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caring for your infant’s teeth begins before a tooth is visible. from birth until about six months of age, you should clean your child’s gums. gently rub a damp cloth over the gums after each meal.

between six months and one year, teeth usually begin to appear. now, it is time to brush the teeth twice each day with non-fluoride toothpaste or plain water. as soon as two teeth are touching, you should floss them every day, preferably before bedtime.

if your child sleeps with a bottle, fill it only with water. other liquids, such as formula or fruit juice, can pool around the teeth and cause decay. this condition, known as early childhood caries, can be painful and have a serious impact on your child’s health.

from twelve to twenty-four months, most of your child’s baby teeth should have erupted. continue to brush twice each day with a soft toothbrush and non-fluoride toothpaste, and floss at least once each day. about once every month, check your child’s teeth for signs of early decay.

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gingivitis warning signs

gums that bleed easily
red, swollen, tender gums
gums that have pulled away from the teeth

the good news is that the beginning stage of gum disease, gingivitis, is preventable and reversible! on the other hand, the effects of advanced gum disease, periodontitis, are permanent and may be irreversible.

gum disease can lead to bone loss and tooth loss, as well as contribute to heart disease and other serious health issues. this means that gum disease at any stage can no longer be considered just a minor issue!

don’t ignore the warning signs! gingivitis develops when bacteria multiply and build up between your teeth and gums. if you notice repeated bleeding in your gums when you brush or eat, this signals a problem.

gingivitis is usually painless and most patients don’t even realize they have a gum infection until it’s diagnosed in our office. the sooner it’s detected, the easier it is to treat and heal.

gingivitis is initiated by bacteria found in dental plaque and gum pockets. the problem is this film of bacteria re-forms almost as soon as you remove it! however, plaque build-up can be disrupted by brushing and flossing – preventing it from causing gum disease.

seventy-five percent of american adults have some form of gum disease. you may have a gum infection and not even know it!

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gingivitis, also known as gum disease, is inflammation of the gums. it is often the first state of periodontal disease.

some of the warning symptoms of gingivitis include:
bleeding when brushing or flossing
redness where the gums and tooth meet
swollen gums
bad breath

what causes gum disease?
gingivitis usually begins when plaque, the sticky, colorless film of bacteria and food particles that constantly forms on your teeth, is not cleaned away every day.
it is hard to see plaque. when plaque stays on your teeth for two or three days, it can harden into tartar. tartar can irritate your gums and lead to gingivitis.
gum disease can also be caused by certain medical conditions, some medications, trauma, smoking or chewing tobacco. during pregnancy, hormonal changes can contribute to gum disease.

examination
to determine if you have gingivitis, we examine your mouth and look for red, swollen, or bleeding gums.
because gingivitis can advance to periodontal disease, we may take x-rays to check your bone levels.
we may also check the depth of the sulcus around each tooth. a sulcus is the tiny groove between the base of the visible part of your tooth and the gum.

what is the treatment?
if you have gingivitis, we thoroughly clean your teeth and may schedule you for more frequent cleanings. we may also suggest a special mouthwash or rinse and discuss your homecare technique.

the good news is that gingivitis is reversible. the sooner we catch it, the better chance you have of keeping your smile for a lifetime.

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many different types of food can cause tooth decay, not just candy. foods that are high in carbohydrates, as well a some fruits, liquids, peanut butter, crackers and potato chips are culprits. factors that cause tooth decay include the frequency in which the foods are eaten and the time they remain as particles in the mouth.
can decay affect infants?
yes. tooth decay in infants and young children most often occurs in the upper front teeth, but also may affect other teeth. sometimes parents do not realize that a baby's teeth can decay soon after they first appear. the decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. this problem is frequently referred to as baby bottle tooth decay. this kind of decay is caused by long-term exposure of a child's teeth to liquids containing sugars. when a child consumes a sugary liquid, acid attacks the teeth and gums and causes decay.
are children safe from soda and other beverages?
dentists believe that kids who consume too much soda and not enough nutritional beverages are prone to tooth decay in addition to serious ailments later in life, such as diabetes and osteoporosis. drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel. soft drinks contain sticky sugars that bacteria in our mouths use as an energy source. they break down into acids and adhere to tooth surfaces.
how does bacteria hurt teeth?
decay is caused by bacteria that feed on any food that contains sugars and carbohydrates. decay occurs when solid or liquid food particles are left unswallowed and cling to the teeth or gums for long periods. bacteria in the mouth use sugars to produce acid that attacks the enamel of the teeth, softening and then eroding them. enamel breakdown leads to cavities. if erosion spreads beneath the enamel, pain and sensitivity may eventually result. this can cause nerve infection, which can result in the need for a root canal.
my children rarely drink soda. are they still at risk for tooth decay?
yes, any prolonged exposure to soda can cause damage. sipping a soft drink all afternoon is more harmful to your teeth than drinking a large soda with a meal and then not drinking any soda for the rest of the day. while many dentists advocate drinking nutritional beverages such as milk, many agree soda should be consumed from a can rather than a bottle with a replaceable cap to discourage prolonged exposure to soda.
how can children prevent damage to their teeth?
children at school should rinse their mouth with water after meals, leaving their teeth free of sugar and acid. children also should seek sources of fluoridation. if you purchase bottled water, be sure that it is fluoridated. encourage children to drink tap or fountain water. use a straw when drinking soda to keep sugar away from teeth. remember, bottled juices are not a good alternative due to the high sugar content. regular dental checkups, combined with brushing with fluoride toothpaste also will help protect children's teeth.
how can you help your child prevent tooth decay?
parents should take their infant to the dentist just after the first tooth appears. brushing teeth after meals, regular flossing and fluoride treatments are the best ways to prevent tooth decay. children should also be supervised as they brush. a good rule of thumb is that when children can dress themselves and tie their own shoes, then they are ready to brush unsupervised. children should be supervised in proper flossing techniques until the age of ten. if you have any concerns about your child's dental health or want some tips on preventing tooth decay, ask your dentist.

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the ideal time is six months after your child's first (primary) teeth erupt. this time frame is a perfect opportunity for the dentist to carefully examine the development of your child's mouth. because dental problems often start early, the sooner the visit the better. to safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.
how do i prepare my child and myself for the visit?
before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. plan a course of action for either reaction your child may exhibit cooperative or non-cooperative. very young children may be fussy and not sit still. talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. bring with you to the appointment any records of your child's complete medical history.
what will happen on the first visit?
many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. if the child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problems. child appointments should always be scheduled earlier in the day when your child is alert and fresh. for children under 24-36 months, the parent may need to sit in the dental chair and hold the child during the examination. also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist. if the child is compliant, the first session often lasts between 15-30 minutes and may include the following (depending on age):
a gentle but thorough examination of the teeth, jaw, bite, gums and ora tissues to monitor growth and development and observe any problem area;
if indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar build-up and stains;
x-rays;
a demonstration on proper home cleaning; and
assessment of the need for fluoride.

the dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. the entire dental team and the office should provide a relaxed, non-threatening environment for your child.
when should the next visit be?
children, like adults, should see the dentist every six months. some dentists may schedule interim visits for every three months when the child is very young to build up a comfort and confidence level, or to treat a developing problem.

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parents typically provide oral hygiene care until the child is old enough to take personal responsibility for the daily dental health routine of brushing and flossing a proper regimen of preventive home care is important from the day your child is born.
clean your infant' gums with a clean, damp cloth. ask your dentist if you may rub a tiny dab of toothpaste on the gums.
as soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste. remember, most children are also getting fluoride from the community water supply.
to avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off the breast and bottle by one year of age; and monitor excessive sucking of pacifiers, fingers and thumbs. never give your child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime.
help a young child brush at night (the most important time to brush due to lower salivary flow and higher susceptibility to cavities and plaque). perhaps, let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. usually by age five or so, the child can learn to brush his or her own teeth with proper parental instruction.
the best way to teach a child how to brush is to lead by good example. allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

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implants are devices that replace the roots of lost teeth, and are used to support crowns, bridges or dentures.

there are many reasons why it's important t replace lost teeth:
having all of your teeth can make you more self-confident. you don't worry that people notice your missing teeth.
when teeth are lost, the area of the jawbone that held those teeth starts to erode. over time, you can lose so much bone that your jaw will need a bone graft before your dentist can place implants or make a denture that fits properly.
tooth loss affects how well you chew and what foods you are able to eat. many people who have lost teeth have poor nutrition, which can affect overall health.
the loss of teeth can change the way your existing teeth come together, called your bite. changes in your bite can lead to problems with your jaw joint, called the temporomandibular joint.
losing teeth can lead to changes in your speech, which also can affect your self-confidence.

root-form implants are the most common type used today. a root-form implant looks like a small cylinder or screw and is made of titanium. after the implant is placed in the jawbone, it eventually is connected to a metal collar called an abutment, which serves as a base for a crown, denture or bridge.

the key to the success of implants is a process called osseointegration, in which the bone in the jaw bonds with the implant. because titanium is biocompatible, the jawbone accepts a titanium implant as part of the body.

success
available studies indicate that surgical placement of root-form implants is successful more than 90 percent of the time. when these implants fail, the problems usually occur within the first year after surgery. after that, only about one percent of all implants fail each year.

implants have become increasingly popular since the american dental association endorsed them in 1986. between 1986 and 1997, the number of implant procedures nearly tripled.

it is now estimated that between 300,000 and 400,000 implants are placed every year in the united states.

implants versus alternatives
depending on your particular problem, implants can be more expensive than the alternatives (denture or bridge). an implant plus a crown costs between $2,100 and $3,000. the fees will depend on many factors. insurance companies generally do not cover this cost, although you should always check with your insurer.

white the upfront cost for implants can be more than for other types of restorations, the investment can pay off in the long run. you do not necessarily need an implant for every missing tooth. dr. tolle can discuss how many implants you will need.

other benefits to implants include:
feel because implants are imbedded in your bone, they simulate your natural teeth better than bridges or dentures.

convenience you will not need to worry about denture adhesives or having your dentures slip, click or fall out when you speak.
nutrition chewing is more efficient with implants. chewing can be difficult with regular dentures, especially ones with a less-than-perfect fit. a regular upper denture also covers your palate, which can reduce your sense of taste.
self-esteem because implants are so much like your natural teeth, you will think about them less. your self-esteem and confidence will be improved because you will not have to worry about denture problems or people noticing that you have missing teeth. regular dentures may also affect your speech, which can make you less self-confident when talking with others.

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a denture is a removable replacement for missing teeth and adjacent tissues. it is made of acrylic resin, sometimes in combination with various metals. complete dentures replace all the teeth while a partial denture fills in the spaces created by missing teeth and prevent other teeth from changing position. complete dentures are either "conventional" or "immediate." a conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. the drawback behind an immediate denture is that it may require more adjustments after the healing has taken place.

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candidates for complete dentures have lost most or all of their teeth. a partial denture is suitable for those who have some natural teeth remaining. a denture improves chewing ability and speech, and provides support for facial muscles. it will greatly enhance the facial appearance and smile.

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a dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed ( up to eight weeks or longer). the denture process takes about one month and five appointments: the initial diagnosis is made; an impression and wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed following any minor adjustments. new denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures will feel awkward at first. while most patients can begin t speak normally within a few hours, many patients report discomfort with eating for several days to a few weeks. to get accustomed to chewing with a new denture, start with soft easy-to-chew foods. in addition, denture wearers often notice a slight change in facial appearance, increased salivary flow or minor speech difficulty.

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a denture is fragile, so it is important to handle it with care. remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpastes. never use harsh, abrasive cleansers, including abrasives toothpastes, because they may scratch the surface of the denture. don't sterilize your denture with boiling water because it will cause it to become warped. if you wear a partial denture be sure to remove it before brushing your natural teeth. when not in use, soak it in a cleanser solution or in water. get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.

should a denture be worn at night?
while you may be advised to wear your denture almost constantly during the first two weeks (even while you sleep), under normal circumstances it is considered best to remove it at night. research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. this promotes better long-term health of the gums.
continue seeing your dentist regularly
it is important to continue having regular dental checkups so that a dentist can examine oral tissues for signs of disease or cancer. as of aging, your mouth will continue to change as the bone under your denture shrinks or recedes. to maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. when in doubt, consult your dentist.

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dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. strategically placed support, or implants, can now be sued to support permanently cemented bridges, eliminating the need for a denture. the cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. call your dentist for advice.

are there any alternatives to dentures?
dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. strategically placed support, or implants, can now be sued to support permanently cemented bridges, eliminating the need for a denture. the cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. call your dentist for advice.

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orthodontics is a special discipline of dentistry concerned with aligning the teeth and jaws to improve one's smile and oral health. "ortho" means correct or straight, and "odont" means tooth.  a dentist usually recommends braces to improve the patient's physical "orofacial" appearance. through orthodontic treatment, problems like crooked or crowded teeth, overbites or underbites, incorrect jaw position and disorders of the jaw joints are corrected.

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patients with orthodontic problems can benefit from treatment at nearly any age. an ideal time for placement of braces is between 10 and 14 years of age, while the head and mouth are still growing and teeth are more accessible to straightening. however, because any adjustments in facial appearance can be traumatic to a child during these sensitive years, parents should discuss the matter with their children before braces are applied.

and braces aren't just for kids. more and more adults are also wearing braces to correct minor problems and to improve their smiles.

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invisalign is a clear way to straighten your teeth without braces. it is a series of clear, removable, custom made aligners. invisalign uses no metal wires or brackets and is custom-made for comfort.

how does invisalign work?
invisalign® uses advanced 3-d computer imaging technology to project tooth movement. invisalign® creates a series of clear thin medical-grade plymer that is virtually invisible when worn. the patient will wear each set of aligners for about 2 weeks. they are removed only to eat, drink, brush and floss. your teeth will move gradually each week. you will see dr. tolle every 4-6 weeks. total treatment time averages 6-15 months.

why use invisalign?
invisalign® can help you get the great smile you’ve always wanted because it’s invisible, removable and comfortable.

invisalign can work for you!
invisalign® treats teeth that are too crowded, with spaces between them, with narrow arches or that may have shifted after having worn braces.

what are the benefits of invisalign?
nearly invisible – you can straighten your teeth without anyone knowing. removable – you can still eat and drink what you want. better oral hygiene – you can brush and floss normally to maintain healthy gums and teeth. comfortable – there are no wires, metal or brackets to cause mouth abrasions.

how much does invisalign cost?
as with other orthodontic options, the cost will be based on the complexity of your case and the length of the treatment. the cost of invisalign® is comparable to conventional orthodontic treatment.
dr. tolle does not want the investment to be a concern in preventing you from having the smile you have always wanted. during the initial examination, dr. tolle will determine the complexity of your case, the length of treatment and the investment for treatment. we offer a variety of payment options to suit your individual needs.

does insurance cover invisalign?
yes, typically an insurance policy that covers orthodontics will cover invisalign®.

how do i get started?
call to schedule an appointment with dr. tolle, to see if you are a candidate for invisalign®! dr. tolle’s staff will be happy to make you an appointment, to reach the office please call 574-546-2851.

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what is invisalign teen?
teens now have a clear choice for braces. if we think they’re right for you, you can get nearly invisible braces with invisalign teen®.
to be a candidate for invisalign, you must have lost all of your baby teeth and your second molars must be partially erupted.

how are the aligners created?
to create your aligners we will take x-rays of your teeth and jaws, photos of your smile, and impressions of your teeth.

we’ll create a treatment plan and send it to the lab. there, your information will be digitized into a 3-d model of your case, and your aligners will be fabricated. each set is designed to gradually move your teeth into their proper positions. the aligners also have a power ridge that, where needed, puts extra force on certain teeth to encourage necessary root movement. you’ll wear each set of aligners for about two weeks, and then replace them with the next set in the series.
treatment time varies, but most people receive 12 – 25 sets.

are they easy to wear?
to help teens remember to wear them, the aligners have a blue dot. when worn as directed, the dark blue dot fades to light blue. teens, parents, and doctors can tell that the teens are wearing them as instructed.

the aligners have no metal, so they’re more comfortable than traditional braces. they can be taken out for eating, dinking, brushing, and flossing. you can wear them while playing sports, or brass or wind instruments. they are nearly invisible, so teens don’t have to be self-conscious about wearing metal braces. but, you must remember to wear them almost 24 hours a day.

invisalign teen® can be an easy way to get a straight, healthy smile. a healthy smile can last a lifetime.


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your dentist will know what appliance is best for your particular problem, but the patient often has a choice. braces generally come in three varieties: the most popular type are brackets, metal or plastic, that are bonded to teeth and are far less noticeable. the "lingual" type of braces are brackets that attach to the back of teeth, hidden from view. bands are the old-fashioned type that cover most of your teeth with metal bands that wrap around the teeth. all use wires to move the teeth to the desired position.

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that depends upon your treatment plan. the more complicated your spacing or bite problem is, and the older you are, the longer the period of treatment, usually. most patients can count on wearing full braces between 18 and 30 months, followed by the wearing of a retainer for at least a few months to set and align tissues surrounding straightened teeth.
will treatment be uncomfortable?
the interconnecting wires are tightened at each visit, bearing mild pressure on the brackets or bands to shift teeth or jaws gradually into a desired position. your teeth and jaws may feel slightly sore after each visit, but the discomfort is brief. keep in mind also that some teeth may need to be extracted to make room for teeth being shifted with braces and for proper jaw alignment.

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do i have to avoid any foods or personal habits?
yes, cut down on sweets, chips and pop. sugary and starchy foods generate acids and plaque that can cause tooth decay and promote gum disease.
cut healthy, hard foods like carrots or apples into smaller pieces. sticky, chewy sweets like caramel can cause wire damage and loosen brackets. avoid hard and crunchy snacks that can break braces, including popcorn, nuts and hard candy. more don'ts: ice cube chewing, thumb sucking, excessive mouth breathing, lip biting and pushing your tongue against your teeth.

what about home care of my teeth with braces?
with braces, oral hygiene is more important than ever. braces have tiny spaces where food particles and plaque get trapped. brush carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush. rinse thoroughly and check your teeth in the mirror to make sure they're clean. take time to floss between braces and under wires with the help of a floss threader. have your teeth cleaned every six months to keep your gums and teeth healthy. insufficient cleaning while wearing braces can cause enamel staining around brackets or bands.

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oral cancer is one of the most deadly kinds of cancer claiming more lives each year than cervical or skin cancer. our practice conducts an oral cancer screening for all of our new patients. the oral exam is non-invasive, requires no anesthetic and takes just a few minutes. a new process known as an oral brush biopsy allows us to easily determine whether a questionable lesion is cancerous. results are known quickly with an extraordinary high degree of accuracy. it's one less thing for you to worry about and early detection could save your life.

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sedation/anxiety free dentistry
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nitrous oxide relaxes you
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a hygienist serves many functions in the dental office. the hygienist carefully examines your teeth, mouth and gums and looks for any signs of decay, periodontal disease, and oral cancer.

a hygienist is trained to use instruments and techniques to thoroughly clean all surfaces of your teeth. the hygienist will help treat for gum disease, such as the scaling and the root planning.

a hygienist will teach you how to effectively care for your teeth at home to help you prevent decay, gingivitis and periodontal disease, show you how to select the proper toothbrush and dental floss.

a dental hygienist is trained and licensed. a hygienist training includes courses in chemistry, physiology, nutrition, microbiology, head and neck anatomy, pharmacology, and radiology. prior to graduation, a hygienist must pass rigorous tests and complete hundred’s of clock hours of instruction in a clinical practice.

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