In general, it’s wise to say goodbye to your wisdom teeth when:

• The teeth only partially emerge. Partial emergence can leave a space surrounding the tooth where bacteria can thrive, and lead to an infection, tooth pain, swelling, stiffness of the jaw, and illness.
• An improperly aligned tooth could inflict damage to nearby teeth.
• A cyst forms, damaging adjacent organic matter such as tooth roots and bone.

Asking about the position of your wisdom teeth with your dentist during a cleaning or checkup will give you an idea whether they will require removal. If you experience any pain, swelling or tenderness related to the growth of your wisdom teeth, schedule an appointment with your dentist to determine the seriousness of the problem. If the problems necessitate the removal of the tooth, you may need to schedule an additional appointment. Your dentist may elect to remove all of your wisdom teeth during the same appointment.

Fortunately, tooth extractions are a relatively minor out patient procedure. First, the dentist will numb the surrounding area to easy any discomfort. Once the area is numb, the dentist will remove the tooth with the use of forceps, and stitch the area together if necessary. If the wisdom tooth is only partially visible, the dentist may need to cut open and pull back the gums to gain access to the tooth. After the extraction, you’ll need to bite down on a piece of gauze for roughly 20 to 30 minutes to allow the blood to clot.

When at home following the procedure, your dentist will instruct you to only eat soft and cool foods for the next couple of days. Avoid smoking, drinking out of a straw, or spitting until the wound begins to heal as each of these activities could cause the clot to become dislodged from the hole your tooth previously occupied. Rinsing your mouth with warm salt water will help keep the wound clean and bacteria free. The majority of swelling and bleeding caused by the extraction will subside after a couple of days.

In most cases, your stitches will dissolve within a few weeks, but sometimes your dentist may need to remove them. Over-the-counter pain medications will help easy any discomfort you feel following most routine extractions, but the surgical removal of a tooth may require your dentist to prescribe you a painkiller. While an infection can set in following a tooth removal, individuals with a healthy immune system have little to worry about. If you have questions about having your wisdom teeth removed, or post procedure cars, be sure to ask your dentist.

Thank you to all our patients who voted for us. Smiles also won best Customer Service for the third year in a row. We are committed to providing our patients with the ultimate in service and patient care and the community recognizes our efforts.

A new accolade this year is best Website. We completed an overhaul of our website last year to make it more informational and helpful to our patients and those looking for a dentist. It’s a great place to learn what we do and why we believe in changing our patients’ smiles and lives.

Over the past several months, we have worked with Dr. Nicholas Caba on the process of transferring ownership of Salem Dental Center to Smiles. We are pleased to have the opportunity to work with Dr. Caba as well as Dr. Timothy Harbolt, who has practiced in the Salem area for over 15 years.

On October 3rd, Dr. Caba and the team saw their first patients as Smiles Dental. We are excited to make this announcement and to have the opportunity to bring another wonderful dental practice into our group!

The daylong event included medical exams, eye exams and glasses, dental cleanings and emergency treatment. In addition, the event also included free haircuts, donated professional clothing for job interviews, kids activities and lunches.

Smiles volunteers helped with numerous tasks, such as patient registration and charting, dental assisting and sterilization. Inspired by Portland’s Compassion Connect events, Compassion Ridgefield was a huge success! Smiles Dental is grateful for the wonderful opportunity they had to give back and support the Ridgefield community!

Dr. Dixson said that accepting the rate cuts enables Smiles’ patients to remain in-network and to keep their out-of-pocket costs low. While the cuts will impact Smiles’ revenues, he told the Columbian that Smiles Dental will focus on cutting dental lab expenses and other ways to continue to provide affordable, quality dental care to all of its patients.

You can read the entire story over at columbian.com

Washington Dental Service (WDS), Washington State’s largest dental insurance provider, has recently decided to cut reimbursement fees to dentists across the state. In an April 4 letter to dentists, WDS announced rate cuts as a response to fee pressure from their competitors.

In an effort to reduce employee benefit costs, employers are considering lower rates offered by WDS’ competitors. “Employers, including our largest self-insured customers, are taking notice and demanding lower premium rates from WDS,” the letter states. The letter continues, “If WDS does not reduce rates, employers are telling us they will obtain lower cost coverage elsewhere.”

Washington Dental Service Decision Will Impact Patients

Several Southwest Washington dentists have decided to drop WDS as an accepted insurance provider when the insurance-fee cuts go into effect. Most patients will likely remain with their current dental providers initially, despite the change in WDS policy.

Unfortunately, what most people don’t realize is that their out-of-pocket costs will rise significantly from what they are accustomed to under the old fee structure. This will put an undue economic burden on patients that are already suffering due to a struggling economy. On the other hand, dental health care providers that accept the fee reductions and continue to accept WDS insurance will see patients actually benefitting from a small reduction in out-of-pockets expenses.

Smiles Dental Will Remain a Preferred Provider for WDS

At Smiles, our mission is simple: Ultimate Service. Superior Performance. Positive Impact. Our mission to provide Ultimate Service can only be achieved by doing everything we can to exceed expectations for every patient. If dental care is not affordable, we can’t fulfill our mission. We focus on providing the patients the best experience at the right price.

While many dentists are canceling their contracts with WDS, Smiles Dental is committed to keeping our patients with the dental provider they have come to trust and depend on for comfortable and affordable dental health care.

While we are disappointed with WDS’ decision, we feel it’s important for all businesses, including dentists to find ways to keep their costs down so that they can do the right thing for all patients by keeping prices affordable.

Smiles has chosen to seek out ways we can be more efficient internally, so that we can decrease our expenses, rather than put the entire financial burden on the patients. We have also increased our efforts to negotiate lower prices with suppliers and vendors. The improvement in efficiencies in our practices will come without sacrificing the Superior Performance our patients deserve and all of our staff provide.

These approaches have helped offset the vast majority of the decreased revenue that will come with the decrease in WDS fee reimbursements and will allow us to retain all of our staff of over 50 employees. We will also maintain our relationship with WDS so our patients will not have ANY increase in their out-of-pocket costs.

At Smiles, we feel it is our responsibility to deal with this issue from within and not burden our patients with skyrocketing out-of-pocket costs that would be incurred through the discontinuation of our relationship with WDS.

Smiles Dental strives to provide each and every one of its patients the ultimate in services by providing superior performance in dentistry so we can have a positive impact in our patient’s smiles and lives.

Ultimate Service. Superior Performance. Positive Impact.

That’s our mission. Despite changes made by WDS, we plan to do everything we can to achieve our goal and change people’s lives through their Smiles.

Appearing in the “Looking Good” category of the Best of Clark County, Smiles Dental was voted the Best Dentist by the readers of The Columbian in March, 2011.

“The Columbian runs a special section for voting so our employees saw it in the paper, and we had to wait for the results,” said Ann Lucas, the Operations Manager at Smiles Dental.

Everyone at Smiles Dental was excited about being recognized for the third year in a row, after being chosen Best Dentist in the 2009 and 2010 Best of Clark County editions. “It is such an honor for all of our team!” said Lucas.

It’s no wonder that their loyal patients responded, voting Smiles Dental for Best in Clark County for 2011. The friendly staff at Smiles has an extensive track record of community service, leading with one of their biggest days of the year, Doctor With a Heart. This year, Smiles Dental offices donated over $50,000 of free dental treatment while serving over 120 patients in their surrounding communities, opening their offices to anyone in need of dental care.

“This is truly one of the most rewarding days of the year and it helps us fulfill our mission of having a positive impact in our communities,” states Lucas. “Our entire staff volunteers their time for the day, providing each and every patient the ultimate in service through superior performance in dentistry so we can have a positive impact in our patients’ lives and in our communities.”

Everyone at Smiles Dental is invested in this mission, serving their surrounding communities throughout the year through a variety of events:

•    All Smiles Dental offices participate in a Smiles Dental Food Drive, where patients and employees bring non-perishable items that are donated to the local food bank each year to help families in need in the community. They also held a coat drive for local adults and children.
•    The Ridgefield Fun Run is attended by staff members from all Smiles Dental offices each year in December. This benefits the Neighbors helping Neighbors Food Bank Program and the Homeless Shelter.
•    Smiles Dental had the largest team last year at the Harvest Classic run, and is also involved in the Christmas and 4th of July Parade each year handing out tooth brushes, tooth paste, floss, chapstick, and some candy.
•    Team members participate in the Sand and Misery Challenge which benefits the American Liver Foundation.
•    Smiles Dental offices are invited to attend many Health Fair Events in both Clark and Cowlitz Counties.
We are proud to be a large part of the communities in which we work and live!

Everyone at Smiles Dental is excited about being voted Best Dentist for Clark County 2011. Speaking for everyone at Smiles Dental, Ann Lucas responded, “We truly love our patients and the support they have in all of us!  Smiles Dental has the #1 patients!”

This year our offices donated over $50,000 of free dental treatment while serving over 120 patients in our community.

On February 11th we opened our offices to those who are less fortunate, in pain, and have not had consistent access to dental care for a variety of reasons, but primarily due to finances. We provide free dental care including teeth cleaning, radiographs, exams, fillings, and extractions.

This is truly one of the most rewarding days of the year and it helps us fulfill our mission of having a positive impact in our communities. Our entire staff volunteers their time for the day to give back to the community.

Smiles Dental strives to provide each and every one of its patients the ultimate in service through superior performance in dentistry so we can have a positive impact in our patient’s lives and in our communities.

We believe our mission of having a positive impact is universal and not just those who can afford excellent dental care. Our Doctor with a Heart Day helps us serve and fulfill this mission.

Q: What should I do if I have bad breath?
A: Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

Q: What may cause bad breath?
A: Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath. Common causes of bad breath include:

• Certain foods – Garlic, onions, etc. Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.
• Keeping a record of what you eat may help identify the cause of bad breath. Also, review your current medications, recent surgeries, or illnesses with you dentist.

Q: What can I do to prevent bad breath?
A: Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.

Tips to help prevent bad breath include:

• See your dentist regularly – Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor. Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.
• In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Q: How often should I have a dental exam and cleaning?
A: You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface. Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth. We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

Q: How can I tell if I have gingivitis or periodontitis (gum disease)?
A: Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages. Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms. Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums. The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone. Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.
• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.
• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives. Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.
• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.
• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.
• Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis. Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen.
• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
• Persistent bad breath – Caused by bacteria in the mouth.
• New spacing between teeth – Caused by bone loss.
• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.
• Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Q: Why is it important to use dental floss?
A: Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth. Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums. Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar). This will further irritate and inflame the gums and also slowly destroy the bone. This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
• Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

Q: How can cosmetic dentistry help improve the appearance of my smile?
A: If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health. This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile. Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over. Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

• Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking. Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.
• Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings. Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth. This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.
• Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile. They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth. Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.
• Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size. Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations. They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.
• Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth. Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.
• Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients. Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

Q: What are porcelain veneers and how can they improve my smile?
A: Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth. They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

• Severely discolored or stained teeth
• Unwanted or uneven spaces
• Worn or chipped teeth
• Slight tooth crowding
• Misshapen teeth
• Teeth that are too small or large
• Getting veneers usually requires two visits. Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

With little or no anesthesia, teeth are prepared by lightly buffing and shaping the front surface of the teeth to allow for the small thickness of veneers. The veneers are carefully fitted and bonded onto the tooth surface with special bonding cements and occasionally a specialized light may be used to harden and set the bond.

Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.

Q: What can I do about stained or discolored teeth?
A: Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile. Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade. The color of our teeth also comes from the inside of the tooth, which may become darker over time. Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull. Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline. Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching. Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains. Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins. Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

• Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth. The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep. It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.
• In office teeth whitening: This treatment is done in the dental office and you will see results immediately. It may require more than one visit, with each visit lasting 30 to 60 minutes. While your gums are protected, a bleaching solution is applied to the teeth. A special light may be used to enhance the action of the agent while the teeth are whitened.
• Some patients may experience tooth sensitivity after having their teeth whitened. This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one weak.
• Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile!

Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth. The most popular method is using a home tooth whitening system that will whiten teeth dramatically. Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.

Tooth whitening is not permanent. A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.

Reasons for tooth whitening:

• Fluorosis (excessive fluoridation during tooth development).
• Normal wear of outer tooth layer.
• Stained teeth due to medications (tetracycline, etc.).
• Yellow, brown stained teeth.

What does tooth whitening involve?

This type of tooth whitening usually requires two visits. At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays.

At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.

You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.