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A: Believe it or not, this is a pretty common occurrence. Here in Southwest Florida many people spend their winters here and their summers back home in the northern states. Oftentimes this means that theses people see two doctors, two dentists, two eye doctors, two cardiologists and the list goes on.

Preparing for a season away from home requires a lot of planning and organization. Unfortunately, most of the time dental records and x-rays are not included and left at home. These are a vital part of your dental history and the lack of these records makes it somewhat difficult for the dentist seeing that particular patient.

In this particular instance it's possible that the dentist may have noted in the patients record a particular area or areas of concern that may need attention at some point. Another factor to consider is that every dentist practices differently. One dentist may prefer to "watch" a tooth or area while another dentist will want to treat a problem as soon as he/she sees it.

Yet another factor to consider is technology. Does the dentist have digital x-rays? Do they take x-rays once per year at check-ups? Do they have laser cavity detection or intraoral cameras?

Intraoral cameras can actually take pictures of these problem areas allowing you to see what your dentist has seen. All of these tools enable your dentist to see and treat small problems before they become bigger ones. This is of great benefit because it allows for more conservative treatment.

Modern, preventive dentistry embraces these tools which benefit the patients by enabling the dentist to perform treatment that is less costly, less time consuming and less invasive. People are living longer, more active lives today so there is no good reason to "watch" an area or tooth.

Watching and waiting only allow problems to grow and become bigger. There is never an instance in which cavities go away or broken teeth fix themselves. The dentist that you have seen here should be able to show you or explain to you where the cavities are and why you need to have them treated. You should also ask your dentist up north if they have any notes that the teeth in question will need treatment in the future.

If neither of these answers satisfies you it may be best to seek treatment elsewhere or at the very least seek a second opinion.

Beauty is in the eye of the beholder, yes. And so is self-esteem. The darkened tooth that drives one individual crazy may matter little to another. You may have a space between your front teeth that, rather than distract from your appearance, is rather engaging.

A good cosmetic dental practice considers your self-image as you see it. Fine cosmetic dentistry is not so much about creating "perfection" but enhancing the attributes that contribute to your personal success. Dark teeth, gaps or spaces, chipped or broken teeth can all prevent a smile from coming naturally.

So dialogue between you and your dentist is the key. You should take the time to carefully explain what you see about your teeth and smile that make you unhappy. Your dentist should then be able to translate your needs into a realistic result.

That transformation can be breathtaking. New whitening techniques can brighten teeth in as little as an hour. Impossibly thin veneers can cover discolored teeth, repair chips and gaps or even give you that "Hollywood" smile you've always wanted. Invisalign can straighten teeth with no metal and no wires and are an excellent alternative to traditional metal braces.

With so many options available, many people are now choosing cosmetic dentistry as way to achieve a new look. Even men are catching on to this exciting new trend. Many who visit the dentist want a "brighter smile" without the commitment home whitening.

A little in office whitening brightens the smile and gives a more healthy, youthful appearance without drastic change. So whatever your interest cosmetic dentistry can give you more self esteem, improve your self-confidence and not compromise your busy Southwest Florida Lifestyle.

On the flip side, a stray wrinkle appears and inevitably, teeth grow darker and begin to yellow. It's disconcerting, but very natural.

Part of this process is strictly physical. Teeth, like bone, are complex - part living and changing, part fixed in time. The hard outer layer is enamel, rich with calcium, our first defense against injury and decay. Beneath is dentin, composing the main mass of a tooth.

Enamel is translucent - in fact, a blue tone. It's the dentin's yellow hue that tricks the eye into perceiving a tooth as bright.

As we age, chewing and normal function wear down and thin the enamel layer. As the enamel thins, the darker dentin color eventually takes over.

Add to this scenario a diet of coffee, tea, colas, red wine and smoking - tar and nicotine actually invade the enamel surface making your teeth look older than the hills. Still strong, mind you, but not so appealing.

Fortunately, a measure of brightness can be regained with cosmetic dental procedures. Tooth whitening is an alternative, porcelain veneers that cover the face of the tooth is another. More cosmetic options are available today than ever before. So, whatever option you choose, a brighter, whiter smile can take years off your appearance and make you feel more youthful and vibrant.

On the flip side, a stray wrinkle appears and inevitably, teeth grow darker and begin to yellow. It's disconcerting, but very natural.

Part of this process is strictly physical. Teeth, like bone, are complex - part living and changing, part fixed in time. The hard outer layer is enamel, rich with calcium, our first defense against injury and decay. Beneath is dentin, composing the main mass of a tooth.

Enamel is translucent - in fact, a blue tone. It's the dentin's yellow hue that tricks the eye into perceiving a tooth as bright.

As we age, chewing and normal function wear down and thin the enamel layer. As the enamel thins, the darker dentin color eventually takes over.

Add to this scenario a diet of coffee, tea, colas, red wine and smoking - tar and nicotine actually invade the enamel surface making your teeth look older than the hills. Still strong, mind you, but not so appealing.

Fortunately, a measure of brightness can be regained with cosmetic dental procedures. Tooth whitening is an alternative, porcelain veneers that cover the face of the tooth is another. More cosmetic options are available today than ever before. So, whatever option you choose, a brighter, whiter smile can take years off your appearance and make you feel more youthful and vibrant.

A: This is a great question and one that has a very simple answer. No, it is not necessary to see a "specialist".

The American Dental Association has not designated the field of implantology as a specialty. Therefore, there are no implant "specialists".

Dental implants can be placed by any doctor who has earned the title of DDS or DMD and currently practices dentistry.

This can be both good and bad. A patient may feel that they need to see some type of a specialist because they may have more experience with implants. Another patient may feel confident that their longtime general dentist with whom they have a great rapport can do the job as well as the specialist. While both of these situations can be true, it is the doctor's experience that should be the key factor.

The doctor you choose should be able to explain your treatment options clearly, adequately answer your questions as well as show some completed cases of his or her own.

There are various implant teaching facilities throughout the country. In selecting a doctor you should pick one who has completed extensive training in one or more of these programs.

Implant treatment can be complex so it is extremely important you have someone with extensive knowledge and expertise and that is familiar with the different aspects of treatment.

There are a couple different phases to implant treatment. The first portion is the surgical phase. This involves the placement of the dental implant into a precise location in the bone. This portion of the implant cannot be seen and will later serve as the support mechanism to the tooth portion of the implant in much the same way that a tooth root supports a tooth. Once the placement is complete the implant is left in place underneath the gum tissue where it integrates and becomes permanently attached to the bone.

After this takes place, the second phase of treatment can begin. This phase is the restorative phase and involves the fabrication and placement of the final restoration(s) on top of the integrated implant(s).

Both phases are equally important and crucial to the success of the entire case.

A dentist or specialist may only perform the first phase requiring another dentist for the second phase. This is where things can become confusing. Going from location to location for the various steps can cause problems if there is not adequate communication during the planning stage.

The best way to avoid this is to either find one doctor who can perform all aspects of treatment or to have a team approach utilizing doctors who practice at the same location. This ensures good communication and proper planning for each step.

Implant dentistry has greatly improved over the past 30 years. If done correctly it is an extremely strong, predictable and reliable replacement for one tooth or many teeth.

 A: Over the years "root canal" has come to typify the very worst scenario that life can deal out. Right up there with IRS audit, in-laws extended visit and crossing the Jolley Bridge in season.

The fact is that we now have ways to relieve the pain that drove you into the office in the first place. Ohhh, the pain! Believe it or not, over 90 percent of all dental pain has something to do with the nerves within the tooth. The severity of the pain and how you describe it indicate to us if the tooth is alive or dead.

It's possible to have a cracked filling or cracked tooth that may not need root canal therapy if evaluated and treated right away. It's necessary to x-ray and examine the tooth to determine the appropriate treatment. If root canal is necessary it can, in most cases, be treated in a single visit.

There are many new materials and techniques available that will make your visit short and comfortable. Typically, once the root canal has been completed a crown must be fitted over the top of the tooth in order to protect it and keep it from breaking. Once this process is completed the prognosis of the tooth becomes favorable and the tooth can last a long time.

A: There are many different options available to you for replacement of the tooth. These options can be simple or complex as well as temporary or permanent depending on various factors.

First, you will need an exam in order to gather a little more information. Which tooth is missing front or back, top or bottom?

Next, what are your needs? If you go out to dinner with friends are you willing to remove the tooth to eat or do you want it to remain in place, look beautiful and function like your original tooth.

What is the cost of the replacement? This is where the temporary and permanent solutions enter the picture.

Do you have to do something temporary in order to save for something more permanent? Or, are finances no concern at all? Are there other adjacent teeth that can complicate the treatment and add to the cost?

Whatever the case, these are all factors that a dentist should consider when taking your treatment needs into consideration. The most important thing that we need to evaluate when dealing with a missing tooth is how much bone remains once the tooth has been removed and healing has taken place.

The remaining bone serves as the foundation and is the best indicator as to replacement choice. If you smile and look like you are waiting for a new tooth for Christmas then a temporary solution can found to get you through. Or, if you are ready to proceed a treatment plan is fabricated that takes into account all of the factors that I have mentioned above.

A: This is a great question. If I had a nickel for every time I get asked this ...

Let me share with you the reason why a filling cannot be done in place of a crown. As I'm sure you know, fillings are generally needed when a tooth has become decayed. The decayed part of the tooth is removed and the tooth is "filled" with a composite or resin filling material.

Silver fillings are not used much anymore these days. In an instance where the tooth is severely decayed or broken, that tooth must be restored by means other than with a filling. When a tooth is severely decayed or broken there is a significant portion of it that is lost. This means there is insufficient tooth structure remaining to replace it with a filling.

You can think of this in terms of a house. Most houses have four walls and a roof. The same is true with a tooth; it has a front, a back, two sides and the top or biting surface. If a house loses a couple of walls and part of the roof it will no longer be able to support itself and collapse. The very same thing is true with a broken tooth.

Once the tooth has broken, a crown is necessary to protect, cover and conserve the remaining tooth structure.

There are many types of crowns available but the most common have a metal structure covered by porcelain. The porcelain covering is tooth-colored and the shade is custom matched to your adjacent teeth.

Generally, when a tooth is broken it is necessary to replace the part that is broken by building the tooth back up to its original height and contour. The crown's metal understructure is cast from an impression of the tooth once it has been built back up. Once the dental lab has fabricated the crown, it is permanently cemented in place. With proper care these restorations will last a long while.

I understand that cost is a concern. It is for just about everyone these days but a crown is the best possible option for keeping the tooth healthy for a lifetime.

Q: I have a broken tooth and my dentist says I need a crown. I don't want a crown. It's too expensive. I just want a filling but they won't do it. Why can't they just fill it?

A: This is a great question. If I had a nickel for every time I get asked this ...

Let me share with you the reason why a filling cannot be done in place of a crown. As I'm sure you know, fillings are generally needed when a tooth has become decayed. The decayed part of the tooth is removed and the tooth is "filled" with a composite or resin filling material.

Silver fillings are not used much anymore these days. In an instance where the tooth is severely decayed or broken, that tooth must be restored by means other than with a filling. When a tooth is severely decayed or broken there is a significant portion of it that is lost. This means there is insufficient tooth structure remaining to replace it with a filling.

You can think of this in terms of a house. Most houses have four walls and a roof. The same is true with a tooth; it has a front, a back, two sides and the top or biting surface. If a house loses a couple of walls and part of the roof it will no longer be able to support itself and collapse. The very same thing is true with a broken tooth.

Once the tooth has broken, a crown is necessary to protect, cover and conserve the remaining tooth structure.

There are many types of crowns available but the most common have a metal structure covered by porcelain. The porcelain covering is tooth-colored and the shade is custom matched to your adjacent teeth.

Generally, when a tooth is broken it is necessary to replace the part that is broken by building the tooth back up to its original height and contour. The crown's metal understructure is cast from an impression of the tooth once it has been built back up. Once the dental lab has fabricated the crown, it is permanently cemented in place. With proper care these restorations will last a long while.

I understand that cost is a concern. It is for just about everyone these days but a crown is the best possible option for keeping the tooth healthy for a lifetime.

A: In the second part of this article, I’ll offer some of the options available to replace a tooth as well as some of the benefits and drawbacks of each. In a previous article I discussed some of the factors that are important in choosing the correct replacement.

This is not a “one size fits all” solution. By this I mean that we must consider the remaining bone, the area where the tooth is missing, the financial situation of the patient as well as esthetic and functional concerns.

One option available would be to place a bridge. This is an option if there are healthy teeth adjacent to the tooth that is missing. The reason the teeth must be healthy is that they will serve as the support for the missing tooth. If there is inadequate bone, either where the tooth is missing, or surrounding the adjacent teeth this would not be a good option. The lack of bone lowers the prognosis for longevity and severely compromises any esthetic concerns the patient may have.

Another option would be a removable partial denture. This would only be an option if there are multiple teeth missing. A partial denture has a metal framework with metal clasps that hook onto the adjacent teeth and help to hold it in place. One drawback is that the clasps are visible and show when you talk or smile. Another is that with a partial over time the teeth and bone are subjected to additional forces they were not designed to take. This causes the bone to erode and the teeth to shift making the partial loose and uncomfortable.

Another type of removable appliance is called a “flipper” and is a temporary solution. These are generally made when esthetics is a concern and the tooth is located in the front. This type of temporary can be used until a more permanent treatment option is chosen. The drawback is that this type of appliance is not very strong is easily broken and Crazy glue won’t fix it. The benefit is that in an emergency situation a ‘flipper” can be made quickly and easily without compromising the patient’s lifestyle. Most typically, it is used as a transitional appliance before and during implant treatment.

More and more dental implants are being chosen as replacements for missing teeth. This technology has been proven to be superior over the last thirty years of use. They are chosen for their superior strength and esthetics. An implant looks and functions the same as a natural tooth. The implant itself is placed in the area of the missing tooth where it integrates into the bone over about a six month period. During this time the patient may choose to leave the site alone or may decide to wear a temporary such as a “flipper” while healing takes place. After the implant has integrated it is uncovered and the tooth portion (called a crown) is fabricated out of porcelain and cemented in place.

As you can see there are almost as many factors to consider as there are options to choose from when selecting a replacement for a missing tooth.

A: This is a very common question I get asked all the time. Most of the time it is middle-aged and older patients that express concern about x-rays.

Occasionally, it is the cost but mainly it is a concern about the radiation.

In recent years there has been a shift in the way most dentists practice. The focus has turned toward more preventive procedures as people are living longer, fuller lives.

In addition, the advances in dentistry have enabled us to provide patients with the most modern technology available. Many dentists are embracing this technology.

Gone are the old-fashioned sharp individual film packets that cut up your mouth and make you gag. Replacing these are digital x-rays that can take a picture of your entire mouth with one image or individual images taken quickly, easily and most of all comfortably. This technology puts out an extremely low level of radiation and is very safe.

In fact, the amount of radiation is so low that being in the sun for 10 minutes emits more radiation than this type of x-ray.

That is only one of the pluses in this new shift in dentistry.

Being in southwest Florida means that many people are seasonal and have a dentist in their home state. Digital x-rays improve the channels of communication as they are easily e-mailed back and forth eliminating the need for having them taken in both places.

The other bonus is that since they are digital there is no electricity wasted in processing then, no chemicals used in developing them and no chemicals used in recycling the developer and fixed. So, believe it or not digital x-rays actually help the environment!

Now, let me get to the heart of your question. x-rays are necessary because they enable us to see the big picture and peer behind the scenes. I cannot begin to tell you how many patients I see that have extensive dental problems that don’t understand why.

In more cases than not they haven’t had any x-rays taken, either because they’ve refused, or their dentist didn’t take them. Further, in today’s world it is much more beneficial to treat small problems rather than wait until they become larger and much more involved and much more costly.

So when your dentist or dental hygienist tells you that you need x-rays they are only looking out for your best interest. Plus, they’re good for the environment.

A: This question was e-mailed to me. I sincerely appreciate all the e-mails I get and I always respond. Some questions, like this one, deserve an expanded answer in print. So, here goes.

First and foremost lets try to remember that your dental hygienist be they male or female are educated, highly trained health care professionals. They must attend college for a minimum of two years, pass all of their exams in order to sit before the board of dentistry to be licensed. Once licensed they can begin to practice what they have been trained to do, dental hygiene. While they are not dentists they are fully capable of performing a variety of dental procedures.

They communicate directly with their supervising dentist keeping them apprised of the patients condition as well as their needs and wants. What they are not are salespeople. Dental hygienists genuinely care for their patients and make recommendations based upon the patients needs for optimum oral health.

Although, I cannot speak directly to your specific question I can say that most dental hygienists are not paid additional monies for “selling” products or services.

Some offices, mainly office chains or dental clinics offer compensation for sales. These types of situations are very unfortunate for the patient but rest assured they are the exception and not the rule.

My recommendations would be to ask your dentist or dental hygienist why you need what he/she is trying to “sell” you. In most cases, they will have shown or explained why before it is offered.

Another important question to ask yourself is why this is being recommended. Your hygienist isn’t with you at home in between cleanings. They can only ascertain your oral health at your visit and from that visit recommendations are made based upon your current situation.

There are many, many scenarios that can lead to suggestions made by your dental hygienist. Some of these include dry mouth, inadequate dental hygiene due to illness, neglect, unawareness, limited dexterity, orthodontic treatment, gum recession, sensitivity, periodontal disease and age. Really, there are too many to list.

If there is no answer to the question of why, then ask your dentist. If the answer or rationale is inadequate then you should probably evaluate other options. However, in most cases you can rest assured because even though your hygienist preaches from the high pulpit of flossing there’s always good intentions at heart and enough floss to catch those who have fallen.