Drs. David and Janna Civils

Why You Really Need to Go to the Dentist Every 6 Months

Posted on February 20, 2012 by Dr. Civils

Have you ever wondered why you really need to go to the dentist every 6 months?

Y-E-S. If ever there was a perfect application for the old adage that an ounce of prevention is worth a pound of cure, this is it. As a matter of fact, the answer for most people should really be – at least twice a year.

We have discussed this topic before (read our blog).

However, many of us fall into this trap thinking “ If I take good care of my teeth at home, I can wait a few extra months, right? “ The answer is not as simple as you might think

The cleaning not only makes your mouth feel better, but improves overall health of the oral tissues that support the teeth. Plaque and tartar first begin to accumulate along the gum-line, when left alone, the accumulation begins to force its way under the gums, causing bleeding and tenderness in the gums known as gingivitis. When tartar accumulation is not removed for extended periods it can cause chronic infection in the gums which leads to bone loss known as, periodontal disease and loss of teeth. Regular checkups and excellent home-care efforts can often prevent this from happening to you!

Not only are your teeth cleaned at your 6 month appointment, the entire mouth is thoroughly examined and evaluated. During this evaluation your dentist and hygienist check bone and gum levels, evaluate for possible decay, examine oral tissues for possible lesions and make notes regarding any significant findings.

Radiographic images ( X-rays) are taken to evaluate areas between the teeth for decay. Often patients ask if it is “ok” to put off x-rays stating , “I think I would know if anything was wrong because it would hurt”. While patients occasionally know that they have decay because something doesn’t feel quite right, x-ray images are designed to assist the dental team in finding decay before the lesion is large enough to cause pain. Lesions that are found while small can be treated with conservative restorations that are less expensive and take fewer visits to the dental office. Putting off dental treatment often results in more extensive treatment needs. Prevention is always the best course to follow when considering your dental checkup schedule.

Early detection is key to a positive dental experience.

Today’s post was written personally by Drs. Civils and their hygienist. Do you have a question for either Dr. David or Dr. Janna? Let us hear from you!

Drs. David and Janna Civils
1114 Magnolia Street
Greensboro, NC
336-272-4177
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Healthy Eating for a Happy Smile

Posted on February 1, 2012 by Dr. Civils

Many people use the start of the year to lose weight by exercising and eating healthier. These are actually the two most common New Year’s resolutions. Not surprising the same foods that are bad for your weight are also bad for your mouth. If you want to prevent cavities what you eat and how often you eat are very important, that’s because the food affects your teeth long after you have swallowed your food. Poor nutrition also affects your the health of your gums (periodontal health).

The changes in your mouth begin the second you eat certain foods. The abundant supply of bacteria in your mouth make dental plaque becomes more acidic. The acid starts the process of demineralization which is the initial stages of tooth decay. I am not just referring to foods like candy, cookies and soda which are obviously bad for your weight and teeth. Foods that are high in fermentable carbohydrates like bread, crackers and bananas are bad for your teeth as well because they break down (in your mouth) into simple sugars: fructose, glucose, lactose and maltose. These simple sugars then become a tremendous food source for the acid producing bacteria in your mouth. The bacteria use the food to produce plague and acid which continues to attack the tooth for 30 minutes after a snack or meal.

The longer food stays near a tooth the more acid and demineralization of tooth structure occurs. So foods that are sticky or break down into small pieces in to grooves of the teeth are worse. It is both the type of food and the frequency that it is consumed that elevate the risk of tooth decay. This continued attack is why habits like heavy snacking contribute to obesity but is also reset the clock on the 30 minute acid attack. So multiple snacks between meals means that the teeth are exposed to literally hours a day of acid demineralization.

On the other side of the equations some foods actually help prevent tooth decay by stimulating the flow of acid neutralizing saliva. Sugar-free chewing gum is a good example – it stimulates saliva, it mechanically removes sugary substances from the surface of the teeth and when sweetened with sugar substitute xylitol can actually reduce the amount of plaque and bacteria in the mouth.

Healthy Foods are good for you waistline as well as your smile.

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Family Dentistry, General Dentistry, General Health | Tagged bright smile, dental health, dental hygiene, dentistry, dr civils, family dentist, famiy dentist, greensboro, gum disease, healthy smile, Janna Civils, lose weight, oral health, oral hygiene, smile, tooth damage | Leave a comment

The Children’s Cavity Contract

Posted on January 24, 2012 by Dr. Civils

In our office we start seeing children at the eruption of their first tooth, usually between the ages of six-months and a year. This may come to a surprise to many people, but this is what is recommended the American Association of Pediatric Dentist. Children this young do not have cavities and by implementing preventative strategies – the parent and dentist can prevent tooth decay all together.

According to the current research, there are specific oral health habits that will make getting a cavity very unlikely. Conversely, dental cavities become very likely without these preventative measures.

We have outlined these dental prevention habits. If you do your part at home and we do our part in the dental office, then we can work together successfully to give your child a beautiful and healthy, “no-cavities” smile.

One of the tools we use in our office to help prevent tooth decay is the “Cavity Contract.” The Cavity contract is a list of specific behaviors that need to be checked-off. By following the guidelines below give the parents a template to help ensure that we are growing happy and healthy smiles.

At Home:

__ Brush morning and night with adult help

__ Floss daily

__ Fluoride rinse when able to expectorate

__ Schedule regular check-ups at 6-month intervals

__ Avoid “sugar-bug” parties (no suckers, gum, or juice)

In Our Office:

__ Prophy cup cleaning

__ Regular exam following any clinical concerns across time

__ Timely referrals when and if needed

__ Fluoride varnish or trays

__ Radiographs taken every 6 months if high risk or every year if low risk

__ Sealants (signed “Sealant Contract”)

__ Restorative needs completed within 2 months of diagnosis

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Bright Smiles, General Dentistry, Pediatric Dentistry | Tagged baby teeth, bright smile, cosmetic dentistry, david civils, dental health, dental sealants, dentist, dentist for children, dentistry, dr civils, family dentist, famiy dentist, greensboro, Janna Civils, oral health, oral hygiene, pediatrics | Leave a comment

What is a Digital Panoramic X-ray

Posted on January 19, 2012 by Dr. Civils

We have recently installed a digtal panorex machine in our dental office. While we have had a film based panorex for years, the technology has led to a lot of questions from our patients. What is a panorex? How is different from other dental x-rays? Why is it better than our film panorex machine?

A panorex is a two dimensional dental x-ray that displays both the upper and lower jaws and teeth in the same image. We use a panorex to view these areas approximately every five years.

Panorex machines have chin and forehead rests, side head positioners, and 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 uses less radiation than a full series of intraoral radiographs.

Because a digital panorex produces anatomically correct geometry and elimination of shadows it is a great tool to evaluate:

Growth and development of the teeth and jaw
Tooth-Sinus relationship
Nerve-Tooth relationships
Abscesses
Fractures
Orthodontic alignment of the teeth
Detecting oral cancer (and non-cancerous growths)
Diagnosis of third molars (wisdom teeth)
Assess the TMJ ( jaw joint)

Panoramic X-ray

A digital panorex has many advantages over a film based x-ray.

Images can be stored electronically and emailed to specialists and insurance companies.
The image quality is far crisper and uniformly exposed than film
They are faster, producing images that can be viewed almost instantly.
They’re safer, with no chemical development and significantly less radiation.
We can enhance images to improve viewing.

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Dental Health, General Dentistry, New Trends in Dentristry | Tagged cosmetic dentistry, david civils, dental x-ray, dentistry, dr civils, panoramic, panorex, teeth whitening | Leave a comment

Oral Sleep Appliance Instructions

Posted on January 9, 2012 by Dr. Civils

It may come as a surprise, but treating sleep apnea may be as simple as visiting your dentist. The mouth of course is the primary means of obtaining oxygen. In the reclined position at night the tongue and soft tissues of the mouth can sag and obstruct the airway. Once diagnosed as obstructive sleep apnea (OSA) by a sleep-specialized physician a possible treatment may include the fabrication of an oral sleep appliance. A sleep appliance keeps the airway open and prevents obstruction by the tongue and soft palate during sleep hence preventing sleep apnea.

As these appliances become more prevalent I get more questions from people about how to wear them and how to properly adjust them. Below I have included the instructions and directions we give our patients on two of the most popular sleep apnea appliances “The EMA” and the “Silent Night”.

1) At Your Sleep Appliance Delivery Appointment:

At your fitting appointment, Dr. Civils will try the upper and lower appliance on separately to check fit and comfort. The appliance will feel snug for the first few minutes. This is completely normal and to be expected. If pressure on any one tooth stands out after 5 minutes, Dr. Civils will adjust the appliance. He will also check that your bite is even in the appliance and adjust it accordingly.
We will try-in the appliance with the longest, softest straps and assure that it is comfortable with respect to your bite and jaw.

2) At Home:

Some patients experience clenching as a result of repositioning, which may lead to soreness in teeth, jaw sensitivity, or increased saliva flow? These symptoms should subside significantly or completely within 10 days.
If these symptoms are severe or do not subside, discontinue use and call our office. You may need to start by using the appliance only (with no straps) or using only the longest, softest straps at first. If you develop jaw pain upon using shorter, firmer straps, drop back to a larger strap.
If only one or two teeth are sore after 1-2 days of wearing the appliance, call our office so we can make the proper adjustments.
If you have difficulty placing the straps on the appliance, try using a toothpick to dot a small amount of vegetable or olive oil on the head of the button to lower surface tension. However, after the strap goes on the button, it may be necessary to rotate the strap to seat it properly.
If you do not experience a significant lessening of apnea episodes and/or snoring, you may need to experiment with shorter, firmer straps.If the long, soft straps become stretched out, you may need to progress to the next firmest strap of the same length. If you feel that you could use a shorter strap without discomfort, you may progress to the next shorter strap. You are welcome to self-direct this progression until satisfactory results are obtained, or we will be glad to provide a regimen for you and follow your progress. As always, feel free to contact our office with questions.
Elastic Mandibular Appliance (EMA)

Strap Color	Firmness	Advancement
White #1	Soft	4 mm
Yellow #1	Medium	4 mm
Yellow #2	Medium	6 mm
Yellow #3	Medium	8 mm
Blue #4	Firm	9.5 mm
Blue #5	Firm	11 mm
Clear #4	Extra Firm	9.5 mm

Silent Nite Appliance

Connector Length	Mandible Advancement
21 mm	Short
22 mm	Medium
23mm	Long
24 mm	Extra Long

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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What to expect following a Root Canal

Posted on January 2, 2012 by Dr. Civils

Ok – you have had a root canal. Now what? Is the pain gone for good? Can I brush and floss normally and what is the next step? These are the instructions we give our patients:

What to expect following endodontic treatment:

The root canal system in your tooth has been thoroughly cleaned, and the irritated tissue and bacteria that have caused you to need root canal treatment are gone.

It is normal to feel some tenderness in the area over the next few days as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications (like ibuprofren). It is very important for you to follow the instructions on how to take these medications. Remember that narcotic medications, if prescribed, may or may not make you drowsy, and caution should be exercised in operating dangerous machinery or driving a car after taking them.

Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, contact our office.

Additionally:

Avoid eating hard and sticky foods in order to protect the tooth and keep the temporary in place, and if possible, chew on the opposite side of your mouth. Do not chew or bite on the treated tooth until you have had a permanent restoration.
Brush and floss your teeth normally.
A final restoration (crown on permanent filling) is needed. It is extremely important in ensuring long-term success. The root canal is only one step in returning your tooth to full function. Be sure to set up this appointment today.
Contact our office right away if you develop any of the following:
- Visible swelling inside or outside the mouth;
- An allergic reaction to medication, including rash, hives, or itching (nausea is not an allergic reaction);
- A return of the original symptoms; or
- Your bite feels uneven.
- It is normal to experience some discomfort for several days after root canal therapy. To control discomfort, take the pain medication prescribed by the doctor as recommended.
- If antibiotics are prescribed, continue to take them as directed, even if all signs and symptoms of infection are gone.

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Dental Health, Family Dentistry, General Dentistry | Tagged broken tooth, david civils, dental health, dentist, dentistry, dr civils, emergency dentist, family dentist, oral health, root canal, tooth damage | Leave a comment

There are No Middle Sized Problems in Dentistry

Posted on December 22, 2011 by Dr. Civils

It often seems there are no middle-sized problems in dentistry. There is a tremendous financial and procedural gap between preventative dentistry (including fixing small problems such as a filling) and restorative dentistry. The difference can often be ten-fold.

I was reminded of the difficulty this dental care dilemma can put on an individual this week. A college student presented to our office as a new patient with a severe toothache. It had been several years since his last dental visit due to financial reasons and college student lifestyle. After we started taking diagnostic x-rays I quickly recognized that the student was in for a huge surprise and an unbearable financial burden. After spending some time with him, the x-rays and working on his course of treatment I developed a treatment plan only dealing with eliminating disease from his mouth. I often refer to this as the “have to” dentistry. This was not elective or cosmetic in any way and the cost was well over $10,000 with 10-15 dental visits required. The main reason for the high cost was that his small dental problems had developed into large ones. The teeth that once needed fillings now needed root canals and crowns to save the teeth. His response was “isn’t there a middle option”?

The truth is many times there is not a middle-sized solution to dental problems. Once dental disease advances the needed dental treatment is often invasive and expensive. I cannot emphasize enough the need to maintain regular dental visits and treat dental problems early while they are small.

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Do I have to fill out the Medical Questionnaire Paperwork (again?)

Posted on December 16, 2011 by Dr. Civils

It is a common complaint we hear at our dental office, “Do I really need to fill out a medical history, AGAIN.” It is surprising to many patients that we want to update this information at least twice a year. I am not sure if it is because medical forms are inherently a little tedious or if the mindset is “I am just getting my teeth cleaned”. The fact of the matter is that there are often items checked on the medical questionnaire that impact oral health or can be predictive of potential problems. Without regularly collecting this information it is very likely that we would overlook, fail to diagnose, or possibly even put you in danger.

Below I have listed some of the most common medical history updates that have a huge impact on your dental care. This list is also very typical of information that we would only know by collecting medical history updates every six months. (These items are commonly left out until asked in person if there are any changes)

Joint Replacement: Did you know that is now recommended that a person that has had a total joint replacement take antibiotic prophylaxis to prevent joint infection before all invasive dental treatment for life. (This is a recent change from the previous recommendation of 2 years)

Asthma – Asthma can develop later in life and certain procedures such as use of nitrous oxide (laughing gas) or medications with aspirin may be contraindicated.

Heart Attack – Did you know that having had a heart attack within the last 6 months is a risk factor for having another one and as a result is recommended that all elective dental treatment be postponed for at least six months?

Chemotherapy / Radiation – Unfortunately cancer and cancer treatments are very common. One of the very common side effects is dry mouth. Untreated dry mouth can cause rampant tooth decay in a very short period of time.

Allergy Medication – One of the most commonly taken medications in the United States are allergy medications and one of the most common side effects is dry mouth which left untreated dry mouth can cause rampant tooth decay in a very short period of time.

Ibuprofen – Can cause your blood pressure to be elevated in the pre-appointment Blood Pressure screening

Aspirin – Even a baby aspirin thins an adults blood to the same amount as a full strength aspirin and could have a negative impact on dental surgery or invasive dental procedures

Birth Control Medication – certain birth control medications interact with antibiotics causing the birth control to be ineffective.

The mouth really is the gateway to the body. Recent research has underscored the relationships of the mouth and the whole body health. By keeping your medical history up to date, you are protecting yourself and helping you and your dentist prevent unnecessary health problems.

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Dental Health, Family Dentistry, General Dentistry, General Health | Tagged bright smile, david civils, dental health, dental insurance, dentist, dentistry, dr civils, family dentist, famiy dentist, greensboro, Janna Civils, medical dentist, medical history | Leave a comment

Three Options for Replacing a Missing Tooth: Dental Implant

Posted on December 7, 2011 by Dr. Civils

You have choices when replacing missing or damaged teeth. What is the best option? The answer really depends on a variety of factors:

Location of the missing tooth
Condition of the adjacent teeth
Medical and Dental History of the Patient
Cost Consideration

In this three part blog we will be comparing and contrasting:

Fixed Bridge vs. Dental Implant vs. Removable Partial Denture

Option 3: Dental Implant

A dental implant and crown is an excellent way to replace a missing tooth. A dental implant and restoration mimic a natural tooth very closely in shape and function.

The first step is the placement of the dental implant which is shaped like a tooth root. Once the root-form implant has healed into the bone (usually 3-6months), it is ready to be restored by the dentist. The first step of restoration is the fabrication of an abutment. An abutment should be thought of as a tooth that is prepared for a crown. The Abutment should continue the root form emergence of the implant with a flared transition to a porcelain crown. Because the contours of the implant and abutment mimic natural tooth so closely this paves the way for a very natural appearing porcelain crown

The advantages of a dental implant retained crown are that the adjacent teeth are not a factor. Each tooth (or implant) remains its individual unit. So the teeth can be cleaned function like natural teeth. Additionally, a dental implant cannot get tooth decay and can be placed in any area of the mouth making them a very dependable and functional solution.

However there are disadvantages of dental implants. The length of time from loss of tooth to permanent replacement with a dental implant is often long (3 to 6 months). Also the reason for the loss of the natural tooth can also impact a dental implant – dental implants are susceptible to periodontal disease, grinding, and trauma. Additionally, a patient’s medical history can have a large impact on an implants success. The placement of an implant is a surgical procedure and requires a healthy individual who is able to tolerate the anesthesia and where the implant will integrate successfully into the bone. (Smoking is a contraindication)

While dental implants are the closes option to replacing a natural tooth they are also the most expensive. The cost of replacing a single tooth is often between $4000 – $5000. Further, many dental insurances companies do not cover the cost of dental implants. It is important to talk to your dentist and do your research to figure out what option is the best for you.

*More information can be found about dental implants in our blog: Dental Implants

Today’s post was written personally by Drs. David and Janna Civils. Do you have a question for either Dr. David or Dr. Janna? We would love to hear from you!

Drs. David and Janna Civils

1114 Magnolia Street
Greensboro, NC
336-272-4177
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Posted in Bright Smiles, Dental Health, General Dentistry | Tagged bright smile, david civils, dental health, dental implant, dental insurance, dr civils, family dentist, famiy dentist, greensboro, gum disease, Janna Civils, missing tooth, tooth damage | 1 Comment

Three Options for Replacing a Missing Tooth: Removable Partial Denture

Posted on December 2, 2011 by Dr. Civils

Removable Partial Denture

You have choices when replacing missing or damaged teeth. What is the best option? The answer really depends on a variety of factors:

Location of the missing tooth
Condition of the adjacent teeth
Medical and Dental History of the Patient
Cost Consideration

In this three part blog we will be comparing and contrasting:

Fixed Bridge vs. Dental Implant vs. Removable Partial Denture

Option 2: Removable Partial Denture

A removable partial denture can be a decent replacement for a missing tooth. A Removable Partial Denture (RPD) is typically made of metal and gum colored plastic and is worn in the mouth similar to an orthodontic retainer. It is held in place by closely adapting to the contours of the mouth and wire clasp that wrap around certain teeth. An RPD should be removed daily for cleaning and sleeping.

The advantages are that it is low cost (relatively) compared to the other to and implant crown or a bridge. It is the most non-invasive of the options which makes it a good option for someone that is medically compromised or cannot handle a more invasive dental procedure. While an RPD does rely on adjacent teeth for support and retention it does not heavily depend on the condition of the adjacent teeth for success.

The disadvantages of a Removable Partial Denture are that they are large, regardless of the number of teeth they are replacing. This is particularly true when considering replacing a single missing tooth. Because they depend on multiple teeth for retention and much of the entire arch for adequate support they are bulky and have some compromised esthetics (meaning you likely will be able to see plastic or metal in your smile). Additionally a RPD is the least comfortable and functional prostheses. RPD’s often need adjustments for sore areas and have a compromised ability to chew and speak as well as other tooth replacement options.

In summary a Removable Partial Denture can be a good tooth replacement option. However because of the compromises inherent in a removable prosthesis discussed in this blog it is important for there to are multiple positives that apply for it to chosen before other restorative options?

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Posted in Dental Health, Family Dentistry, General Dentistry | Tagged broken tooth, cosmetic, cosmetic dentistry, david civils, dental health, dentist, denture, dr civils, family dentist, greensboro, Janna Civils, missing tooth, oral health, tooth replacement | 2 Comments

Drs. David and Janna Civils

Why You Really Need to Go to the Dentist Every 6 Months

Healthy Eating for a Happy Smile

The Children’s Cavity Contract

What is a Digital Panoramic X-ray

Oral Sleep Appliance Instructions

What to expect following a Root Canal

There are No Middle Sized Problems in Dentistry

Do I have to fill out the Medical Questionnaire Paperwork (again?)

Three Options for Replacing a Missing Tooth: Dental Implant

Three Options for Replacing a Missing Tooth: Removable Partial Denture

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