timberlake dental

Do I Really Grind My Teeth?

Some of our patients are surprised when we tell them that we see evidence in their mouths of teeth grinding, or bruxism.  Many people have no idea that they are grinding their teeth.  And what happens very frequently is they come back in six months and say, “You know . . . I think I might be grinding my teeth.  Ever since you told me that six months ago, I’ve been noticing {insert symptom here}.”

Signs vs. Symptoms

In order to explain this phenomenon of a dentist telling the patient about something they are doing which they are unaware of, it is important to understand signs vs. symptoms.  Signs are objective, observable facts.  This means they are not swayed by opinions or feelings, and they can be shown by a photograph, an x-ray or other type of image, a lab result, etc…  Signs are noted by the dentist during an evaluation of your mouth.  Signs can exist without any symptoms, so it is possible that a dentist can inform you of the signs of a condition without your being aware of any issues.

Symptoms are subjective evidences of a condition or disease of which the patient is aware.  For instance, pain is a symptom because it cannot be observed, and the patient must describe it to their doctor for it to be properly documented and used to aid in diagnosis.  Other examples of symptoms include anxiety, fatigue, or muscle tension.

Bruxism (Teeth Grinding)

Bruxism is a very common condition in which a person closes the upper and lower jaws, creating high pressure on the teeth, gums, supporting jaw bones, facial muscles and jaw joints.  It can include hard squeezing called clenching, or a side-to-side or back-and-forth movement called grinding.  When bruxism occurs, it will manifest in one or more clinical signs and possibly some symptoms.

Signs of Bruxism

  • Attrition – the flattening of the biting surfaces of teeth and loss of enamel caused by clenching or grinding
  • Potholes – a specific type of attrition where the enamel has been worn through, and the underlying dentin is exposed and worn down into a concavity
  • Gum Recession – movement of the gum attachment away from stressful biting forces on the tooth to a position further toward the root, can cause exposure of the root and tooth sensitivity
  • Tooth Abfraction – a loss of tooth structure at the gumline causing a notch or concavity
  • Facial Muscle Enlargement – as with any other muscle in the body, when exercised frequently, they will enlarge
  • Linea Alba – Latin for “white line”, this is a visible line on the inside of your cheeks caused by friction against the grinding teeth, like a callous
  • Scalloped Tongue – the sides of your tongue can be pressed against the inner surfaces of the teeth when clenching or grinding, causing it to conform to the shape of the teeth and have a scalloped appearance

Symptoms of Bruxism

  • Facial pain, including headaches – constant clenching of muscles can create muscle soreness in the cheeks, temples, forehead, and the neck
  • Muscle tightness – a tight or tense feeling in the muscles of the cheeks and temples
  • Joint pain or sounds – the jaw joints, located in front of your ears, can be tender to touch, have sharp shooting pains, or make popping, clicking, or crunching sounds
  • Generalized tooth pain or sensitivity – the pressure of clenching or grinding can cause all of the teeth to be sore or sensitive to temperature

Not everyone who clenches or grinds his or her teeth will exhibit all of these signs or symptoms.  It is important for the dentist to get the whole picture and put together each patient’s specific signs and/or symptoms in order to accurately diagnose the condition of bruxism.

What Can I Do About It?

The most common treatment for bruxism is a hard, custom-made nightguard to protect the teeth, gums, bone, muscles and joints at night.  People who clench during the day can follow some habit-breaking techniques to prevent daytime damage.  If extensive damage is present, you will probably need some dental work to repair it before moving on to the preventive phase.

Will an Over-the-Counter Nightguard Work?

OTC nightguards are typically made of a soft, thermoplastic material that you can heat and shape to fit your teeth.  This material is not great at preventing the damage from bruxism because the soft, squishiness actually increases muscle action and deteriorates very quickly.  The best protection for your teeth, gums, bone, muscles and joints is a hard nightguard that is custom-made for you by your dentist.  These will actually reduce muscle force and provide real protection.

Need More Information?

If you think you may exhibit one or more of the listed signs and symptoms, please don’t hesitate to discuss it with Dr. Chowning.  You can also call the office at 940-382-1750 to set up a consultation.

Are Dental X-rays Safe?

We are often asked by our patients about the safety of dental x-rays.  Many people are concerned about the levels of radiation they are exposed to when diagnostic x-rays are taken.  Since exact measurements are difficult to obtain, this article will use averages and comparisons to help you understand what levels of radiation you are receiving with dental x-rays.


There is risk associated with any type of x-ray because it involves the use of radiation.  The level of risk varies among the different types of x-rays and is typically measured in a unit of effective dose called a milliSievert (mSv).  What most people worry about when they hear “radiation” is whether or not it can cause cancer.  According to the World Health Organization’s publication, Communicating radiation risks in paediatric imaging: Information to support healthcare discussions about benefit and risk, the risk of cancer incidence that is increased by various types of diagnostic x-rays is compared with a baseline lifetime cancer risk.  This publication is focused on the risk to children because: “Stochastic risks are of special concern in pediatric imaging since children are more vulnerable than adults to the development of certain cancer types, and have longer lifespans to develop long-term radiation-induced health effects.” Basically, kids are more susceptible than adults to cancer from radiation.  Their studies showed that the increase in cancer incidence for children aged 1-10 years from dental x-rays is negligible (<1 in 500,000).  That risk would be even lower in an adult.

The risk is also measured by comparing it to the naturally occurring radiation that all people are exposed to on a daily basis.  These measurements vary widely based on location (there is a black sand beach in Brazil with the highest level of natural radiation on earth), so a worldwide average and national US average are shown in a chart on background radiation from Wikipedia.

A set of four bitewing x-rays, which is typically taken once per year, has an average effective dose of 0.005mSv.  The average amount of radiation someone in the US receives from cosmic radiation is 0.33mSv, more than 66 times that of your yearly dental x-rays.  The graph below shows other levels of natural background radiation experienced annually.

Click to enlarge


The benefit of these x-rays is the early detection of multiple types of oral disease, including cavities, gum and bone infections, and oral cancer.  As with any disease, the earlier it is detected, the less invasive treatment can be and the better the long-term prognosis.  The risk of these diseases going undetected is the progression of disease, spread of infection, loss of teeth, loss of bone in the jaws, and in severe cases even death.

Risk vs. Benefit

Due to the prevalence of oral diseases and the risks associated with those diseases, it is the opinion of our practice, as well as that of the American Dental Association, that the benefits of early detection with diagnostic x-ray imaging outweigh the risks associated with the x-rays.  Patients are far more likely to experience the consequences of undetected dental and oral diseases than they are to experience an increased cancer incidence due to dental x-rays.  Because each patient has different risk factors, the number of x-rays and the frequency at which they are taken can vary widely.  For example, a patient with a high risk for cavities needs dental x-rays on a more frequent basis than a patient who has a low risk.  A patient with extensive dental work needs more dental x-rays than a patient with no existing dental work.

X-rays and Pregnancy

The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women reaffirmed its committee opinion in 2015: “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) … [is] safe during pregnancy.”  Dr. Chowning typically postpones any dental x-rays during a patient’s pregnancy until after the baby is born unless the patient has a very high risk for dental disease, which could affect the patient’s overall health and that of the pregnancy.

Concerned about Radiation from Dental X-rays?

The number and type of dental x-rays taken on every patient is customized for his or her specific needs.  Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.

Mouthwash:  Which One is Right for You?

Because of the vast number of mouthwashes available to us today, it can be difficult to know which one is right for you.  A recent Crest survey found that 52% of Americans say they do not believe that mouthwash and rinses have any health benefits.  As dentists, we believe that using a mouthwash is very important for having great oral health, and we routinely recommend them to our patients to help them improve their oral hygiene and overall health.  Anything that decreases the number of harmful bacteria in your mouth improves your overall health.

So which mouthwash is right for you? 

Step 1:

Identify your problem area(s) in the following list.  We turn to mouthwashes to help us in several different areas of oral hygiene:

  • Strengthening enamel against cavities – Do you have a high risk for cavities?
  • Removing plaque from the teeth and gums – Is there a large amount of plaque buildup on your teeth?
  • Reducing inflammation from the gums – Are your gums red or swollen, and do they bleed when brushing or flossing?
  • Lowering the number of harmful bacteria present in the oral cavity – Do you have a high risk for periodontal disease?
  • Moistening the tissue inside the mouth when patients suffer from dry mouth – Do you suffer from dry mouth?

If you don’t know the answer to these questions, you should ask your dentist or hygienist at your next visit.  They can answer these questions for you after your professional cleaning or a clinical evaluation.

Step 2:

Read the ingredients of the mouthwash you are considering.  The table below shows most active ingredients used in mouthwashes with their benefits and risks.

Step 3:

Consider the following very important rules regarding some of the ingredients:

  • If you experience any type of dry mouth, you should NEVER use a mouthwash that contains alcohol.  Alcohol has a drying effect and actually allows bacteria in your mouth to proliferate over time.
  • An anti-cavity mouthwash containing fluoride is a great tool for helping children prevent cavities.  It should only be used with adult supervision to ensure the child is not swallowing any of the mouthwash.
  • While hydrogen peroxide in mouthwash is useful in reducing gum inflammation, it should never be used in an undiluted form.  Full-strength hydrogen peroxide can cause harmful changes in the tissues of your mouth.
  • Some mouthwashes are recommended for use before brushing and flossing; some are recommended for use after brushing and flossing.  Please read and follow the instructions carefully.
  • Mouthwash is helpful as a supplement to your daily oral hygiene routine.  It is not meant to be used as the sole method of cleaning your teeth and is never meant as a replacement for brushing or flossing.

Once you put these three steps together, you should be able to find the appropriate mouthwash that will address your specific needs and use it properly.  If you still feel confused about which one is best for you, please don’t hesitate to ask for our recommendation.

More Questions about Which Mouthwash is Right for You?

Call 640-382-1750 today to schedule a consultation with Dr. Chowning or one of our fabulous dental hygienists.  They can assess your current needs and help you choose the mouthwash that is best for you!

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Teeth Whitening Options

Most everyone wants white teeth!  It is the fastest and least expensive form of cosmetic dentistry.  Whitening your teeth brightens your smile, making it the first thing people notice about you.

There are several different ways to whiten your teeth.

When Should You Whiten Your Teeth?

The short answer is: whenever you want!

A longer, more detailed answer is that there are several factors people use to determine when their teeth need whitening.  If you answer yes to any of these questions, you might want to whiten your teeth.

  1. Do you hide your smile or laughter behind your hand because you think your teeth are yellow?
  2. Do you have dental work that no longer blends in with the other teeth?
  3. Are your teeth yellower than the whites of your eyes?

Please keep in mind that it is unwise to compare your teeth to photos you see online or in magazines.  Professional photographs are always altered to show perfectly white teeth.  When evaluating your teeth, be realistic.  Only compare with natural teeth (not dental crowns or porcelain veneers!) you have seen in person.

Over-the-Counter vs. Professional Products

There are some important differences in the whitening products you can buy over-the-counter compared to the products sold only by your dentist.

Over-the-Counter Whitening Products

OTC whitening products can be divided into two categories:

  1. Whitening Toothpastes or Powders – These products whiten the teeth by simply polishing away surface stains. The toothpastes contain abrasive or gritty ingredients that act like sandpaper to your teeth.  This is a good option for people who drink lots of coffee, tea, or red wine.  They are NOT safe to use on sensitive teeth or teeth with exposed roots.
  2. Whitening Strips or Gels – The chemical ingredient in over-the-counter whitening strips or gels is the same ingredient in professional products: carbamide peroxide. Both carbamide peroxide and hydrogen peroxide act to penetrate enamel and oxidize the molecules that cause discoloration in teeth.  The concentration of peroxide chemicals in OTC whitening products is lower than the concentration in professional products.  OTC products also do not contain any chemicals for protecting the teeth against sensitivity.  We will discuss why this matters in the next section.

Advantages of Professional Whitening Products

As stated above, OTC products have lower concentrations of the active ingredient.  With the higher concentrations of carbamide peroxide and hydrogen peroxide available in professional whitening products, whitening is faster and more effective!

Another advantage of professional teeth whitening is the use of a custom fit whitening tray.  Over-the-counter whiteners use a generic fit mouthguard type tray or messy, slippery strips.  These do not hold the whitening ingredient firmly against the teeth.  With a custom tray, the material stays in close contact with the teeth and only where the gel is designed to go.  This prevents using too much gel and helps you conserve the gel for longer use.  It also prevents the gel from reaching sensitive tooth roots and gum tissue.

Professional Teeth Whitening at Timberlake Dental

At Timberlake Dental, we believe in providing only the best dental care.  There are many different types of teeth whitening available, and there is no question that take-home whitening in custom-made whitening trays is the best.

We offer custom whitening trays and a kit of professional strength whitening gel as a gift to our patients at no charge once any necessary dental work has been completed!

Take-Home Whitening

This is the gold standard in teeth whitening.  Take-home teeth whitening is the most predictable and affordable way to professionally whiten your teeth.

Flexible custom whitening trays are made on an exact replica of your upper and lower teeth.  These trays fit the teeth intimately and hold the whitening gel exactly where it needs to go for the best result.  The trays last for many years and rarely need replacement.

The trays act as a carrier for the whitening gel.  We provide you with a kit of whitening gel when you receive your custom trays.  We will instruct you on how to properly load gel into the trays to maximize the lifespan of your gel supply.

Wear the whitening gel in your trays for the prescribed amount of time, per Dr. Chowning’s instructions.  If your teeth do feel sensitive, shorten the time you wear the gel and whiten every other day.

It typically takes 10-14 days of whitening daily to reach the maximum whitening effect of Opalescence® gel.  When wearing the gel for shorter and every other day, allow a little more time.

Once you have achieved your whitening goals, you only need to perform maintenance whitening as needed.  On average, maintenance is performed once every 6 months.  Patients with habits that stain the teeth, like smoking or heavy coffee drinking, will whiten more frequently.

Interested in Professional Teeth Whitening?

Call 940-382-1750 today to schedule a teeth whitening consultation with Dr. Chowning!

What, Exactly, is a Root Canal?

What is a root canal?

A root canal is the anatomical term to describe a portion of a tooth.  Teeth are hollow, and the internal chamber that contains the nerves and blood vessels inside the tooth is called the root canal.  The nerves and blood vessels are also called the pulp.

What is root canal treatment?

Root canal treatment is a dental procedure that involves removing the nerve tissue and blood vessels from the root canal inside the tooth and sealing the cleaned space with a root canal filling material.

Why is it necessary? 

A root canal is necessary when the pulp (nerve and blood vessel tissue inside the tooth) becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep cavities, repeated dental procedures on the tooth, leaking crowns, a previous injury to the tooth, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

What is an Endodontist?

An endodontist has two or more years of specialized training in root canal treatments, in addition to their dental training. On average, they perform nearly 25 root canal treatments a week.  Because they limit their practice solely to endodontic treatment, endodontists are efficient and precise. This equates to positive experiences and faster healing. Endodontists are highly skilled at treating difficult root canals like those on molars and teeth with curved roots.

Why would I be referred to a specialist? 

Dr. Chowning believes that you deserve the best treatment for each individual procedure that you may require.  There are some teeth with complicated canal systems requiring a more specialized technique.  These scenarios include teeth with multiple canals, canals that have calcified (shrunk) over time, and canals that split or curve on their path down the root.  We also believe that complicated root canals should be performed with the aid of an operating microscope, which allows the endodontist to visualize the internal surfaces of the roots.  These are especially important in the diagnosis of root fractures, which can cause root canals to fail in the future.  Left undiagnosed, a root fracture can lead to repeated treatment on a tooth that has a poor-to-hopeless prognosis.

Is a crown necessary to cover the tooth after root canal treatment? 

Yes.  A root canal treatment removes the nerves and blood supply from the internal chamber of the tooth.  With no blood supply, teeth become brittle and can easily fracture.  A crown is necessary to protect the tooth.  If the tooth is not adequately covered, it could crack and need extraction despite having the root canal treatment.  Ideally, the crown should be placed within 2-3 weeks of the root canal treatment.

What is an alternative to root canal treatment?

If the nerve inside a tooth is irreversibly inflamed, infected, or dead, the only alternative to a root canal treatment is extracting the tooth.  Most teeth can be restored with a dental implant after extraction if the proper planning is done before the tooth is extracted.  Please ask Dr. Chowning for more information if you do not wish to save the tooth with a root canal treatment.

Do you need a root canal?

If you have a toothache, a swelling in your mouth, or a tooth that you already know needs a root canal, please call today to schedule a consultation with Dr. Chowning.  He will evaluate any problem areas and discuss all of your treatment options with you.

pH: A Surprising Cause of Cavities

How does the pH of your mouth affect your risk for cavities?

Most people know and understand that a diet high in sugar can be detrimental to their oral health.  But many people are unaware of the dangerous effects of acid to tooth structure.  In recent years, we have seen an increase in cavities among adults with good oral hygiene and diets low in sugar.  How does this happen?  It’s all about the pH!

Tooth decay starts with a process called demineralization, which is the softening of enamel or dentin surfaces caused by acid.  Just as acid can etch the surface of glass, it will damage and soften the surface of tooth enamel, making it much easier for bacteria to penetrate and cause decay.  In a healthy mouth with a neutral pH or 7.0 or higher, it takes a long time for bacteria to produce enough acid to cause a cavity.   Research has shown that demineralization of enamel occurs when the pH drops to 5.5.

Prolonged exposure of your teeth to any acid consistently weakens enamel, allowing cavities to form in an otherwise healthy mouth.  All carbonated drinks, including sparkling water, are very acidic, ranging from 2.5-4.0.

Is your water causing cavities?

If it is sparkling water, then it definitely could be.  If you’re using a reverse osmosis filtration system, even your tap water could become acidic and increase your risk for cavities!  Denton tap water is usually either neutral or slightly basic.  Reverse osmosis filtration drops the pH to a more acidic level.

pH testing of various brands of bottled water shows that even some of those are acidic.  The pH of your water can vary.  The easiest way to find out your water’s pH is to buy some small pH test strips at the drug store or online.

It is important to remember that enamel begins demineralization (or dissolving) at a pH of 5.5 or lower, so anything that will be exposed to your teeth for a long period of time should be above pH 5.5 in order to prevent cavity formation.


What can you do about it?

Here are a few tips to improve the pH in your mouth and decrease your risk for cavities:

  1. Only enjoy acidic drinks (anything below pH of 5.5) with meals or snacks.  Do not sip on them between meals or overnight.
  2. Only drink neutral drinks (pH 7.0 or above) in between meals.
  3. Avoid adding lemon juice to your drinks. Lemon juice is extremely acidic and drastically lowers the pH of your drink.
  4. After an acidic drink, chew xylitol-containing gum. Our favorite brand is Ice Cubes gum.  It comes in a wide variety of flavors, is available in most grocery and convenience stores, and contains almost 2g of xylitol per piece.  Not only does xylitol kill cavity-causing bacteria, the chewing motion stimulates saliva production, which brings the pH in your mouth back to neutral.
  5. Know your drinks.  In our experience, most of our patients have no idea that their favorite drink is very acidic and damaging to enamel.  You can test your beverages yourself with a pH testing kit or search the internet for common drinks.  Most food and drinks have an MSDS sheet (Material Safety Data Sheet) that includes their pH levels.

Do you have more questions about how pH can be affecting your mouth?

Call our office today at 940-382-1750 to set up a consultation with Dr. Chowning.  He will discuss your specific dietary habits and how they could be affecting your teeth.


What is Gingivitis?

A lot of people hear this word from their dentist and are not really sure what it means.  Have you been told that you have gingivitis by your dentist or dental hygienist?  Do you sometimes see blood when you spit your toothpaste out in the sink?  This blog will describe what gingivitis is, what it is not, what causes it, and what you can do about it.

What Gingivitis Is

The word gingivitis is easy to break down into its two components: gingiva and the suffix “–itis”.  Gingiva is the scientific term for gum tissue.  The suffix “–itis” always indicates inflammation.  Appendicitis is inflammation of the appendix.  Dermatitis is inflammation of the skin.  Inflammation will always exhibit at least one of four characteristics: redness, swelling, heat, and pain.

In gingivitis, the most common characteristics of inflammation are redness and swelling.  Any bleeding of the gums without injury indicates the presence of gingivitis (and, no, brushing, flossing and professional teeth cleanings do not count as injuries).  Gingivitis can be localized or generalized.  Localized gingivitis is isolated to a small area of the mouth, perhaps 1-2 teeth.  Generalized gingivitis is inflammation of the gum tissue around all of the teeth.

What Gingivitis Is Not

While gingivitis is typically present at the same time as many of these other conditions, it is technically not the same thing.

Periodontal disease – Periodontal disease is the loss of gum and bone attachment to teeth.  The jawbone and gums are the foundation on which our teeth function.  They support the teeth and hold them in place.  When periodontal disease is present, that support is compromised.  In severe periodontal disease, the teeth will become loose and, in extreme cases, can even fall out.  Periodontal disease often occurs in conjunction with gingivitis.  Gingivitis, if untreated, will advance to periodontal disease.  However, periodontal disease is called a “silent” disease because the inflammation can be hidden underneath the gums, not visible to an untrained eye.

Gum recession – Gum recession is the process of gum tissue receding down the root surface of a tooth.  Recession exposes the root and also compromises the support for a tooth because it is a loss of attachment.  Gum recession is often accompanied by gingivitis, but recession can be present without any inflammation.

What Causes Gingivitis

Plaque – The #1 cause of gingivitis is the accumulation of plaque.  Plaque consists of bacteria, their by-products, and food debris.  Plaque is an irritant to gum tissue, so when it is not properly cleaned away, the gums respond with an inflammatory reaction.  Plaque is the easiest cause of gingivitis to treat.

Hormones – Many people experience changes in levels of inflammation due to changes in levels of hormones.  This can affect patients going through puberty, pregnancy, and menopause.

Mouth breathing – Constant mouth breathing has a drying effect on all the tissue inside the mouth.  Saliva is instrumental in maintaining the pH of a mouth, moistening the tissue, and fighting bacteria.  Mouth breathing allows a greater accumulation of bacteria on the gum tissue, leading to inflammation.  This can affect people who have nasal obstruction, severe allergies, or sleep-disordered breathing.

Braces – Orthodontic treatment creates beautiful smiles.  Sometimes it also contributes to gingivitis.  All of the additional fixtures in the mouth during orthodontic treatment provide countless hiding places for bacteria to accumulate.  More bacteria means more gingivitis.

Some prescription medications – There are a few prescription medications that cause gingivitis as a common side effect.  Dr. Chowning is familiar with these drugs and their influence on gum tissue.  They will advise you in the event you are taking a medication that could cause changes in your gum tissue.

What You Can Do About Gingivitis

  • Improve your oral hygiene routine at home! Your routine should include brushing twice daily and flossing before bedtime.  Adding a pre-brush mouthrinse that contains hydrogen peroxide (like an over-the-counter whitening mouthrinse) will help reduce inflammation in your gum tissue.
  • Have your teeth professionally cleaned! Patients who are prone to gingivitis should never miss a cleaning.  Many even need to have cleanings more frequently than ever 6 months.  The good news is that more frequent cleanings always mean more comfortable cleanings.  If you skip cleanings, the bacterial buildup that is causing the gingivitis will persist and can worsen into periodontal disease.
  • Talk it over with your dentist. You may have more than one risk factor for gingivitis, like mouth breathing or hormones.  Chowning will give you customized recommendations for your specific situation.

Worried about Gingivitis?

Call our office at 940-382-1750 to schedule a consultation to discuss your concerns with Dr. Chowning and start a plan to resolve your gingivitis.

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Special Needs Dental Care

Millions of Americans have special health care needs.  When it comes to dental care, these special needs include any physical or mental disability that creates challenges in preventing and/or treating dental disease.  This encompasses a wide range of factors, from a mild case of rheumatoid arthritis that makes flossing difficult to severe physical and mental handicaps that create barriers to obtaining routine dental care.

If you or a loved one have special health care needs, this blog will provide valuable information about how to lower the risk for dental disease and increase the likelihood of successful visits at the dentist.

Preventive Care

Because special health care needs can make dental care challenging, it is essential to be as preventive as possible.  Preventing dental diseases like cavities and gum disease is always easier and less expensive than treating them.

The following list includes the important tasks your dentist and his staff of professionals perform to prevent dental disease.

  • Professional Cleanings – Many patients with special health care needs struggle to clean their teeth adequately. This leads to an overgrowth of plaque and tartar buildup.  When someone has trouble cleaning their teeth, it creates a snowball effect: plaque and tartar attract more bacteria, which produce more plaque and tartar.  It is difficult to stop this cycle.  Intervening with professional teeth cleanings gets you back to square one.  Many patients with special challenges will need these cleanings on a more frequent basis to ensure that the teeth and gums are staying clean and healthy.
  • Sealants – Dental sealants are one of the best cavity-fighting preventive treatments we have in dentistry today. Sealants fill in and “seal” the deep pits and grooves in the biting surfaces of the back teeth.  Sealants prevent bacteria from penetrating and causing a cavity.  They also create a shallow, smooth surface that is easier to clean with a toothbrush.
  • Fluoride Treatments – If Dr. Chowning determines that the risk for cavities is high due to the special needs you or your loved one face, he will recommend professional fluoride treatments when you have your teeth cleaned. Fluoride is a natural mineral that strengthens enamel and makes it more resistant to decay.  Professional fluoride treatments on a consistent basis are scientifically proven to prevent the formation of new cavities.  Fluoride applications are quick and painless.

Home Care Help

With physical or mental challenges to oral hygiene, help from a caregiver is the best solution.  Patients with mental or cognitive disabilities should not be expected to properly clean their teeth and gums on their own.

  • Lessons and Tips – If you are a caregiver for someone with special needs, ask your dental hygienist to show you how to take care of the teeth and gums. The hygienists are experts at brushing and flossing someone else’s teeth!  They can give you tips on how to quickly and easily manage the oral hygiene routine.
  • Electric Toothbrushes – Electric toothbrushes are a great tool for removing plaque. Research shows that an electric toothbrush consistently removes more plaque than a manual toothbrush.  These are wonderful additions for patients with physical disabilities, like multiple sclerosis or arthritis.
  • Flossers – Rather than using a piece of floss wrapped around your fingers, you may find it much easier to use a flosser or floss-pick. These tools allow you to reach the back teeth without having to put your entire hand in someone’s mouth.
  • Low Sugar Diet – Because of the increased cavity risk that is inherent with special health care needs, it is important that special needs patients avoid sugars and simple carbohydrates. Sticky, gummy candies and mints or lollipops create a constant sugar source for bacteria to create cavities.

Longer Appointments

Whether it is positioning a patient who is physically disabled in the dental chair or spending extra time with someone who has behavioral challenges, special health care needs make dental visits last longer.  We want every dental visit to be comfortable and non-threatening.  We will take extra time to explain procedures to patients with mental or cognitive challenges.  Please be prepared to spend more time in the dental office so that we can provide you with the very best care.


We value the relationships we build with each patient.  Not only does seeing the same person at each visit make our patients more comfortable, it improves the quality of care we can provide.

When you have your teeth professionally cleaned by the same dental hygienist at each visit, we can track small changes in your dental health.  We remember the small adjustments we make to keep you as comfortable as possible.

We also know that our patients with mental challenges thrive under consistency.  Keeping their appointments at the same time of day with the same dental professional leads to successful visits.

Medical Consultations

Our goal, as you can see from reading above, is to prevent dental disease in our special needs patients.  Not all dental problems are preventable, and sometimes invasive dental treatment is necessary.

With special health care needs usually come multiple medical considerations.  When our patients with special needs require dental treatment, we will consult with your medical doctor to ensure that your health is protected.  Some medications have interactions with dental drugs, and some affect the way a patient would respond to dental treatment.  All of these possibilities take top priority when we plan any needed dental treatment.


Many medications cause dry mouth as a side effect.  This can have a devastating effect on the teeth and gums, drastically increasing the risk for dental disease.  We understand that many of our special needs patients take multiple medications and change the medications they take on a frequent basis.  We will update your medical history, including prescription medications, at each dental visit.  Please make sure to have a current list of all medications you are taking.  This can play a vital role in your dental care.

Do You or a Loved One have Special Needs that Make Dental Care Challenging?

Call 940-382-1750 today to schedule a consultation with Dr. Chowning.  He will patiently assess your situation and get you on the right track to great dental health.

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Can a Sinus Infection Make my Teeth Hurt?

Spring is here.  And with it come seasonal allergies.  It is very common for dentists to see an increase in “toothaches” during this season.  We put “toothaches” in quotes because while the tooth definitely aches, it is not a tooth problem.  Many patients will call us with a toothache and come in for an evaluation, only to be told that the tooth is perfectly fine.

Why does sinus pressure make my teeth hurt?

The natural anatomy of our upper teeth, jawbones and sinus cavities predisposes us to this problem.  The maxillary sinus cavities are large, air-filled spaces located just inside our cheekbones.  They extend inward toward the nose and downward toward the upper teeth.  Often the jawbone separating our upper teeth from the above sinus cavity is extremely thin.

The sinus cavities are supposed to be empty.  These air-filled spaces allow for the passage of air as we breathe and lighten the weight of our skull so that we can hold our heads up.  Anyone who has ever experienced sinus congestion knows that it can be hard to breathe and make your head feel heavy.

When the sinuses are filled instead of empty, pressure is created in that bone-encased space.  Many people feel this pressure inside their cheekbones or under their eyes.  Many also feel this pressure on their upper molars and premolars.  The nerves that supply sensation and feeling to our teeth enter the tooth at the very tip of its root.  Many upper molars’ roots protrude up into the sinus cavity.  When there is an increase in pressure in the sinus, it can cause sensitivity, soreness or just a plain old toothache.

What symptoms are commonly associated with sinus pressure toothaches?

  • Because the toothaches associated with sinus cavities are caused by an increase in pressure, anything that changes the pressure would change the pain in the tooth. Things like the impact of running or jumping and tossing your head upside down to blow-dry your hair will affect the pain of a toothache caused by sinus pressure.
  • Because of the pressure on the tooth’s nerves, the teeth may be more sensitive to cold air or liquids.
  • The increase in pressure on the roots of the teeth also causes a soreness or tenderness when chewing, grinding, or tapping on the side of the tooth.

What can I do about it?

First of all, you should rule out any problems with your teeth.  If you have not seen a dentist in a while, you should schedule a visit to have the tooth or teeth evaluated.

If you have been seen regularly by your dentist and know that you have no cavities or other problems with your teeth, you may want to begin by treating your sinus pressure.  Take over-the-counter decongestants and antihistamines.  If these do not help, you should see your medical doctor to treat your sinus condition, allergies, cold or flu.

Many patients have experienced this multiple times and are able to recognize it as a sinus problem and not a tooth problem.  If you are not sure, come see us anyway.  When in doubt, rule out a real toothache!

Have a toothache that could be from sinus pressure?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning. He will do a thorough evaluation of the area that is bothering you and distinguish between a tooth problem and a sinus problem.

How Does Aging Affect Oral Health?

There are two reasons aging is important to oral health: 1) the population of elderly people in America is growing rapidly, and 2) more and more of those people are keeping their natural teeth!

Research projects that by the year 2030, twenty percent of the U.S. population will be over the age of 65.  This rapid growth results from advances in healthcare, which allows people to live much longer than in previous generations.  Advances in dental care result in more of these elderly people keeping their natural teeth much later in life.

It is important to understand the value of oral health in an aging population and the changes necessary to protect oral health in aging individuals.

What Factors of Aging Affect Oral Health?

As we age, certain bodily functions naturally decrease.  There are other important bodily functions that are affected by the prevalence of systemic diseases or health conditions and the medications necessary to treat them.

This list includes the most common links between aging and oral health.

Dry Mouth

The body naturally produces less saliva as we age.  This problem is often compounded by prescription medications that cause dry mouth as a side effect.  Because our aging population takes more medications, the risk for dry mouth in elderly people is extremely high.

Saliva performs several very important functions, including protection of the mouth against cavities, gum disease, and mouth sores.  When saliva is decreased, the risk for all of these problems increases exponentially.

Elderly patients with dry mouth are at a high risk for cavities, especially on the roots of the teeth.  They are more likely to experience progressive gum disease, and they have a greater chance of suffering from painful ulcers and mouth sores.

Multiple Health Concerns

Aging patients typically have one or more systemic health concerns, like high blood pressure, arthritis and diabetes.  These conditions all affect the body’s ability to fight infection, function normally and heal completely.  This means oral health problems like cavities and gum disease can be more destructive in the presence of these diseases.

Arthritis affects oral health in two separate ways.  1) Arthritis can affect the jaw joints, making chewing difficult or painful.  2) Arthritis in the hands makes maneuvering a toothbrush and floss much more difficult and less effective in cleaning the teeth.

Decreased Manual Dexterity

Aging can affect one’s ability to brush and floss teeth effectively.  Patients may have trouble opening wide enough to clean their teeth properly.  Using a manual toothbrush or flosser becomes increasingly frustrating as hands become less flexible or shaky.

Decreased Cognitive Function

Many elderly people suffer from conditions affecting their mental abilities, like Alzheimer’s disease or dementia.  Patients without cognitive diseases can also suffer from forgetfulness, which leads to lack of proper self-care.

This contributes to poor oral hygiene and home care of the teeth and gums.  As the risk for dental disease goes up and home care goes down, elderly people are very likely to suffer problems with their oral health.

Why is Oral Health So Important to Aging Adults?


Chewing is the first step in the digestive process.  Elderly patients are more likely to be missing teeth and have a dry mouth.  Missing teeth reduce a person’s ability to properly chew his food.  This carries an increased risk for choking and decreased digestion of food.

A dry mouth, or lack of saliva, also affects the digestive process because saliva contains important enzymes for breaking down food particles.  Without them, food is not broken down the way it should be.

These interruptions in the digestive process affect the way the body absorbs nutrients from food.

Quality of Life

Enjoying a nice meal is one of the greatest pleasures in life.  Being able to smile, laugh and speak well improve one’s quality of life.

When oral health is affected, there is no question that the quality of life is decreased.  Everyone deserves to eat, speak, and smile comfortably into their old age!

How Can You Protect an Aging Loved One’s Oral Health?

There are several important steps you can take to ensure your aging loved ones maintain good oral health.

  1. Monitor or assist in oral hygiene.  At a certain point in life, your elderly parents or loved ones may need help cleaning their teeth properly.  If they live with you, check on them regularly.  If they live in a nursing facility, check with their caregivers to make sure someone is keeping up with oral hygiene.
  2. Maintain consistent dental visits.  It is easy to forget about routine dental visits when patients have many other health concerns.  Make it a priority to have regular check-ups with their dentist.  Many nursing facilities have dentists who do on-site dental care.
  3. Proceed with any recommended preventive dental care.  There are many prescription dental materials available today which can help fight cavities and reduce the risk of decay and gum disease.  These preventive options are wonderful for elderly patients who may not be able to tolerate extensive dental treatment.

Do You Have an Aging Loved One in Need of Dental Care?

Please call us today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will advise you on how to best care for your loved ones and keep their oral health in the best possible shape!



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