1025 Vey Way • The Dalles, OR 97058 • 541.296.5766 • E-mail

Dennis Alleman, DMD, PC

Ask Dr. Alleman - FAQ


















Yes, Gold can be cosmetic dentistry! Still the finest dental restoration

Gold fillings or restorations are still the standard against which all other dental materials are measured. Because of its superior biocompatible and physical properties, I'm sure it will continue to be so for many years. Gold inlays and onlays have potential to support and nurture your tooth for the long term. I knew a really nice lady who lived to be 103 and who enjoyed her gold fillings for over 60 years! I saw her for her cleanings and exams for 15 of those years and never had to fix any of her gold fillings. It's no wonder that gold is the material of choice that most dentists prefer for their own dental fillings.

Today, gold restorations are mostly used in the back teeth, and are done with a conservative technique that can allow the gold restoration to blend in and not distract from your nice white smile at all.

When it comes to strength and durability, compared to all other dental materials-it's not even close! And it even gets better-Gold restorations can be bonded or sealed to the tooth to making the gold inlay or onlay the finest dental treatment possible. It's not even close!

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Low self esteem, Lack of Confidence due to unsightly appearance?

The appearance of your teeth has a dramatic effect on both your attractiveness to others and your self-image and self- esteem. Studies have shown that a person's appearance will have a strong effect on social and career success, by influencing how you are seen by others.

While the appearance of your teeth is one of the most important contributors to facial beauty, it is often neglected when improvements to appearance are sought...I'm sure that the people at TV's Extreme Makeover series rate a great smile tops in importance when they are doing what they do.

Dental makeovers have become more common, less invasive, and more effective in correcting deformities and common dental problems. The effect of these procedures can be dramatic both in terms of rejuvenating appearance and in terms of elevating self- image and self-esteem.

Ugly teeth are no longer a matter of fate. Now you can do something about it. Comfort, Function, and Beauty are becoming a matter of priority and choice.

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Smile with Porcelain Veneers & Bio-Tips

Dr. Alleman many times uses porcelain veneers for the same purposes as
He uses for direct or indirect composite bonding (cracked or worn teeth, gaps, crooked or discolored teeth).

Porcelain veneers are very thin shells (laminates) of quality porcelain (sort of like false fingernails). After a minimum preparation (sort of like sanding), an impression of the teeth is taken and our lab technician makes the very thin and refined porcelain veneers.
I'm always amazed by the skill and artistry of the lab technician's veneer technique!
After laboratory fabrication, the veneers are bonded to the teeth.

Porcelain Veneers are the utmost in quality and refinement for the cosmetic case.
The indirect technique used in fabrication, allows exquisite control of shape, thickness and quality control. The porcelain material is the cleanest, strongest and most life like of all the bonding materials. It is also the most durable, by far.

Once they are bonded in place, Porcelain Veneers look, last, feel and function like natural teeth. They are very strong and beautiful!

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Worn down teeth? Smile with Bio-Tips

Grinding and tooth wear is a big problem for some people. You might notice that your teeth are flat, short and sensitive, even though your gums are healthy, or that you look older, bite your cheeks and have frequent headaches! What can be done about it besides wearing football-like mouth guard or having all of your teeth ground down to stumps for full coverage crowns?

A technique that I first started using fifteen years ago to temporize rehabilitation cases has now been refined with today's new bonding techniques and superior composite and
Porcelain materials.

Bio-tips are fabricated in the same manner as veneers for the front teeth, except they are made to replace only the missing top part of the back teeth. The healthy base and gum areas are not invaded.

Since many grinding and tooth wear problems start from jaw joint instability, most often we start by taking records to determine your jaw and joint systems health status. We often
Need to stabilize your bite and jaw joints so you can relax and reduce the destructive pressure in your bite. To do this we use an acrylic stabilization appliance (mago). The mago is kind of like (yes-a football mouthguard)-but it can be adjusted over a period of time until your muscles relax and your bite is stable and comfortable.

Next impressions are taken and models of your existing teeth and bite are mounted on a "jaw simulator" device. The bio-tips can then be made by me or by our lab technician in porcelain or composite material.

Once bonded, like regular veneers, Bio-Tips are very strong and lifelike. Our patients like being comfortable again and they enjoy looking and feeling younger!

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Tooth Colored and Natural Looking Crowns

A crown is a restoration which can replace the entire top (crown) of a tooth. It is necessary when damage to a tooth removes too much internal structure to be able to restore it with an ordinary filling. The restoration must be done with a technique which will strengthen and hold the tooth together, stand up to greater force, and satisfy increased cosmetic demand

Cosmetic crowns are constructed by an indirect technique which allows our lab technician to achieve much greater fit and contour of your restoration to match your existing teeth.

Different types of cosmetic crowns can be made, depending on your individual need for strength in function or for finesse in esthetics. Modern materials allow us to achieve more natural results than has ever before been possible.

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About Silver Amalgam fillings and their replacement

There is much controversy today, concerning the hazards of mercury in dental amalgam.
From my perspective, amalgam restorations have been mainstay of dental care for over two hundred years. And still have use in limited situations today. But who wants to use a restoration technique today, that is centuries old, and is not very cosmetic to boot!

Silver Amalgams are only silver for a short time after placement before they turn nearly black from corrosion in your mouth, so I call them "black" fillings. Because they have historically been cheap and easy to place, amalgams have been abused and overused from the start. It is common to see teeth that have been stained grey, and which have suffered cracks, decay and nerve death from overused amalgam filings.

Clearly, there are better modern alternatives. Dr. Alleman uses an economical tooth colored composite material which is bonded or sealed to the tooth with a high intensity light. Once completed, the tooth has a natural appearance and is actually stronger than before because of the adhesive bond that seals the tooth.

Bonded Composite Restorations appear to be a nice way to go for today's "bread and butter" restorations, when compared to the old "black" amalgam fillings!

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Sedation and Anxiety Control

We will understand if you are someone who might have some of these concerns about dental treatment: High fear, previous traumatic dental experiences, difficulty getting numb, a bad gag reflex, very sensitive teeth, complex dental needs, limited time to complete dental care

We will understand if you: Hate needles and shots, hate the noises and smells associated with dental care, or are afraid or embarrassed about your teeth.

In addition to pleasant, caring staff, comfortable surroundings, and professional know-how, Dr. Alleman can offer several levels of conscious sedation and anxiety control for your comfort and care. Depending on your needs, you may select Oral Conscious Sedation, Nitrous Oxide Sedation, or Anxiety Control to make your dental care possible.

Sedation dentistry works and is safe. For Oral Conscious Sedation, You take a small pill prior to your appointment, no intravenous tubes or needles. You will have little or no memory of the experience. You probably won't remember any sounds or smells. People who have difficulty getting numb will find that conscious sedation eliminates this problem. Sedation dentistry is a safe way to reduce the fatigue of extended dental treatment requiring long visits.

A typical visit requires that you have a companion transport and accompany you to our office. You will be drowsy. When you arrive, you will be escorted to our comfort room, covered with a thick, warm blanket, and placed on a vital signs monitor. After you are comfortable, Dr. Alleman and his experienced dental team will administer local anesthetic and take care of your dental needs. When your treatment is done, your companion will transport and accompany you home, and will stay with you for the rest of your comfortable, relaxing day.

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Bad Breath- Halitosis

While bad breath might be a symptom of an underlying systemic disorder, it is most often the symptom of inadequate oral hygiene and the resulting dental decay and periodontitis.

Periodontitis is a disease affecting the gums and bone supporting the teeth. In many cases it is caused by inadequate brushing, flossing and regular home care. As the disease infects the oral tissues, the irritated gums pull away from the teeth and form pockets of tarter, pus and bacteria, which give up a foul odor. In its advanced stages, irritated mouths can also be susceptible to sores and fungal infections, which are often painful and further contribute to decreased oral hygiene and worsening of the disease and bad breath-catch 22.

Mouthwashes and rinses are ineffective in controlling this problem. In fact, once the disease progresses to a certain point, your homecare are unable to help and you will need professional care to control it.

Patients with bad breath need a thorough dental evaluation by Dr. Alleman. If dental decay, gum disease, or infection is diagnosed, it can be treated readily. Our professional staff can also show you how you can remain disease free, so you will no longer have the embarrassment of bad breath. (oxyfresh, dental fitness program)

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Baby bottle decay- Rampant Infant Caries

Your child will erupt 20 baby teeth, starting around the age of 6 months and finishing at about 18 months. The baby teeth are very important to normal child development and will need to be healthy to guide the permanent teeth into position. Your child will need the baby teeth to be cavity free until around age 11.

Unfortunately, some children cannot be breast fed, or will not sleep without a bottle. They are at risk. Children who have erupted baby teeth, or who are past the age to be weaned, are highly susceptible to rotted baby teeth when being put to bed with a bottle containing milk, juice, or other sugar containing liquids. As the child sleeps, the reduced salivary flow concentrates the sugars into decay causing bacteria and acid which destroys the baby teeth quickly.

Rampant Infant Decay is a tragedy. Its condition and treatment is painful, traumatizing, and expensive to both the child, parents and to those who must invasively treat an infant or child. Most of the time, treatment requires sedation or hospitalization with general anesthesia. The good news is that this disease or condition is almost totally preventable!

Parents should look at their child's mouth regularly and know what healthy teeth and mouth should look like. Since your child has no motor skills, and cannot adequately clean or brush, you should do this for him or her by wiping the teeth and gums with a soft cloth daily and before bed. You must continue this until your child has adequate motor skill to do this for him/herself- probably until around age 7 or 8. Wean your child from the bottle at night as early as possible -before the first teeth erupt, if you can.

Since most children have all 20 of their baby teeth in at about 18 months of age, bring your child in to see Dr. Alleman and his nice helpers at about 18 months old, or earlier if you see any brown spots or anything unusual.

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Preventing Cavities with Sealants, Flossing and Topical Fluoride

Fluoride has been a great benefit to patients of all ages in preventing tooth decay- especially on the smooth surfaces of the teeth. Flossing has also been shown to reduce the number of cavities interproximally or between the teeth. But today we are finding that the most decay-prone areas of the teeth are the grooves and depressions on the chewing surfaces on the tops of the teeth. We are seeing an increased number of "cave-ins" from decay progressing down the grooves to attack the inside of the tooth. This pattern of decay has become more common, because fluorides have strengthened the outsides of most teeth today.

To protect the teeth, the grooves are cleaned and are then sealed with a plastic like coating called a sealant. The process is painless, effective and easy to do.

Studies have shown that Sealants, Topical Fluoride Applications and Flossing can reduce tooth decay by 90 to 100 per cent!

The American Dental Association recommends, and Dr. Alleman agrees, that Sealants be placed as soon as the first permanent back teeth come in at around age 6. Sealants should continue to be placed on each permanent back tooth as it comes into the mouth. All back teeth that need to be sealed should be present by age 13.

Modern dental Sealants are probably one of the most cost effective and successful health factors available today, and are a major part of all decay prevention care.

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Uses and Types of Mouthguards

While mouthguards are not mandatory equipment in all sports, their worth is indisputable. Athletes often have to live with the disfigurement of an early sports injury for the rest of their lives. Mouthguards cushion blows to the face and neck, and should be a part of every athlete's gear, no matter what the sport! Even adults or weekend athletes need to protect their smile and preserve their health.

We feel that its smart to wear a mouthguard, and that you should wear one at all times when playing sports. Wear a mouthguard custom fitted by your dentist, especially if you wear bridges or braces.

Don't wear removable appliances like retainers when playing sports.

There are two types of mouthguards: Custom Made: designed by a dentist and made on a model of your teeth. These cause little interference with speaking or breathing. They provide the best protection and fit over braces and fixed bridges. They also cost more.
Ready-Made: Purchased at most sporting goods stores. They are the least expensive, least effective, and least comfortable.

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What is a Dental Crown?

Teeth are often restored with fillings of amalgam or composite plastics. These materials can often accomplish the aim of replacing the part of the tooth that has been lost in a strong and good looking manner.

There comes a point; however when the damage to the tooth has removed too much tooth structure to hold a filling or the tooth is cracked and is in danger. The restoration must be done with a technique that will attach to the remaining tooth, stand up under heavier use and meet more elaborate cosmetic requirements.

A crown is the restoration that can strengthen and replace the entire top of the tooth. A crown can also be a part of the attachment of a fixed bridge for the replacement of several teeth. The tooth is strengthened because it is covered from the outside with a casting made of metal or ceramic that will wraparound and hold the tooth together.

The chewing of the tooth will be improved because it can be shaped to match more efficiently with the opposing and adjacent teeth. A crown can improve cosmetics by the use of modern ceramic materials that produce color and translucency that is more natural than has ever been possible before.

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Why get a Dental Crown?

The crown serves two important functions. Firstly, it restores the function and appearance of your tooth and face. Teeth support the muscles and tissues of our face, so anything less than a full tooth will affect our appearance and will age the way we look.

Secondly, a crown will be the same size and shape as our natural tooth and will keep the teeth from drifting or shifting and breaking from the resulting unnatural overload force generated from untreated teeth.

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What Are Crowns Made Of?

Dental crowns are most often made of gold alloy or porcelain. Crowns can also be made of stainless steel or of nickel-chrome containing non precious metal, but, stainless or nonprecious metal crowns are not considered quality modern restorations, today.

Gold alloy crowns are the quality standard, and have been the premium in terms of longevity and value for centuries. Today's modern gold alloys are better than ever, and can replace a missing tooth and support surrounding teeth longer and better that any material that exists. Unfortunately, it is yellow in color and some people want white teeth!

Porcelain crowns are made for the esthetic areas of our mouths. This can range from the front teeth only, to the entire mouth, depending on the individuals desire for looks, and for the risks one is willing to take in function. With that said, Modern porcelain crowns are beautiful and better than they have ever been. Porcelain crowns can be made of all porcelain and bonded to the natural tooth for the ultimate in cosmetics (good for front teeth), or they can be strengthened with porcelain fused to metal cores (good for back teeth). Despite the advances in porcelain technology, porcelain still has some significant realities. That is: porcelain is brittle and it can break under function, it also roughens after time in use, and can wear the opposing teeth enough to create problems as time goes on.

Ultimately, the choice is yours, and we will do our best to help you with the decision that is right for you.

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Dental Crown Care

People who have dental crowns have been given a blessed gift of restoration for their teeth and overall health. However, Crowns are not natural teeth and require special home care, with attention to regular brushing and flossing and frequent dental checkups.

While the crown protects the crown of the tooth, the margin- or the place where the metal or porcelain meets the natural part of the tooth is usually near or below the gumline and is vulnerable to leakage, bacterial infection and decay underneath the crown!

Xrays of natural teeth can reveal problems relatively easily, but not so well with a crowned tooth or teeth. Often decay underneath a crown is not detectable until it is too late, as decay has gotten underneath the crown and destroyed the tooth.

The best advice that I can give is this: Dental crowns and bridges don't last forever!
Make them last longer by exceptional home care habits and frequent dental checkups.
Limit noxious oral habits if you can. Don't fall in love with your existing crown and bridge work! If you spot something wrong, get it fixed now. It may seem expensive but, it will be a great value in the long run!

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How Many Implants Should Be Placed?

A good rule of thumb is that one implant should be placed for each tooth to be replaced. A wobbly removable denture can be snugly stabilized with two to four implants.

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What's The Best Treatment Now Days?

Root canal/post and core buildup/crown: -- This is the traditional way to restore a badly broken down tooth that still had a solid root. Drawback is its relatively high failure rate due to leakage, recurrent decay and root fracture. Usually takes 2-3 visits.
Cost: least, Value: lowest $800/200/800= 1800

Extraction/ 3 unit fixed bridge: -- This is the traditional way to restore a space replacing an extracted tooth. Drawback is that two natural and healthy teeth have to be cut down to fit as abutments for a three unit fixed bridge. Drawback is that cleaning is a problem since three teeth are essentially joined together and puffy gums and bad breath are common. Drawback is that natural contours of the gums are often compromised leading to increased gum disease and discomfort. Usually takes 2-3 visits.
Cost: medium, Value:medium 200/800/800/800= 2600

Extraction/implant/abutment/ crown -- This is still a mystery to most people- and to most dentists as well, but in reality, it is fairly simple, represents a much better treatment than the previous two options, and should be considered the first and best method to restore a badly broken down tooth. Procedure is very predictable, durable and non invasive. Adjacent teeth are not touched. Cleaning is easy and contours of the gums are controllable. Drawback is 2-4 months healing time for osseointegration of the implant. Usually takes 2-4 visits.
Cost: medium, Value: high 200/1000/600/800= 2600

Consider this -Once the implant is stable and the abutment is placed, you essentially have a strong new tooth that will not decay. It can be treated just like a natural tooth. It is not a potentially weak tooth as in option 1 and it is not a false tooth as in option 2. It can be treated like a real tooth in almost every way.

Consider this -Implant care consists of two phases, the Surgical Phase and the Restorative phase. Most general dentists only do the restorative phase. Dr Alleman has the expertise to do both phases for your convenience.

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Information to come

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Tips About Removable Partial Dentures

Removable Partial Dentures (RPD) are attached to your natural teeth with metal clasps or by devices called precision attachments. The natural teeth need to be prepared to accept the clasps which will retain the RPD. Sometimes the natural teeth have sufficient shape to work, but, most of the time crowns are needed to provide strength and shape to fit the clasp or precision attachment an provide better retention, fit and stability for the RPD.

Your new partial may take a little getting used to, at first, but after a little while it just becomes a part of you.

Dr. Alleman's helpers will give you instructions for cleaning and care of your new partial, but, in general, clean it regularly after eating, keep it in its container when it's out of your mouth, and let your tissues rest by taking the RPD out at night or sometime during the day.

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Tips About Complete Dentures

For a little while, your new dentures might feel strange until you get used to them. Remember, that each denture is an individual and custom made work of art, and that it is normal for them to feel different from what you had before. They might feel loose or a little sore at first until your muscles and tissues retrain to their new fit.

Wear them carefully at first and then, we will see you within 24 to 48 hours after delivery to relieve any sharp areas or sore spots.

You might think that you are done with the dentist now that you have your new teeth, but we have found that regular checkups are just as important now, and that dentures and oral tissues need to be checked and possibly relined or repaired due to normal wear over time and normal shrinkage of your gums and bones.

Today's dentures have been significantly improved through advances in both dental and technologies. As a result, dentures that fit properly usually do not require denture adhesive to stay in, except maybe at the very first if you feel insecure. But, insufficient bone and gum structure, worn or loose dentures, or dry mouth decrease the stability of a denture and you may find adhesive helpful. ( Sea Bond is a good one).

Many people who are not able to successfully wear a stable denture today, are amazed and delighted that dental implants have allowed them to be comfortable and stable again! Titanium implants are placed in the remaining bone and retain the denture with small precision attachments. Testimonials report that the implant retained dentures feel very good and allow much improved stability and chewing ability.

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Good Oral Hygiene with Dentures

Your denture needs to be cleaned each day just as you would clean your natural teeth. When cleaning your dentures, first make sure you are in a safe place like over the sink full of water- if you drop them they will break! Then rinse them and your tooth brush and scrub them gently with denture toothpaste.

In addition to taking care of the dentures, taking care of the rest of your mouth is essential when you wear dentures. This includes brushing your gums, tongue and palate every time you brush your dentures and before you wear them first thing in the morning.

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Dry Mouth-Xerostomia

Dry mouth is common-and it is a problem. The lack of adequate saliva affects many people. When the natural flow or consistency of saliva is changed, you can experience trouble swallowing, oral pain from dry tissues, fungal and yeast infections, and rampant and sudden tooth decay, as saliva's diluting and cleansing flow decreases and acidifies. The tongue can stick, food doesn't have much taste, and digestion suffers.

Xerostomia, or dry mouth syndrome, can come with aging or is a common side effect of many medications. Let us know if you take lots of medications or if you are about to a new treatment regimen or chemotherapy. We can combat the extreme effects and provide relief with prescriptions for dry-mouth toothpaste (Biotene), saliva substitute solutions, saliva producing chewing gum(Xylitol) and suggest sugarless hard candies to suck on.

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Endodontic Disease Symptoms

Endodontic disease can manifest itself in a wide variety and combination of symptoms. Some of these include:

  • Lingering sensitivity to cold fluids
  • Lingering sensitivity to hot fluids
  • Sensitivity to sweets
  • Pain to biting pressure
  • Spontaneous toothache
  • Constant, dull ache
  • Loose tooth
  • Swelling or fever
  • Pain when rising or laying down

If you have some of these symptoms, it might be wise to visit us, because you might have endodontic or root canal disease or other dental problems. Some of the symptoms can also be caused by decay, defective fillings, gum disease, cracked teeth, or other tooth or bite related problem. Sometimes the symptoms occur from disorders that are not related to the teeth.

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Brushing and Flossing

We brush and floss to prevent plaque buildup on the vulnerable parts of our teeth and gums. Plaque is the soft sticky layer of bacteria and waste products that constantly forms on our teeth and supporting structures. Usually it is invisible to the naked eye, but when a person is not brushing and flossing adequately, it can build up to where it appears to be a thick whitish coating on the teeth at the gumline. If not removed, it can lead to decay and gum disease.

If plaque is left on a tooth surface for 24hours or more, it can mature into a rough hard calcified formation known as calculus or tartar. Think of tartar as a kind of coral reef forming on your teeth. This "coral reef" contains billions of toxic bacteria which secrete concentrated waste products that cause decay, destroy the surrounding bone, and advances underneath your gums to cause gum disease and eventual tooth loss. The destructive process happens slowly, so you might not notice problems until its too late.

Tartar cannot be removed by your regular home care. Once it is formed you are defenseless. You either must receive professional cleaning or professional treatment-or resign yourself to gum disease and tooth loss!

Many people think that they are destined to have tooth problems. Many think that "soft teeth" runs in their families, or that since their relatives had to have dentures that they will have to as well, or that having babies causes women to lose teeth. The good news is that most of these traditional beliefs are in fact myths. THE FACTS ARE that dental disease is almost totally preventable and unnecessary, and that no one needs to suffer or lose their teeth from it.

It is clear and simple that if plaque can be controlled, by merely disrupting or removing the plaque matrix from every tooth surface at least once every 24 hours, dental tartar and disease cannot occur. (of course, we can damage our teeth other ways though)

The sad news is that few of us really know or have been trained to brush and floss efficiently enough to control plaque adequately in our daily routines. And in the world of health, dental disease control, and effective home care, what you don't know can seriously hurt you!

You can learn by having your hygienist help you at your regular checkup or care appointment. You can also learn and practice at home through the use of disclosing tablets, a well lighted mirror, and "elbow grease". Each member of your family must practice until he/she has the personal skill to effectively clean their teeth each day.

Disclosing tablets or solutions are colored dyes that can be bought at the local drugstore over the counter. They stain plaque and dirty surfaces with a removable color, so you can see where you missed. Use this technique :

  1. Brush and floss as best that you can
  2. Chew up one or two tablets, and then carefully look and remember where you missed.
  3. Brush and floss again.
  4. Chew up one or two more tablets and then reevaluate again.
  5. Brush and rinse again and enjoy that really clean feeling!

Do this every day for the first week and continue until you learn what you personally need to do to be personally healthy. After that, clean and disclose regularly enough to check up on yourself. It's a cool thing to do!

Remember, moms or dads are responsible for brushing infants and young children's teeth (they just don't have the manual control yet.) But its still OK for the kids to try to brush early on.

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Why Replace a Missing Tooth

Many people are not aware that missing even one tooth can be a serious problem and can leads to more serious problems. They assume that since they can still eat that they're OK.

But very often, just the losing of one tooth can lead to the loss of support, and other teeth begin to drift into the vacant space, causing a change in bite. It also forces the remaining teeth and nearby muscles and joints to carry an additional load, sometimes beyond their ability to adapt. The resulting "cave in" or domino like breakdown can result in more broken or lost teeth, muscle imbalance and spasm or head and neck joint problems. Since the damage can occur slowly, you might not become aware of it until it's too late.

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Your Child's First Dental Visit

"First visit by First birthday" sums it up. Your child should visit the dentist when the first teeth come in. Usually the baby teeth come in between 6 months and are finished with 10 upper teeth and10 lowers at around 18 months. We like to see infants by 12 months to see if they are developing well and have no cavities.

We look for 20, white, baby teeth arranged in two little "horseshoes".

You can bring your child in earlier if you have questions or notice anything unusual.

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Pregnancy and Gum Disease

Many mothers have experienced gum disease, dental pain, or tooth extraction during or shortly after their pregnancy. This is often seen as being a normal side effect of pregnancy. But the fact is that although common, this is dental disease. It is an infection, and it is not normal for anyone. Furthermore it is preventable and treatable.

There are three basic events which happen during pregnancy which can make an expectant mother more susceptible to gum disease and other dental problems as well.

Firstly, hormonal changes may make the gums tender or puffy, harder to clean, and less able to fight off infection and inflammation.

Secondly, pregnant women tent to eat smaller, more frequent meals, exposing their teeth and gums to more sugars and acids more often.

Thirdly, Fatigue, craving for junk foods etc. may lead to malnourishment and inadequate oral hygiene.

We recommend that pregnant women schedule a thorough dental checkup, cleaning and personal oral hygiene instruction early in their pregnancy.

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Infant Decay Prevention

Infant decay, or baby bottle cavities is common and disabling in children who are allowed to sleep with a bottle or breast in their mouth.

Taking your baby off the breast when he/she falls asleep can help prevent baby tooth decay. Hold your baby while bottle feeding. Always take a bottle that is filled with milk or juice away from a sleeping child.

If your child requires a bottle at bedtime, provide one filled with water. Instead of a bottle, try to comfort your child with a pacifier or favorite toy or blanket.

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Infant Thumb Sucking

Thumb sucking is perfectly normal for infants. Most usually stop by the age of two. But prolonged thumbsucking or other oral habits, beyond the age of 6 or 7 can lead to crowded, crooked teeth and bite or breathing problems and should be addressed.

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Infant Runny Nose and Breathing Problems

Many people (including some pediatricians) feel that frequent colds and runny noses are normal for most children. But nothing could be further from the truth!

These are often the signs of allergies, nasal obstructions, or of tonsils and adenoids that are blocking the child's airway and cause a constant struggle for breath and life that you or your child may not notice.

Left undetected or untreated, an obstructed airway can prevent your child from developing normally.

Early detection and treatment can free your child from struggling for each breath and can provide an unobstructed airway which is essential for developmental blossoming and normal development of both face and body.

Since 80% of cranial growth is complete by age 8, it is crucial that airway obstruction be detected and treated very early. Often as early as age 2 or three.

Studies have shown that abnormal development and growth has been corrected to normal, simply by early intervention and treatment.

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Universal precautions, non latex, state of the art sterilization and monitoring, digital x-rays, separate water system, magnification...

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There Has To Be A Better Way

Dr Alleman is a general dentist who has had training in both conventional orthodontics and in functional jaw orthopedics. We believe that early diagnosis and guidance of growth and development can prevent or simplify treatment traditionally started later on.

After years of study and observation, Dr Alleman has seen the benefits of early orthopedic guidance of facial growth allowing unobstructed and free development of strong, beautiful, and healthy faces.

Dr Alleman has noticed that faces and smiles treated later on (after the permanent teeth are in), and primarily with braces, seemed to be harder to treat and had to wear braces for longer times. This was especially so when the teeth were crowded.

The traditional orthodontic treatment for crowded teeth has been to extract premolar teeth and then to retract the front teeth back into the extraction spaces. This is not only hard to do, but results in finished cases that relapse easily, and leave the patient with a "dished in" look due to the accentuated prominence of the nose and chin, as the teeth, lips and cheeks are retracted to fill in the premolar extraction sites.

Patients treated this way tend to look older than they should, and since the resulting bite is stress containing, many suffer complications with headaches and facial pain.

Dr. Alleman noticed that the traditional orthodontics he was trained with seemed to straighten the teeth but failed to improve the face!

Think about this-- Dr Alleman doesn't want you or your family members to look old or to have headaches or relapse. There had to be a better way. And there is!

Treat the full face, not just the teeth-and start early. Functional Jaw orthopedics recognizes that early evaluation and guidance of the face and jaw development is usually easier to treat and results in the patient having to wear braces for shorter times if at all.

Functional Jaw Orthopedics encourages early detection and correction of airway and breathing problems in the infant. Then uses simple oral functional appliances to expand the patient's jaws and to improve airway and errant lip and tongue habits as needed. Once started, the patients seem to blossom outward to develop full and youthful faces. Since the expansion is forward and not retracted, they can breathe easier and have less bite strain with fewer headaches and complications. Often, that's all there is to it and the patient doesn't need the traditional braces or extractions. If necessary however, back teeth are extracted instead of premolars, and braces are only worn for a short time to align the teeth and finish the case.

Functional Jaw Orthopedics: a combination of multidisciplinary early orthopedic care, guidance of growth and development through the primary and mixed dentition and finishing with "braces" in the early adult dentition, is the better way for beautiful, lasting smiles.

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How Does Orthodontic Care Work?

The best time to start orthodontic treatment is as early as possible. Your child will be evaluated for normal development at the first infant visit. Every child is different, but if problems are noted, orthodontic treatment could begin with a visit to your pediatrician or ENT physician for evaluation of allergies and airway issues.

If your child requires treatment, early intervention is best and can make a real difference. We see the best results with treatments that would be impossible once your child's face and jaw have fully developed.

It is important to note that about 80% of a child's facial development is complete by about age 8, and that there is a huge difference in the ease and effectiveness of orthopedic treatment in an 8 year old compared with a 12 year old.

Also, when started earlier, completion of treatment at a later age is much easier.

Usually during an initial examination, we will evaluate your child's facial growth, spacing between teeth, crowding, extra or missing teeth, bite and breathing. We will look for habits like tongue-thrusting or finger-sucking that can hinder growth and development. These problems can change tooth alignment as well as alter facial appearance.

Orthodontic treatment can bring your child's teeth, lips, and face into harmony. And we all know that a pleasing appearance and a beautiful smile give children-and adults-a big advantage in life!

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What Causes Orthodontic Problems?

Some orthodontic problems are inherited, such as tooth size and jaw size which may lead to crowding or spacing of teeth. Overbites, underbites, extra or missing teeth, and irregularities of the face and jaws also can be inherited.

But most orthodontic problems stem from small occurrences that begin early in life and then develop into major deformities as the child grows.

Other orthodontic problems can be caused from accidents, dental decay which can lead to the premature loss of teeth and growth space. A number of childhood habits can lead to orthodontic problems, such as sucking on a thumb, finger, pacifier or lip.

Mouth breathing, swallowing difficulty and tongue-thrust, Teeth grinding, forward head posture, and runny nose are evidence of your child's struggle to breath and live. Most often these are symptoms of enlarged tonsils and adenoids brought on by allergies.

It is critical to realize that we have a small window of time to detect and treat developing abnormalities in a growing child. Usually from infancy until about age 8. After that, we are usually dealing with an established facial deformity that is not impossible, but is much harder to treat. There is a huge difference in time of treatment and satisfaction in results between an 8 year old and a 12 year old.

It is also true that early detection and start of treatment should be done as soon as possible in life, if needed. A small nudge in the right direction, at the right time, can guide your developing child's facial growth in the right direction. Using the body's natural program for development and growth, your child's facial development will right itself and follow the correct pathway for optimum health. Often, the small nudge early, is all that is needed and extensive and expensive treatment may not have to be done later.

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What About Adult Orthodontic Care?

It's never too late for Orthodontic Care! Adult care is a great benefit for those who could benefit from better stability in their bite or who are contemplating major dental work, or who just want to look better.

The major difference between orthopedics and adult orthodontics is that usually most growth and development has slowed at about age twenty, and has stopped at around age thirty. So we can't use the body's growth to establish our dental and facial improvement. We have to actually move the teeth through mature bone, and this is slower, requires all the hardware (braces, wires etc.), and requires long term retainer use to control relapse, which is a constant force after adult orthodontic care. But, wearing a retainer is easy and is a small price to pay for your better health and smile!

Invisiline For those who don't want to endure the "braces" look or who don't want to put up with the discomfort of sharp and bulky orthodontic braces, Invisiline is an attractive alternative...and it works!! Unfortunately it doesn't work for some cases.

But if you have a case that is mainly crowded and not skeletally misaligned, Invisilign technology is quick and easy and largely invisible during treatment.

Invisilign is a technology whereby models are taken of your existing teeth. From these models computer imaging is done and a pathway is designed to correct your malocclusion. From the computer imaging, clear plastic "retainers" are made to gradually move your teeth into their ideal position. Sometimes as many as 12 or 13 appliances are made 13 and changed every 3 to four weeks or so. So all you have to do is change your appliances when your dentist tells you to until your teeth are straight. Then usually you can use the last appliance as a retainer to keep them straight.

The down side to Invisilign is that all the appliances have to be made at the start of the case, and that requires a large expense to the dental laboratory. So there is a large up front cost necessary. The lab usually charges their cost and profit up front, or about $2850, for a $ 5000 case.

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Silent and Deadly Periodontal Gum Disease

Periodontal disease can go on for years without pain and without detection unless specific examination techniques are performed.

Visual oral examination by itself, (even by a dentist), will not reliably detect periodontal disease until it has reached an advanced stage.

Early detection and adequate diagnosis require measurement of pockets (the crevice between the tooth and gum) with a periodontal probe.

Early detection and treatment is critical to prevent tooth loss and disfigurement, because the damage done as the disease progresses is irreversible.

Although the procedures to prevent gum disease are simple and painless in the beginning, millions of Americans have never had it done.

Treatment of periodontal disease in its later stages is a very different and serious matter.

Some signs of periodontal disease are: bleeding gums, redness, swollen and tender gums, bad breath and loose, painful teeth.

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Joint Replacement or Heart Infections Linked to Severe Gum Disease

Periodontal Disease is a commonly occurring oral infection of the adult population. (80% of adults are infected). This infection slowly progresses over our lifetime and is often manifested in its advanced stages in the senior population.

Because of the lack of discomfort in many cases, many adults are unaware that they have this disease until they visit their dentist. However the bacteria from this bone destroying disease has been shown to be readily spread throughout our body's vascular system and can cause infections in susceptible hearts and around artificial joints.

Your regular checkup, cleaning and periodontal treatment for a clean and healthy mouth is not only good insurance but is also important life insurance!

The American Heart Association recommends that some cardiac patients and joint replacement patients maintain immaculate oral health and receive antibioitic prophylaxis prior to most dental care procedures.

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Complications in the Mouth Related to Cancer Treatment

Many people who have to undergo cancer treatment develop complications in the mouth ranging from sores and dry mouth to rampant decay and bone deterioration. These can be serious, painful and difficult to treat.

While much of this is unavoidable, the destruction can be minimized. Dr. Alleman recommends that a pre-therapy dental evaluation with a full set of dental x-rays be performed. Any decay, gum disease and abscesses should be treated prior to chemo or radiation therapy.

Even patients who have no pain or dental disorders need a thorough cleaning. Our goal is to have a patient's mouth in optimum health prior to beginning and during anti-cancer therapy.

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Your Senior Smile and Dental Health

Many senior citizens are surprised and dismayed by a sudden and often devastating attack of dental disease. They are unaware that senior citizens are vulnerable to an increase in dental disease as a result of the normal aging process and often as a side effect of medications that they take.

Reduced, salivary flow and an increase in daily medications, coupled with declining visual and motor skills can affect oral health dramatically. It is not uncommon to suddenly find sudden and serious dental problems cropping up seemingly overnight in someone who has been trouble free for many years.

Dr. Alleman has noticed that teeth will darken with age because of long term exposure to plaque and with changes to the dentin inside the teeth. The gums may recede and uncover the roots. Exposed roots will be darker than the enamel part of the tooth and are prone to decay. Fillings can decay and darken too, as they weaken over time.

Dry mouth or Xerostomia, is a serious and all too common condition among seniors. Saliva is a lifesaving lubricant to wash away plaque and its associated bacteria and tooth destroying acids. It is essential to effective digestion and well being! Flow of saliva can be reduced by a medical disorder, or be a side effect of antihistamines, decongestants, pain killers or diuretics.

The build up of plaque will accelerate tooth decay. There will also be more gum infection which will cause a loss of bone support for the teeth. Poorly fitting or poorly cleaned dentures, illness and fatigue can compound senior's dental problems.

The bottom line seems to be that as time goes by, seniors need to become more diligent with their health care and get to know their health care providers better. As always, more frequent visits to your dentist and caring staff will keep you healthier and more trouble free.

These days your dentist may recommend better and more effective home care methods. He may evaluate dry mouth or sores in your mouth and might recommend artificial saliva solutions or other calmative options. He may help you prevent root decay with the help of custom trays and fluoride to wear at night to reduce your vulnerability. And he might also introduce you to cosmetic bleaching or a denture facelift to improve your looks and vitality and make you feel better.

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The Impact of Lost Teeth on Total Dental Health

In the past, the loss of teeth (edentualism) was dismissed as a natural part of the aging process, and dentures were considered a natural part of old age.

While such ignorance is rapidly becoming a thing of the past, there is still a not a general awareness of the seriousness of edentualism.

Multiple tooth loss is most commonly caused by Periodontal (gum) Disease and bone loss. Research and clinical experience has shown, in addition, that there is a high correlation between the presence of Periodontal Disease and with the incidence of chronic debilitating diseases such as, Diabetes, Cardiovascular Disease, and Arthritis.

So it's not very surprising that studies now show that a shortened life expectancy by as much as ten years for people who have lost their natural teeth, compared to those who have not.

In addition to longevity, quality of life differences are just as significant. The functional efficiency of dentures has been measured to be only 20% of that of natural teeth. Loss of natural teeth often causes a feeling of loss of wholeness, a sense of deterioration and aging.

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More Facts about Sedation Dentistry

Sedation Dentistry really works! You can sleep through your dental appointment.

It is safe! You take a small pill prior to treatment, no intravenous tubes or needles.

You will have little or no memory of the experience. You probably won't remember any sounds or smells.

You will sleep for up to four hours after taking the pill. The time you sleep will vary depending on your treatment.

Complex dental treatments that often require many dental appointments can usually be done in as little as one!

People who have difficulty getting numb will find that sedation dentistry eliminates this problem.

Sedation dentistry is also a great way to eliminate the fatigue associated with extended dental visits requiring long appointments.

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Seniors and Burning Mouth Syndrome

Burning mouth can occur in anyone, but is usually found in people over 50. There are several reasons why it occurs.

Denture Problems: A new denture, an old denture, or one that doesn't fit well, can irritate your entire mouth.

Reduced Salivary Gland Function: invites dry mouth, difficulty eating or swallowing, oral discomfort, loss of or change of taste, or a burning sensation. Saliva substitutes or rinses can be prescribed or recommended to provide relief.

Medications: Most of the medications prescribed for seniors have xerostomia (dry mouth) listed as a significant side effect. Dry mouth is a serious problem that your physician may not be familiar with, so ask about it so your medication can be adjusted.

Vitamin Deficiency: There is evidence linking burning mouth and angular chelitis with nutrition and Vitamin B Deficiency.

Candida Infections: This is a common oral fungus that sometimes comes on when we are feeling badly, or are taking medications, especially antibiotics. They are usually whitish and many types are painful. Topical anti-fungal agents can be prescribed to help with this.

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Loud Snoring, Sleep Apnea, and Restless Leg Syndrome

Snoring is caused by restriction of airflow due to relaxed oral and pharyngeal tissues as we try to sleep. Snoring is often thought to be merely an annoyance to those around us, but we now know that oxygen and regenerative sleep is critical to healthy well being. The constant struggle to breath and the reduction of oxygen each night (hupoxnia) robs us of a good part of our vitality and quality of life.

Obstructive Sleep Apnea (OSA) is breathing cessation caused by blockage of soft tissues of the airway. Breathing cessation or apnea can last from several seconds to nearly minute. When breathing stops, the brain senses a buildup of carbon dioxide and wakes you up to breath- but not always! This can be lethal in many ways!

Restless Leg Syndrome (RLS) is related to the struggle to rest, as buildups of neural and muscular irritants such as lactic acid and carbon dioxide, build up during unsuccessful sleep. This can be very uncomfortable and can even be violent as one fights to find a restful sleeping position.

In the morning, the nightly buildup of carbon dioxide in the blood causes headaches. The lack of deep sleep can leave one drowsy and usually grouchy, during the day.

It's not my intent to use a scare tactic here, but chronic sleep deprivation and obstructive sleep apnea probably affects everyone over fifty years of age and it can take your life slowly or suddenly.

Some of the ways are:
Disruption of family well being, chronic hypoxia, high blood pressure, frank strangulation, heart attack or atrial fibrillation or highway/industrial or some other type of accident due to fatigue.

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What Can Be Done About It?

Firstly and frankly, listen to your spouse and seek help when needed!

We are fortunate here in The Dalles to have two sleep specialist physicians and a first class sleep studies laboratory in the Mid Columbia Medical Center who can evaluate your condition and can treat or recommend treatment.

Our local sleep studies lab has a first rate "hotel" where a polysomnogram or evaluation of your sleep and its quality can be done during a comfortable overnight stay. In my opinion, everyone over fifty should do this! The results are enlightening and life changing!

Treatment is recommended depending on the findings. In the past, many surgical corrections were tried, but with limited success and a lot of pain. In my opinion, the high failure rate was due to the changing nature of our soft tissues, making this a dynamic condition and requiring frequent readjustment of our airway and breathing efficiency.

Today, for many cases non-surgical treatment is preferred. The "gold standard" for OSA treatment is CPAP or Continuous Positive Air Pressure. CPAP is a little machine that is triturated or adjusted at the sleep lab, As you sleep, the air pressure is adjusted by the technician until you reach a comfortable and healthy air flow. The next day you take it home. CPAP may take a little getting used to at first, and I've heard some complaining about it being uncomfortable or inconvenient, but my thought is- Get over it, How much is your life worth??

The second way to treat Snoring or Mild Sleep Apnea is to open the airway just as you would for emergency resuscitation-move the lower jaw forward.

For those who can't take the restrictiveness of CPAP, or who want more mobility, a Dental Oral Appliance is a good thing. You can easily take it on trips or camping, or similar outings!

I have tried and evaluated many oral sleep appliances and believe that I have found the best appliance available today. It is easy to make and deliver. It is custom fitted to your teeth and is adjustable so that you can move your lower jaw to a comfortable forward position as you wish.

Many spouses will act as testimony that the Oral Appliance works. They call thank us!

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What's Your Snore Score?

Using the following scale, answer the questions by circling the number that most appropriately describes your situation, 1-never, 2-very infrequently, 3- occasionally, 4- often, 5- almost always

  1. How often have you been told you snore?
  2. Does your snoring disturb your bedpartner?
  3. Does your snoring disturb others in the next room?
  4. Has your snoring become progressively worse?
  5. Do you snore when you sleep on your back?
  6. Do you snore when you sleep in all positions?
  7. Have you been told that you stop breathing for long periods between snores?
  8. Has your snoring ever caused you to wake up suddenly?
  9. Does your bedroom partner leave the room to sleep elsewhere because of your snoring?
  10. Has your snoring caused you social embarrassment on vacations? At conferences? In motels?

Score 3 or more on questions 1 thru 4: Your snoring interferes with your personal life.
Score 3 or more on questions 4, 7, and 8: Likelihood that you experience periods of sleep apnea. You should contact a physician.
Score 3 or more on question 5: You may be a positional snorer. Remedies that encourage you to sleep on your side or tummy might work.
Score 4 or more on question 6: Likelihood of airway obstruction. You should see a physician for evaluation of your upper airway.
Score 3 or more on all questions in this survey: Indicates that sleep apnea is very likely. You should see a physician and spend a night in a sleep disorders center.

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Treatment of TMJ Disorders

Proper diagnosis is crucial to make sure you receive appropriate treatment for your condition. Treatment should only be recommended after conducting a thorough Health History, Dental and Functional (Occlusal) Exam, Appropriate X-rays and Imaging and perhaps confirming complex cases with models or other diagnostic tests.

Treatment may be simple or may require more complex or multidisciplinary care, depending on the severity of the condition. Some of these treatments include:

  • Taking a non-aspirin pain reliever or prescription medications such as muscle relaxants, or anti-inflammatory, sedative agents
  • Eating soft foods and avoiding chewing gum
  • Physical therapy, including moist heat or ice
  • Relaxation or Bio-feedback techniques to control muscle tension
  • Stress management training
  • Posture training
  • Wearing a bite stabilization appliance (MAGO) to eliminate the harmful effects of grinding and clenching while stabilizing and distressing the jaw joints and muscles
  • Adjusting the bite, known as "occlusal equilibration", involving removing interferences when the teeth touch
  • Replacement of defective restorations that prevent the jaws from meeting properly
  • Orthodontics or braces to properly align teeth and jaws
  • Surgery

In most cases, symptoms related to TMJ disorders can be successfully treated to reduce or eliminate your discomfort. Postponement of treatment usually results in more damage to the joints, muscles or teeth and prolonged, unnecessary suffering.

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Headaches and TMJ Disorders

One out of every 10 Americans suffers from chronic headaches, and they spend over half a billion dollars every year for over the counter medications to relieve their pain. They never realize that their headaches may be caused by TMJ, and that their pain is the result of a bad bite, which can put your jaw to skull relationship out of alignment.

When this happens, TMJ symptoms can appear. This cluster of symptoms may include: headaches, earaches, ringing of ears, loud jaw clicking or grinding, lockjaw, and stiffness or pain in the jaw, neck, or back. This cluster has puzzled doctors in the past, but now we know it as TMJ or TMD.

According to recent studies, 40 million Americans suffer with TMJ (Temporomandibular Joint Dysfunction) or MPD (Myofacial Pain Disfunction). The good news is that we are taking the lead in finding solutions

If you, or someone you love, is suffering from symptoms similar to what has been described, you may find that TMJ care is the missing piece in that puzzle and that the treatments work!

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Choosing tooth whitening for your smile

Tooth whitening or "bleaching" is safe, fun way to make your smile sparkle! Bleaching or whitening, lightens the color of teeth whether darkened from age, coffee, tea, or tobacco. Its lightening effects can last for several years after treatment, depending on your personal habits. You can touch up the effect as often as you like.

Bleaching has a very high success rate, but results can vary depending on several factors such as teeth stained from smoking or similar activities, from taking certain medications such as tetracycline or minocycline, or from fluorosis and certain dental enamel conditions.

Bleaching will not lighten fillings, crowns or veneers.

In certain cases Dr Alleman will discourage treatment. If you have sensitive teeth, gum disease, teeth with worn enamel, or if you are pregnant or breast feeding, you probably should not whiten your teeth with bleaching for now.

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Is Tooth Whitening Safe?

Research has proven bleaching to be both effective and safe. The American Dental Association has given its seal of approval to a wide range of tooth whitening products.

Generally, the only side effect from treatment may be some sensitivity to hot or cold food and drink. If this occurs, sensitivity normally disappears within 48 hours.

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