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Dental Topics



Dental Topics

The information below is intended to serve as a reference. If you have any concerns or questions, please direct them to your Dentist for specifics.

Please click a category below to learn more about that subject:

Canker Sores
Caring for Children's Teeth
Cracked Tooth Syndrome
Dental Implants
Fluoride Supplements
Gum Disease
MI Paste

Oral Lichen Planus
Periodontal Disease
Preventive Dentistry
Root Canal Treatment
Tooth Decay
Tooth Wear
Tooth Whitening

Making sure your dental visit is as comfortable as possible is one of our many concerns and top priorities as your dental care provider. For certain procedures we use local anesthetics (what some people call Novocaine) to avoid any pain or discomfort.

What types of procedures do you use local anesthetics for?
Most commonly local anesthetics are used for restorative work, such as fillings and crowns. Local anesthetics may also be used during a hygiene visit to make you more comfortable.

What if I have had difficulty with local anesthetic in the past?
If you have had problems, with local anesthetic, let us know. We use a variety of anesthetics and techniques that can work effectively for nearly any situation.

What if I am nervous about having local anesthetics injected?
Many people experience anxiety or fear when they will be receiving an injection. Please contact us if you are experiencing any nervousness and we can explore the options available to make you more comfortable. We do offer Nitrous Oxide to calm patients and relaxing medications might also be a viable option for you.
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Experiencing dental anxiety in not uncommon. Although we will do all we can to ensure your appointment is comfortable and safe, sometimes this isn't enough. We do have Nitrous Oxide available as an option to help relax patients and there are several different oral medications that Dr. Chyz would be happy to discuss with you if you're feeling anxious about your appointment. Please contact us if you have any questions or concerns regarding your appointment and we can explore the options to help you feel more at ease about your dental visit.
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Bleaching/Tooth Whitening

How can I whiten my teeth?
Our office offers two options to patients for tooth whitening: a take home system and an in office system.

Take Home System
The take home system is a bleaching process that lightens discolorations in the teeth. First we will take impressions of your teeth. From those impressions we form comfortable, soft, custom bleaching trays that hold the bleaching material to the teeth. The material is generally applied in the evening or during sleep.

Is tooth whitening safe?
Current home whitening products have been extensively studied and when used with supervision, and not abused, the products are completely safe.

What are the side effects?
Some people who whiten may experience increased tooth sensitivity to cold during whitening. These symptoms are temporary and will go away within 1-3 days after stopping whitening treatment. In most cases the use of a fluoride gel and/or desensitizer in the trays can allow patients to continue to bleach comfortably and effectively.

How long will it take to whiten my teeth?
Whitening results depend upon the color and degree of discoloration in your teeth as well as the concentration of whitening material and the amount of time that trays are used. Usually results are seen after the first treatment. The average patient whitens for about two weeks, although we have had some patients with severe staining bleach for as long as nine months to achieve their desired results.

Is maintenance required to keep my teeth white?
Touch-up whitening (1-3 nights) every 6-18 months will maintain your new smile. Touch-up kits are available at our office and can be used with the existing bleach trays.

In office whitening system: ZOOM!T
The ZOOM!T system uses a powerful bleaching agent along with a special light to activate the bleach. It typically takes two hours in the office and follow-up with take home trays is generally recommended. With the Zoom system, as with any in-office system, one visit may not be sufficient to achieve the result that you desire.
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Canker Sores - Apthous Stomatitis/Aphthous Ulcers

What they are?
Canker Sores, also known as aphthous ulcers or apthous stomatitis, are small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Apthous ulcers are not contagious.

How big are they?
Sizes of canker sores can range from the size of a pinhead to that of a quarter, but are an average of about 3 mm in diameter.

When will my canker sores go away?
Typically canker sores will clear up within a week or two.

What causes a canker sore?
  • Increased levels of stress
  • Heredity
  • Certain types of foods (acidic foods)
  • Deficiencies in Iron, Folic acid, or B12
How can I treat a canker sore?
Several over the counter medications are available to treat canker sores, mostly numbing topical gels to help relieve the pain. For more painful sores, we have a medication that will eliminate pain after one application.

What if it doesn't go away or gets worse?
If canker sores don't start to heal within a couple of weeks, worsen, or become infected, you should schedule an appointment with us to have it evaluated.
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Caring for Children's Teeth

From the time a child is just an infant it is important to start taking care of their gums and teeth. Even though teeth don't begin to erupt until a child is about 4 months old, their gums should be cleaned after each feeding.

To clean your infant's gums:
Simply use a soft, damp cloth or a gauze pad and gently wipe the gum tissue.

To clean your child's teeth:
After the first teeth erupt begin cleaning them with a small, soft toothbrush and a very small (pea sized) amount of fluoride toothpaste.

Baby Bottle Syndrome
Avoid giving children extended access to juice of sugary snacks - especially at bed time. Baby bottle Syndrome - the extensive decay of teeth with children who go to sleep with a bottle - is a tragedy that is easy to avoid. Unlimited juice during the day, however, can be nearly as damaging as a bottle at night.
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Cracked Tooth Syndrome

Cracked teeth can develop for a number of reasons; clenching, grinding, chewing on hard objects, a trauma to the mouth, or even everyday repetitive chewing. Teeth that have been weakened by fillings-silver amalgams in particular- are more vulnerable to cracking.

A cracked tooth can cause symptoms such as:
  • Pain with chewing, especially when biting with certain foods in a specific place.
  • Pain or discomfort upon release.
  • Discomfort with exposure to cold.
Symptomatic cracked teeth can usually be saved with a crown (and sometimes a crown and a root canal). Occasionally cracks are deep enough to make a tooth unsavable. Generally, the earlier a cracked tooth is treated, the more favorable the outcome. Once a cracked tooth hurts, the chance of the tooth needing root canal treatment is much higher.

Cracks can often be seen in teeth that do not have symptoms. Sometimes these cracks are superficial and insignificant and sometimes they are connected to deeper cracks that put the tooth at risk. There are no tests to discover hidden cracks that do not yet hurt. Every tooth that we treat is inspected inside for hidden cracks. In addition, certain surface cracks suggest a structural component than others. Dr Chyz will discuss this with you so that you can decide how proactive we should be when cracks are suspected.
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What Are Crowns?
A crown is a restoration that covers, or "caps," a tooth that is badly broken down, cracked or has had root canal treatment. Crowns are also placed over dental implants. Crowns are generally a natural shape and size. They can be fabricated out of different materials, including Porcelain, Gold, and Composite Resin. Porcelain crowns may be all porcelain, or they may be porcelain fused to gold or porcelain fused to zirconia. In our office, we favor two metal free crowns - Porcelain Fused to Zirconia and All Porcelain. We also favor full gold for patients who are heavy clenchers and are willing to trade esthetics for durability.

What is involved in having a crown made?
Having a crown made is generally a two step process. On the first visit a shade is taken (if the crown will be tooth colored) and local anesthetic is used to make the tooth numb. The tooth is reshaped to accommodate the crown. An impression is taken to allow the lab to fabricate the crown and a temporary crown is cemented onto the tooth. On the next visit, the temporary is removed and the crown is cemented on once the dentist verifies that it fits correctly.

Will it look natural?
You bet! In our office, we take extra steps to create the most natural crowns possible. We take high quality digital photographs that our skilled ceramist uses to guide him as he chooses various porcelain tints to match adjacent teeth (for a single crown). Where most labs use surface stains to match colors, they reduce the durability and natural appearance of the porcelain. We virtually never resort to surface stains. Of course if gold is the choice, the crown will have the shape of a natural tooth, but not the color.

How long do crowns last?
Crowns should last approximately 5-20 years. The national average is 10 years. That's quite a range. This range is affected by the fit of the crown, type of cement used, patient oral hygiene and dietary habits.
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Dental Implants

If you have lost a permanent tooth or have missing teeth, you may have the option of restoration with a dental implant. Dental Implants are made of titanium - a substance that integrates, or heals, into the jawbone. A specialist surgically places the implant (a small titanium post) into the jawbone, where it functions as a tooth root. After the implant integrates into the bone Dr. Chyz attaches an artificial tooth, or crown over the implant to complete the restoration. The result is a strong replacement tooth that restores chewing function, and looks, feels, and functions as a natural tooth.

The miracle of dental implants has enabled countless people to have mouths free of missing teeth.
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The American Dental Association has endorsed fluoridation of community water supplies as safe and effective for preventing tooth decay for more than 40 years. Fluoride is nature's cavity fighter, occurring naturally in the earth's crust, in combination with other minerals in rocks and soil. Small amounts of fluoride occur naturally in all water sources, and varying amounts of the mineral are found in all foods and beverages. Water fluoridation is the process of adjusting the natural level of fluoride to a concentration sufficient to protect against tooth decay, a range of from 0.7 parts per million to 1.2 ppm.

The effectiveness of water fluoridation has been documented in scientific literature for well over 55 years. Even before the first community fluoridation program began in 1945, data from the 1930s and 1940s revealed 50-60% lower tooth decay rates in children consuming naturally occurring, optimally fluoridated water compared to children consuming fluoride-deficient water. Since that time, numerous studies have been published making fluoridation one of the most widely studied public health measures in history. Studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.

How Fluoride works.
When teeth are forming, fluoride becomes incorporated in the enamel along with calcium. Fluoride makes the tooth more resistant the acid, resulting in a greater resistance to forming cavities. After the teeth are formed, fluoride can become incorporated in the surface enamel, making the tooth more resistant to acid.

Fluoride in our office.
Fluoride is recommended as an in-office treatment for children, teens and adults who are experiencing cavity problems. In office treatment is accomplished using a gel or foam in trays, or by applying a fluoride varnish to the teeth.

A higher potency toothpaste is recommended for use at home by patients at risk of developing cavities.

For patients who have severe cavity problems, we sometimes recommend custom fluoride application at home in trays.
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Fluoride Supplements - ion level in drinking water

Current Supplementation Regimen (2002)

Age Water Fluoride Concentration (ppm)*


Less than 0.3

0.3 - 0.6

Greater than 0.6

Birth to
6 months




6 months to
3 years

0.25 mg/day**



3 years to
6 years

0.50 mg/day

0.25 mg/day


6 to at least 16 yrs

1.0 mg/day

0.50 mg/day


* 1 part per million (ppm) = 1 milligram/liter (mg/L)
** 2.2 mg sodium fluoride contains 1 mg fluoride ion.

It is suggested that only children living in non-fluoridated areas use dietary fluoride supplements between the ages of six months to 16 years. Your physician or dentist can prescribe the correct dosage for your child based on the following considerations:

  • Level of fluoride in your drinking water. If the fluoride level is not known, it should be tested first. State and local health departments can provide information on testing drinking water for fluoride levels.
  • A complete fluoride history should include all of your child’s sources of fluoride. Don’t forget all water sources, or the amount and frequency of fluoridated toothpaste used when brushing.
  • If your child is to benefit from the cavity protection that dietary fluoride supplements can provide, long-term use on a daily basis is needed.

Provided by the CDC and approved by the American Dental Association, the American Academy of Pediatrics, and the American Academy of Pediatric Dentistry.

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MI Paste (Remineralization Paste)

What does MI Paste do?
Teeth need calcium and phosphate. Healthy saliva contains these minerals, and in conjunction with certain salivary proteins MI Paste is able to enhance the delivery of bio-available calcium and phosphate to the tooth surface during the demineralization/remineralization process. Calcium and phosphate are known to help:

  • Strengthen tooth enamel – and even repair early enamel “pre–cavities”
  • Reduce sensitivity
  • Buffer plaque acid

How do I use MI Paste?
MI Paste can be applied by the hygienist at your dental hygiene appointment, or it can be applied at home in a custom tray, or to specific areas with a clean finger. Try to leave the paste on the teeth for 3 minutes. It is safe to swallow MI Paste*

*Products containing RECALDENT™ (CPP-ACP) should not be consumed by people with milk protein allergies. RECALDENT™ (CPP-ACP) is digestable by people with lactose intolerance.

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Oral Lichen Planus

Lichen Planus is a chronic disease that can appear on the skin and in the mouth in the form of lesions. Lichen Planus in the mouth, or Oral Lichen Planus, occurs in different forms and the appearance can vary at different times. The lesions may be white, slender, radiating lines or they may be red and ulcer-like. Although the visual appearance of oral lichen planus may resemble the lichen plant at times, it has no connection.

Lichen Planus affects about 2% of the population, and occurs slightly more often in women. Lichen Planus is not contagious and there is no evidence to indicate that it is hereditary disease. There is no know cure for Lichen Planus.

Patients with oral LP may be at a slightly increased risk of developing oral cancer. Because of this increased risk, it is wise to discontinue the use of alcohol and tobacco products which also increase the risk. Regular visits to the dermatologist — every six to twelve months — for an oral cancer screening is recommended.

Spicy foods, citrus juices, tomato products, caffeinated drinks like coffee and cola, and crispy foods like toast and corn chips can aggravate LP especially if there are open sores in the mouth.

There are medications to help ease the pain of more ulcerative lesions, and studies have shown that regular, professional teeth cleanings and the use of a mild toothpaste that does not contain Sodium Lauryl Sulfate can improve the condition. For severe outbreaks, corticosteroids may be prescribed.

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Periodontal Disease/Gum Disease

What is periodontal disease?
Periodontal disease is a chronic inflammatory disease that affects the gums, bone and ligaments that surround teeth. Untreated (or more accurately uncontorolled) periodontal disease will eventually result in tooth loss. Plaque, the bacterial film that develops on teeth, as well as calculus (tartar) play a roll in the disease process.

How do I know if I have periodontal disease?

Early Disease
It is often impossible to self diagnose early periodontal disease. Puffy or bleeding gums certainly provide a hint, but some people may have early disease and not signs. A dental exam that includes periodontal charting (a measurement of the gum pockets) is necessary to make an accurate diagnosis.

Advanced Disease
Signs of advanced periodontal disease include:

  • Gums that have pulled away from he teeth
  • Longer looking teeth
  • Persistent bad breath
  • Infection, or pus, between the teeth and gums
  • Loose or shifting teeth
  • A change in your bite
  • A change in the fit of partials or dentures

How is periodontal disease treated?
Treatment for periodontal disease depends on how far the disease has progressed. At the early-moderate stages, non-surgical treatment is generally sufficient to stop the progression of the disease. This treatment is also sometimes called “scaling and root-planning” or “deep cleaning”. When there are isolated deeper problems, we offer an advanced non-surgical treatment, called Perioscopy. This treatment allows our hygienist to meticulously clean deeper disease without surgery. For more advanced stages of periodontal disease, where surgical treatment may be necessary, we refer to an outstanding periodontist.

It is important to remember that periodontal disease is managed, not cured. Management involves a partnership between the patient and the dental office. We help each patient improve the effectiveness of their home care. In addition, we recommend a 3-4 month periodontal cleaning (Supportive Periodontal Therapy) interval because periodontal pockets that are 4mm or deeper cannot be reached at home.

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Perioscopy is a fairly new and advanced technique that extends our ability to provide effective non-surgical periodontal therapy. Perioscopy procedures involve the use of a miniature digital camera that allows our hygienist to view diseased areas below the gumline on a screen while they work. With the Perioscope, diseased areas that could only be treated with surgery can often be treated non-surgically.

The goal of Perioscopy treatment is to remove tartar deposits from the tooth root, below the gumline, that otherwise may go undetected. By cleaning this area exceptionally well, the gum tissue can begin to heal and become healthy again, with a regimen of brushing, flossing and regular dental hygiene visits.

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Preventive Dentistry

Preventive measures can do wonders for your dental health. A few simple homecare practices, paired with regular visits to your dental professional will go a long way toward maintaining optimal oral health.

Daily preventive "home care" activities share the common goal of removing plaque from the mouth. If allowed to build-up, plaque adheres to the teeth, tongue and soft tissue. Over time, plaque can mineralize into a hard substance called calculus (tartar). Only professional cleanings can remove calculus.

Inadequate plaque control is the primary cause of gingivitis (inflamed gums), periodontitis (bacteria gum disease), and halitosis (bad breath). Patients can minimize bacterial accumulation through regular brushing, flossing, and tongue scraping, and periodic dental hygiene appointments (dental prophylaxis).

While the above description is common for dental offices, prevention doesn't stop there in our office. We carefully assess existing wear and tear on the teeth, periodontal changes and changes that may be associated with cavity formation. If you are at risk of experiencing disease progression, we offer strategies that may prevent you from developing disease. For periodontal disease, our focus is on oral hygiene, cleaning intervals, your bite, and habits, such as smoking. For cavities, we know that if you get a cavity, more are likely to come unless we identify the cause and change it. If you grind your teeth, we can fabricate a comfortable appliance that will protect your teeth from this damaging habit. In addition, we recommend various products that can assist you in protecting your teeth

The hygiene visit is where we monitor the success of preventive recommendations as well as helping our patients maintain their smile.
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Root Canal Treatment

What is a root canal?
A root canal is a very small, thin canal that travels from the top pulp chamber to the tip of the root. All teeth have at least one root canal. Inside the pulp chamber is a layer of cells and a network of tissue fibers containing nerves, veins and arteries. This network travels down the root canal to the jawbone and supplies the pulp with blood.

What happens if the pulp becomes infected?
If bacteria attack the pulp through decay, cracks or a break, it will become infected and the bacteria will eventually destroy the pulp. When this happens toxins can escape through the root canal to the jawbone causing further infection, pain and swelling. To stop the infection and save the tooth, root canal therapy must be done.

What is root canal therapy?
Root canal therapy is a treatment that usually involves the removal of infected pulp, the soft tissue inside the tooth that contains the blood vessels, nerves and connective tissues, from the pulp chamber and root canals. Once the diseased material is removed, the tooth is sealed.

Will it hurt?
Generally root canal treatment does not hurt – it generally makes a painful situation comfortable. Stories of bad pain with root canals are generally related to teeth that have been infected for long periods and have more severe infections.

How is a root canal therapy done?
Usually local anesthesia is administered to avoid any pain that might occur during the procedure. Then the dentist will make an access opening in the tooth and remove any tooth decay in the process. Once the tooth is opened the dentist uses a series of tools to remove the infected tissue. After all the dead pulp is removed the canals are filled with a solid material to prevent future infection.

Is that all?
No. After the root canal treatment is complete, a restoration is required to seal and protect the tooth. Usually a crown is recommended.

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Tooth Decay/Cavities/Caries

How do cavities form?
Cavities or Dental Caries are caused by acid. The acid can come from food or beverages, from our stomach or from plaque. Plaque is a sticky, bacterial film that forms on our teeth. Plaque adheres to our teeth and the bacteria in plaque feeds on the sugars and starches we consume, producing acid that damages enamel. Some of us have more of the acid producing bacteria than others, leading researchers to consider people who get cavities as having a transmissible bacterial infection. See “Cavity Process” for a more detailed explanation.

What happens as a cavity gets worse?
Once the acid has eaten through the enamel of the tooth, it begins to destroy the dentin, a much softer inner layer of the teeth. Untreated, decay will reach the pulp of the tooth, the center, where the nerves and blood vessels are located. If the bacteria reaches the pulp, the tooth will most likely become infected and abscess. At this point a root canal may be necessary to save the tooth.

How do I know if I have a cavity?
Dental Caries often have no symptoms at all until the decay reaches the pulp of the tooth, and at this point a root canal may be necessary. Sometimes there will be sensitivity to extreme temperatures, or certain foods. In the dental office, we diagnose cavities in a variety of ways. X-rays and an explorer (the pick instrument) are the most traditional. Today, with high powered magnification, we can often see cavities before they appear on x-ray. We also have a high tech laser device that can detect cavities with greater accuracy in the grooves of teeth.

How are cavities treated?
To treat a cavity, first the decay must be removed. Usually local anesthetics are used to numb the area and the decay is then removed with an instrument called a bur, and suction. The area is then cleaned and filled with a restorative material such as composite (tooth colored material), gold or porcelain.

What can I do to prevent more cavities from forming?
This is probably one of the more important, and often overlooked question in dental offices. If your cavity is on a new area of a tooth, there is an imbalance in your mouth that is letting acid damage your teeth. Unless we figure out the cause and offer solutions that change the dynamic, more cavities are likely to form. Diet changes, fluoride, xylitol gum, sealants, chlorhexidene mouth rinse and remineralization agents can be used to fight the disease. See “Cavity Process” for more information.

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Tooth Wear

Tooth wear is generally caused by Bruxing – the process of grinding ones teeth. Clenching, on the other hand is caused by squeezing the teeth together at times other than when eating. Clenchers characteristically have problems with broken teeth and fillings, while bruxers wear out the surfaces of their teeth. About one in three people suffer from bruxism, which can easily be treated by a dentist.

Can bruxism cause harm?
People who brux will, over time, change the way their teeth interact. These changes can contribute to periodontal problems, they can cause headaches and they make people look older than they actually are. Unchecked, the loss of tooth structure from bruxism can leave a patient needing very expensive treatment to restore lost tooth structure.

What are the signs?
When a person Bruxes, the tips of the teeth look flat. As tooth wear progresses, the enamel is rubbed off, exposing the inside of the tooth which is called dentin. When exposed, dentin may become sensitive. As the wear progresses, teeth may begin to chip and look tattered. Bruxers may experience pain in their muscles or temporomandibular joint (TMJ). People who brux have usually been told that they were grinding their teeth in their sleep.

Clenchers may or may not experience obvious signs. Muscle development is more defined in clenchers. It is common for strong clenchers to break teeth, but it is also possible for this habit to go unnoticed.

What can be done about it?
For nocturnal bruxers, where we see tooth damage or symptoms, a plastic orhotic appliance can be made, called a bite splint or night guard, that protects the teeth from further wear and reduces the amount of muscle tension that patients develop. For daytime clenchers, therapy is primarily geared to increasing awareness of the habit and trying to stop.

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Porcelain veneers are thin shells of ceramic material, which are bonded to the front of teeth. Veneers are used in situations where there is a need or desire to change the shape, size or color of a tooth or teeth and the teeth do not need crowns. Porcelain veneers preserve more tooth structure than crowns.

What happens during the procedure?
The first step, when considering porcelain veneers or other cosmetic procedures, is to have an examination and consultation. See “Begin With The End In Mind” for a detailed explanation of the process we use to design a smile.

Once a treatment plan has been agreed upon, the teeth are prepared for veneers. Photos and impressions are taken to facilitate the fabrication of the veneers. Temporary veneers are made to protect the teeth and to simulate the final veneer shape and color.

One week after the preparations, we have our patients back to check their temporary veneers. At this visit we get feedback from our patient to pass on to the lab.

At the next appointment, the veneers are tried in. If they meet our expectations, they are bonded to the teeth.

Finally, we check the veneers one week later. This allows us to make sure that all the details are just right. We also often fabricate a night guard to protect your investment.

How should I take care of my Veneers?
Veneers that fit properly do not require special attention. Excellent oral hygiene is just as important for veneers as it is for teeth. For patients who have grinding or clenching habits, a protective night guard is often recommended.

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Why should I have X-Rays taken?
X-Rays, or radiographs, show us several conditions that could otherwise be overlooked. Cavities between the teeth and under old dental work generally cannot be detected without x-rays until the problem is quite advanced. X-rays can also detect asymptomatic infections or cysts before they become difficult to treat. Still, Dr. Chyz makes every effort to keep the number of x-rays taken to a minimum.

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What is Xylitol?
Xylitol is a NATURALLY occurring sweetener, derived mostly from berries, plums and hard wood, such as birch or beech. Xylitol tastes like sugar, has fewer calories and has been shown to reduce cavities by 80% in school age children. Xylitol can also reduce the incidence of ear infections and it is safe for diabetics. Our office is now carrying a Xylitol based chewing gum that actually helps to prevent cavities.

How does Xylitol work?
The main cavity causing bacteria in the mouth, Mutans Streptococci (MS), consume the sugars and carbohydrates we eat and secrete acid.. This acid dissolves (or demineralizes) tooth enamel – a process that will lead to a cavity if repeated too frequently. Xylitol chewing gum helps shorten the acid cycle and it also helps reduce the levels of acid forming bacteria in the mouth. Xylitol accomplishes this because the MS bacteria cannot digest Xylitol. Xylitol also inhibits attachment and transmission of the bacteria and can be delivered through chewing gum or lozenges as an effective anticaries therapeutic measure. In addition, Xylitol gum chewed by mothers during the first two years of their children’s lives led to much lower levels of caries in the children later.

How much gum will I need to chew?
Our recommendation is to chew 1-2 pieces of Xylitol chewing gum for 5 or more minutes after meals or snacks when you can’t brush.

What does Xylitol gum cost?
Spry™ Xylitol chewing gum is available in peppermint, spearmint, fresh fruit, cinnamon, and strawberry flavors. They are sold at our office for $20.00 per case. Each case contains 20 packs of gum, 10 pieces per pack. Xylitol products can also be found on the internet.

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