Frequently Asked Questions

• I don't have a toothache, and I brush and floss regularly. Do I really need a check-up?

  Biannual teeth cleanings (approximately every six months) performed by one of our skilled dental hygienists are central to keeping your teeth and gums looking, feeling, and functioning well. If you have periodontal (gum) disease, more frequent visits to our office will probably be recommended for your oral and overall health.

  During cleanings, plaque and calculus (more commonly known as tartar) are removed from teeth. Plaque is a sticky deposit on teeth in which bacteria grow, and tartar is basically calcified or hardened plaque, so it is more difficult to remove. When tartar builds up under the gumline, causing gum disease, more extensive treatment than a standard cleaning is needed to remove it and help ensure healthier gums. Our hygienists also polish teeth, floss (partly to test the condition of gums, to see if they bleed), and they document any bleeding along with stains they noted during the cleaning in a patient's file.

  Dental exams with either Dr. Liao or Dr. Shiao make it so problems can be diagnosed and treated before they grow to be big, often painful and expensive. A typical exam includes a visual assessment of teeth and occlusion (bite), along with an appraisal of current restorations (fillings, crowns, bridges, etc). When x-rays have been taken, we carefully review them to identify areas of decay and other possible areas of concern for cysts, tumors, and other disorders of the mouth. Panoramic x-rays are especially revealing and beneficial to this process. Dr. Liao or Shiao will perform a general screening for early detection of gum disease and oral cancer, as well.

  In between cleanings and exams at our office, brushing teeth at least twice a day (in the morning and at night) is the most important thing you can do to take care of your teeth. Brushing after every meal is even better, if you can. If not, chewing sugar-free gum after meals can get food particles out of teeth. Additionally, clean between teeth daily with floss or interdental cleaners, and remember to brush your tongue. Brushing your tongue, especially the back areas, can make a big difference in how clean your mouth feels and smells, and how clean it actually is. Restorations, such as bridges and partial dentures, should be cleaned thoroughly, too, just like natural teeth. Toothbrushes should be replaced every two to three months.

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• Should I replace my silver (amalgam) fillings with composite fillings?

  Silver (amalgam) has been something of the "gold standard" of dental fillings for years, but recently, composite tooth-colored fillings have become a popular method. Dentists and patients have plenty of reasons to prefer composite fillings, but before you surrender your silver, consider some facts about fillings.

  Silver fillings are durable, lasting on average at least 10 to 20 years, and they are very strong, making them ideal for use in the large back molars. They also tend to be less expensive than composite fillings, but usually require more invasive preparations. The biggest drawback to silver fillings is aesthetic, as they can cast a gray hue over the surface of a tooth. Silver fillings have gotten a bad reputation because of their mercury content, but the FDA and the ADA have agreed that there's no proof that they have adverse side effects. In fact, the mercury in amalgam fillings is only one component of a chemically stable alloy. Silver fillings have been used in dentistry for hundreds of years, and allergic reactions are rare.

  Composite fillings, made out of a mixture of glass and quartz materials, provide a tooth-colored restoration that looks more like your natural tooth. Composite materials are also versatile and can be bonded (held adhesively) to teeth, which calls for less invasive preparation and leaves more healthy tooth structure beneath the filling. Compared to amalgam, composite fillings are slightly less durable and are better suited for teeth with light or moderate bite pressure, and they can take longer to place. Depending on your dental insurance plan, composite fillings can cost a bit more than amalgam.

  Unless Dr. Liao or Dr. Shiao notices cracks or damages in your current fillings or expresses other concerns regarding your dental health, replacing silver fillings is a matter of personal preference.

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• How can I tell if I'm at risk for gum disease?

  According to the American Academy of Periodontology, gum disease is the number one cause of tooth loss in adults over age 35. Gum disease ranges from gingivitis to the various forms and stages of periodontitis, and the prevalence of gum disease increases with age because teeth wear down and become more sensitive as time passes, gums naturally recede, and medications can affect oral health. If your gums feel tender or sore, or if they look red and swollen, you may have periodontal (gum) disease. Other signs include bleeding and/or receding gums, pain or sensitivity in your teeth (and even loose teeth, caused by weakening gum fibers and/or bone loss), and persistent bad breath. If left untreated, gum disease can lead to tooth loss as well as various other health problems. More and more life-threatening illnesses are being linked to the presence of diseases in the mouth.

  The first thing to do is get a thorough dental evaluation. If you have any degree of gum disease, we can help. Drs. Liao and Shiao strongly believe in and focus on the importance of healthy gums for a healthy mouth and body. Gum disease used to require surgery more often than not. While surgery is still an option and sometimes needed, many cases are now treated with less invasive techniques first, such as deep cleanings, local antibiotics, and special rinses. Please come in and let us help you achieve and maintain healthier gums for a healthier you.

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• Is smoking really that bad for my teeth?

  Smoking isn’t just bad for your teeth—it affects the health of your entire mouth, especially your gums. Lighting up stains your teeth, causes bad breath, and promotes the buildup of plaque and tartar. Cigarette smoking is also one of the leading causes of tooth loss. Worst of all, smoking has been linked to the development of periodontal (gum) disease and may lead to the loss of taste and smell. Smokers also tend to require more dental treatment, due to the damage done by smoking. Certain procedures, such as dental implants and oral surgeries, can be less successful in smokers due to damaged gum tissue. This results in a higher cost of dental healthcare and often more frequent (and complicated) treatment.

  Pipes and cigars aren't any safer, causing similar rates of tooth and bone loss even if the smoke is not inhaled. Smokeless tobacco products like snuff and chewing tobacco also pose great health risks to your gums, increasing your risk for both oral cancer and cancers of the throat, esophagus, and lips. Additionally, they contain a significant amount of sugar, which when pressed against your teeth for long periods of time can lead to tooth decay.

  So what’s the verdict on tobacco? Seek help on how to quit using, or just don’t start.

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• Are there any specific oral health concerns associated with diabetes?

  While having diabetes does not automatically put your dental health at risk, it does make a person more susceptible to certain conditions. Uncontrolled diabetes causes high glucose levels in saliva, which can promote the growth of bacteria in the mouth and increase the risk of cavities. Diabetes also reduces the body’s resistance to infection, which can make an individual more likely to develop illnesses such as gingivitis or even serious periodontal (gum) disease. Symptoms of gingivitis, which is an early form of gum disease, are red, sore, receding, or bleeding gums. If you notice these to any degree, be sure to make an appointment with either Dr. Liao or Dr. Shiao. Other, less serious, problems that can occur include thrush (a treatable infection in the tongue and cheeks), ulcers, and dry mouth.

  Interestingly enough, this connection is a two-way street. For patients with severe gum disease, the infection in the gums can affect the blood glucose levels and the immune system, actually increasing the overall risk of developing diabetes. If you have diabetes, you know the importance of a healthy lifestyle. Smoking can be particularly damaging to diabetics, as it causes excess dryness and damage to the gum tissue. Ultimately, the most important factor is blood sugar. If you keep your diabetes under control with a healthy lifestyle and maintain good oral hygiene through regular check-ups, diabetes won't get the best of your smile.

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• What should I do in case of a dental emergency?

  Let's face the facts: accidents happen, and especially when it comes to our teeth and mouths, they can be pretty frightening. Being careful is good prevention, but being prepared promises reassurance in any oral health emergency. It's important to know when home care will suffice and when a trip to the dentist is necessary, so here are some guidelines to help you through common situations:

  Toothache/Sore Gums

  Rinse with warm water to remove any food or debris. If you notice anything lodged between teeth, floss to remove it. Take an over the counter pain medication (but never apply the medication directly to tooth or gums), and contact us if the pain persists.

  Chipped Tooth

  Save the pieces, if you can, and rinse them thoroughly. Apply an ice pack or a cold compress to the swollen lip or gum tissue near the chipped tooth to prevent swelling. If the area is bleeding, apply gauze for ten minutes, or until the bleeding has stopped. Make an appointment to see Dr. Liao or Dr. Shiao as soon as possible.

  Broken Tooth

  With recent advancements in restorative and cosmetic dentistry, you might not lose your tooth. If there’s enough remaining healthy tooth structure, one of our dentists can create a crown that will “grab onto” your natural tooth, eliminating the need for root removal. While the success of this process, known as “crown lengthening,” depends on the severity of the break, it’s worth asking about options other than complete removal.

  Knocked Out Tooth

  Depending on the situation, find the tooth and, holding it by the crown (top) only, rinse it briefly with warm water. If the tooth is whole, gently reinsert it into the socket (if possible) and bite down on gauze or cloth to keep it in place. If you cannot reinsert it, place it in a container of milk or salt water. Contact us as soon as possible! If treated within 2 hours, the tooth might be salvaged.

  Soft Tissue Injuries

  Soft tissues such as gums, cheeks, lips, and the tongue tend to bleed heavily, only because the tissue contains a great deal of blood flow. To control the bleeding, first rinse with a warm, mild salt water solution. Apply pressure with gauze or a moistened towel for 15 to 20 minutes. Afterwards, to reduce swelling and help stop residual bleeding, apply a cold compress to the outside of your mouth. In the event of a serious soft tissue injury in which the bleeding is profuse or the damage is visibly traumatic, it's best to stay calm, keep applying pressure, and go to the nearest emergency room or urgent care center.

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• Am I candidate for dental implant restorations?

  Drs. Liao and Shiao, together with our whole team at Dublin Smiles, work hard to stay on the leading-edge of restorative dentistry. If you or someone you love struggles with ill-fitting, uncomfortable dentures or a retainer with false teeth, we have a permanent solution. Quickly becoming the preferred method of teeth replacement, implants can give your smile a second chance. They are useful in denture stabilization, but they can also be used in conjunction with crowns, bridges, and in single-tooth replacements.

  Permanent implants are not only more durable and long-lasting than traditional tooth replacements, they also look and feel more like natural teeth. Most importantly, they function like natural teeth, so you can chew, talk, and smile with confidence again.

  Many patients suffering from advanced tooth decay, root canal failure, trauma to the mouth, or just extreme natural wear and tear on teeth are benefiting from this revolutionary option in restorative dentistry. However, there are still some things to consider before you decide on dental implants. For example, they are best performed after adolescence, when the teeth and jaw bone are fully developed. Additionally, the implant procedure can be more complicated for individuals with periodontal (gum) disease, active diabetes, immune deficiencies, and for patients who smoke. To ensure that you get the treatment that’s right for you, keep Drs. Liao and Shiao informed and up-to-date about your entire medical history and dental habits.

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• I've heard a lot about laser dentistry lately. What is it, and what is it used for?

  Advancements in laser technology have reinvented a variety of dental procedures. Lasers are not only remarkably precise, but they can also shorten procedure time, minimize pain, and speed the healing process of many treatments. Even better, lasers are as useful in common procedures as they are in complicated ones, having been incorporated into everything from cavity detection and fillings to complex periodontal surgery. During routine cleanings or surgical procedures, lasers can reduce or completely eliminate the need for drills, scalpels, anesthesia, and sutures. Surgery without sutures carries less risk of infection and need for repeat visits.

  Just as doctors use different scalpels for different procedures, dentists have different lasers for the various surfaces in your mouth. There are lasers for cavitiy detection, for teeth whitening, for viewing purposes, and lasers for surgical procedures. Hard tissue lasers are used on teeth and bone, to prepare teeth for certain treatments, remove decayed areas, or repair fillings. Soft tissue lasers, as the name implies, are better suited for gum, cheek, and tongue tissue, and as they seal blood vessels in the process, these lasers can reduce the pain and healing time associated with surgery.

  The Academy of Laser Dentistry (ALD) has been actively researching technology and developing standards of excellence since 1993, and is dedicated to educating and certifying dentists internationally in the safe use of laser technology. Though most experts agree that lasers are the future of dentistry, it’s estimated that only around 5% of dentists currently offer them in their offices (although that percentage is growing).

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• What are the benefits of a dental radiograph (x-ray) examination?

  X-rays, also known as radiographs, are commonly used in dental exams of patients of all ages. Panoramic x-rays, which are taken every five to seven years and show the entire mouth, are particularly useful diagnostic tools. Panoramic x-rays are taken with a machine that circles your head providing a complete overview of all the teeth as well as the roots, upper and lower jawbones, the sinuses, and other hard surfaces in the mouth. Many problems with teeth and the surrounding tissues cannot be seen when we visually examine your mouth. An x-ray examination is needed to reveal:

  • Small areas of decay between teeth or below existing restorations (fillings)
  • Deep cavities
  • Infections that can develop in the mouth bones
  • Periodontal (gum) disease
  • Abscesses or cysts
  • Developmental abnormalities
  • Some types of tumors
  • TMJ Dysfunction
  
  

  Detecting and treating dental problems at an early stage can save you unnecessary discomfort, money, and time. In cases where x-rays help us detect oral cancer and gum disease early, radiographs can also help save your life!

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• Is professional teeth whitening safe?

  You have a number of options when it comes to whitening your teeth.  Depending on your schedule and your brightening expectations, you and one of our doctors can decide which is best for you. With in-office whitening procedures, you can get a brighter smile in just 45 minutes-1.5 hours.

  Opalescence® Boost is a one-hour, one-visit whitening system that is great for busy patients! Boost uses a chemically activated formula of bleach that whitens teeth effectively without the bothersome ultraviolet rays or heat of a whitening light. On top of that, Boost’s unique formula contains fluoride and potassium nitrate to help strengthen enamel, increase your teeth’s defense against cavities, and minimize the sensitivity often caused by teeth whitening. The Boost system also features a syringe-to-syringe mixing technique that ensures both a fresh and an evenly mixed bleaching product. Don’t be alarmed by the red color of the bleach solution! It eases placement and removal by showing exactly where the bleach is on your teeth, but the color does not affect the level of whiteness that can be achieved.

  For the convenience of whitening in your own home, we offer trays custom made to fit your mouth. There are also a variety of over-the-counter gels, strips, and toothpastes designed to whiten your teeth, but they contain less concentrated ingredients that typically take longer to show results.

  As far as safety goes, numerous studies have examined the effects of whitening and bleaching methods. Some products, including certain whitening toothpastes and take-home kits available through dentists, have been evaluated and approved by the American Dental Association (ADA). While having the ADA seal of acceptance is a good sign, many safe and effective products don't have an ADA seal simply because their manufacturers did not seek one. Bleaching is not recommended for children under 16, as their teeth are still developing, and is also not recommended for women who are pregnant.

  The most common side effects of teeth-whitening are teeth and gum sensitivity. This sensitivity is usually temporary, and should subside soon after you've stopped using the product.

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• Why is fluoride good for my teeth?

  Each day, foods and acids feed bacteria in your mouth, which can accumulate on your teeth to form plaque. Plaque wears away at a tooth's enamel in a process known as demineralization. Fluoride is a naturally-occurring mineral that can promote the remineralization of enamel, replacing important minerals that strengthen your teeth and can protect them from decay. Fluoride can also help reverse early stages of decay.

  Children with newly-erupted permanent teeth benefit a great deal from fluoride exposure, but adults should make sure their teeth come into contact with it, too. The safe and easy way to ensure your teeth are getting enough fluoride is to use fluoride toothpaste, available at drugstores in a variety of types and flavors. If Dr. Liao or Dr. Shiao recommends more intense fluoride treatments, there are a number of gels, rinses, or even in-office procedures that can do the trick. Though the most fluoride is absorbed from direct contact with the teeth, many public drinking water systems contain small, safe amounts of fluoride that can have positive health effects.

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• What causes tooth discoloration?

  The two main types of tooth discoloration are extrinsic (external or surface stains) and intrinsic (internal stains). External stains affects the outside of the tooth, while internal stains discolor a tooth from within. External stains can be attributed to anything that comes into contact with the surface of the teeth, such as red wine, coffee, tea, or tobacco products. Internal discoloration reflects the actual condition of the tooth, often occurring as a result of treatment procedures, exposure to excessive amounts of fluoride (Fluorosis), and certain antibiotics.

  Some types and degrees of discoloration respond well to whitening methods, while others require veneers, bonding, or other restorative procedures. Dr. Liao or Dr. Shiao can determine which type of stains you have and which whitening method, if any, will work best for you and what your other treatment options are.

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• What could be causing my dry mouth, and what can I do about it?

  Symptoms of dry mouth can include a sticky, dry, or burning sensation in the mouth, altered taste, chronic bad breath, an altered sense of taste, and insufficient saliva. Dry mouth is particularly common in the elderly and the very young, but it can affect anyone at any given time, and there are a number of common causes.

  Dry mouth is a known side effect of many medications, from prescriptions to antihistamines. Medical conditions such as diabetes can also cause recurrent dry mouth. Cancer treatment (chemotherapy and radiation), hormone changes during pregnancy or menopause, and high levels of stress are other conditions that can lead to dry mouth.

  Dry mouth can be uncomfortable and is one of the leading causes of chronic bad breath, but it can also make teeth more prone to decay and soft tissue more susceptible to infection. Because insufficient saliva endangers the health of your entire mouth, it’s important to ask us about oral sprays, prescription drugs, or simple lifestyle changes that can provide relief.

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• When I floss, my gums bleed. If they don’t hurt and my teeth look fine, is it really a big deal?

  If your gums are not sore, it's safe to assume your bleeding gums are not the result of an aggressive brushing or flossing. Bleeding gums that apparently have no cause are always a warning sign, often indicating such conditions as gingivitis or even periodontal (gum) disease. Gingivitis (inflamed, bleeding gums) is not a one-way ticket to gum disease; in fact, if it’s caught early enough, gingivitis can be treated and even reversed. The first lines of treatment when it comes to gingivitis are lifestyle changes. Poor oral hygiene, smoking, uncontrolled diabetes, and high levels of stress can all contribute to gingivitis. Choosing a toothbrush with soft bristles can ease gum damage, too, and getting regular dental cleanings will control plaque and tooth decay. It's important to stop gingivitis before it progresses, as studies have shown more and more serious illnesses are associated with gum disease. Heart disease, strokes, diabetes, even osteoporosis and inflammatory diseases such as Rheumatoid Arthritis have been linked to poor oral health.

  Though not the first suspect in a simple case of bleeding gums, oral cancer is also a possibility. Oral cancer can be difficult to diagnose because many of its symptoms are associated with other medical conditions. They include sores, difficulty swallowing or moving the jaw, bleeding gums or cheeks, and a continuous pain in the mouth. If our doctors find no other causes for your bleeding gums, we may recommend a visit to a specialist.

  Regular check-ups are vital to cancer prevention, as are good oral hygiene, avoiding tobacco, and maintaining a balanced diet. Inform us if you’re experiencing any of the above symptoms. You’d go to the doctor if a cut on your hand were infected, so do your gums the same service! They’ll thank you later.

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• My teeth are killing me, but I can’t really tell where the pain is coming from.

  Believe it or not, you could have a sinus infection. Recently, direct connections have been made between sinus infections and impacted or damaged teeth. They can also occur after extensive dental work or cracked restorations. Pain in the sinuses can mimic the sensation of a toothache (or actually cause one) because of the proximity between the two areas.

  If you’re experiencing chronic sinus pain with a general, unidentified toothache, contact us so Dr. Liao or Dr. Shiao can check it out. A regular check-up and a series of x-rays should be able to determine a tooth-related cause, but if they don't, we can also perform a “percussion test," during which we gently tap on individual teeth to discover the source of your discomfort. After all, when deciding on a treatment plan, it's helpful to know whether it’s a toothache or just your nose playing tricks on you.