Q: What is Plaque (Tarter)?
A: Plaque is a sticky, colorless layer of harmful bacteria and sugars that sticks to teeth, especially near the gum line and between teeth. Everyone develops plaque because bacteria are constantly forming in our mouths. These bacteria use ingredients found in our diet and saliva to grow. Plaque causes cavities when the acids from plaque attack teeth after eating. With repeated acid attacks, the tooth enamel can break down and a cavity may form. Plaque that is not removed can also irritate the gums around your teeth, leading to gingivitis (red, swollen, painful, bleeding gums), periodontal disease and tooth loss. Additionally, if not removed, it may become hard and is called calculus (tartar). Calculus can only be removed by the dentist or a dental hygienist. Plaque and tartar will harm your teeth and gums if it is not cleaned off regularly.
Q: How Can I Prevent Plaque and Tartar Buildup?
A: It's easy to prevent plaque buildup with proper care. Make sure to:
Q: How Often Should Your Teeth Be X-rayed?
A: Even though no X-ray can be considered routine, many people require X-rays on a regular basis so that their dental condition can be monitored. Exactly how often this happens will depend on your medical and dental history and current condition. Some people may need X-rays as often as every six months. For others, X-rays may not be needed for as long as two years. A full set of X-rays or a Panorex may be taken only every five years or so. Who needs more frequent or regular radiographs? They include:
- Children - Many children need X-rays every six months to one year, depending on age, because they are highly likely to develop caries. X-rays also help monitor tooth development.
- Adults with extensive restoration work, including fillings - All the conditions that helped create the caries to begin with continue, making it necessary to check for decay beneath existing fillings or in new locations.
- Anyone who drinks sugary sodas, chocolate milk or coffee or tea with sugar - Even mildly sugary beverages create an environment in the mouth that's perfect for decay, so anyone who drinks these beverages regularly will need to have more regular X-rays.
- People with periodontal (gum) disease - Periodontal treatments may need to be stepped up if there are significant or continuing signs of bone loss.
- People who are taking medications that lead to dry mouth, also called xerostomia - Saliva helps keep the acid levels (pH) in the mouth stable. In a dry mouth, the pH decreases, causing the minerals in the teeth to break down, leaving them prone to caries. Medications that can decrease saliva are those prescribed for hypertension, antidepressants, antianxiety drugs, antihistamines, diuretics, narcotics, anticonvulsants and anticholinergics.
- People who have dry mouth because of disease, such as Sjogren's syndrome, or because of medical treatments that damaged the salivary glands, such as radiation to the head and neck for cancer treatment.
- Smokers, because smoking increases the risk of periodontal disease.
Q: What are the types of X-rays?
A: X-rays are divided into two main categories: intraoral, which means that the X-ray film is inside the mouth; and extraoral, which means that the film is outside the mouth.
- Intraoral radiographs
Intraoral X-rays are the most common radiographs made. If you're like most people who visit the dentist, you've had many sets of intraoral radiographs in your life and you'll likely have many more. Because they give a high level of detail, these are the X-rays that allow dentists to find caries, look at the tooth roots, check the health of the bony area surrounding the tooth, see the status of developing teeth, and otherwise monitor good tooth health. The various types of intraoral X-rays show different aspects of the teeth:
- Bitewing x-rays highlight the crowns of the teeth. On each radiograph, the upper and lower teeth in one portion of the mouth are shown, from the crown to about the level of the jaw. These are the xrays we take most often, as they show the areas we need to monitor more closely and frequently.
- Periapical X-rays highlight the entire tooth. On each radiograph, the teeth from either the upper or lower jaw in one portion of the mouth are shown. The difference from bitewings is that in a periapical X-ray, the whole tooth is shown, from the crown down past the end of the root to the part of the jaw where the tooth is anchored. We may take periapical x-rays (aka PAs) in lieu of bitewings if you have much restorative work (crowns, etc). We also take this type of x-ray if we are trying to see if a tooth has an abscess or a cyst.
- Periodically, a dentist may recommend a "full-mouth radiographic survey," or FMX. This means that every tooth, from crown to root to supporting structures, will be X-rayed using both bitewing and periapical radiographs. We generally take a FMX OR a Pan (see below) an average of every five years in most cases.
- Occlusal X-rays are larger and highlight tooth development and placement. On each radiograph, nearly the full arch of teeth in either the upper or lower jaw is shown. These X-rays are taken with the X-ray machine either pointing straight down from near the nose (to take pictures of the upper jaw and teeth), or straight up from under the chin (to take pictures of the lower jaw and teeth).
- Digital radiographs are one of the newest X-ray techniques around. We use digital radiography for intraoral imaging in our office on everyone (generally elementary school and older). With digital radiographs, film is replaced with an electronic sensor. The X-rays hit the pad the same way they hit the film. But instead of developing the film in a dark room, the image is electronically sent directly to a computer where the image appears on the screen. The image can then be stored on the computer or printed out. One of the great advantages of this process is that radiographs can be digitally compared to previous radiographs in a process called subtraction radiography. The computer can digitally compare the two images, subtract out everything that is the same and give a clear image of anything that is different. This means that tiny changes that may not be noticeable with the naked eye can be caught earlier and more clearly with digital-subtraction radiography. Subtraction radiography requires a specialized projection technique and additional software.
- Extraoral radiographs
Extraoral X-rays are made with the film outside the mouth. These can be considered the "big picture" X-rays. They show teeth, but their main focus is on the jaw or skull. Extraoral radiographs are used for monitoring growth and development, looking at the status of impacted teeth, examining the relationships between teeth and jaws and examining the temporomandibular joint or other bones of the face. Extraoral X-rays are less detailed than intraoral X-rays, so they are not used for detecting caries or flaws in individual teeth.
- Panoramic radiographs show the entire mouth area - all teeth on both upper and lower jaws - on a single X-ray. This type of X-ray requires a special panoramic X-ray machine. The tube head that emits the X-rays circles behind the patient's head, while the film simultaneously circles across the front. That way, the full, broad view of the jaws is captured on one film. Because the machine moves in a set path, the patient has to be positioned very carefully. And, because the beam and the film are both moving, any movement from the patient will blur the image on the screen. That's why such care is taken to keep the patient's head absolutely still in exactly the right position. The machines may have chin rests, forehead rests, and side head positioners, plus bite-blocks that patients will be asked to close their teeth around. All this may look and feel intimidating, but the process is very safe and often uses less radiation than intraoral radiographs. If you need to have your wisdom teeth removed, implants placed, etc, you will need this type of x-ray. Otherwise, we generally alternate it with an FMX every five years.
Q: Are x-rays safe?
A: All types of radiation can cause damage to body cells. In very high doses, such as might be released during a nuclear reactor accident, the damage can be swift, leading to "radiation burn" and other serious effects. People who receive large doses of radiation as part of their cancer treatment can also experience skin burns or damage to healthy body tissue near the cancer.
The X-rays used in dental and medical offices emit extremely small doses of radiation. However, cells can be damaged by many small doses of radiation that add up over time. Although the amount of radiation used in dental X-rays is very small, the effect is cumulative, so all radiation counts. That's why experts recommend that X-rays be used judiciously and with precautions to help protect the patient from unnecessary radiation exposure. To keep exposure to X-rays low for their patients, dentists and regulatory agencies have done several things:
Reduced X-ray dose -
The single most important way dentists keep their patients safe from radiation is by limiting the beam to the small area being X-rayed and by reducing the amount of radiation that strays from that path. This is done by a process called collimation, in which the machine directs the X-rays through a lead-lined column and out a tiny opening at the end. So although an X-ray machine looks quite large, the X-rays are limited to a small area less than three inches in diameter as they come out of a small cone at the end. X-ray machines are well shielded and there is very little radiation exposure beyond the diameter of the primary beam.
Changed to using film holders -
Do you remember the days when dental patients had to hold X-ray film in their mouths with their fingers? Those days are long gone. Now, fingers have been replaced by holders that not only keep the film in place, but also help the dentist aim the X-ray machine. By using film holders, there is less chance of the film slipping or being held in the wrong place, which means that fewer repeat X-rays need to be taken.
Required regular X-ray machine checks and licensure -
Federal law requires that X-ray machines be checked for accuracy and safety every two years, and some states require more frequent checks. Once the machine passes the testing process, the dentist receives a license to operate the machine. If you have any doubts about the safety of the X-ray machine in your dentist's office, feel free to ask to see a copy of the inspection license. Ingram Dental Clinic is in full compliance with all standards and inspections set by the Alabama Department of Public Health Division of Radiology.
Recommended or required use of lead shields -
Before making radiographs, dentists will cover a patient from the neck to the knees with a lead-lined full-body apron. If the apron doesn't extend up to the neck, a separate neck protector called a thyroid collar may also be used. These shields have been used for decades to help protect patients from radiation scatter. Many states now require lead shields to be used. Although this type of protection was very important in the old days of high-scatter machines, today the lead aprons offer more peace of mind than actual protection.
Developed digital radiography -
A new system of taking X-rays, called digital radiography, reduces radiation by as much as 90 percent over conventional film-based x-rays. Dr. Ingram and Staff use Intraoral and Extraoral (Panorex) Digital Radiography to maximize your safety.
Q: How Do I Know if I Have a Cavity?
A: Only your dentist can tell for sure whether you have a cavity. That's because cavities develop below the tooth's surface, where you can't see them. When you eat foods that contain carbohydrates (sugars and starches), these carbohydrates are eaten by the bacteria in plaque, producing acids that eat into the tooth. Over time, the tooth enamel begins to break down beneath the surface while the surface remains intact. When enough of the sub-surface enamel is eaten away, the surface collapses, forming a cavity.
Cavities are most likely to develop in pits on the chewing surfaces of the back teeth, in between teeth, and near the gumline. But regardless of where they occur, the best way to spot them and treat them before they become serious is by visiting your dentist regularly for checkups
Q: How Can I Help Prevent Cavities?
A: By doing the following:
Brush at least twice a day and floss daily to remove plaque from between teeth and below the gumline
- Have regular dental checkups. Preventive care can help stop problems from occurring and keep minor problems from becoming major ones
- Eat a well-balanced diet that limits starchy or sugary foods. When you do eat these foods, try to eat them with your meal instead of as a snack to minimize the number of times that your teeth are exposed to acid
- Use dental products that contain fluoride, including toothpaste
- Make sure that your children's drinking water is fluoridated. If your water supply does not contain fluoride, your dentist or pediatrician may prescribe daily fluoride supplements
- Use XYLITOL, or Nutrasweet an artificial sweetener found in many sugarless gums, drinks, some toothpastes and rinses, and also as a sugar substitute you can find in healthfood stores.
207 Rome Avenue • Piedmont, AL 36272
(256) 447-6071 phone • (256) 447-6077 fax