Dúvidas Freqüentes
Dúvidas Freqüentes

Below are some of the most frequent questions our patients ask about dentistry and issues of oral hygiene. If you have additional questions or wish to schedule an evaluation appointment, please contact us by telephoning (11 3262-4750) or send us your questions on the Contact page.

You can also find answers to your questions in the section of Procedures, where you can read complete explanations about the main treatments as well as subjects related to Prevention, Health, Cosmetic Dentistry, Implants and much more.

PREVENTION AND HEALTH HINTS

1. What are Cavities?

Dental cavities or caries are the result of an infectious disease that affects all the hard tissues of the teeth. Cavities happen only when plaque is formed over the teeth in the presence of sugar. The acid produced by bacteria attacks the surface of the tooth causing it to gradually dissolve. This reaction happens whenever we finish eating a meal and grows more pronounced over time. When you clean your teeth correctly (by brushing and flossing) you combat plaque and reduce the possibility of getting cavities.

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2. What is Plaque?

Bacterial plaque is a whitish film that is deposited on teeth and on the soft tissue of the mouth, combining bacteria, food residue and saliva. Plaque converts the sugars from the food into acids and poisons that can cause cavities and periodontal disease. Furthermore, if it isn’t removed, plaque can become calcified and lead to bone loss and gum inflammation. Plaque is formed continuously and can only be controlled with regular personal oral hygiene and professional care offered by your dentist.

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3. What is Tartar (Calculus)?

It is bacterial plaque, hardened by the precipitation of mineral salts found in the saliva. Much like the bacterial plaque, there is an abundance of bacteria in tartar. In order to eliminate tartar, a thorough cleaning is done by your dentist. Nowadays this cleaning is done with ultrasound. The use of ultrasound to clean tartar is, without a doubt, one of the greatest discoveries of modern dentistry. It is a painless method that quickly eliminates tartar accumulation, thus preventing gingivitis and bone loss.

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4. Is it normal for gums to bleed?

No, bleeding gums are an indication of gingivitis, that is to say, gum inflammation, which usually is associated with bacterial plaque, where the gums present an inflamed, red and swollen appearance.

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5. How can I treat bad breath?

Bad breath can be caused by a large number of factors. In some cases it is related to the accumulation of bacterial plaque on the tongue, which can be removed by brushing. But in most cases, bad breath can be indicative of oral diseases such as Periodontitis, cavities or even oral cancer. There are also diseases of the digestive system that can cause bad breath. See your dentist if you cannot control the problem yourself.

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6. How do I know if I have oral cancer?

Check your mouth, face and neck for spots, white blotches or an increase in their size, or for sores that take too long to heal. Any of these symptoms should be immediately communicated to your dentist. In order to prevent oral cancer, avoid smoking and excessive and frequent alcohol consumption.

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7. How should I brush my teeth?

Start by placing the brush, turned towards the gum, along the axis of the tooth and make approximately 10 vibrating, pumping, movements tooth by tooth or every couple of teeth. Repeat this over all the teeth, on both inner (the tongue side) and outer (the cheek side) surfaces.

For the inner (tongue) side of front teeth (upper and lower), place the brush in a vertical position and carry out the movements along the brush’s axis, remembering to have the bristles make contact with the edge of the gum.

For the chewing surfaces, place the brush bristles on top of them, keeping the head of the brush flush with the tooth surface. Press down and make back and forth movements.

Inform you dentist if there is frequent bleeding while brushing. Don’t forget to brush your tongue because bacteria that cause bad breath lodge there.

The use of electric brushes is recommended as they can easily remove bacterial plaque. If you have a very large gap between teeth, the use of a between-teeth brush is recommended. These brushes can also be used for patients wearing orthodontic appliances.

Usando o fio dental

Imagens: Colgate www.colgate.com.br

Colgate

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8. When should I brush my teeth?

Always brush after meals, especially at night before going to bed. The best brushes are the medium hard brushes. Use a good quality toothpaste with Fluor. There isn’t a lot of difference between the various brands of toothpaste, so choose one that you like.

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9. Is it important to floss?

Yes, all the teeth in our mouth have 5 exposed surfaces, all of which need to be cleaned to avoid the accumulation of bacterial plaque and ensuing illnesses. Even the best of brushings will only clean three of the tooth surfaces because the bristles cannot get into the space between teeth. These are the surfaces where dental floss has to be introduced with care and wide strokes – as if shining shoes – all the way from the gum line to the tip of the tooth. A length of 30-40 cm (12-15 inches) is sufficient, wound around your middle fingers while the index finger and the thumb do the cleaning. If bleeding occurs, it is usually an indication of gum inflammation and not, as many think, that the dental floss cut the gum.

Escovando os dentes

Imagens: Colgate www.colgate.com.br

Colgate

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10. How do I use a floss threader?

Bend the tip of the dental floss or tape and thread it through the opening of the floss threader. With fixed bridges, insert the lead end under the bridge, pulling it through the other side. Then clean underneath the bridge. With orthodontic appliances, insert the lead end between the tooth and the wire. Clean as usual.

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DENTAL IMPLANTS

1. I would like to have an implant but I am afraid. What shall I do?

The installation of a dental implant is a very straightforward procedure. In the case of a single implant it should take no longer than 30 minutes. Typically there is only a bit of minor discomfort after an implant is installed and you can go to work the next day. The fixing of an implant on bone may seem daunting to some, but it is important to realize that bones do not have a lot of nerves or sensitivity to pain. It is rather the gums that are sensitive, which can be easily controlled with medication. Conscious sedation can be used to reduce anxiety.

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2. What are osseo-integrated implants?

They are a new generation of implants, introduced since the 60’s, which only now have reached a degree of universal acceptance. They are usually titanium screws placed in toothless areas and provide chewing capacity and functionality similar to natural teeth. Normally they are installed in two stages: one for insertion of the titanium implant – a more extensive surgery – and another, a few months later, for placing the attachments that will support a prosthesis. The prosthesis can be quickly made after the second stage.

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3. Are they better than conventional prostheses?

They are certainly superior to dentures and removable prostheses (“removable bridges”). Functionally, they have similar capacity to fixed prostheses where the toothless area is relatively small, but the choice of one treatment over the other has to be carefully weighed by the dental professional, taking into consideration the requirements of the patient because individual situations are so diverse they preclude ready-made generalizations. When people have lost all their teeth or when the toothless area is towards the back of the mouth, implants normally represent a better solution from the functional point of view.

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4. What are the chances of success?

Long term studies show that certain types of implants present success rates better than 90%, and the prostheses attached to them present success rates of 97% (loss of an implant doesn’t necessarily imply loss of the prosthesis since the latter is supported by other implants as well). However, this is an average success rate which will vary in different areas of the mouth. The failure rate for patients who are completely toothless in the lower jaw is close to 0% (zero percent); but in the back of the mouth, if there is low density bone and short implants are required (due to maxillary sinus considerations), that rate may drop to 33%.

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5. What is so magical about titanium?

Nothing. It is a material that has been in use in orthopedics for many decades. Simply put, titanium is not subject to corrosion when inserted inside the human body and does not present the same immunological rejection problems of other metals of the same family, such as niobium, for instance. The success of the technique is due to a number of different factors and the titanium characteristics are a positive contributor, but will not, of themselves, guarantee success. In a word, success depends on the correct pacing of the surgical procedure (to prevent overheating the bone), a sufficient healing period prior to installation of the prosthesis, and the choice of an appropriate prosthesis. The protocol for carrying out implants involves attention to details that must not be overlooked. The expertise of a competent and well trained professional is crucial to achieving excellent results.

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6. What are the surgical risks?

They are minimal. Surgery is usually performed under local anesthetic (freezing) and is a lot less traumatic than many other dental surgery procedures, such as the removal of impacted teeth. The post-op is very good and most patients do not report any major discomfort. However, as with any surgical procedure, there are inherent risks, such as post-surgery infection, excessive bruising and others, but incidence rates are low so they do not represent a counter-indication to the procedure.

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7. Is there a guarantee of success?

In principle, the high success rate is a good guarantee but, as with all biological processes, there is an element of uncertainty. It is not possible to have absolute certainty of success, but in light of the success rates we quoted above, the discomfort of the surgery weighs less than the benefits of a fixed prosthesis. Even in cases of failure, the procedure can be redone.

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8. Why do failures happen?

In most cases it is because the case is not a good candidate for implants. Attempting to install implants in non-favorable cases has to be a conscious and informed decision on the part of the dental professional and the patient, after all other alternatives have been discussed. However, failures can happen even in very favorable cases and it is nearly impossible to determine the real cause.

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9. What happens if the implant presents some degree of mobility after the prosthesis is installed?

It means the implant has failed. Any mobility is indicative of failure.

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10. How long does an implant last? What is its useful life?

We can say that in 95% of cases, if the implant is not lost in the first two years of use, they will last for most of the patient’s life.

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11. How good is it aesthetically?

It depends largely on the method used and the condition of the area. Cosmetic value has greatly improved over the last few years, but remember, no matter how good the implant and the professional may be, it will always be a prosthesis, i.e., a substitution of an artificial tooth for a natural one. It is common to see an inflated expectation of implants, but it will often be followed by a certain degree of frustration. In many cases, the aesthetic solution is just acceptable. The best way to think of this is functionality: the implant’s functionality is far superior to other prosthetic procedures. In the absence of teeth, it is the best there is.

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12. Do I need to return to the dentist after installing the teeth?

It is necessary to do at least one x-ray follow up a year. The patient needs to make a commitment to these follow-ups.

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13. What if the dentist says he will install three implants and come surgery time he installs, say, two or four?

Proper planning precludes this type of problem, which should be discussed prior to surgery since the patient’s participation during the surgical procedure must be passive and, let us face it, this is not the best time to be discussing issues of pricing and forms of payment. If need be, the necessary implants are installed and all “paperwork” discussion is left for a better time.

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14. Is it overkill for the dentist to request a cat scan for bone analysis?

No, especially for the upper arch. A detailed study including a cat scan avoids unpleasant surprises, especially of the nature of the previous question.

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15. In respect to chewing capacity, will it improve after the implants are in?

Implants present functional results far superior to those of dentures and removable prostheses. Patients who have been wearing dentures for a long time will notice a very significant difference with implants.

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16. If there isn’t sufficient bone mass, are there any ways to increase the quantity of bone available?

Yes. Surgery can be done on the maxilla to increase the edge and/or lift the maxillary sinus by removing bone from the chin, from the stem of the mandible or from the hip. In the mandible, the inferior alveolar nerve may be rerouted and possible post operatory effects of this procedure greatly reduce its indication.

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17. How long does the surgery take?

Normally not more than an hour or two. In exceptional cases it may be longer.

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18. How long will I have to be without a prosthesis?

In the case of complete toothlessness, the period is of no more than 3 or 4 days after the first surgery. During phase 2, when the implants are accessed, the patient is not left without prosthesis. In the case of partial prostheses, often times the patient is not left without prosthesis at all.

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19. Will I have to extract a natural tooth to have an implant put in?

A natural tooth is always better than any prosthesis. However, in some situations in which the natural teeth are extensively compromised, for example, by periodontal disease, we can consider this possibility. Advance planning taking into consideration all alternatives and cost is mandatory. There is no consensus as to the degree of compromise that makes the substitution of an implant for a natural tooth advantageous.

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20. Since this is a foreign material, are there any risks of rejection or viral contamination, for example? How is an implant sterilized?

There is no rejection because titanium is an immunologically inert material. As to contamination, it usually happens through surgery and not by failures in the manufacturing process. Any of the methods normally used for sterilization of the implant – hot air or autoclave – offers total safety.

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21. Can I eat anything after the prosthesis is installed? If I fracture any of the prosthesis’ teeth, is the whole implant lost?

No, but the restrictions are not very severe. Certain foods can fracture even natural teeth. At any rate, a diet with minor cares is sufficient to preserve the teeth of prostheses supported by implants. Another positive factor is the ease with which fractured prosthesis teeth can be repaired.

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22. If the implant fails, what is the best procedure?

Failure may happen, particularly in areas of low bone density that allow only short implants. It is without a doubt one of the risks in the process. The best alternative is to try again, especially if there is sufficient bone because after removal of the implant the bone tends to get a little denser. It is best not to be in too much of a hurry to solve the problem, which although not very frequent, is, of course, very unpleasant. Normally, when working in areas where higher probability of loss is involved, the patient is informed prior to surgery.

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23. I have a complete upper prosthesis. I would like to know if it is possible to have an overdenture without the palate. How many implants? What would it cost?

An overdenture without a palate is a good alternative. It would require at least 4 implants. Another alternative is to have a fixed prosthesis over implants. In this case we would need between 4 and 6 fixation points. The cost of this type of treatment varies and implementation requires prior exams to determine the bone availability in the region.

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24. I have a tooth with a minor infection. A dentist I saw wants to do surgery in the root and leave the crown as is but another one believes that, instead of the surgery, it is better to do an implant. The difference in price is very large. What is the best solution?

Both alternatives can be good, depending on the case. The first option would be more indicated if the root is in good condition and can continue functioning. But the second alternative would be best if the root has a fracture, lesions or cavities. Nowadays there is a tendency to favor implants because, as we know, these are very long lasting treatments with predictable results. This is why a cost/benefit analysis of the treatment is worthwhile.

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25. I would like to know if someone with a predisposition for bacterial plaque can have an implant.

Yes, someone with a predisposition for bacterial plaque and periodontal disease can have an implant, as long as the process is under control.

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26. I would like to do my dental treatment because I realize how important it is, but I have an absolute terror of the treatment and I also think it must be expensive.

Nowadays we have access to the most recent advances of Implantology at very accessible prices. Treatments can be done over time to make payment easier.

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27. I need to have surgery to raise the maxillary sinus (bilateral) to install implants in the upper part of the mouth. I would like to know what risks there are and what the post-op is like. Will I have a lot of pain? In other words, everything I need to know to reassure me and enable me to make a decision.

The surgery for raising the maxillary sinus is a routine and safe procedure where there is atrophy of the maxilla. The biggest risk is lack of success due to the perforation of a very fine membrane inside the sinus. The post-op is usually very good, with only minor pain and swelling in some cases. If it is truly indicated it should be done, as it is the best way to rehabilitate the posterior area of the maxilla.

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28. I live in Salvador, Bahia, and I am planning a trip to Sao Paulo for dental treatment. I am embarrassed to say it has been years since I last went to the dentist because I am terrified of it. I have the following questions: How can I budget for this? Do I send the diagnostic exams ahead or do I bring them at the time of my visit? (x-rays, pictures, etc)

We are equipped to complete treatments in a shorter period than normal in our Outpatient Day Clinic. If you are interested in a more detailed analysis of your case, it would be very helpful to have a panoramic x-ray of your arch. At any rate, I can guarantee that current procedures are completely painless.

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29. I would like to know if it is possible to replace two removable prostheses with clasps with fixed prostheses without clasps or by implants. I would like to put an end to the sight of metal every time I smile.

A treatment such as your presents little complexity and can be completed in a short time in our Outpatient Day Clinic. We also suggest dental bleaching so that your whole smile will be whiter and more aesthetically pleasing. If you are interested in a more detailed analysis of your case it would be a great help to have a panoramic x-ray and pictures of your arch.

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30. I have two fixed bridges (one on either side) in the upper arch and I have two implants started (the pins were put in). I would like to complete the implants and replace all the teeth with white, nice looking teeth, because my teeth are yellowed and the bridges are old, with the metal showing. I live in Salvador, Bahia, and I would like to know how many days I would need for a treatment.

A treatment such as yours is of low complexity and can be done in 10 to 15 days at our Outpatient Day Clinic and Dental Spa. We suggest we also perform a dental bleaching so that you can have a whiter and more aesthetically pleasing smile.

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31. I wear upper and lower dentures and I am 52 years old. Can I recover my teeth? Could you tell me the costs?

Nowadays it is possible to recover your teeth as there are many available solutions, particularly with dental implants. In order to give you an estimate I would need more detailed information such as x-ray exams that can be easily done.

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CLINICAL ODONTOLOGY

1. I have a small pus blister that comes and goes from time to time. What could it be?

It is probably a dental abscess. You need to see your dentist for him/her to examine your case.

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2. One of my teeth has already had a root canal treatment but I still feel a slight sensitivity on it. What could be happening?

You may still have contamination at the tip of the tooth’s root. This may be caused by an unsatisfactory treatment or by a re-infection of the tooth. In such cases a retreatment of the root canal should solve the problem. Or in some cases it may be due to a tooth fracture, in which case an extraction is needed.

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3. Some years ago I hit my tooth and it got dark. Why did this happen and how can I treat it?

When a tooth suffers trauma, internal bleeding in the tooth may sometimes happen, which results in staining from the ferrous salts found in the blood’s hemoglobin. Or there may be an additional layer of dentine inside the tooth which is a darker yellow. In the first case it will be necessary to do a root canal treatment. In the latter case a single tooth bleaching may solve the problem.

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4. I feel like a noise and/or ache in my ear when I chew or open my mouth. Can my chin fall off?

Your chin cannot fall off but there may be a serious problem with the jaw joint which needs to be examined by the dentist. In the majority of cases the treatment is done with removable appliances, commonly known as splints.

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5. Four months ago I had a root canal treatment on the last molar. After the anesthetic my chin went numb and hasn’t recovered sensitivity yet.

Probably what happened is the needle with the anesthetic touched the nerve. Some sensitivity should return over time. Although there are laser treatments which can be indicated in cases such as yours, total recovery of sensitivity is not very likely.

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6. I have a lot of sensitivity in my teeth when I drink ice water or with air. What is my problem?

Often times this type of sensitivity is caused by receding gums that expose the tooth cervix or even the root itself. The dentist has to evaluate your case to determine the best course of action, which may be a dental restoration, an application of Fluor to the area or surgery to cover the cervix. A cavity might also be causing pain.

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7. I would like to know what is the use of having an arc over the roof of my mouth because I have one now and it bothers me a lot.

This type of arc is usually intended to aid orthodontic movement and should not hurt. It is best to go see your orthodontist to see if the appliance needs adjustment.

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8. Lately some white lesions have been appearing in my mouth that take a long time to heal. I would like to know what type of dental specialist I should see? I am 28.

You should look for a specialist in Semiology or Stomatology.

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9. I have an upper and a lower prosthesis and I used to like to go dancing at discos. But I’ve been told the black light makes my prostheses change color. Some of my co-workers were laughing at me when they found out I had them.

Probably your prostheses don’t have the same fluorescence as natural teeth. Nowadays there are artificial teeth that do. I believe you will need to change your prostheses to get the desired effect.

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