crown fail. When the tooth has lost significant structure then a buildup is necessary in order to provide proper support of the new crown and to bring the tooth back to full function.

Back

Root Canal

Causes of a Root Canal
Root canals are necessary when a cavity that has been left untreated becomes larger. Once the cavity reaches the pulp of the tooth, an infection forms at the base of the root canal, causing an abscess. This abscess is generally painful and will need to be removed.

The doctors at John L. Sulak, DDS know that serious tooth decay can often lead to a root canal. A root canal may be needed if the decay has reached the tooth's nerve. Essentially, a root canal involves cleaning out a tooth's infected root, then filling and sealing the canal.

Root Canal Procedure:
1) An opening is made through the crown of the tooth into the pulp chamber.
2) The pulp is removed, and the root canals are cleaned, enlarged and shaped.
3) The infected area is medicated.
4) The root canals are filled.
5) The crown opening is filled with a temporary.

If you are experiencing severe tooth pain, you may need a root canal. The only sure way to know is to call our Modesto, CA dental office at (209) 524-4000 and setup an appointment with Dr. Sulak.

Back

3i Implants

BIOMET 3i OSSEOTITE ® and NanoTite™ Dental Implants are intended for immediate function on single tooth and/or multiple tooth applications when good primary stability is achieved, with appropriate occlusal loading, in order to restore chewing function.

Contraindications: Placement of dental implants may be precluded by patient conditions that are contraindications for surgery. BIOMET 3i Dental Implants should not be placed in patients where the remaining jaw bone is too diminished to provide adequate implant stability.

Back

After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.

BLEEDING. Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can be controlled by biting on a gauze pad placed directly on the bleeding area for 30 minutes. If bleeding continues please call the office for further instructions.

SWELLING. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon as it is the body’s normal process in repairing itself. Swelling does not always appear immediately. It may take 12 to 24 hours before swelling becomes apparent. Swelling may not reach its maximum until 2-3 days post-surgery. Swelling may be minimized by the immediate use of ice packs post-surgery. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days call the office.

DIET. Drink plenty of fluids. Avoid hot liquids or hot food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

PAIN MEDICATION. You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Be sure to take the prescribed antibiotics as directed to help prevent infection. Do not take any of the above medication if you are allergic, or have been instructed by John L. Sulak, DDS not to take it.

HOME HYGIENE CARE. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments is no problem, but be gentle initially with brushing the surgical areas. Good oral hygiene is essential to good healing.

PHYSICAL ACTIVITY. Keep physical activities to a minimum immediately following surgery. Physical activity could cause throbbing or bleeding of the surgical implant area.

WEARING DENTURES. You will always have teeth during your recovery period. Temporary partial dentures or full denture arches should not be used immediately after surgery and for at least 10 days.

Back

Astra Tech Implants

To put it simply, with the ASTRA TECH Implant Systemâ„¢, esthetics are integrated into the implant system design. We work together with nature in supporting the natural healing process instead of interfering with it.

Back

Full Arch Implants

In many circumstances all of the upper or lower remaining teeth need to be removed due to advanced periodontal disease and/or dental decay. One approach is a full upper or lower plate; however, this treatment modality is not recommended. The treatment of choice is to replace the upper or lower teeth with caps that are in place permanently and supported by dental implants. A common goal of treatment is to have (twelve teeth-caps) supported by eight implants. The four caps that are not supported by the implants are connected to adjacent implant supported caps. With this optimal approach, the maximum amount of bone is preserved.

Back

Implant Alternatives

Before making the decision in going the implant route, ask yourself if there is another option. We offer many different implant alternatives.

The different alternative options to implants that we provide are:
- Tooth Supported Bridge
- Removable Partial Denture
- No Treatment

Back

Implant Benefits

1. Eliminates the need to "cut down" the neighboring teeth to make a bridge.
2. Maintains the jawbone structure.
3. Feels and functions like natural teeth.
4. Does not rely on other teeth for support.
5. Replaces partial plates and may be used to secure loose dentures.
6. Cleaned and flossed like a natural tooth.

Back

Back

Multiple Tooth Implants

In cases where multiple teeth are missing or have been extracted, multiple implants can be used to bring back your smile. The implants are placed into the jawbone and are given time to heal. After the bone has healed around the implants, an abutment is attached to the implant which then allows for a crown or bridge to be placed right on the implant. These new teeth will look and act just like natural teeth.

Ask Dr. Sulak, a popular implant dentist in Modesto, if dental implants are right for you.

Back

Nobel Biocare - Dental Implants

For more than twenty years, Nobel Biocare dental implants have been produced from chemically unchanged variants of commercially pure titanium. They are cold-worked for exceptional strength and durability, and all feature TiUnite, our proprietary surface that produces benefits in implant stability and bone formation.

Back

Single Tooth Dental Implant

Do you have missing teeth? It is critically important to replace missing teeth. Eating and chewing with missing teeth can sabotage your bite and lead to incessant discomfort. Missing teeth can give rise to a mouth rearrangement that often results in facial changes that look decrepit.

A single tooth implant procedure may be done if a tooth has been extracted or is missing. A titanium implant base is placed into the jawbone to resemble the tooth root. We allow a period of time for the jawbone to heal over the implant base before fitting for a crown.

Next, an abutment is screwed into the base of the implant to allow for a crown to be fitted on top. Finally, a custom fabricated crown is placed over the abutment to function like a real tooth.

Back

What Are Dental Implants

An implant is a titanium "root" which can be placed into the jawbone. Once integrated with your bone, the implant can be used to support a crown, a bridge, or secure a complete denture. Dental implants may be used to eliminate partial plates and dentures. Implants have been used successfully for over thirty years, have a high success rate and function and feel like your natural teeth. Dental implants are now the standard of care for replacing missing teeth. Dental implant treatment represents a slightly greater investment than conventional treatment; however, the benefits of implant therapy for most patients outweigh the minor additional cost involved.

Dental Implant FAQ

What is a Dental Implant? Why are Dental Implants the best option? How will my teeth look and feel? Am I a candidate for Dental Implant treatment? Is my age a factor for Dental Implant treatment? How long will it take to complete treatment? When should a tooth be extracted and replaced with a Dental Implant?	Is a dental implant procedure painful? How long do Dental Implants last? Can a dental implant work with existing dentures? Is there special care required? What is the cost of Dental Implant Treatment? Is Dental Implant treatment covered by my insurance? What is the difference between a traditional crown and bridge and an implant supported crown and bridge?

Back

Zimmer Implants

If something happens to your natural teeth, you can continue to live confidently with implants from Zimmer Dental. Unlike dentures and bridgework, implants are a solution proven by experience to last for many years. They look and feel like your natural teeth and eliminate the worry of slipping or coming loose.

For more than two decades, dental implants have been used successfully with people just like you — a safe, medically proven alternative that delivers confident living. By working with Zimmer Dental, your doctor can offer you the most advanced implants and prosthetics available today.

Back

Am I a candidate for Dental Implant treatment?

If you are missing one or more teeth and in general good health, you are a candidate for dental implant treatment. There are a few qualifying factors that need to be addressed:

1. Quality and quantity of available bone for implant placement.

2. Uncontrollable diabetes or other medical conditions.

Overall, there are very few conditions that would keep someone from having implant treatment. Even people who have lost a significant amount of bone can qualify for dental implant treatment; although, an additional procedure(s) to add bone or to create new bone may be necessary. Advances in this type of treatment have made it possible for most people who would not previously have been considered candidates to have successful implant treatment.

Back

Can a dental implant work with existing dentures?

Every patient's situation is unique; however, from time-to-time we can use an existing denture by altering the denture to accommodate the necessary denture attachments to fit the implants.

What is the difference between a traditional crown and bridge and an implant supported crown and bridge?

There are several differences.

1. A dental implant preserves jaw bone.
2. We do not have to destroy neighboring health teeth by grinding down the teeth to pegs in order to accept a crown.
3. Implants last longer than traditional crown and bridge. Implants are designed to last a lifetime, while a traditional crown and bridge is projected to last approximately 10 years and may need to be replaced.

Although dental implants have become the standard of care, they are more expensive than old tooth replacement methods. They are a better choice for the money; however, some dentists still recommend traditional tooth supported bridges for patients due to their own comfort level, or when patients insist on having the immediate lowest possible fee for tooth replacement. Most dentists today detest the idea of grinding down perfectly healthy teeth to place a traditional bridge, and therefore, will almost always recommend dental implant treatment in these cases.

When should a tooth be extracted and replaced with a Dental Implant?

There are times when it makes sense to extract a tooth and replace it with a dental implant.
1. If a natural tooth is failing or about to fail.

2. If a tooth has severe periodontal disease (gum disease) that has eroded the bone that supports teeth. Sometimes in these cases, it is preferable to extract the teeth; eliminate the disease and infection and replace the teeth with a dental implant.

3. When a tooth has had a root canal (nerves have been removed from the tooth) leaving the tooth brittle and susceptible to fracture. Teeth with severe fractures are usually extracted and are ideal candidates for replacement with dental implant treatment.

Back

How long do Dental Implants last?

Dental implants are designed to be permanent; however, there are a few factors that may contribute to the long term success of dental implant treatment, such as the original quality of the surgical and restorative treatment, proper home care and regular check-up visits to your dentist or dental specialist. Dental implant treatment is one of the most successful procedures in the medical-dental field, with documented success rates over 95%. Dental implants have been around for over 30 years and have closely documented clinical research that demonstrates that dental implants will be successful throughout the lifetime of a patient. By comparison, research also demonstrates that the average tooth supported bridge (conventional dentistry) lasts from 7-10 years and that partials and dentures are functional for approximately 5 years before having to replace the appliance.

Back

How long will it take to complete treatment?

Traditional treatment may take anywhere from several weeks to several months, depending upon the quality of the bone in which the implants are placed. If an additional procedure is required in order to augment the bone, the total treatment time may be between six to nine months. Some implant candidates may qualify for Immediate Load / Immediate Function procedures, also known as "same day implants".

Back

How will my teeth look and feel?

A single tooth supported by an implant is like turning back the clock of time. The implant replaces the natural tooth root so the jaw bone and supportive gum tissue is as vibrant as ever. Multiple single implants may support single teeth or an implant supported bridge. Dental implants may also support the base for full arch dentures to attach to which provides the look, feel and function of natural teeth. Dental implant treatments is the only tooth replacement solution that prevents jaw bone resorption, which can cause your smile to look unnatural and in some cases, change your facial appearance. The long term esthetics of dental implants are superior to any other treatment option.

Back

Is a dental implant procedure painful?

Most implant patients report that the discomfort is far less than they expected and is no more remarkable than having a root canal or having a tooth extracted. Of course, you are anesthetized during the procedure, and although everyone's pain tolerance is different, most patients are very comfortable simply taking over-the-counter analgesics afterward.

Back

Is Dental Implant treatment covered by my insurance?

Dental insurance coverage of implant treatment depends on your individual policy. Dental benefits are determined by the amount an employer is willing to spend on the policy. Generally, dental policies cover basic routine preventive maintenance, basic care and emergencies. Most insurance plans only cover the basics with an annual maximum allowable benefit of $1,000-$1,500. Most insurance plans do not include dental implant coverage; however, often they will pay the same benefit they would cover for the lowest cost alternative treatment option (partials and dentures) and some of the diagnostic records, if a specific request is made for alternative benefits. You should review your both your dental insurance plan and your medical insurance plan. Medical coverage is very rare and Medicare does not cover implant treatment. All in all, it is best to assume that there is no medical insurance coverage available.

Back

Is my age a factor for Dental Implant treatment?

Providing your overall health is good, there is really no age restriction. The desire to improve your quality of life is frankly a more important consideration than age. It is not unusual for people with dentures to upgrade to implant supported dentures. It provides a renewed self-confidence in their smile and speech and also provides renewed chewing stability, plus brings back foods into their life that were once off limit.

Back

Is there special care required?

Home care for a dental implant single tooth or for a dental implant crown and bridge is cleaned like a natural tooth, with regular brushing and flossing and regularly schedule hygiene appointments as directed by your dentist. Home care is a little more complicated for people who are missing all of their teeth, in that special brushes and floss are often recommended. Permanently fixed implant supported replacement teeth are cleaned like all other bridges. If a surgical specialists who placed the implant(s) is involved, they may want to see you at least once each year in addition to your regular dentist. These visits, combined with proper home care, are essential to the long term success of implant treatment.

Back

What is a Dental Implant?

Implants are a tooth replacement option that involves placing a new "root" into the bone of your jaw. Once this titanium "root" has infused with your bone it can be used to support a crown, bridge or denture. These implants can also be used to replace partials and other forms of dentures. The success rate for dental implants are extremely high and is due in part to the fact that root-form implants are made of a biocompatible material, titanium. Because titanium is accepted so well by the human body, it is also used for orthopedic implants, such as hip and knee replacements. Dental Implants have now become the standard for replacing older dentistry and missing teeth because they look and feel like your natural teeth and have a higher success rate than all other forms of tooth replacement. The initial cost is generally higher for an implant over other forms of tooth replacement, but the long term benefits easily outweigh the difference in additional cost. An investment in implant dentistry is an investment in overall health, appearance and well being, as it involves preserving the integrity of facial structures, as well as replacing missing teeth.

Back

What is the cost of Dental Implant Treatment?

The actual cost of dental implant treatment is based on a number of factors, such as the number of missing teeth being replaced, the type of implant supported teeth (treatment option) recommended and whether additional procedures are necessary to achieve the proper esthetic and functional result. The only way to accurately estimate the cost for an individual patient is to have an examination and consultation with your dental specialist. The total fee is usually comparable to other methods of tooth replacement; however, long-term, implant treatment is generally more cost effective than other options, such as bridges, partials and dentures that need to be replaced every 5-10 years.

Back

Why are Dental Implants the best option?

Dental implants can last a lifetime, unlike bridges, partials and dentures that may need to be replaced several times. Unlike bridges, partials and dentures, a dental implant replaces the lost tooth root, which will prevent jaw bone resorption that occurs with bridges, partials and dentures. The loss of tooth roots will cause a change of the smile and contours of the face over time. A bridge, once the common single tooth replacement method, requires the alteration of each neighboring healthy tooth, which is cut down and shaped to accept a crown. With dental implant treatment, there is no compromise to adjacent teeth. The lost root and crown is replaced leaving neighboring healthy teeth in place. Removable partials connect to healthy teeth by hooks. Partials may be removed for cleaning and may need to be replaced often. A partial hook connected to healthy teeth will create tooth stress and will loosen the healthy teeth over time. Full arch dentures and partials have the added disadvantage of accelerating the bone resorption process, which, among other things, causes the appearance of premature aging.

Back

About Periodontal Disease

Periodontal diseases are infections of the gums which gradually lead to the destruction of the bone support around your natural teeth. These diseases effect more that 80% of Americans by the age of 45.

Dental plaque is the primary cause of gum disease. Bacteria found in plaque produce enzymes and toxins which injure the gums. Injured gums turn red, swell and bleed easily.

If this injury is prolonged, the gums separate from the teeth, causing pockets (spaces) to form.

Plaque can also harden into a rough, porous substance known as calculus (tartar).

This can occur both above and below the gum line. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate.

If left untreated, this leads to tooth loss. Pain is usually not present until damage from this disease is very advanced.

Back

Advanced Periodontitis

Advanced periodontitis occurs when a major amount of gum and bone tissue has been lost and the teeth are losing more and more support due to the loss of periodontal ligament and bone. Some teeth are unable to be saved and must be extracted. If left untreated, advanced periodontitis can cause severe health problems elsewhere in the body.

Back

Gingivitis

One of the earliest stages of gum disease is gingivitis. Gingivitis causes the gums to become swollen and bleed due to the toxins, enzymes and plaque byproducts that are created. In order for your gums to return to a healthy state, treatment from Dr. Sulak is required in addition to proper oral hygiene.

Back

Healthy Gums

Healthy gums are generally pink and anchor the teeth firmly in place.

Back

Periodontal Health Affects

Research has shown that gum disease can influence heart disease and other health conditions in negative ways. They suggest that gum disease could even be a more serious factor in heart disease than smoking, cholesterol, hypertension and age. One reason for this is the fact that the bacteria found in diseased gums can come loose and move throughout the body. When this bacteria reaches arteries it can cause arterial plaque to build up and harden which in return adversely affect blood flow.

Back

Periodontitis

When the bone tissue starts to deteriorate, this is known as a form of gum disease called Periodontitis. This happens when the byproducts of plaque attack the tissues that hold your teeth to the bone. The gums begin falling away from the teeth and form pockets in the gums which allows more plaque to collect below the gum line. When this occurs, the patient becomes more sensitive to hot and cold and the roots of the teeth are more vulnerable to decay.

Back

Sensitivity

Teeth that are suffering damage from gum disease will always be more sensitive to cold and if you avoid cleaning them due to this sensitivity, it can only make the problem worse.

After dental treatment, some teeth may be more sensitive because this is their way of dealing with injury. Injuries to teeth such as cavities, gum infection and jaw clenching can damage the nerves in a tooth. The sensitivity should not last long after treatment as long as your teeth are kept clean, otherwise the sensitivity is likely to get worse. If your teeth are ever extra sensitive, please consult with Dr. Sulak as this could be a sign that you need a root canal or gum tissue treatment.

Back

After Extraction Care

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. We ask you to bite on a gauze pad in the tooth extraction area for 30 minutes after the appointment. If the bleeding or oozing persists, repeat the process. After the blood clot forms, it is important not to dislodge the clot. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge the clot. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack applied to the area 20 minutes on, 20 minutes off, will keep swelling to a minimum. Take pain medications as prescribed by John L. Sulak, DDS. The swelling will usually subside in about 48 hours.

Use the pain medication as directed. Call the office if the medication doesn't seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It's important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least twice a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling after 2-3 days, or a reaction to the medication, call our office immediately at (209) 524-4000.

After the Removal of Multiple Teeth

BLEEDING. A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

SWELLING. Use ice packs on the same side of the face of the surgical area. Apply ice 20 minutes on, 20 minutes off, during your waking hours for a maximum of 36 hours only. Ice does not have an effect after 36 hours. Call the office for further assistance.

DISCOMFORT. For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.

DIET. Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day. Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

HOME HYGIENE CARE. Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.

WEARING DENTURES. The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

- The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).

- A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days. - If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.

If immediate dentures have been inserted, sore spots may develop. In most cases, John L. Sulak, DDS will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

Back

After Wisdom Tooth Removal

Post-operative care of the removal of impacted teeth is very important. Carefully follow instructions to minimize unnecessary pain and complications of infection and/or swelling.

BLEEDING. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or slight blood traces in the saliva is not uncommon. To help minimize bleeding site, avoid any sort of exercise or excitement. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. This action should create a blood clot and bleeding will stop; however, if bleeding does not stop repeat as necessary. As an alternative to the gauze gently bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call the office at (209) 524-4000 for additional instructions.

Standard After Surgery Instructions:
- The gauze pad placed over the surgical area should be kept in place for a half hour prior to removal.
- Vigorous mouth rinsing the surgical area following surgery should be avoided. Vigorous sucking through a straw should be avoided. Touching the surgical area should be avoided. These actions may cause the blood clot to become dislodged and cause excess bleeding.
- Begin taking the prescribed pain medications as soon as you begin to feel discomfort.
- Place ice packs to the sides of your face where surgery was performed.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

SWELLING. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon as it is the body’s normal process in repairing itself. Swelling does not always appear immediately. It may take 12 to 24 hours before swelling becomes apparent. Swelling may not reach its maximum until 2-3 days post-surgery. Swelling may be minimized by the immediate use of ice packs post-surgery. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

PAIN MEDICATION. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours. For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive or operate machinery and avoid alcoholic beverages. Pain or discomfort should subside more every day. If pain persists, it may require attention and you should call the office for assistance.

DIET. After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Nourishment and regular fluid intake is important to your recovery. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

HOME HYGIENE CARE. There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

ANTIBIOTICS. If John L. Sulak, DDS has prescribed antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Call the office in the event of a rash or other unfavorable reaction at (209) 524-4000.

NAUSEA. Occasionally, a prescribed pain medicine may induce nausea and/or vomiting following surgery. Do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications
- NUMBNESS. As discussed in your per-surgery consultation numbness of the lip, chin, or tongue can occurs, but there is no cause for alarm. This is usually a temporary condition. If you do experience numbness be careful not to bite your lip of tongue as you will not feel the action. Call John L. Sulak, DDS if you have any questions.

- TEMPERATURE. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.

- DIZZINESS. Taking pain medications can make you dizzy. You can get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.

- SUTURES. Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. In about a week post surgery the sutures will be removed by John L. Sulak, DDS . It is a simple procedure that does not require any anesthesia or needles and only takes a few minutes.

- SORE THROAT PAIN. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.

- JAW STIFFNESS. Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Back

Functional Crown Lengthening

Decay can frequently be found below the gum line. In order to gain access to the decay, it is necessary to reduce some of the bone surrounding the area of decay so the gum tissue can be positioned either higher up or lower down on the tooth making access to repair decay feasible. In other circumstances, the tooth may fracture below the gum line. Often the tooth requires a crown (cap) to cover over the fracture line. In order for the crown to fit over the fracture line, it is necessary to raise or lower the gum and reshape the bone accordingly so that the fracture line now becomes visible above the gum. The tooth is now ready for a crown (cap). When smiling, ideally there should be a display of upper teeth and a slight amount of gum displayed as well. In many circumstances there is an excessive amount of gum displayed (this is known as a gummy smile). In order to reduce the gum display so that there can be an ideal amount of tooth and gum showing, it is necessary to move both the gum and bone higher up on the teeth. The bone is gently sculpted to create room for the gum tissue to be ideally positioned. Hence the correct proportions of the teeth and gum are now visible.

Back

Impacted Canine

Canine teeth are some of the last teeth to emerge. Sometimes overcrowding in your mouth will prevent your canines from coming in. Other times, abnormal tissue growth will prevent them from erupting.

Early detection through the use of x-rays is the key to treating impacted canines. If necessary, extra teeth will be removed to ease the way for canine eruption. Braces can be used on the upper teeth to make room for the canines. In adults, surgery is often the best treatment for this problem.

Back

Oral Pathology

Oral Pathology is the specialty of dentistry which deals with the diseases of the mouth. This science investigates the causes, effects and treatment of these diseases. They include autoimmune problems, trauma, oral cancer, degenerative disease, viral and bacterial issues. Your dentist will recommend the required treatment if a problem is found.

Back

Post-Surgery Instructions

Fold a piece of clean gauze into a pad thick enough to bite on and place directly on the extraction site. Apply moderate pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked, replace it with a clean one as necessary. Do not suck on the extraction site (as with a straw). A slight amount of blood may leak at the extraction site until a clot forms. However, if heavy bleeding continues, call your dentist. (Remember, though, that a lot of saliva and a little blood can look like a lot of bleeding).

The Blood Clot
After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot.

Here's how to protect it:
- Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours.
- Do not clean the teeth next to the healing tooth socket for the rest of the day. You should, however, brush and floss your other teeth thoroughly, gently rinse your mouth afterwards.
- Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Get plenty of rest.
- If you have sutures, your dentist will instruct you when to return to have them removed.

Medication
Your dentist may prescribe medication to control pain and prevent infection. Use it only as directed. If the medication prescribed does not seem to work for you, do not increase the dosage. Please call your dentist immediately if you have prolonged or severe pain, swelling, bleeding, or fever.

Swelling & Pain
After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat tomorrow if needed. Be sure to follow your doctor's instructions.

Diet
After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcoholic beverages and hot liquids. Begin eating solid foods the next day or as soon as you can chew comfortably. For about two days, try to chew food on the side opposite the extraction site. If you are troubled by nausea and vomiting call your dentist for advice.

Rinsing
The day after the extraction, gently rinse your mouth with warm salt water (teaspoon of salt in an 8 oz. glass of warm water). Rinsing after meals is important to keep food particles away from the extraction site. Do not rinse vigorously!

Back

Post-Surgery Instructions for Children

Anesthesia - The feeling of numbness will begin to wear off in 30 minutes to 4 hours. Until that time, avoid all hot foods or liquids, and do not chew. This is to prevent accidentally burning or biting the lips, cheeks, inside of your mouth or tongue until the feeling has returned

Gauze Pack - Fold the gauze into a small pack and place over the extraction site and apply firm pressure for one to two hours. Change the gauze pack every 15-30 minutes.

Bleeding - It is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery.

Ice Pack - For the first 2 to 8 hours after surgery, ice packs should be applied to the outside of the face over the area of the extraction site. The ice pack should be held in place for 15 minutes on, and then removed for 15 minutes. Doing this throughout the day will help reduce discomfort and swelling.

Medications - DO NOT TAKE ASPIRIN PRODUCTS due to the possible increase in bleeding potential. If prescription medications were prescribed please follow label instructions carefully. For most extractions, a non-aspirin over the counter pain medication will provide good pain relief. Do not take more than the recommended dosage!

Diet - A liquid or soft diet should be adhered to for the first 12 to 24 hours after surgery. It is important to drink plenty of liquids for the first day or two. Avoid the use of a straw as it may dislodge the blood clot that is forming in the extraction site.

Oral Hygiene - Clean the rest of your mouth as usual, however avoid bumping or brushing the extraction site. DO NOT RINSE OR SWISH YOUR MOUTH for the first 24 hours following surgery.

Possible Complications:

Dry Socket - This is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate to severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. If you think you have ANY of these symptoms call our office as soon as possible.

Fever - Monitor your temperature for the first 24 to 48 hours. Any elevated temperature should be reported to our office.

Swelling - After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or a cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat the following day if needed. Be sure to follow your doctor's instructions.

Back

Pre-Surgery Instructions

Before any oral surgical procedure you should:

- Eat a light and easily digestible meal the night before your appointment
- If you are going to be sedated, DO NOT eat or drink anything on the day of your appointment
- Wear short sleeves and loose-fitting clothing
- Arrange for a relative or friend to stay in the office with you and be ready to drive you home
- You may NOT drive a car on the day of the surgery if you are to be sedated!

Back

Surgery FAQs

Pre-surgical
Q: Is there a food and drink restriction prior to surgery?
A: If treatment calls for the patient to be sedated then yes there are food and/or drink restriction. The patient must not consume anything, including water for 6-8 hours prior to surgery.

Q: Will antibiotics be prescribed prior to surgery?
A: We commonly use antibiotics to kill bacteria found in the mouth, which will also prevent infection after treatment, particularly with the placement of dental implants immediately after extracted teeth. The specific drug used depends on the medical profile and well being of the patient and the type of treatment.

Q: Do I need to avoid certain medications?
A: It is important to discuss all medication with John L. Sulak, DDS during your pre-surgical consultation. In most cases medication should be continued unless specifically instructed to withhold them. Typically Plavix, Aspirin, Coumadin and other types of blood thinners can also be continued. When necessary John L. Sulak, DDS will consult with your physician to safely manage your medications.

Q: Are the rules different for ORTHOGNATIC SURGERY different from tooth extractions of dental implant placement?
A: Yes, very different. Patients who are undergoing surgical procedures on only one jaw usually go home the same day. Patients who are having surgery on both jaws will generally stay overnight. Generally it is necessary to wire the jaws together after orthognatic surgery. In general, the jaws are immobilized securely with rubber bands for the first 1-2 weeks and then loosely for an additional 3-5 weeks. It is very important to discontinue any medication which are “blood thinners” or which may increase your tendency to bleed. Please stop taking the following medications at least 2 weeks before surgery. John L. Sulak, DDS will provide specific instructions prior to your surgery date.

Surgery
Q: Will anesthesia be used?
A: John L. Sulak, DDS will discuss your anesthesia options. Our goal is to provide minimal discomfort as possible.

Q: How is the anesthesia administered?
A: Depending upon your treatment we may administer a local anesthesia such as lidocaine or nitrous oxide. For a more involved treatment we may recommend an oral sedation or intravenous sedation.

Q: What do I need to be aware of before intravenous sedation?
A: You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment. No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery. A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience. Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. Contact lenses, jewelry, and dentures must be removed at the time of surgery. Do not wear lipstick, excessive makeup, or nail polish on the day of surgery. If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office. If you take routine oral medications, please check with John L. Sulak, DDS prior to your surgical date for instructions.

Q: Will my vital signs be monitored during and after treatment?
A: John L. Sulak, DDS and/or one of their highly trained surgical assistants will continuously monitor your vital signs.

Q: How long will the surgery take?
A: The length of surgery depends on your treatment. Some surgery's are less than 30 minutes, while other procedures may take considerably longer. John L. Sulak, DDS will provide you with the estimated time of surgery at your pre-surgical consultation.

Q: Will there be a lot of bleeding with a tooth extraction?
A: It's important for a blood clot to form to stop the bleeding after a tooth extraction. You will be asked to bite on a gauze pad for 30-45 minutes immediately after the extraction. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times. After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

Post Surgery
Q: How long is the on-site recovery before I can leave the office?
A: Plan to stay in our recovery room for at least 20 minutes if sedation was involved, or until John L. Sulak, DDS is satisfied that you are recovered sufficiently to go home. If your procedure required sedation you must be completely alert before leaving the office for home. You must have a ride home. You may not drive yourself. It is recommend that you do not drive for a minimum 24 hours after surgery.

Q: Will you prescribe antibiotics and pain medication?
A: Procedure and patient health are determining factors of what antibiotic and/or medication will be prescribed. Call the office if the medication does not seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable. Dr. Sulak will discuss what, when, how long and dosage with you in both the pre-surgery and post surgery interviews.

Recovery
Q: How long will I be off of work/out of school?
A: Depending on the extent of the procedure and type of sedation you may resume work and a normal life style anywhere from a few hours to a few days. It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

Q: Will there be swelling or facial bruising?
A: After the tooth is extracted, you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours. In some treatments there may be some minor bruising; however, in procedures such as dental implant placement ordinarily there is no bruising seen. For teeth removal or jaw procedures, women and/or very light skinned patients may experience slight bruising. Taking blood thinner will help reduce bruising. It is, however, not uncommon to have a black eye or discolored cheek or neck following extensive procedures. John L. Sulak, DDS will discuss what bruising if any would be related to your procedure treatment.

Back

Tooth Extraction

Dr. Sulak is an experienced tooth extraction dentist in Modesto. When the extraction of a tooth is required:

1) An incision in the gums is made
2) The tooth is removed
3) The area is stitched up and is allowed to heal

During this time, it is important to think about a tooth replacement option. An extracted tooth leaves an open area in the jaw which, in time, allows the neighboring teeth to drift into the area where the tooth was extracted. This in turn, causes a chain reaction to all the surrounding teeth. Also, if you are considering placing an implant in the future, you should consider asking your dentist to place a bone graft at the time of surgery to preserve the bone width and height.

Back

Wisdom Tooth Development

Wisdom teeth generally begin to form in your pre-teen years. By late teen years, the crown of the wisdom teeth will begin to erupt through the gums if there is adequate room. By mid twenties, your wisdom teeth will either be able to fully erupt or will have become impacted. Early removal of wisdom teeth makes the procedure easier for the patient to tolerate and promotes faster healing after wards.By your early forties, the wisdom teeth roots have become fully anchored to the jawbone and if required to be extracted, will be much harder and will need more time to heal.

Back

Wisdom Tooth Positions

Wisdom teeth under ideal circumstances should grow in straight like any other tooth. However, it is common for wisdom teeth to become impacted inside the jaw or just under the gums. If this occurs, your wisdom teeth should be removed.

Common Impactions:
1) Horizontal Impaction
2) Angular Impaction
3) Vertical Impaction
4) Soft Tissue Impaction

Back

Wisdom Tooth Problems

The problems involving your wisdom teeth may be caused by the size of your jaw and/or by how crowded your teeth are. Common warning symptoms that there is an un-natural problem in the development of your wisdom teeth could be pain and swelling.

Symptoms can be caused by:
1) Infection to the gums
2) A crowded tooth displacing neighboring teeth
3) A decayed wisdom tooth
4) Poorly positioned wisdom tooth
5) A cyst that destroys bone

Back

Retainer

A gadget that the orthodontist gives you to wear after your braces are removed. The retainer attaches to your upper and/or lower teeth and holds them in the correct position. You wear the retainer 24 hours a day at first then at night to make sure that none of your teeth move while your jaw hardens and your teeth get strongly attached to your jaw.

Back

Space Maintainer

A space maintainer is a removable or fixed appliance designed to maintain an existing space. They are usually fitted to children when they have lost baby teeth early. The gap left from losing this tooth needs to be held open for the permanent tooth to erupt in its correct position.

Back

Brushing with Orthodontics

Be sure to brush your teeth right after every meal and before you go to bed. It's best to use a fluoride toothpaste to help fight cavities. Your orthodontist may prescribe a fluoride mouth rinse to help prevent cavities. Try to brush like this:

- Start by brushing the outside of each tooth at least 10 times.
- Then brush where your gums and teeth meet, using a circular motion.
- Brush the inside surface of each tooth at least 10 times too.
- Brush the chewing surfaces of your teeth last.

Back

Can the fee for Orthodontic Treatment be financed?

Yes, there are several different payment options. Please call our friendly staff at John L. Sulak, DDS at (209) 524-4000 for more details.

Back

Do I continue to see my Dentist for regular visits during Orthodontic Treatment?

Yes, you will need to continue to see your dentist for regular checkups.

Back

Does Orthodontic Treatment hurt?

There may be a little discomfort after adjustments, but Tylenol or Advil can usually remedy any discomfort.

Back

Eating Tips with Orthodontics

While you are wearing braces, you can eat almost all of your favorite foods. Please stay away from these troublemakers:

- Sticky foods like gum, taffy and caramels
- Hard foods like apples and carrots (cut them into pieces)
- Crunchy foods like corn chips, popcorn and nuts
-Sweet foods like cake, cookies and candy

Back

Flossing with Orthodontics

Because your toothbrush won't reach between your teeth, brushing alone won't keep your teeth clean and healthy. Flossing can help. A floss threader, available from us or a pharmacy, helps you floss with braces on. Floss once a day, like this:

1. Thread floss through the threader and slip it up behind your archwire.
2. Pull the floss between two teeth and up under your gum margins.
3. Rinse with lots of clean water, and watch your teeth and braces sparkle!

Back

Fluoride Use for Orthodontics

Use a fluoridated toothpaste. Your orthodontist may prescribe a fluoride rinse if necessary.

Back

How long do I have to wear my braces?

We let our patients know their estimated completion date and let them know that if they miss or reschedule appointments, don't wear their elastics, and do not cooperate, it will take longer.

Back

How long do I have to wear my retainers?

For the first year you need to wear them all day and all night. After that, retainer wear depends on your individual treatment and the difficulty in holding the teeth in your corrected position.

Back

How long is full Orthodontic Treatment?

Treatment is 18-30 months, depending on the difficulty of the case and amount of treatment needed.

Back

How much do braces cost?

Every mouth is different. There is no standard fee. The doctor needs to do an exam to evaluate orthodontic needs on an individual basis.

Back

Ortho Care and Use Instructions

In this section you will find care and use instructions for various orthodontic appliances.

If you have questions that aren't answered here please feel free to contact our office.

Back

What is a bite plate?

A bite plate helps to correct a deep bite and it keeps you from biting into your lower braces.

Back

What is the right age for Orthodontics?

The American Association of Orthodontists recommends that every child receive an initial orthodontic examination as early as age 7. The timing of orthodontic treatment is extremely important and greatly affects the treatment result. Early diagnosis and treatment by a specialist can help prevent more serious problems.

Orthodontics is not just for children. While most people tend to associate orthodontics with children, adults are also prime candidates for treatment. Approximately 25% of all orthodontic patients are adults. Advances in technology and the introduction of more indiscriminate, clear braces make the benefits of orthodontics a must for any adult.

Back

Why do you need braces if teeth are straight but the bite is off?

Orthodontics isn't only for pretty teeth. A good, healthy bite helps eliminate other health problems in later years. It also helps save teeth from wearing.

Back

Child's First Dental Visit

We have several important goals during your child's first visit to our office. First, we want to introduce your child to staff and the dental setting in as non-threatening a way as possible.

The Goals:
1. To provide pleasant introductions to the dental setting and staff, an overall positive experience for your child.
2. To perform a comprehensive exam and assessment of your child's dental health and needs, both now and future.
3. To obtain radiographs when possible in order to provide important additional diagnostic information.
4. To perform preventive measures such as cleaning, topical fluoride application, oral hygiene instructions and dietary guidance.
5. To provide the parents or guardians a thorough analysis of the child's dental and oral status, including restorative needs, orthodontic treatment needs, and home care recommendations.
6. To provide an assessment of treatment methods that would best serve you, given your child's behavior and abilities.

Back

Child's First Pediatric Dental Visit

According to guidelines from the American Academy of Pediatric Dentistry (AAPD), your child should be seen by his/her pediatric dentist no later than six months after the eruption of the first tooth. This visit mainly will involve counseling on oral hygiene, habits, and on the effects that diet can have on his/her teeth. It is NOT recommended to wait until age 3 to visit your dentist and as a general rule, the earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits. The AAPD also recommends a dental check-up at least twice a year; however some children that may be at a higher-than-average caries risk may need to be seen more often.

Back

Enamel Fluorosis

In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.

Back

Mouth Guard

Accidents can happen during any physical activity. A mouth protector can help protect the soft tissues of your tongue, lips and cheek lining. Over-the-counter stock mouth protectors are inexpensive, pre-formed and ready-to-wear. Boil and bite mouth protectors offer a better fit than stock mouth protectors. Softened in water, they are more adaptable to the shape of your mouth. Custom-fitted mouth protectors are made by your dentist for you personally. They are more expensive, but a properly fitted mouth protector will stay in place while you are wearing it, making it easy for you to talk and breathe.

Back

Pulpotomy

Baby teeth that have large caries (cavities) and some degree of pain occasionally require that the 'coronal' (top) portion of that tooth's nerve be removed before a filling or a crown (preferably) is placed. The main goal of this procedure is to preserve the baby tooth, since baby teeth help to maintain adequate room for the permanent teeth. Pulpotomies have published success rates that range from 60% to 90% and represent a good and reliable way to save a badly decayed baby tooth.

Back

Baby Bottle Tooth Decay

Baby bottle tooth decay or syndrome is a form of tooth decay that can destroy the teeth of an infant. This decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. The teeth most likely to be damaged are the upper teeth.

Baby bottle decay is caused by frequent and long exposure of a child's teeth to liquids containing sugar such as milk, formula, fruit juices, pop and other sweetened liquids. These liquids fuel the bacteria in a child's mouth, which produces acids that attack enamel.

Back

Baby Tooth Care

Healthy teeth are important to your baby's overall health. Teeth help your baby chew food and form words and sounds when speaking. They also affect the way your baby's jaw grows.

Every baby is different. Generally, the 2 front teeth start to appear between 4 and 7 months of age. Teething is usually painless, but it can make some babies uncomfortable and fussy. Giving your baby a cold teething ring or a cold washcloth to chew or suck on may help. Teething does not cause a fever. If your baby has a fever, you should talk to your doctor.

Start cleaning your baby's teeth twice a day as soon as the first tooth appears. Until your child is 1 year old, you can use a wet wash cloth or gauze to clean your baby's teeth and gums. At about a 1 year to 18 months of age, you should start using a soft baby toothbrush and a small dab of toothpaste that does not have fluoride in it. This type of toothpaste is safe for your baby to swallow.

Be sure to take your baby to a dentist by his or her first birthday, especially if there is a high risk for cavities or any other problems with his or her teeth. It is better for your child to meet the dentist and see the office before he or she has a tooth problem.

Back

Can you do all the work at once with a Sedation?

In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule we also consider your child's comfort after he/she leaves the clinic, in order to determine how much local anesthetic we can use.

Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity they try to feel the area or areas that are numb.

For these and other reasons it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.

Back

Children Tooth Development

Children continually get new teeth from age 3 months to the age 6 years. Most children have a full set of twenty (20) primary teeth by the time they are 3 years old. As a child nears the age 6, the jaw grows making room for the permanent teeth. At the same time, the roots of the baby teeth begin to be resorbed by the tissues around them and the permanent teeth under them begin to erupt.

Primary teeth are just as important as permanent teeth for chewing, speaking and appearance. They also serve as placement holders for the permanent teeth. Primary teeth also provide structure to help shape the child's face.

Back

Early Childhood Caries

Now known as "Early Childhood Caries" is an aggressive form of caries that occurs in infants and very young children. It is typically associated with prolonged consumption of liquids containing sugar, and affects initially the top front teeth, later spreading to other "baby teeth". Because of the aggressive nature of this disease, early intervention is necessary.

The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that ALL children should see a dentist before age one.

Back

Gaps between childs teeth

It is normal and even "ideal" for baby teeth to have spacing between each other.

Keep in mind that when permanent teeth erupt, their size will be considerably larger than that of baby teeth. As the baby teeth are lost, the erupting permanent tooth will quickly take advantage of this excess space.

Children who do not have spacing in their primary dentition can have a higher incidence of crowding (crooked teeth) in the permanent dentition.

Back

Having baby-teeth pulled

How is that going to affect him or her?

Children require extraction of one or more primary teeth in certain situations. These situations may include extensive decay on their front teeth, and/or localized infection (for example an abscess or a gum boil).

Extractions are also necessary in cases of trauma, where the baby teeth have been pushed back, pushed forward, broken or simply knocked out.

Parents are obviously concerned of the aesthetic and functional effects (on speech, feeding, and breathing) of removing one or more front baby teeth.

There is good evidence that has shown NO long-term speech impediments on these cases. We also know from our professional experience that once the gums heal, children will be able to eat almost anything, since they can still bite-and-cut with the remaining teeth.

As far as aesthetics is concerned, your pediatric dentist can offer you information on fixed appliances that can replace the missing tooth/teeth, assuming your child meets the right criteria.

Back

How Enamel Fluorosis occurs

By swallowing too much fluoride for the child's size and weight during the years of tooth development, a child can develop enamel fluorosis. This can happen in several different ways.

First, a child may take more of a fluoride supplement than the amount prescribed.

Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.

Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.

Back

Missing Permanent Teeth

Hypodontia (the common dental term) describes a situation when fewer than 6 permanent teeth are missing, the term Oligodontia is used when more than 6 permanent teeth are missing (they were never formed). The most common missing teeth are the third molars (otherwise known as the Wisdom Teeth), followed by the premolars and the lateral incisors. Although it is not uncommon to have one missing tooth, patients with multiple missing teeth generally have a strong genetic component and it has been linked to conditions such as Ectodermal Dysplasia and several syndromes. Because early recognition aids in proper treatment, your dentist will refer you to specialists (orthodontist, oral surgeons, etc) that will determine which options suit you best to replace the missing teeth.

Back

My child has crooked teeth, will he or she need braces?

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old.

The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms we refer to this as Early Treatment.

Early treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition, or in early mixed dentition (when the first permanent teeth begin to erupt).

Early treatment has been proven to be effective despite objections by some people in the orthodontic community.

The AAPD recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial esthetics.

Back

My child is getting shark teeth what can i do?

One of our most common consults occurs when children around the age of 7 begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth), however if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.

Back

My child's teeth have stains on them, are these cavities?

When a baby-tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose, however, this change is minimal and should not be confused with a carious lesion (cavity).

The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist.

Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the "cavities" are large). Teeth with cavities typically assume a darker (brown) discoloration, and depending on the extent, may exhibit loss of tooth structure.

Teeth that have been previously "bumped" may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may-not be associated with pain.

Other less common causes of changes in color may be: Fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

Back

Pediatric Dental X-Rays

In general, children need x-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible to tooth decay than adults. The American Academy of Pediatric Dentistry recommends x-ray examinations every six months for children with a high risk of tooth decay. Children with a low risk of tooth decay require x-rays less frequently.

X-rays allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable and affordable.

X-ray films detect:
- Cavities
- Erupting teeth
- Diagnose bone diseases
- Evaluate the results of an injury
- Plan orthodontic treatment

Particular care is applied to minimize the exposure of young patients to radiation. With contemporary safeguards, the amount of radiation received in a dental x-ray examination is extremely small. The risk is negligible. In fact, dental x-rays represent a far smaller risk than an undetected and untreated dental problem.

Back

Pediatric FAQs

Please feel free to read the most frequently asked questions that are asked about pediatric dentistry.

What is oral sedation?

A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. Our academy (AAPD) has clearly defined the indications for this procedure, and these are as follows:

A) Preschool children who cannot understand or cooperate for definitive treatment.
B) Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
C) Patients requiring dental treatment, and who cannot cooperate due to a cognitive, physical or medical disability.
D) Patients who require dental care but are fearful and anxious, and cannot cooperate for treatment.

As with any procedure in which a child's conscious state is altered, there are some risks involved.

The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed, and this may limit the extent of work that we can provide.

Sedation dentistry is also an option in cases of accidents or trauma, but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred.

If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.

Can you do all the work at once with a Sedation?

In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule we also consider your child's comfort after he/she leaves the clinic, in order to determine how much local anesthetic we can use.

Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity they try to feel the area or areas that are numb.

For these and other reasons it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.

What is a General Anesthesia appointment and how safe is it?

The use of general anesthesia for dental work in children is sometimes necessary in order to provide safe, efficient, and predictable care.

The general anesthetic is given to your child by a specialist (anesthesiologist) and ONLY after the child has been thoroughly screened by a physician.

Our academy (AAPD) recognizes the need for general anesthesia in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it.

Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care. Your pediatric dentist and his staff will discuss all the necessary steps that must be taken in order to promptly and safely complete your child's dental treatment after this treatment option has been chosen.

Like any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with an oral sedation include, but are not limited to: Allergic reaction, respiratory arrest, cardiac arrest, and death.

Statistically, the chances of a serious complication are similar to those of being involved in a life threatening motor vehicle accident.

Please make sure you fully understand as a parent or legal guardian all the risks involved with this procedure. Also review the instructions that you must follow the day before the procedure.

Will you need to give my child a shot to do the dental work?

This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic and numbs the tissue were the injection will be administered.

Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth) it is very difficult to obtain profound anesthesia, however we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation).

Younger children, particularly pre-schoolers may interpret the feeling of numbness as pain, and therefore cry. Please follow the postoperative instructions that we give you, in order to minimize complications such as lip biting.

My child's teeth have stains on them, are these cavities?

When a baby-tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose, however, this change is minimal and should not be confused with a carious lesion (cavity).

The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist.

Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the "cavities" are large). Teeth with cavities typically assume a darker (brown) discoloration, and depending on the extent, may exhibit loss of tooth structure.

Teeth that have been previously "bumped" may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may-not be associated with pain.

Other less common causes of changes in color may be: Fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

My child is getting shark teeth what can i do?

One of our most common consults occurs when children around the age of 7 begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth), however if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.

My child has crooked teeth, will he or she need braces?

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old.

The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms we refer to this as Early Treatment.

Early treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition, or in early mixed dentition (when the first permanent teeth begin to erupt).

Early treatment has been proven to be effective despite objections by some people in the orthodontic community.

The AAPD recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial esthetics.

Always know that you are welcome to ask us anything you want to know about your child's dental health or any other questions you may have.

We're here to help!

Back

Thumb Sucking

It is completely normal and healthy for your baby or young child to suck on a thumb, finger, or pacifier. Children usually give up sucking habits on their own by the time they are 4 to 5 years old.

If they stop the habit at this age, the shape of the jaw is usually not affected and the teeth grow in normally.

Children who continue sucking on a pacifier, finger, or thumb when their permanent adult teeth start to come in are more likely to have bite problems.

Sucking can cause:
- The top front teeth to slant out
- The bottom front teeth to tilt in
- The upper and lower jaws to be misaligned
- The roof of the mouth to be narrowed
- The need for braces

Treatment: Your doctor may decide to construct an appliance to discourage thumb sucking.

Back

Toothpaste for my child

There is no such thing as the best toothpaste. We recommend ONLY products that have been ADA (American Dental Association) accepted or approved.

The selection is usually made on a case-by-case basis, however the main consideration when selecting toothpaste is your child's age.

This is due to the risk of fluorosis in younger children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

Back

What is General Anesthesia and how safe is it?

The use of general anesthesia for dental work in children is sometimes necessary in order to provide safe, efficient, and predictable care.

The general anesthetic is given to your child by a specialist (anesthesiologist) and ONLY after the child has been thoroughly screened by a physician.

Our academy (AAPD) recognizes the need for general anesthesia in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it.

Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care. Your pediatric dentist and his staff will discuss all the necessary steps that must be taken in order to promptly and safely complete your child's dental treatment after this treatment option has been chosen.

Like any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with an oral sedation include, but are not limited to: Allergic reaction, respiratory arrest, cardiac arrest, and death.

Statistically, the chances of a serious complication are similar to those of being involved in a life threatening motor vehicle accident.

Please make sure you fully understand as a parent or legal guardian all the risks involved with this procedure. Also review the instructions that you must follow the day before the procedure.

Back

What is oral sedation?

A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. Our academy (AAPD) has clearly defined the indications for this procedure, and they are as follows:
A) Preschool children who cannot understand or cooperate for definitive treatment.
B) Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
C) Patients requiring dental treatment who cannot cooperate due to a cognitive, physical or medical disability.
D) Patients who require dental care but are fearful, anxious and cannot cooperate for treatment.
As with any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed, and this may limit the extent of work that we can provide. Sedation dentistry is also an option in cases of accidents or trauma, but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred. If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.

Back

Will you need to give my child a shot to do the dental work?

This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic and numbs the tissue were the injection will be administered.

Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth) it is very difficult to obtain profound anesthesia, however we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation).

Younger children, particularly pre-schoolers may interpret the feeling of numbness as pain, and therefore cry. Please follow the postoperative instructions that we give you, in order to minimize complications such as lip biting.

Back

Crown Lengthening

Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.

Back

Brushing

Step 1 - Place bristles along the gum line at a 45 degree angle. Gently brush using a circular motion along the outer and inner tooth surfaces.
Step 2 - Brush each tooth individually. Tilt brush vertically behind the front teeth. Using the front half of the brush, use the same circular motion.
Step 3 - Place the brush against the biting surface of the teeth using a gentle back-and-forth motion. Brush the tongue to remove odor-producing bacteria.

Back

Flossing

In order to floss properly, begin by taking approximately 18 inches of floss and winding one end a few times around your middle finger. Leave approximately 6 inches of floss between your hands and wrap the opposite end of the floss around your other middle finger once. Put the floss between your thumbs and index fingers and hold tightly.

As you insert the floss between your teeth using a gentle rubbing motion, curve the floss in the shape of a C once it reaches the gum line. Move the floss up and down against the side of the tooth in a gentle manner, making sure you work the floss into the adjacent tooth before moving onto the next space. Before you move onto the next space, wind a little floss around your middle finger in order to get a new section of floss to work into your gums.

Back

Fluoride

Fluoride is an important part of healthy tooth development and will help prevent cavities.

Fluoride can provide protection from tooth decay in a couple ways:
1) It helps to strengthen the tooth's enamel so it can repel the acid that is formed by plaque.
2) Teeth that have been damaged by plaque can repair and re-mineralize themselves with the help of fluoride.

Fluoride is incapable of repairing already formed cavities, but it does assist in reversing low levels of tooth decay and helps in preventing new cavities from forming.

Back

Oral Exam

An oral exam is performed on both new and existing patients to determine their dental and health status. New patients receive a more comprehensive exam that includes x-rays and checks for gum and bone disease, systemic disorders and oral cancer. A more routine exam is done for existing patients to see if there have been any changes in health since their last visit. In order to look for gum disease, the gum tissue is measured with a small ruler to measure the pocket depth between the tooth and connective tissue. A measurement of over 4mm could indicate disease or infection. Gum disease can develop easier in deeper pockets due to the extent that plaque collects in these deep pockets. If the oral exam reveals the need for tooth scaling or root planing, these services are performed in lieu of or in addition to the routine cleaning.

Back

Plaque

Plaque is essentially the start of gum disease problems. Plaque is a build-up of particles from the foods you eat every day. Once sugars are introduced to plaque, it turns into a tooth eating acid that sits just above the gum line. If regular oral care isn't standard, the acid will start eating at the teeth and gums. Plaque that is allowed to sit for a prolonged period of time can cause cavities, gingivitis and other problems in your mouth. If it's left longer than that, serious dental procedures may be required to restore your decaying smile.

Back

Root Planing

Sometimes after a tooth scaling, the roots of a tooth must be planed in order to create a smooth surface for the gum tissue to re-attach to. In addition to the planing, your dentist may also prescribe medication in order to control infection and pain.

Back

Sealants

Dr. Sulak treats children. One of the best ways to keep a child cavity free is with proper home care instruction and with sealants. Sealants have been proven to prevent cavities but they do not replace proper hygiene. Ask Dr. Sulak, your dentist in Modesto if sealants are right for your child.

Back

Tooth Scaling

In order to remove plaque, tartar and calculus deposits from your teeth, a tooth scaling must occur. In some cases plaque and tartar are present below the gum line and a sub-gingival tooth scaling must occur.

Back

Bonded Bridge

The most conservative approach when attempting to replace a missing tooth is a bonded bridge or often referred to as a Marilyn Bridge. An impression of the area is taken and a new tooth referred to as a pontic is formed. Attached to the pontic on either side are abutments or “wings” that will support the pontic. The most common type of Marilyn Bridge uses abutments that are cemented on the backside of the adjoining teeth and hold the pontic in place where the missing tooth used to be. The adjacent teeth may need to be slightly modified to accept the “wings” of the pontic. The advantage of this type of procedure is that you are not having to put full coverage crowns on the adjoining teeth.

Back

Crown Aesthetics

If your smile is in need of a makeover, crowns can provide predictable results. Crowns can give an unattractive tooth back its beautiful shape and color. For smaller or worn down teeth, a crown can restore the natural size of the old tooth. A crown can replace either part of or the tooth's entire structure. For procedures requiring only the areas visible from the outside, a veneer may be an alternative option.

Back

Crown Procedure

A crown is sometimes termed a "cap" or "jacket." A crown will restore a large filling or a cracked tooth to its original size, shape and tooth color. A crown may be recommended after root canal therapy has been completed, as the tooth tends to become brittle and is more likely to fracture. A crown can strengthen and protect the remaining tooth structure and improves the appearance of your teeth. With the advances in technology, we now have the ability to make ceramic crowns with no metal.

To place a crown, your dentist must reduce 1-2 mm of the tooth to make room for it. Your dentist will then use a piece of thread or cord or use a laser to push the gum down around the tooth, to take an impression of the tooth. The impressions are sent to the lab where the crown is made. During that time, you will have a temporary crown. These crowns are usually made of plastic and are made in your dentist's office on the day of your visit. They are not meant to last. If a temporary crown is left in the mouth, the cement eventually washes out and the tooth can decay. At a second visit, your dentist will remove the temporary crown and test the permanent one. Sometimes crowns need additional polishing, glaze or some other adjustment before they are placed. Once the crown is ready, it's cemented to your tooth.

Back

Fixed Bridge

A bridge may be used to replace a single tooth. A bridge consists of both a false tooth, called a pontic and the anchors (abutment crowns) that support the pontic. The entire structure spans the space vacated by the missing tooth.

Neighboring tooth structure is removed shaping them to receive an anchor crown. An impression is then taken and sent to a dental lab where they fabricate the bridge.

The structure part of the bridge is created with a strong metal alloy that can handle the anticipated stresses.

Tooth-like porcelain is then fused to the structure. Once the bridge is tested for a correct fit, the anchor crowns are cemented to the neighboring teeth.

Back

Full Porcelain Crowns

These are very esthetic, bonded crowns. They are mostly used for front teeth because they are the most natural looking type of crown and are often used in 'cosmetic' dentistry. There are many types, but they all have a common feature - no metal. They can occasionally break, but dental technology has advanced far enough to make them quite strong.

Back

Gold Crown

The 'gold' standard. Dental gold is about 60% gold alloy which is meant to match the hardness of the enamel of opposing teeth so both wear about evenly, an important trait.Gold does not tarnish or corrode and has some bacterial inhibiting quality. Gold crowns are strong and will not break. However, gold crowns obviously are not considered esthetic; they are gold colored. So usually gold crowns are used for lower back molars because they don't show there.

Back

Inlays and Onlays

An inlay or onlay is a method of repairing a tooth that is somewhere between a filling and a crown. They are used when the tooth is unable to support a filling, but is not damaged to the point that it needs a crown. An inlay is much like a filling but is inserted into the ridges (cusps) of the chewing surface. An onlay is a little more extensive than an inlay and covers multiple cusps of the tooth. Inlays and onlays are commonly made with ceramic or composite materials but can also be made of gold. They are very durable and can last a long time depending on the material used and how well the patient takes care of them with regular brushing, flossing and visits to the dentist.

Back

Porcelain Fused To Metal Crown (PFM)

The most common type of crown and has a proven track record. PFM crowns are fairly aesthetic and they look like real teeth. However, the margins or borders may appear dark because PFM crowns have a metal substructure with layers of porcelain fired over the substructure. Porcelain is very hard, much harder than natural enamel and may cause excessive wear of the enamel of opposing teeth. Porcelain may break with extreme biting forces.

Back

Replacing Old Fillings

There is now new technology that allows you to replace old silver and gold fillings with a more natural looking, composite filling. Composite fillings are bonded to the tooth and research has proven them to be about 90% as strong and healthy as natural tooth material.

Other Benefits:
- Beautiful in appearance
- Completed in a single visit
- No filling leaks
- Less chance of tooth cracking

Back

Stainless Steel Crowns

Stainless steel crowns, also known as 'silver crowns or caps', are a very common procedure used to restore 'baby teeth' (and occasionally permanent teeth) that have large caries or those that had a pulpotomy (baby root canal). Although most teeth can be filled with a white or silver filling material, stainless steel crowns are by far the most predictable and durable option to fix 'baby teeth' with large caries, large defects, or damaged enamel. This is particularly true in very young children that have caries at a young age, since it is preferred that the 'fixed' teeth last as long as possible.

Back

Tooth Colored Fillings

In order to make a filling appear almost invisible to the naked eye, composite fillings are often used. These fillings are designed to match your natural tooth color and are bonded to your teeth, which makes them less likely to fall out. These fillings are used to replace older fillings made of silver or gold. Tooth colored fillings have a more aesthetic appearance, can be completed in one visit, form a strong seal and are less likely to crack a tooth.

Back

Types of Crowns

With today’s advances in dentistry, there are several options when choosing a type of crown. The most common crown utilized in dentistry is referred to as a PFM or porcelain-fused to metal crown. For those that have sensitivities to metals or are worried about aesthetics, there are all porcelain crowns or crowns that are composed of a material called composite. There have been several advances in all porcelain crowns and some labs are now utilizing zirconia which is much stronger than a typical porcelain crown. Also, they still are making all metal crowns, which are typically gold, and are usually used on a molar or a back tooth. Of course all of these different options vary in durability, appearance and cost. Please contact our office for any further questions. We would be more than happy to find the crown that is right for you and your situation.

Back

Types of Fillings

When a cavity needs to be filled, there are four choices in the filling material:

The most common is a composite filling, this is a natural tooth colored filling and bonds to the tooth for extra strength. There are also gold and silver fillings. Silver fillings are inexpensive and strong while gold fillings may look nicer and provide a better fit. The final option is a porcelain filling, also called an inlay, which is the most durable of fillings and is also the color of your natural teeth.

Ask Dr. Sulak, a cosmetic and restorative dentist in Modesto, which filling would be best for you.

Back

Nitrous Oxide Sedation

Nitrous oxide, also known as laughing gas, is most often used for patients who are mildly or moderately anxious or nervous. It eases their fears so that they can relax and receive treatment comfortably and safely. Nitrous oxide is administered by placing a small mask over the patient's nose. As the gas begins to work, the patient becomes calm, but is still awake and can communicate. When the gas is turned off, the effects of sedation wear off almost immediately.

Back

Sedation FAQs

What is the medication?:
One of many safe and widely-used sleeping pills will be used. In certain cases, nitrous oxide gas may also be used as an additional medication.

Can I drive home?:
No. The effects last many hours and driving is not safe. We will call your ride at the end of your appointment to bring you home. You should not plan to do anything but sleep for the rest of the day. By the next morning you will feel normal, rested and ready to get on with your life.

Will you use local anesthetic (Novocain)?:
Always. Oral sedation is not general anesthesia. Treatment is no different than if you were not sedated. The difference is that you will be much more relaxed, memory of the procedure will be minimal and the time will seem to fly by.

Will I be asleep?: Most people do doze during their appointment, but our primary goal is relaxation and comfort with safety.

How safe is it?:
Properly administered oral sedation is the safest form of sedation. We use sophisticated monitoring equipment during all procedures and you are always attended by a trained doctor or staff member.

Is it expensive?:
No. There is a sedation fee to cover the expense of the drugs and the monitoring, but we don't try to profit from sedation. Our profit (and yours) is in your comfort and in the quality of your care.

Would I be unusual in wanting sedation?:
Not at all. Oral sedation in our office is very popular for surgery, for long appointments and for complicated procedures as well as for basic dental anxiety.

Back

Causes of Sleep Apnea

When the tongue is causing restriction of the upper airway and causes air to stop flowing this is called Obstructive Sleep Apnea (OSA). It is a common disorder that can develop into more severe respiratory or cardiovascular problems if left untreated. Symptoms of OSA include loud snoring, waking up to use the restroom frequently, feeling tired or falling asleep during the day and being 30+ pounds overweight with a large neck size.

Back

CPAP

A continuous positive airway pressure device (CPAP) is used to treat people with sleep apnea. A CPAP is a device that uses a mask, tubes and fan to push the tongue away from the back of the throat and allows proper air flow. It will halt all occurrences of apnea and greatly reduce snoring. An individual with a CPAP device should wear it whenever they sleep, even for short naps. While a CPAP does not cure sleep apnea it will drastically improve your sleep problems.

Back

Obstructive Sleep Apnea

The Greek word "apnea" literally means "without breath." Obstructive Sleep Apnea (OSA) is very common. Left untreated people with sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Back

Snoring

Snoring is caused when the muscles and soft tissue in the throat and mouth relax making the breathing airway smaller. A relaxed and/or collapsed airway produces soft tissue vibrations during breathing and snoring is the result. Dr. Sulak has provided oral appliances that can greatly reduce or stop snoring for most people.

Back

Snoring Appliance

A snoring appliance is a custom fit mouthpiece that is made from plastic and is easy to clean with a toothbrush. It is designed to keep the upper and lower jaw in place when the throat relaxes during sleep. This allows the air passage to remain open while providing a quiet and relaxing sleep.

Back

Bite Splints

Bite splints (plates) are effective in relieving TMD symptoms.

A bite splint provides an acrylic platform to bite against. Some bite plates move the mandible to a new position.

Generally, splints are worn part-time and for most people nighttime is best.

Back

Causes of TMJ/TMD

Back

Headaches

If you suffer from frequent head or facial pain, an incorrect bite may be the cause due to constant cranial muscle strain.

Headaches from dental stress are a type of muscle tension headache. A tension headache may be on one or both sides of your head and feels like a dull, non-throbbing ache that can usually be relieved by aspirin.

When you swallow, your upper and lower jaw muscles must hold your jaw firmly against the skull. Between swallowing over 2,000 times a day and a poorly aligned bite, the jaw muscles can overwork causing muscle strain which in turn leads to a headache.

People who suffer from migraine pain and chronic headaches clench their jaws in a balanced, centered position. This causes extremely intense muscular contraction, but little strain on the jaw.

Nighttime jaw clenching usually goes unnoticed but it sets the stage for migraine pain and chronic headache pain.

Back

TMD Symptoms

TMD symptoms may include:

1. Headaches, migraines or tension headaches
2. Worn or loose teeth
3. Painful muscles in the neck and shoulders (muscle spasms)
4. Pain behind the eyes.
5. Clicking and popping of the jaw joint (TMJ)
6. Locked jaw or restriction in opening or closing the mouth
7. Earaches or a clogging feeling in the ears
8. Tingling or numbness in the hands and the fingertips

If you are experiencing any of these symptoms, please call our office and we will be happy to discuss your symptoms, and talk about the possible treatments available for your situation.

Back

TMJ / TMD

Do you ever experience a clicking or popping sound when opening or closing your mouth? Have you been suffering from headaches or migraines and no one seems to be able to help you? Have you been taking pain medicine for years and would like to get off of it? Do you feel any clogging or congestion in one or both of your ears? These are just a few of many symptoms that might be associated with TMD, or Temporomandibular Dysfunction, a common condition affecting the jaw joint or Temporomandibular Joint (TMJ).

TMJ dysfunction, often referred to as TMD, is a disharmony between the way the jaw joint works in an unstrained position and the way the teeth and bite work during those movements. Possible causes of this disharmony include tooth loss, accidents (like whiplash), mal-positioned and/or underdeveloped cranial or jawbones, and perhaps habits like clenching or teeth grinding. Many people go through life suffering from headaches and a variety of facial and neck pains without knowing the ultimate cause, which in many cases is TMJ disorder.

TMJ or The Temporomandibular Joint
They are the two joints which connect the lower jaw to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of the head.

Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. When the TMJ is not functioning normally and it is not within its physiological limits, it creates a condition called TMD.

TMD or Temporomandibular Dysfunction, is a group of conditions resulting from not having a normal function or 'comfortable' positioning of the TMJ, and will present as a cycle of pain, muscle spasms and jaw problems.

When teeth are missing, out of alignment, crowded or misshaped, chewing and biting can not be achieved in a balanced way, so the TMJ and the muscles of chewing try to compensate for this unbalanced movement which results in symptoms that will confirm the presence of TMD.

Temporomandibular Joint Disorder (TMD) is not just a disorder, but a group of conditions, often painful, that affect the jaw joint or Temporomandibular Joint (TMJ) and the muscles that control chewing.

TMD falls into three main categories:
1. Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw functions and the neck and shoulder muscles.
2. Internal derangement of the joint meaning a dislocated or displaced disc or injury to the condyle (the rounded part at the end of the jaw bone).
3. Degenerative joint disease such as Osteoarthritis or Rheumatoid Arthritis in the jaw joint.

Back

TMJ Treatment

Simple cases of TMJ can be treated with anti inflammatory medications and hot/moist compress.

Treatment for more complex cases includes the fabrication of an orthotic. The orthotic is designed to reposition the jaw to the correct neuromuscular position.

Once this position has been established, definitive treatment can include orthodontics or reconstruction of the bite.

Back

ArmourBite Mouthguards

HOW DO THE ARMOURBITE® PRODUCTS DIFFER FROM MOUTHGUARDS?
The ArmourBite® Mouthpiece and ArmourBite® Mouthguard do more than simply provide protection. They enhance performance. ArmourBite® Technology is not only backed by some of the biggest names in pro sports, it’s also recommended by dentists, pro trainers, strength coaches and wellness experts.

WHO SHOULD USE UA PERFORMANCE MOUTHWEAR?
Hundreds of professional athletes are currently relying on the superior performance and protection benefits of custom UA Performance Mouthwear. But it isn’t just for pros – UA Performance Mouthwear is for all athletes who want to excel in their sport or activity.

HOW DO I GET MY UA PERFORMANCE MOUTHWEAR?
Once you have decided which model is right for you, getting your own Under Armour Performance MouthwearTM is a quick and simple 3-step process. First, your dentist takes your bite impressions. Next, the impressions are shipped to our lab where we custom make the product. Third, the completed mouthwear is shipped back to your dentist for a final fitting.

HOW LONG DOES IT TAKE TO GET A CUSTOM PIECE OF UA PERFORMANCE MOUTHWEAR?
Once fitted, the orders typically take up to 10 days for delivery. Talk to your dentist about shipping options to receive your product sooner.

Back

Bad Breath

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. The odors will continue until the body eliminates the food. People who diet may develop unpleasant breath from infrequent eating. If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor. Dry mouth occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. Tobacco products cause bad breath, so if you use tobacco, ask your dentist for tips on kicking the habit. Bad breath may also be the sign of a medical disorder, such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Back

Bruxism

Bruxism, commonly known as "tooth grinding," is the process of clenching together and the grinding of the upper and lower teeth. During sleep, the biting force of clenched jaws can be up to six times greater than during waking hours.

Bruxism can cause complications over the years:
- Wear down tooth enamel
- Break fillings or other dental work
- Worsening of TMJ dysfunction
- Jaw pain, toothaches, headaches, or earaches
- Tooth sensitivity
- Tooth mobility
- Chipped teeth
- Erodes gums and supporting bones contributing to gum disease

There is no cure for bruxism; however, the condition can be managed. The most common procedure to help to alleviate pain and discomfort is a Nightguard.

Back

Canker Sores

Canker sores are common in adults and children, and generally tend to cause discomfort, particularly during eating. Although several factors have been named as possible 'causes' of aphthous ulcers, trauma is the most common trigger for them. It has also been observed that they appear in patients who are under stress, or those experiencing health problems. They have also been attributed to hormonal changes, and to some types of dietary deficiencies (ie, Vitamin B12, Iron, Folic Acid, etc.). Although there is no specific treatment for the ulcer itself, except for severe cases (where usually steroids are prescribed); treatment is usually focused on the pain caused by the ulceration.

Back

Cold Sores

Recurrent Herpes Labialis (the common dental term) is a very common viral infection in children and adults. It is caused in most cases by a sub-type of the Herpes Virus, and in most patients it is preceded by an illness (a cold), exposure to sun or exposure to cold. Most patients experience what is known as 'prodromic' symptoms such as itching or burning sensation in the area where the blisters soon appear. This information may allow your dentist to recommend therapies that may minimize or eliminate the appearance of the blisters. This infection is usually self limiting and can last up to 14 days before the scabs fall off.

Back

Dry Mouth

Back

Mouth Guard

Accidents can happen during any physical activity. A mouth protector can help protect the soft tissues of your tongue, lips and cheek lining. Over-the-counter stock mouth protectors are inexpensive, pre-formed and ready-to-wear. Boil and bite mouth protectors offer a better fit than stock mouth protectors. Softened in water, they are more adaptable to the shape of your mouth. Custom-fitted mouth protectors are made by your dentist for you personally. They are more expensive, but a properly fitted mouth protector will stay in place while you are wearing it, making it easy for you to talk and breathe.

Back

Pregnancy

We ask that our female patients who are pregnant or think they possibly could be to inform us prior to your x-ray examination and dental treatment.

Back

Tobacco

You are probably familiar with the links between tobacco use and lung disease, cancer and cardiovascular disease.

Current studies have also established that tobacco smoking not only causes direct damage to your mouth but also makes periodontal diseases more damaging and harder to treat.

There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth, more gum recession and more loss of the bone that hold teeth in your mouth. In addition, smokeless tobacco greatly increases your chance of developing oral cancer. Any tobacco usage can complicate the placement of dental implants.

Besides smokeless tobacco, cigarette smoking negatively impacts the health of the gums. The healing capacity of the mouth is significantly altered. The healing time from any procedure is always increased. Needless to say smoking creates more tartar, more stain, bad breath and an increased potential for mouth cancer.

Other chemicals impair the function of your white blood cells which are your first line of defense against infection. The tars contain carcinogens which over time induce cell mutations and cancers.

Quitting tobacco use will lower the risk of your developing cancer and improve the health of your teeth and gums, as well as your heart and lungs.

Smokeless tobacco poses very serious problems including:
- Causes tooth decay
- Eats away your gums
- Leads to tooth loss
- Bad breath
- Stains your teeth
- Causes oral sensitivity to hot and cold
- Decreases sense of taste and smell

If oral cancer is left untreated long enough, it may even cause death.

Back

Tooth Fractures

There are many types of cracked teeth. The treatment and outcome for your tooth depends on the type, location and severity of the crack.

Unlike a broken bone, a fracture in a cracked tooth will never heal. Early diagnosis is important, even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.

A crown will bind and protect the cracked tooth. When a crack reaches the tooth root, root canal treatment is frequently needed to treat the injured pulp. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.

Back

Traumatic Ulcer

It is not uncommon for children to inadvertently "bite" on their lips or cheeks, particularly following a dental visit where local anesthetic was used. The main reason why this occurs is the natural curiosity that a child has about the area of the mouth that is "numb". We try our best to explain to children that local anesthesia is temporary and we give them (and their parents) instructions on how to prevent "lip biting". In the event that this occurs, please notify our office so we can determine if your son/daughter will require treatment (i.e., antibiotics or pain medicine).

Back

Cavities

Cavities generally develop in the "hard-to-see" places in your mouth. These are normally the places where you need to floss. When bacteria combine with food particles, they form plaque that adheres to your teeth.

As long as plaque remains on the tooth, acid produced by bacteria will eat away the tooth structure. Once through the enamel, the acid attacks the dentin, which is that part of the tooth containing sensitive nerve fibers.

If the tooth decay reaches the dentin, a filling is needed to halt the degenerative process. Otherwise, it continues at an accelerated rate becoming larger and larger.

If not detected and repaired with a filling, the decay can reach the tooth nerve and cause the need for a root canal. With the decay removed and a filling in place, the tooth is restored to its original contour.

Back

How do I use dental floss?

Floss is cheap, so don't be stingy! Tear off about a forearm's length to start. Wrap one end around the middle finger of one hand to 'anchor' it and pick up the other end about 4-6 inches away with the middle finger of the other hand. This allows you to manipulate the floss with your thumb and fore finger. As you soil a section of floss, 'reel' in another 4-6 inches of clean floss with the anchor finger as you release the floss with the other finger. Never shoe-shine the teeth in a back-and-forth motion as you will either notch your teeth and/or cut your gums.

Back

How often should I get dental checkups?

For people without any periodontal disease a check up and cleaning every six months is standard protocol. People who have active periodontal disease, or who have been previously treated should have a check up and cleaning every three months.

Back

How often should I get x-rays?

For most people, a complete radiographic survey should be done every 3 years and a "check up" or "recall" set every 6 to 12 months. A complete set of x-rays is estimated to expose you to the same amount of radiation you get on a flight from San Francisco to Seattle.

Doctors use x-rays as an aid in diagnosing problems. Without x-rays, "seeing" the problem will be difficult if not impossible.

Back

Tongue Scraper

In general, the tongue, with its rough surface, is the most common source of bad breath. 'Tongue scrapers' are very effective in keeping the tongue clean.

Back

What causes tooth decay?

Tooth decay happens when plaque or bacteria come in contact with the tooth and is allowed to sit. The bacteria, once fed with sugars, will begin eroding the enamel.

Causes for tooth decay include:
- Poor oral hygiene (brushing / flossing)
- Poor diet
- Stress
- Smoking
- Genetics

Adults tend to get cavities around old fillings, which may be cracked, rough around the edges or loose in the tooth. Another common form of tooth decay in adults is root cavities. These are likely to occur in adults who have receding gums due to age or periodontal disease. As the gum line recedes, the tooth root becomes exposed. Since root tissue is softer than enamel, it decays more easily.

Back

What is the best kind of toothbrush?

Generally speaking, a soft bristled toothbrush is best. Whether you use a manual toothbrush or an electric, anything harder than soft, is too hard. Stiff bristles may give you that clean feeling, but they can also abrade your teeth and cause gum recession.

Back

Your First Visit

New patients receive a comprehensive examination which includes a screening for oral cancer, gum and bone disease, blood pressure and systemic disorders. A routine oral exam is performed on established patients to determine any changes in dental and health status since the previous visit.Your gum tissue is measured with a fine instrument ruler to calibrate in millimeters pocket depth between the tooth and the connective gum tissue around the tooth. Pocket depths more than 4 millimeters, could indicate disease and infection. The deeper the pocket, the greater the extent plaque bacteria collects and infection in gum disease develop.X-rays are taken as needed.Tooth scaling and root planing occur as needed. Routine cleanings also include a professional polishing (Prophy) that removes only the soft sticky plaque that is above the gum line.