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 What will be done on my first visit?
Our first visit with a new patient is extremely important. The first step is always to listen to your concerns and goals. A thorough exam and records are obtained, and from this information an accurate diagnosis of existing and potential dental problems is determined. A treatment plan of action is formulated, incorporating your specific goals and desires.
 How old should my child child be for their first visit?
Unless your child has risk factors for having problems with his teeth, such as sleeping with a cup or bottle, teeth staining or thumb sucking, three years of age is typically the best time to start bringing your child in for dental cleanings and exams. At this appointment we will assess your child's oral growth and development, as well as discuss age appropriate home care. We will also accomplish their dental cleaning and take radiographs if appropriate. The most important principles of these early visits is to provide a positive first experience in the dentist office and to communicate to you, the parent, the best ways to keep your child's teeth clean and healthy.
For more information regarding this subject, please select the "Children's Dentistry" link on this web page or read the brief but excellent article on the same topic at this link, http://pediatrics.about.com/cs/pediatricadvice/a/dental_health.htm.
 Why do my gums bleed?
Our gums (or gingiva) tend to bleed for a variety of reasons. The most common reason gums bleed is that they are experiencing a superficial gum infection called gingivitis. Gingivitis is caused by harmful bacteria found in dental plaque. At this stage a routine dental cleaning is usually sufficient to remove the sources of infection and restore periodontal health. If not treated at this early stage, a more advanced gum infection called periodontitis can develop which can damage the bone around your teeth and even lead to tooth loss.
Sometimes people experience ginvival inflamation (bleeding gums) in a few isolated areas even though they see their dentist for regular dental cleanings. The first step in a situation like this is always to make sure that the patient is flossing effectively each night before bed. The time of day really doesn't matter, but most people find it easier to remember to floss and brush when it is part of their routine, waking up, after lunch, or before bed are all good as long it is done daily. In a patient who has been seeing their dentist for regular cleanings and is not experiencing any medical conditions that have oral implications, the bleeding will significantly decrease after about a week of effective home care (rinsing with listerine after flossing can accelerate this process).
If you follow these instructions and are still experiencing bleeding in a few areas, it is important that we look more closely at these areas and make sure that they are smooth, easy to clean and do not retain food. If this bleeding is in an area of dental work it is important that this dental work is ideally contoured and shaped. My expectation for any dental restoration is that it is as easy to keep clean as a natural tooth. If this is not the case, it should be corrected.
 Why are my teeth sensitive to cold?
Typically, teeth become hypersensitive to cold due to a combination of two factors. The first is that the dental pulp or "nerve" of the tooth has been traumatized and is experiencing acute inflamation as a result. The trauma may originate from several different sources, but whether it is due to dental decay, a chipped or fractured tooth, or from intense clenching or grinding of your teeth, the mechanism is the same. In mild cases of trauma, it is important to treat the tooth with care and see your dentist to determine the best course of action.
The second factor is that the tooth lacks adequate thermal insulation for the dental pulp. The most common examples of this situation are teeth that have been restored with a large silver fillings, and teeth that have experienced significant gingival recession, and/or the tooth's exposed root surface has been abraided (typically due to overenthusiastic tooth brushing or a combination of malocclusion and parafunction). In both cases the tooth lacks ideal thermal insulation; the silver filling conducts the cold temperature close to the dental pulp where it is felt more intensely, the abraided root lacks the bulk of gingiva and tooth structure which is necessary to protect the dental pulp from these traumatic temperature fluctuations.
Sometimes teeth with new restorations can be sensitive initially. This is due to the slightly traumatic nature of the bonding of this restoration, as well as the fact the act of removing decay and shaping a tooth can cause pupal inflamation as well. Usually the sensitivity coincides with how close to the dental pulp the dental decay or fracture progressed to. In most cases this sensitivity rarely persists for more than a couple of weeks.
More superficial "protective" bonded restorations, particularly those covering vulnerable root surface are rarely sensitive and in fact provided a measure of physical insulation that helps to reduce the tooth's sensitivity to cold.
If the tooth is sensitive and feels as though it is "high", or making stronger contact than the neighboring teeth, then the tooth may need to be adjusted so that the occlusion (or "bite) is more harmonious. In this case the tooth will usually feel better in the next day or so.
In cases where the tooth is so sensitive to cold that pain is extremely intense and can be counted in tens of minutes rather than seconds, it is important to see your dentist. It is unlikely that the symptoms will resolve on their own.
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