Q. I have a terrible fear of going to the dentist yet I know I need to. What should I do?

A. If you fear going to the dentist, you are not alone. Between 9% and 15% of Americans state they avoid going to the dentist because of anxiety or fear. The first thing you should do is talk with your dentist. In fact, if your dentist doesn't take your fear seriously, find another dentist. The key to coping with dental anxiety is to discuss your fears with your dentist. Once your dentist knows what your fears are, he or she will be better able to work with you to determine the best ways to make you less anxious and more comfortable.

The good news is that today there are a number of strategies that can be used to help reduce fear, anxiety, and pain. These strategies include use of medications (to either numb the treatment area or sedatives or anesthesia to help you relax), use of lasers instead of the traditional drill for removing decay, application of a variety of mind/body pain and anxiety-reducing techniques (such as guided imagery, biofeedback, deep breathing, acupuncture, and other mental health therapies), and perhaps even visits to a dentophobia clinic or a support group. (webmd.com)

Q. I'm interested in changing the shape of my teeth. What options are available?

A. Several different options are available to change the shape of teeth, make teeth look longer, close spaces between teeth or repair chipped or cracked teeth. Among the options are bonding, crowns, veneers, and recontouring.

Dental bonding is a procedure in which a tooth-colored resin material (a durable plastic material) is applied to the tooth surface and hardened with a special light, which ultimately "bonds" the material to the tooth.

Dental crowns are tooth-shaped "caps" that are placed over teeth. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Veneers (also sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials that are designed to cover the front surface of teeth. These shells are bonded to the front of the teeth.

Recontouring or reshaping of the teeth (also called odontoplasty, enameloplasty, stripping, or slenderizing) is a procedure in which small amounts of tooth enamel are removed to change a tooth's length, shape or surface.

Each of these options differ with regard to cost, durability, "chair time" necessary to complete the procedure, stain resistant qualities, and best cosmetic approach to resolving a specific problem. Talk to your dentist to see if one is right for you. (webmd.com)

Q. How do whitening toothpastes work and how effective are they?

A. All toothpastes help remove surface stains through the action of mild abrasives. Some whitening toothpastes contain gentle polishing or chemical agents that provide additional stain removal. Whitening toothpastes can help remove surface stains only and do not contain bleach; over-the-counter and professional whitening products contain hydrogen peroxide (a bleaching substance) that helps remove stains on the tooth surface as well as stains deep in the tooth. None of the home use whitening toothpastes can come even close to producing the bleaching effect you get from your dentist's office through chair-side bleaching or power bleaching. Whitening toothpastes can lighten your tooth's color by about one shade. In contrast, light-activated whitening conducted in your dentist's office can make your teeth three to eight shades lighter. (webmd.com)

Q. What's the latest word on the safety of amalgam-type fillings?

A. Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that they are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.

The American Dental Association (ADA), the FDA, and numerous public health agencies say amalgams are safe, and that any link between mercury-based fillings and disease is unfounded. The cause of autism, Alzheimer's disease, and multiple sclerosis remains unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.

In March of 2002, the FDA reconfirmed the safety of amalgams. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. The National Institutes of Health conducted several large-scale studies that concluded in 2006 that amalgam fillings were safe.

In addition, there has been concern over the release of a small amount of mercury vapor from these fillings, but according to the ADA, there is no scientific evidence that this small amount results in adverse health effects.

Q. How safe are dental X-rays?

A. Exposure to all sources of radiation -- including the sun, minerals in the soil, appliances in your home, and dental X-rays -- can damage the body's tissues and cells and can lead to the development of cancer in some instances. Fortunately, the dose of radiation you are exposed to during the taking of X-rays is extremely small.

Advances in dentistry over the years have lead to the low radiation levels emitted by today's X-rays. Some of the improvements are new digital X-ray machines that limit the radiation beam to the small area being X-rayed, higher speed X-ray films that require shorter exposure time compared with older film speeds to get the same results, and the use of film holders that keep the film in place in the mouth (which prevents the film from slipping and the need for repeat X-rays and additional radiation exposure). Also, the use of lead-lined, full-body aprons protects the body from stray radiation (though this is almost nonexistent with the modern dental X-ray machines.) In addition, federal law requires that X-ray machines be checked for accuracy and safety every two years, with some states requiring more frequent checks.

Even with these advancements in safety, it should be kept in mind, however, that the effects of radiation are added together over a lifetime. So every little bit of radiation you receive from all sources counts. (webmd.com)

Q. Will my plan cover the care my family will need?

A. This should be a prime consideration and a major motivation in choosing one plan over another. If your employer offers more than one plan, look at the exclusions and limitations of the coverage as well as the general categories of benefits. You should discuss your family's current and future dental needs with your family dentist before making a final decision on your dental plan.

Q. Why Is a Dental Crown Needed?

A. A dental crown may be needed in the following situations:

• To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth.

• To restore an already broken tooth or a tooth that has been severely worn down.

• To cover and support a tooth with a large filling when there isn't a lot of tooth left.

• To hold a dental bridge in place.

• To cover misshapen or severely discolored teeth.

• To cover a dental implant

Q. It's been a while since I have been to a dentist because I can't stand the sound of the drill. I think I have a cavity but am reluctant to call a dentist. What can I do?

A. Dental technology has come a long way in recent years. If you have a new cavity that requires a filling, there is "new" air abrasive equipment which replaces the drill for removing decay. It is quick, silent and in most cases you do not need a shot of anesthetic because there is no heat or vibration to cause pain.

Air abrasion theory has been around in dentistry since the fifties but has only recently become practical to use because of downsizing of equipment and the development of filling materials which can be used with the new way of preparing teeth for fillings.

Our patients love it. For youngsters who are experiencing their first cavity, it is a great way to go - no noise, no needle, no pain! It won't work for all cavities, but with your dislike of the drill, you should certainly see a dentist who uses this technology.

Additionally, for patients coping with dental anxiety, we offer a Guided Relaxation service to help mentally center you prior to you procedure.

Q. I am missing several teeth. A friend told me that she recently had implants to replace her missing teeth and is very happy. What are implants?

A. Dental implants are a wonderful way to replace missing teeth when certain conditions exist. Such things as your overall general health and the length of time you have been missing your teeth must be considered. The replacement of missing teeth using dental implants frequently requires a team approach.

After your dentist does a thorough examination and treatment plan the surgical phase of treatment takes place. In most cases a periodontist or an oral surgeon will put the implant(s), the artificial root(s) into the jaw. When healing is complete, usually after 4-6 months, the tooth or bridge segment can be placed on top of the healed implants by a general dentist or a prosthodontist. Some dentists are trained to place the surgical part of the implant as well as the prosthetic or tooth part.

You should ask your dentist if you are a good candidate for implants and ask for a referral if he or she doesn't do them.