Child Preventative Care:

Q: How often should my children have their teeth cleaned?
The American Dental Association recommends that children who have healthy mouths should have their teeth cleaned every six months. If your child is in braces, it may be necessary to have their teeth cleaned more frequently because braces make homecare more difficult.

Q: How often do my children need to have dental x-rays taken?
There are two types of x-rays that are typically taken at our dental office. Bitewing x-rays are taken to help diagnose decay between the teeth. The recommended standard of care for bitewing x-rays is once a year, although if your child seems to be overly susceptible to cavities, we may recommend bitewings more frequently. Panoramic x-rays are taken every three to five years starting when the permanent front teeth erupt. This x-ray helps us monitor tooth, bone, and jaw development and gives us a guide for recommending orthodontic treatment.

Click here to read about our state of the art digital x-ray system and logicon caries detection software.

Q: Is fluoride really necessary?
Fluoride is one of the best preventative measures available in dentistry. Fluoride tablets and fluorinated water help to strengthen the teeth as they are forming under the gum. Topical fluoride you receive from your dentist helps to strengthen enamel on teeth that have already erupted and to remineralize areas that are close to becoming cavities.

Q: Is there anything else that will help my children prevent cavities?
Studies have shown that products containing xylitol (a naturally occurring sugar substitute derived from corn) or licorice root can help to reduce the risk of cavities. When used in the proper doses, these products kill the bacteria that cause decay. Ask one of our hygienists or assistants for specific products and instructions.

Click here to read about some of the products we offer.

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Baby/Toddler Care:

Q: When do I start bringing my baby/toddler to the dentist?
The American Dental Association recommends that children begin seeing the dentist as early as age 1. Simple “look-see” appointments can be set up to check your child’s development and to make sure that there is no visible decay. Our office offers this as a complimentary service.

By the age of 3, is when we generally recommend a “classic cleaning” appointment which includes a more thorough exam with dental x-rays. Normally by this age, all of the primary (baby) teeth have erupted, and the child’s attention span is long enough to allow a thorough appointment.

Q: When do I start brushing my baby’s teeth?
You can start brushing/cleaning your baby’s teeth as soon as they come in. The easiest and most effective way to keep the teeth clean is to use a soft, wet wash cloth and gently rub the tooth with the cloth once a day. Baby teeth roots may not be fully formed so the tooth can sometimes feel loose. You can start using a baby toothbrush when the baby molars have come in.

Q: What is Baby Bottle Decay?
The liquid from the bottle pools around your baby’s teeth providing food for decay-causing bacteria. The bacteria form acids that dissolve tooth enamel, causing decay. Any liquid containing processed or natural sugar, even breast milk, can cause decay producing acid attacks on your baby’s teeth.

Q: How do I avoid Baby Bottle Decay?
Here are several steps you can take to help avoid Baby Bottle Decay:

• Clean your baby’s teeth after each feeding.
• Never give your baby a bottle in bed unless it contains only water.
• Begin flossing your child’s teeth once all of the baby teeth have come in.
• Bring your child to see us for regular dental check-ups each and every year.

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Special Needs Children:

Q: Does my special needs child need special care?
What determines whether or not a child needs specialized care, sedation, or a pediatric dentist, is the child’s behavior. Dentistry requires a certain amount of patient cooperation in order to be successful. We have a well-trained staff who works with children on a daily basis to achieve the desired outcome.

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Pre-teen and Teen Dental Care:

Q: Do I still have to go the dentist once I have all of my permanent teeth?
Absolutely. It is important to continue regular dental visits so that we can monitor the health of your teeth and gums. Your permanent teeth are just that, permanent. Prevention and regular care will help to make sure that your teeth will be healthy for the rest of your life.

Q: What can I do if I don’t like the look of my teeth?
There are several options for changing the look of your teeth. The color of your teeth can be changed by whitening products. The alignment and spacing of your teeth can be changed through orthodontics or cosmetic bonding. Your dentist and hygienist can review all of your personal options.

Q: If I’m in braces and seeing my orthodontist, do I still have to have regular visits with my general dentist?
Definitely yes. It is actually more important that you continue seeing your regular dentist while you are in braces. Your orthodontist is focusing on straightening your teeth, and orthodontists do not normally clean your teeth, do a thorough cavity check, or check for gum disease. But he can do his job better if your teeth are regularly cleaned during treatment. Also, braces and other orthodontic devices tend to trap food and plaque that is difficult to remove.

Q: What causes bad breath and what can I do about it?
Bad breath can have many different sources. It can be burped up from your stomach, filtered through your lungs, or be caused by bacteria in your mouth. We have an array of products and suggestions that can help to get rid of the source of bad breath coming from your mouth. Start with good oral hygiene, then ask you dental hygienist for suggestions and help.

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Children’s Appliances:

We offer custom made athletic guards, space maintainers, and anti-thumb sucking devices.

Q: Who needs an athletic guard?
Any child who plays full contact sports or any other sport or hobby where being hit in the mouth is a possibility. It is important to protect the permanent teeth from any type of damage.

Q: Why would my child need a space maintainer?
Sometimes a primary tooth is lost before the permanent tooth is ready to come through. Causes for premature tooth loss are usually injury or extensive decay. If it seems as though the permanent tooth will take longer than a year to erupt, a space maintainer may be recommended.

Q: When should my child stop using a pacifier or sucking his thumb/fingers?
It is best when children stop using a pacifier or sucking on their thumb/fingers by the age of four. If a child keeps the habit past age four, then we will recommend intervention. If over-the-counter options fail, then we may recommend an appliance called a “thumb rake.” This appliance is cemented to the roof of the mouth and prevents the pacifier or thumb from being placed in the optimum position. Usually after about six months, the habit is broken and the appliance can be removed.

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Laser Dentistry:

Whenever possible, we use the DELight™ ERYag Dental Laser which often eliminates the need for anesthetic injections during filling appointments. No shots; no numb lip!!

Click here to read more about our laser.

Q: How does the laser work?
The laser emits water and a special light that target and remove tooth decay. Since it specifically targets the decay, the laser leaves behind as much healthy tooth structure as possible.

Q: Can the laser be used at all appointments?
The laser is very successful when treating cavities that are not too close to the nerve. It can also be used for lingual and maxillary frenectomies (attached tissue that sometimes causes speech issues). Children usually appreciate an option that does not require a shot. However, the laser cannot be used to remove existing amalgam fillings, to prepare crowns, or to complete root canals.

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Sealants:

Q: What is a sealant?
A sealant is a safe, plastic coating that is painted onto the chewing surfaces of the teeth that have a lot of pits and fissures; no anesthetic is needed to place sealants. The sealant provides a protective layer between the tooth and any food or bacteria in the mouth. By cleaning the tooth thoroughly then placing the sealant, we can help to give your child the best preventative care possible.

Q: Why does my child need sealants?
Children often have a difficult time brushing their teeth properly. Sealants cover the deep grooves and pits that trap food and bacteria which cause cavities. We recommend that children have their permanent teeth sealed as soon as they are fully erupted.

Q: Can my child still get cavities?
A sealant protects the biting surface of the tooth, but it cannot be placed between the teeth. Therefore, your child can still develop cavities between teeth. It is important to maintain a consistent schedule of brushing and flossing as well as regular dental visits and dental x-rays to help prevent other cavities from forming.

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Adult Preventative Care:

Q: How often should I get my teeth cleaned?
The American Dental Association recommends that adults with healthy mouths have their teeth cleaned every six months. Adults who are undergoing orthodontic treatment, who have gum problems, who are pregnant, or who have other health problems may need to have more frequent cleanings. Your hygienist will help you determine the treatment that will give you the healthiest smile possible.

Q: Do adults need to have x-rays taken.
Bitewing x-rays are recommended once a year for all patients, adults and children. These x-rays help to diagnose decay between the teeth and bone loss around the teeth. We also recommend a panoramic x-ray every three to five years to help monitor the TMJ joint, to look for cysts and polyps, or any other anomalies in the bone. We may also need to take other x-rays for specific procedures such as crowns and root canals.

Click here to read about our state of the art digital x-ray system and logicon caries detection software.

Q: Can adults still benefit from fluoride treatments?
Yes, fluoride is still beneficial for adults. Not only does the topical fluoride help to strengthen enamel and remineralize areas that could turn into cavities, but it can also decrease sensitivity due to gum recession, help to keep exposed cementum on crowned teeth from getting decay, and help reduce the risk of root caries on exposed teeth. If you have invested money in crowns, bridgework, or fillings, then fluoride is a must!! It prevents decay from starting all around your dental work, thus extending the life and longevity of your dental work.

Q: Is there anything else that will help me prevent cavities?
Studies have shown that products containing xylitol (a naturally occurring sugar substitute derived from corn) or licorice root can help to reduce the risk of cavities. When used in the proper doses, these products kill the bacteria that cause decay. Ask one of our hygienists or assistants for specific products and instructions.

Click here to read about some of the products we offer.

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Gum Treatments:

Q: How do I know if I need gum treatments?
If your gums are infected, then you will need gum treatment. Your dentist and hygienist use several tools to diagnose gum disease. They use x-rays, take measurements, look for bleeding points, and take into consideration your personal health history. They will then discuss your need for treatment and what is best for your mouth.

Q: What is the treatment for gum disease?
The most conservative, non-surgical treatment for gum disease is scaling and root planing, sometimes called “deep” cleaning. Most patients prefer a local anesthetic during this procedure to help keep them comfortable. During scaling and root planing, the hygienist will go beneath the gumline and remove any tartar build-up and bacteria that has caused the gum and bone to be infected. This procedure usually takes several appointments. Once this procedure is completed, the gum tissue has the opportunity to become healthy.

Video Showing Scaling & Root Planing

Q: If I have gum disease, will it ever go away?
There is no cure for gum disease, but it can be stabilized so that no further damage occurs and the active infection is removed. Studies have shown that the bacteria which cause gum disease recolonize every ninety days. After having scaling and root planing, the recommended treatment is a procedure called perio maintenance. In an effort to reduce the possibility of recolonization, the hygienist cleans below the gumline as the tissue allows (in most cases, anesthesia is not necessary for this procedure). Perio maintenance is a type of cleaning that is recommended every three months to keep the disease causing bacteria and tartar at bay. For most people, scaling and root planing followed by regular perio maintenance is all the treatment that is necessary to stabilized the disease and for the gums to become healthy.

Q: Why can’t I just have a “regular” cleaning?
A “regular” cleaning, or prophylaxis, is the standard of care for an already healthy mouth. This type of cleaning only removes plaque and tartar from above the gumline since the gum tissue is not diseased. A “regular” cleaning cannot be effective in reducing the effect of disease causing bacteria below the gumline.

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Crowns:

We have several options for crowns. All are custom made in a laboratory and take 2-3 weeks to make. We will make a temporary crown for you to wear while you are waiting for your permanent crown to be made. Dr. Kokel will make recommendations based on your specific needs.

Q: Why would I need a crown?
Crowns are the best treatment option for teeth that are cracked, have large existing filling, or have decay that is too large to hold a filling. A crown covers the tooth from the outside holding the remaining tooth structure in place while still looking natural.

Video Showing Crowns

Q: What types of crowns are there?
We offer six different types of crowns. Depending on your specific dental needs, Dr. Kokel may recommend one type over another. The types and their advantages are listed below.

• Porcelain fused to metal crown (PFM) – a PFM crown has a gray, metal substructure with a porcelain layer baked on top of it. The porcelain comes in a variety of shades so we can match your natural tooth color. The porcelain is polished to reflect light like your natural tooth.
• Porcelain fused to zirconia – this crown is very similar to the PFM, except zirconia looks white instead of gray like the metal in a PFM. The zirconia is used for the substructure. Many patients prefer this option. There is no price difference between the two.
• All zirconia crown – an all zirconia crown is completely made of the white zirconia with no porcelain baked on top. This type of crown is good for patients who grind their teeth because it is not made with layers that can chip off. However, the zirconia cannot be polished to the same shine as the porcelain.
• All gold crown – It’s just that, all gold! Gold crowns are very durable and are always an option, especially in areas where the other types of crowns will not work well.
• Stainless steel crown – this crown is used mostly for pediatric patients on their primary teeth.
• All feldspathic porcelain crown – this crown reflects light most like a natural tooth making it the most aesthetic crown available. This crown is a good option when the look really matters.

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Dental Implants:

It is important to your overall health to replace missing or broken teeth. Sometimes a dental implant is the best option.

Video Showing Implants

What is a dental implant?
A dental implant is a natural looking, secure replacement option for missing teeth. A dental implant consists of two parts: the titanium root (surgically placed) and the restorative crown (the part of the tooth that is visible). An oral surgeon places the implant, then after receiving final healing clearance, Dr. Kokel can begin the process for the crown.

What if I’m missing more than one tooth?
Other than replacing a single tooth, sometimes implants can be used to support more than one tooth, or to replace all of your teeth. Implant supported dentures are held in place by implants and do not move around like a traditional denture, so there is less rocking and slipping.

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Oncology (Cancer) Patient Care:

Q: I have had head or neck cancer, how do my cancer treatments affect my oral health?
The most common dental side effect to radiation treatment in your head and neck is damage to the salivary glands which results in dry mouth. Having dry mouth can increase the risk of root and tooth decay, bad breath, and gum disease.

Q: What can I do about dry mouth?
There are a variety of products available (such as fluoride, MI Paste, and Biotene) that are designed to combat the effects of dry mouth. Some are over the counter and some are only available through a dental office or by a prescription. Depending on your particular needs, your dental hygienist can help you decide what is best for you.

Q: What about oral cancer?
Oral cancer is on the rise due to the spread of the human papilloma virus (HPV). At every hygiene appointment, Dr. Kokel performs a visual scan for oral cancer as part of her routine exam. For peace of mind, we also offer the ViziLite® Plus oral cancer screening exam that can help to identify abnormal cells in the tissue beneath the surface before they are visible to the naked eye.

Click here to read more about the ViziLite® Plus exam.

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Fillings:

Q: What type of filling material does your office use?
There are several different kinds of filling material.

• Composite Resin – a safe, plastic, tooth-colored filling material that is placed here in the office during your filling appointment. It comes in varying shades of white so that we can best match your natural tooth color. It is perfect to make a small filling seem invisible so that no one will ever see it.
• Porcelain – this is also a tooth-colored filling material that comes in many natural colors. The porcelain is very durable and wears like your natural tooth. It is made in a laboratory where the technicians have many hours to get your tooth contours perfect. Porcelain is usually reserved for bigger decay.
• Silver fillings – this material contains mercury which is now under fire by the FDA. It is very durable and predictable, and it can be placed here in the office during your filling appointment.
• Gold fillings – this material is made of a gold alloy and can be used for all sizes of decay. It is made in a laboratory by a technician. With the current high costs of gold, other materials have recently become more popular.

Q: Do I have to have anesthesia?
Frequently, adults do need to have some type of anesthesia due to the size and location of their cavities. If at all possible, Dr. Kokel will use the DELightTM ErYag laser which eliminates the need for anesthesia.

Click here to read more about our laser.

Q: I have a groove right at the gumline of one of my teeth, what should I do?
These areas of depression between the tooth and the gumline are called abfractions; they are caused when you grind or clench your teeth and can become deeper with erosion or abrasion. Composite resin can be bonded to the tooth surface, filling in the area. Typically, Dr. Kokel can use the laser to create the ideal surface for composite retention.

Q: Can you fill in the gaps between my teeth?
Many people have extra spacing between their teeth. Depending on the extent of the spacing, some patients can have “bonding” or composite filling material placed on the neighboring teeth instead of having complete orthodontic work. Dr. Kokel will be able to let you know if bonding will work for you.

Click here to see before and after photos of what bonding can do for you.

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Whitening, Veneers, and Occlusal Guards:

Q: Can I make my teeth whiter?
Of course you can! We offer customized whitening trays which you can take with you to whiten your teeth at your convenience and in the comfort of your own home. Ask our hygienists or assistants for more details.

Q: Is there another alternative to orthodontics?
Sometimes placing veneers can be an option for smoothing out the look of the front teeth and changing the color. This is typically considered a cosmetic procedure.

Video Describing Veneers

Click here to see before and after photos of what veneers can do for you.

Q: I think that I grind my teeth, is that a problem and what can I do about it?
Grinding and clenching your teeth (bruxism) can lead to premature wear, abfractions, cracked teeth, loose teeth, and jaw pain (all are results of occlusal disease). The most conservative treatment is a custom made occlusal or night guard.

Video About Teeth Grinding

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Bridges, Partials, and Dentures:

Bridges, partials, and dentures are three different options that are used to replace missing teeth.

Q: Why do I need to replace missing teeth?
It is important to replace missing teeth so that your remaining teeth remain in their proper position. Loosing just one tooth can lead to bite collapse, gum disease, temporomandibular joint problems, cracked teeth, and several other problems. Having a full complement of teeth keeps your jaw and overall bite functioning properly.

Q: What are my options for replacing my missing teeth?
There are several options for replacing missing teeth, the most common are fixed bridgework, removable partials, dentures, and implants (click here to learn more about implants). The differences and benefits of each are listed below.

• Fixed bridgework – having fixed bridgework can be a good financial decision and correct the condition of missing teeth. If the teeth on either side of the extraction site are already in need of crowns, this is a great option. Bridgework is cemented in place; it does not come out, and it looks very natural.
• Removable partial – a removable partial can replace many teeth as long as there are a few healthy teeth for the partial to clasp onto. The missing teeth do not need to be in a row; they can even be on opposite sides of your mouth. Since this is a removable partial, it needs to be removed for cleaning and sleeping.
• Full dentures – when all of the teeth are missing, or if you don’t have teeth strong enough to support bridgework or a partial, then a full denture might be the right choice for you. A custom made denture is natural looking and can give you back your confident smile.

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