Fina Family Dental
General Dentistry In the beautiful Chesapeake Bay
and Implant Center area of the Northern Neck of Virginia

   Frequently Asked Dental Questions

 General Questions

  Is teeth whitening safe?

  The following statements are provided by the American Dental Association. Association. Possible side effects are italicized.  
  Whitening products may be administered by dentists in the dental office, dispensed by dentists for home-use, or purchased over-the-counter (OTC).
  Peroxide-containing whitening products (OTC)
  Carbamide peroxide, used in many OTC whitening products, breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active whitening agent. A whitening product containing 10 percent carbamide peroxide yields approximately 3.5 percent hydrogen peroxide. The most commonly observed side effects with peroxide-based bleaching agents are tooth sensitivity and occasional irritation of soft tissues in the mouth, particularly the gums. Tooth sensitivity often occurs during early stages of bleaching treatment. Tooth sensitivity and tissue irritation are usually temporary and stop after the treatment.
  Dentist-applied whitening products
  Many different professionally applied tooth whitening products are used by dentists. These products use hydrogen peroxide in concentrations ranging from 25 percent to 40 percent. Dr. Fina uses 36% hydrogen peroxide. This is ten times as strong as compared to available OTC products, so much more effective whitening is available at the dentist. As with OTC products, tooth sensitivity and tissue irritation can occur during treatment, but are usually temporary and stop within 24 hours after treatment.
  Safety of whitening products
  If concentrated whitening products are used in excess, teeth can become porous and enamel can break down. When products are overused the surfaces of teeth and the surrounding gums can be weakened and brake down. Teeth can even become almost translucent rather than white, so heeding the recommendations of the dentist and the instructions for the product is advisable.
  We recommend that if you choose to use a whitening product, you do so after consultation with Dr. Fina. This is especially important for patients with many fillings, crowns, and extremely dark stains. A thorough oral examination is essential to determine if bleaching is an appropriate course of treatment. You and Dr. Fina together can determine the most appropriate treatment.

  How do we treat gum disease?

  How Dr. Fina treats gum disease is largely dependent upon the stage of your infection and the amount of deterioration involving your gums, teeth, supporting tissues and bone.  
  After reviewing your x-rays and performing a thorough periodontal exam, Dr. Fina will discuss your treatment options, answer questions, and explain what happens:  
Non-Surgical Treatment 
The most well-known type of non-surgical treatment is known as scaling and root planning. This under-the-gum procedure involves a careful removal of plaque and tartar from the tooth roots. During this procedure, your hygienist will remove harmful bacteria and irritants from deep beneath your gums to prevent plaque from accumulating again.
Surgical Treatment
A recommended periodontist may perform periodontal surgery to eliminate bone infections or to regenerate lost bone. The most common surgical treatments include pocket reduction and bone regeneration.
Maintenance after Surgical or Non-Surgical Gum Treatment
After gum treatment, regular dental checkups are highly recommended to keep your teeth in good shape. Also recommended are excellent home care including regular flossing.

  Do I grind my teeth?

  Stressed out by the fast pace of life? Our dental practice sees evidence of this every day.  
  Tooth wear can lead to sensitivity to heat and cold, loose teeth, fractures, facial pain, and debilitating headaches. All this can occur while you sleep from grinding your teeth. Dentists call this bruxism. As many as 90% of us grind our teeth each night. On the average we have five episodes per night. Not everyone shows dental deterioration right away, depending on differences in enamel strength. The bite force, in any case, is so powerful - over 200 pounds per square inch - and the noise is fearful, you cannot physically duplicate this phenomenon when you're wide awake. While you're sleeping, a lot of damage is being done.  
  Bruxing seems to be associated with the REM stage of sleep, when dreaming and rapid eye movement occur. There is some evidence that a bite out of alignment contributes to bruxing, but most agree stress is the problem. Most people learn about a bruxing habit from the spouse who has to put up with the noise. More clues: waking up in the morning with sore jaw joints or muscle fatigue, loose teeth.  
  Come see us for an evaluation. Our practice can relieve the damages of bruxism with a custom dental appliance. We also recommend physical therapy, sometimes muscle relaxants. The best solution, though: learning how to handle the stress in your life.  

  Are amalgam fillings dangerous?

  All the media coverage about amalgams causes people sincere anxiety. We'd like to cast a little light on the subject of mercury, a component of amalgam and, if we can, allay your fears.  
Scores of legitimate, verifiable studies have addressed the issue of mercury at one time or another in the past 100 years. The findings:
·    Mercury vapors are all around us, all the time.
·    There's more mercury in a can of tuna fish than in a filling.
·    Though a like amount of mercury is combined with other metals to obtain a filling alloy, the resulting amalgam has different characteristics than any of its parts. The mercury in amalgam becomes inert, with only a trace of vapors after placement.
·    Over the life of a filling, amalgams do break down. For patients with an average of seven fillings, the daily intake of mercury amounts to about 0.3 micrograms. According to the World Health Organization, a safe daily threshold of exposure is 300 to 500 micrograms.
  But are these fillings safe? Norway, Denmark and Sweden have banned the use of amalgam. However, these bans are in place primarily over the issue of environmental concerns. In the USA, strict regulations for the disposal of amalgam are enforced in most states and require dentists to have filters to clean dental waste water. There never has been a study that can prove anything is absolutely safe for every individual. This means, as doctors, we keep up with scientifically based research and testing, and keep an open mind to alternative materials.  
  This issue is subjective. If you prefer to have fillings with another material, we are happy to accommodate you. We will also outline the risks associated with removing your old fillings, the costs, and the pros and cons of an alternative material. We encourage you to talk with us about your concerns.  

  Are you a good candidate for Laughing Gas?

  Although nitrous oxide (laughing gas) is a safe option for most dental patients, some considerations should be taken before undergoing this treatment. Make sure you discuss your full medical history with your dentist. If you fall into any of the groups listed below, thoroughly weigh the pros and cons of using laughing gas before opting to use this agent:  
  · History of chronic obstructive pulmonary diseases
  · Severe emotional issues
· Drug dependency
  · First trimester of pregnancy
  · Treatment with bleomycin sulfate (also known as blenoxane, this agent is used to treat cancer)
  It should be noted that regardless of your situation, Dr. Fina and his staff are there to help you make an informed decision.  

  What is OIL PULLING? Is it beneficial for tooth care?

  Oil pulling is the process of swishing a tablespoon of cooking oil around your mouth. The benefit of oil pulling is a reduction the bacterial load in your mouth. Due to the hydrophobic nature of the bacterial cell membrane, the cells are drawn into the cooking oil. After swishing until the oil becomes milky and then spitting out the oil, the bacteria go with it. This reduces the bacteria available to contribute to tooth decay and gum disease.  
  Some people have used sesame or sunflower oils, but these oils are high in inflammation producing omega 6 fats. Coconut oil is preferable because it contains lauric acid which is anti-inflammatory in oral tissues.  
  Should I be oil pulling? Oil pulling can serve as an adjunct to other forms of dental care, but is not considered a substitute. 10-20 minutes of swishing with coconut oil is the recommended protocol. More research and larger scale studies are needed to establish the scientific legitimacy of oil pulling. However, the American Dental Association does not recommend oil pulling because there are no reliable, peer-reviewed scientific studies showing improvement in oral health.  

References for further reading:


  What values of INR (blood clotting time) are acceptable to do dental work including extractions?

  The recommendations of the Committee for Standards in Hematology in 2011 are as follows:  
  1) The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4 is very small.
  2) The risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued.
  3) Oral anticoagulants should not be discontinued in the majority of patients needing dental extractions.
  4) Patients with the following conditions need to have extractions done either by a specialist or in a hospital: patients on oral anticoagulants with co-existing medical problems e.g. liver disease, renal disease, thrombocytopenia or who are taking anti-platelet medication. Such patients may have an increased risk of bleeding.
  5) reference:

 Dental Emergency Questions

  I have an injured tooth. What should I do?

  As with any trauma to the mouth, you should consult with us immediately to determine if treatment is required. We will examine the area and take necessary x-rays.
  If you are in pain from a broken, cracked or chipped tooth, you may want to take an over the counter anti-inflammatory pain reliever such as Advil or aspirin. If possible, keep any part of the tooth that has broken off and bring it with you to your appointment. Avoid chewing on the injured tooth and avoid extreme temperatures.

  I have a chipped, cracked, or broken tooth. What should I do?

  If there is no pain and the chip is small, it's up to you to decide if, when and how the tooth should be repaired. Depending on the size of the chip, it can be smoothed or cosmetically corrected. Ask us to explain the options available to you. If a filling or artificial tooth becomes chipped, it should be replaced. Cracked or broken teeth should be repaired as soon as possible to prevent further damage. Keep in mind that cracks are not always visible, even on x-rays. Symptoms may involve pain while chewing and sensitivity to cold and possibly hot foods and liquids as well as air, which may over time, become more pronounced. ;

  My tooth is knocked out. What should I do?

  To improve the chances of the tooth being saved, Dr. Fina suggests the following:
  · Handle the tooth carefully. Avoid touching the root of the tooth (the part of the tooth that was embedded in the gum).
  · If the tooth is dirty, hold it by the upper part (the crown) and rinse it off with milk or contact lens solution until most of the dirt is washed away. If you don't have either of those available, then it is best to leave the tooth alone. Wiping it off with a handkerchief or shirttail may cause additional damage to the microscopic cells still on the root surface.
  · It is important to keep the tooth moist. If possible, drop it into a glass of milk. If no milk is available, then place the tooth in the mouth between the cheek and gum.
  · A young child who has had a tooth knocked out may not be able to safely "store" the tooth in his or her mouth without swallowing it, so don't give the tooth to a young child for safe-keeping in his or her mouth. Place the tooth in milk or have the child spit into a container and place the tooth in the cup with the saliva. The most important thing is to keep the tooth moist. Use a cup of water if nothing else is available.
  · See Dr. Fina as quickly as possible. If getting to the office immediately after a tooth has been knocked out is impossible, then you may want to try slipping the tooth back into its socket. In many cases, it will slip right in. Make sure it's facing the right way. Don't try to force it into the socket. If it doesn't go back into place easily and without pressure, then its better just to hold it between the cheek and gum or to keep it in milk, saliva or water.

  I have a partly dislodged tooth. What should I do?

  Sometimes a tooth is knocked loose or comes partway out of its socket because of an injury. We call this an extruded tooth. If the tooth is not broken, and the nerve and blood vessels are still attached, the tooth may be saved. To save the tooth, you need to contact us right away. Leave the tooth in your mouth even though it is partially out of the socket. Take an over the counter pain reliever and apply a cold pack to relieve pain until you reach our office.

  I lost filling or crown. What should I do?

  Sometimes fillings or crowns fall out. In some cases, a filling or crown may become loose because there is decay underneath it. The decay destroys part of the tooth, so it no longer has a tight hold on the crown or filling. These situations are rarely an emergency. However, it can be painful because the exposed tooth tissue is often sensitive to temperature, pressure or air. If you lose a crown, put it in a safe place and make an appointment to see us as soon as possible.
  Don't wait too long. What is left of the tooth will not be as strong as your crown. It could be damaged more without the crown to protect it. Also, when a crown is missing for a long time, your teeth may move into the space where the crown was. If this happens your crown may no longer fit.

  I have a lot of pain. What should I do?

  Any injury to the gums or teeth can be very painful. At other times, you may have dental pain and not know why. For example, sudden pain may be caused by pieces of food that come in contact with a decayed area of the tooth. Food, heat or cold may create pressure near the nerve and cause pain. The nerve inside the tooth also may be exposed if you lose a filling or crown.
  Pain that gets worse over time can also be caused by food that's stuck between your tooth and gum. If you don't brush and floss well, the bits of food remain. Bacteria multiply in this area, and an infection of the tooth and gum may develop. This type of infection is called an abscess. It can be at the root end of the tooth (in bone) or in the gums. An abscess can be a serious health problem if it is not treated. If swelling inside or outside of the mouth is occurring, you need to seek help immediately either through our office or your medical doctor.
  Call us to make an appointment so that we can evaluate the cause of your pain and get you back to health quickly.

  I have an injury to my lip and/or gum. What should I do?

  Trauma to the lips, tongue and inside of the mouth is quite common. The soft flesh of the lips and their exposed location make them vulnerable to injury. Any cut inside the mouth usually bleeds heavily because of the rich supply of blood to the area.
  Many lip and tongue injuries occur during sports activities. They often can be prevented through the use of a mouth guard. We can create a professional, custom fit mouth guard for you. Contact our office for more information.
  At home, you can clean injured skin surfaces with mild soapy water and a soft, clean cloth. To clean cuts inside the mouth, rinse with salt water or a hydrogen peroxide solution (one part hydrogen peroxide and one part water). Be sure not to swallow this peroxide rinse. However, do not be concerned if it foams. This is what the rinse normally does when it contacts mouth tissue.
  If your lip is swollen or bruised, apply a cold compress. If there is bleeding, apply pressure with a clean cloth for at least 5 minutes. Using ice can help limit swelling, bleeding and discomfort. Wrap crushed ice in clean gauze or a clean piece of cloth and hold it on the affected area.

 Braces Questions

  Who can benefit from clear braces?

  Any of the following conditions can be effectively treated with clear braces:
  1) Crowding
  2) Spacing
3) Overbite
  4) Underbite
  5) Rotated teeth

  Clear aligners or traditional metal braces – Which should I choose?

  In cases where ClearCorrect is not suitable, for example with extreme tooth movements or complex bite misalignments, traditional metal braces are used.

  Is there a differences between ClearCorrect and Invisalign?

Only minor differences occur between the two equivalent methods. ClearCorrect costs the dentist somewhat less and we pass the savings on to you.  

 CEREC Questions

  What is a CEREC Crown Machine?

  The acronym CEREC stands for Chairside Economical Restoration of Esthetic Ceramics. This complex machine can generate high-quality dental restorations with the aid of 3D computer technology.  

What are the benefits of a CEREC crown?

  Crafted from metal-free, porcelain materials, CEREC crowns won’t crack or leak over time, blend with your natural teeth, and allow for more conservative repairs. They also eliminate the need for messy impressions, temporary restoration, and a second visit. Patients appreciate the convenience of having their crown, inlay, or onlay designed and placed in a single visit.  

How do I get my CEREC crown?

  First, Dr. Fina will create a 3D image of your tooth. Using this data, the CEREC machine generates a model of your custom crown. Patients can listen to music, relax, and wait while the CEREC unit mills the restoration. Your dentist will then place the final crown before you leave our office.  

 Denture Questions

  What should I expect with my first denture?

Your first denture will be a challenge, one you'll want to approach slowly. All the benefits of a comfortable, functional denture will come to you--with practice.
Learning new denture skills takes a little time and motivation. Here's what to expect.
A denture is rigid, but it rests on soft tissue. So it's going to move. And the softer the tissue, the more mobility. You'll learn to compensate for this.
For stability, the denture base is extended in the mouth. Chewing on one side has a tendency to dislodge the other side. Remember to place foods on both sides of your mouth and chew with balanced force.
  At first you may lose tactile sense that tells you what size food is and where things are while you're chewing. You may even bite your cheek and this is something you'll learn not to do. Expect to have an increased saliva flow, as your body is adjusting to the denture. You'll just have to swallow more for a day or two.  
  With natural teeth, most of us rest the tongue just behind the lower front teeth. But if you have a habit of moving your tongue back, you'll lift a lower denture out. Your tongue needs retraining. With practice, you won't even think about it.  
  And you may notice you sound a little different at first. Speech problems associated with a denture are among the first you'll learn to conquer.  
  Denture wearing takes practice to master. It's important to remember that each person learns to handle a denture at his or her own pace. Be patient, and don't be too hard on yourself. Please call if you're having any difficulties.  

  Do I need a new denture?

  If your denture has some miles on it and you've noticed it doesn't fit well anymore, it's time to consider a new denture. A new denture can bring new function--and a more youthful appearance, too.  
  The fact is, your mouth is always changing. The ridges that support a denture recede. You may have noticed this. The upper denture will move up and back, the lower denture settles down. Your facial appearance is altered. This is due to the natural resorption of your jaw bone with time in the absence of teeth. A settling denture may cause your chin to approach your nose at as much as 1/16th inch per year. On top of that, the bite often goes awry, moving the upper teeth back behind the lowers. Your facial structure shifts over time, your cheeks sag a little, new wrinkles around the mouth appear. Diagonal lines run from the nose to the corners of the mouth.  
  This transformation is not caused by a bad denture, but an old denture. Dr. Fina’s office can rework your denture by extending the base to compensate for the shrinkage in gum tissue. This moves the front teeth forward to their original position. This can take years off of your appearance.  
  You can't expect dentures to last more than 5 to 10 years and still give you a natural look. But by replacing dentures as your mouth changes, you'll enjoy renewed function and, by the way, a youthful fullness to your face. Please give us a call to schedule an appointment to assess your denture's fit.  

  Are your dentures causing you to shy away from people?

  Are you a denture wearer who's afraid to be seen in public because you think your denture is unattractive? Do you find yourself eating alone because you can't eat certain foods gracefully? Do you wear your lower denture in your pocket?  
  Ill-fitting dentures that slip can cause embarrassment, of course. But if you can't trust your denture, you may become susceptible to social isolation. Maybe you feel uncomfortable out and about, or live in fear of a denture accident in the company of friends and family. Some people give in to the real desolation of life with a bad denture.  
  Well, don't do it. Start fresh. Dr. Fina can help you regain function, comfort, and a natural appearance by replacing or refitting your denture. In fact, with the right fit, most denture wearers can eat anything that's put in front of them, and look good doing it.  
  If you recognize reclusive behavior in yourself or a friend, please call our office. We'll evaluate your denture and find a way to make it work again--so you can get on with life.  

 Oral Cancer Questions

  What does oral cancer look like?

  The most common symptoms of oral cancer are a sore in the mouth that doesn’t heal, or pain that doesn’t go away. Cancer sores are often characterized by irregular borders, uneven textures, or changing coloration across the sore. During an oral cancer exam we look for sores, red patches, leukoplakia (hardened, raised white or gray areas), and lumps.
Other symptoms are:
  sore throat or a feeling that something is caught in the throat
  trouble chewing or swallowing
  numbness of the tongue or jaw
  loosening of the teeth or pain around the teeth
Dr. Fina may suggest a biopsy which is a sampling of the soft tissue in the mouth and subsequent microscopic tissue analysis.

    Not so pretty Oral Cancer photos . . .


  Where in the mouth does oral cancer occur?

  All other soft tissue, e.g., gums, floor of the mouth, palate, salivary glands, throat

    Not so pretty Oral Cancer photos . . .


  How are oral cancers treated?

  There are several possible treatments that can be used alone or in combination depending on the severity of the growth. Surgery is the usual first treatment and this may be followed by radiation therapy and/or chemotherapy.  

How can I help prevent oral cancer in my mouth?

  It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation.
When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by Dr. Fina as quickly as possible. During the oral cancer exam, he and your dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

   Leslie J. Fina, DDS, PhD,
  Fellow of the ICOI Implant Society

  Fina Family Dental
  P.O. Box 277
  746 Jessie DuPont Memorial Hwy.
  Burgess, VA  22432-0277

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