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Exams and X-rays

Dental Exams

At Delmarva Dental Services, we strive to provide exams that are both comfortable and convenient. Routine evaluations are essential to maintaining good oral health, so our dentists recommend that patients visit us at least twice per year for check-ups. These oral health exams can also be accompanied by a professional teeth cleaning, which can reduce plaque and tartar and give special attention to hard to reach areas. In addition, dental cleanings can give the teeth a more polished, refreshed appearance. An oral cancer screening can also be included in your regular oral exam to identify any tissue irregularities in their earliest stages.

Regular exams enable us to provide a precise diagnosis on the state of your oral health. If we see any potential concerns, we will talk with you about treatment options and create a personalized plan to address those issues and to help prevent major dental complications in the future.

Dental X-rays

Radiation Exposure Radiographs (X-rays) have a huge impact upon our lives from airport scanners to cancer treatment but in many ways they are a mystery to most people. X-rays have always been present but weren’t discovered until 1895 by Wilhelm Roentgen. Since that time they have been used for diagnosis and treatment of injury and disease. An x-ray is a wave of electromagnetic energy. There are two types of electromagnetic energy (waves), nonionizing (low frequency) and ionizing (high frequency) energy. Examples of non ionizing waves are UV light, visible light, microwaves and radio waves. X-rays are ionizing radiation which can damage cells including the DNA by removing an electron (ionizing) from the atoms in molecules. The higher the x-ray dose the greater the damage. Low doses spread out over time are thought to be harmless because the body repairs any damage. However, we know high doses cause cancer from studies of atom bomb survivors in Japan. Radiation doses can be measured in many ways. The more common ways to measure is the biological effect on the body. The older unit of measure was the Rem, and millirem. The newer international measure is the Sievert, millisievert or microsievert. The measurements are similar to the meter and millimeter for distance. Different parts of the body absorb and therefore, are affected differently by radiation. The salivary glands are more affected by an x-ray scan of the head than the jaw bone. Parts of the body that grow faster are affected more than slower growing areas. Cancer cells grow very fast and are more affected by radiation. This is why radiation is used to treat cancer tumors. The whole body absorbed doses listed in the table are an average of all the body parts Ionizing radiation (x-rays) can come from many sources such as cosmic radiation from our solar system, radioactive elements in the soil, and radon from the air. The average person receives about 620 millirems (6,200uSv) per year, half from the environment and half from medical procedures. The following table shows the amount of radiation received to the whole body from various x-rays sources.Whole Body Absorbed Dose

Two very important computer enhanced developments have lessened the effect of x-rays to our bodies. The first is the use of digital sensors rather than film. Digital sensors are more sensitive than film and much less radiation is needed. For example dental film x-ray exposure is three times digital x-ray. The second development is the ability to focus the x-ray beam in a more precise way which concentrates the radiation to the smaller area of interest. This minimizes the effect of the radiation to the body. For example, a medical CAT scan of the head is 10 times more radiation than a “cone beam computerized tomograph “(CBCT) of the head. Highly focused radiation is also used for cancer radiation treatment. Delmarva Dental Services takes it responsibility to your health seriously. We will be more than happy to discuss the risks versus the benefits of any diagnostic or treatment procedure.

3D X-Rays

Delmarva Dental Services is excited about our 3D Dental scanner. Cone beam computerized tomography (cbct), or 3D for short, is a refinement to the computerized assisted tomography (CAT scan) used in medicine. The main difference is that the dental 3D CBCT is a highly focused beam to a small area, which drastically reduces the radiation exposure. (See “Radiation Table”). It is an important tool in dentistry because it shows teeth and jaws in 3 dimensions instead of the typical 2 dimensions. It can show the actual size of roots on teeth to be extracted, proximity of roots to the maxillary sinus, bone width prior to implant surgery, and abscesses on teeth that don’t appear on conventional x-rays. There is also program that can show a 3 dimensional model of the scanned area. We can virtually place dental implants in the 3D model and make surgical guides prior to implant placement. This makes implant surgery more predictable, more accurate, less timely, less invasive, less uncomfortable and more successful. 3D CBCT Views

Do Dental X-Rays Cause Brain Cancer?

Dr. Elizabeth B. Claus, an epidemiologist at the Yale School of Medicine in New Haven, Conn., and at Brigham and Women’s Hospital in Boston, led a study published in a journal entitled “Cancer” (April 2012) suggesting an association between mouth X-rays and tumors called meningiomas.The tumors, which take their name because they arise in the meninges, the membrane surrounding the brain and spinal cord, account for about a third of brain tumors detected in the United States. Although they’re most often benign and slow-growing, they can cause disability by exerting pressure on the brain. Claus and her research colleagues reviewed histories of dental X-rays among 1,433 patients diagnosed with meningiomas between the ages of 20 and 79 in 2006-2011 and compared them with dental X-ray histories of healthy subjects matched for age, gender and geography. All were asked to recall from memory all dental X-rays they’d ever received. What the Yale study found was that people who developed the tumors were more than twice as likely as those in the control group to report having received bitewing x-rays at least yearly. The study’s authors conclusion states;

“Exposure to some dental x-rays performed in the past, when radiation exposure was greater than in the current era, appears to be associated with an increased risk of intracranial meningioma. As with all sources of artificial ionizing radiation, considered use of this modifiable risk factor may be of benefit to patients” Cancer 2012;. © 2012 American Cancer Society.

The study relied on the subjects’ memory of how many x-rays they had many years ago and this type of self reporting data is usually inaccurate. The study does not prove that dental x-rays cause these tumors; much more research would be needed to determine that. And experts say the finding does not change the recommendation to have x-rays only when necessary. Otis W. Brawley, M.D., chief medical officer of the American Cancer Society said, “We need more data before we can even begin to state there is a relationship between dental x-rays and these tumors. Until that research is done, the best advice we can give people is to get dental x-rays when they are necessary and only when they are necessary.” Delmarva Dental Services uses digital x-rays which are ¼ the dose of the radiation dose in this study. (See “X-ray Exposure”) After reviewing the new research, the American Dental Association issued a statement reiterating its longstanding position that dentists should order dental X-rays “only when necessary for diagnosis and treatment. Since 1989, the ADA has published recommendations to help dentists ensure that radiation exposure is as low as reasonably achievable,” the ADA said in the statement, released to coincide with the online publication of the new study in Cancer, the journal of the American Cancer Society. The ADA currently recommends X-rays every 1-2 years for healthy children and every 2-3 years for healthy adults.

Dental Cleanings

A dental cleaning (prophylaxis) is usually performed by a licensed dental hygienist who has a 2 or 4 year degree in dental hygiene. It’s not just a cleaning, it is much more than just cleaning teeth. It consists of many tasks performed during the visit. At Delmarva Dental Services we schedule an hour for this service. Many offices schedule less time, a half hour or 45 minutes. We routinely perform the following services during the prophylaxis.

We may provide the following additional services:

Most people come every six months for this appointment. Here at Delmarva Dental Services we decide on how often you should have your teeth cleaned based on your individual needs. It could be more or less frequent than every 6 months. The service and information you receive during this valuable appointment will help you have a healthier and better quality life.

Oral Cancer Screening

Oral cancer kills 8,400 people per year in the United States, more than skin cancer and cervical cancer. Each year 28,000 new cases are diagnosed. Oral cancer occurs more often in people who use tobacco in any form such as: cigarettes, chewing tobacco, pipes, and cigars. It occurs more frequently in people who consume large quantities of alcohol especially liquor. It can occur in all ages, races, and lifestyles. Over 25 percent of oral cancers occur in people who do not smoke and only drink alcohol socially. The overall survival rate of oral cancer is 52 percent. This survival rate has not improved in 50 years. Almost every other cancer has had significant improvements in survival rates. Early detection plays a much greater role in these improvements rather than advances in treatment. The following yearly tests have greatly improved the survival rates of the following cancers: the mammogram for breast cancer, the PSA for prostate cancer, the PAP smear for cervical cancer and the colonosopy for colon cancer. When a dentist diagnoses cancer, the patient is on average 64 years old and the cancer is in Stage III. If the cancer was diagnosed in Stage I, the 5-year survival rate is increased to 79 percent.There are several factors that make early detection difficult. The lesions can take on many different forms. It may be small, flat, a red or white patch, a growth, a lump, a thickening, a rough spot, crusted, or an irritated area. They are often painless. Many lesions are in areas of the mouth that are difficult to see, requiring examination by a dentist or dental hygienists. Until recently, suspicious lesions required a surgical biopsy for diagnosis. The logistics involved and the nature of the procedure caused the patient as well as the dentist to delay the procedure.Fortunately, Delmarva Dental Services uses a new test that is similar to a PAP smear. It is simple to perform. We just brush the surface of the suspected area several times and send the specimen to the laboratory. The lab sends the results in a few days. Areas that test positive can be surgically biopsied or totally removed. Areas that test normal have avoided the more complicated surgical biopsy and the patient can feel reassured. The simplicity of the new test should allow oral cancer survival rates to improve provided people come to the dentist for their checkups. This includes denture patients as well because it’s not just about teeth, but your life.


You have probably been to the dentist or have taken your child to the dentist and gotten a good check up. Then the dentist recommends sealants for your teeth. If you have gotten a good check up and there is nothing wrong, why do you need sealants? What are they? Our molars have pits and grooves. We need these to chew our food. Sometimes these pits and grooves can be deep. It is easy for food to get stuck in them and hard to keep them cleaned out. Food and bacteria will build up and put your healthy tooth at risk of getting tooth decay. Sealants will help prevent this from occurring.

What Are Sealants?

Sealants are a thin, plastic coating that helps to “seal out” tooth decay and protect the tooth. Sealants protect the chewing surfaces by keeping bacteria and food out of the grooves. Getting sealants is very easy. There is no numbing or drilling involved. The tooth is first cleaned, followed by conditioning and drying. The sealant material is then applied to the tooth and the material is worked into the pits and grooves of the tooth. After the sealant material is applied, a special light is used to harden the sealant material. It takes about a minute for the sealant to form a protective shield on your tooth. You can eat right away! You can’t see them unless you are looking really hard for them. Sealants are clear, white or slightly tinted to match the tooth. They cannot be seen when talking or smiling. Because sealants are very thin and only fill the pits and grooves, your teeth should not feel any different. Sealants are applied mostly to molars and premolars. Your dentist will decide at the exam which of your teeth need the sealants. To prolong the life of your sealant you should always avoid chewing ice (see Ice) and hard candy. Sealants are very affordable, especially when compared to the cost of a filling. You may wonder, why is sealing a tooth better than waiting to see if decay happens and filling the cavity? Decay permanently damages teeth. Sealants protect them. Fillings are not a permanent solution, they can wear down after time too, requiring replacement. Each time a tooth is filled, more drilling is done and the tooth becomes a little weaker. Bottom line is, sealants can save time, money, and the need for more aggressive dental work. But sealants are only one part of preventive dentistry. They do not replace fluoride treatments. Brushing, flossing, good nutrition, limited snacking, and regular dental visits are still the best way to maintain a bright, healthy, beautiful smile. Delmarva Dental Services has been placing sealants since 1981.


Fluoride was first placed in water systems on January 25, 1945 in Grand Rapids, Michigan. Since that time it has significantly reduced cavity rates in two thirds of Americans that are served by fluoridated municipal water systems. Studies show that people who drink this from birth experience have 40 percent fewer cavities. The Center for Disease Control and Prevention has called community water fluoridation one of the ten public health achievements in the United States from 1900 to 1999. Fluoride can be found in water naturally in some areas. It is added to toothpaste, over the counter rinses, dental office treatments, and prescription rinses, gels, tablets, drops and vitamins. The mechanism of action of fluoride is that it becomes absorbed into the plaque and the tooth itself. This makes the tooth more resistant to the acid from plaque that dissolves the tooth, causing a cavity. Fluoride can also remineralize (recalcify) or put lost calcium back in the tooth of beginning cavities. We use this method at Delmarva Dental Services routinely since we can identify cavities sooner by using intraoral cameras, which magnify the tooth 40 to 100 times. Delmarva Dental Services recommends in office fluoride treatments for most children and adults who have had cavities and or cold sensitive teeth or patients with extensive dental treatment, gum recession, anyone with beginning cavities or anyone still getting cavities; our hygienists can paint weak areas of your teeth with a fluoride varnish or prescribe a fluoride gel (Prevident) for home use. Delmarva Dental Services recommends fluoride drops, tablets, and rinses for children depending upon their age, cavity rate, and level of fluoride in their water.

Oral Hygiene

Proper dental home care will insure healthier gums and teeth, greater treatment success and less need for treatment. The following home care products and techniques will help attain these goals. Delmarva Dental Services recommends brushing after every meal, but we realize this cannot always be accomplished. Regardless of the number of times you brush your teeth, prior to bedtime you should brush your teeth for 3 minutes (it’s longer than you think) and floss. Generally, electric toothbrushes are more effective than manual and the Braun 7000 series is the best.

When brushing, think of your teeth as having three surfaces; a chewing surface, cheek surface, and tongue surface. Brush each surface separately and only two teeth at a time. Use a circular motion angled toward the gum line when brushing the cheek and tongue sides (an electric does this for you). Adults should brush their tongue or use a tongue scraper. Children should be supervised.

Delmarva Dental Services recommends low abrasive toothpastes with fluoride for most adult patients (see video “Toothpasts Too Abrasive” ) Children should use a pea-sized amount of an ADA approved toothpaste containing fluoride that tastes good. Delmarva Dental Services recommends ADA approved tartar control toothpaste for patients who have heavy tartar (calculus).


Johnson and Johnson invented flossing 100 years ago. Flossing once a day is more important than brushing when it comes to adults. Flossing has a greater impact on the prevention of gum disease and proximal cavities (cavities between the teeth) that seem to be more prevalent in adults. Picture a tooth in the shape of a cube. The bottom is the hidden root. There are 5 surfaces for cleaning; three by brushing and two by flossing. A toothbrush can brush the chewing surface, cheek surface and tongue surface, but flossing is the only way to reach the proximal surfaces where the teeth come against one another. Most brands of floss are efficient but there are specific types for particular problems. “Glide” and “Colgate Preferred” are good when the contacts between the teeth are tight. There is no significant difference between waxed and unwaxed floss. Some good brands of floss are “Johnson & Johnson”, “Reach” and “Gentle Gum Care”

There are also various flossing aids such as floss forks, floss holders, and mechanical flossers such as the “Power Flosser”, although hand held flossing is usually best. There are also devices, which help patients floss under fixed bridges and implant bridges called “floss threaders” and “Superfloss”. Delmarva Dental Services customizes patients’ home care to their individual needs

Water Pik

For many years research showed little benefit of using a ”Water Pik” over conventional brushing and flossing. However, recent research has shown it to be a benefit to patients with gum disease (periodontal disease). When used with a “Pik Pocket” attachment. Delmarva Dental Services offers “Waterpiks” with “Pik Pocket” to our patients who have deep pockets. They flush the pockets with a special antibacterial solution. Patients who do not have gum disease can use the “Waterpik” together with brushing and flossing but not as a substitute.

Rubber Tip

Delmarva Dental Services recommends this to our patients who are healing from gum lifts, crown lengthening and when their gum tissues are red, flabby and need stimulation.

Mouth Rinses

Delmarva Dental Services recommends“Listerine” for adult patients, especially those who have gum disease (periodontal disease). Listerine is not as good as flossing as their advertising claims. Therefore, do not substitute Listerine for flossing. It is however, the best nonprescription mouthwash for the gums. We will also advise our patients to use this in their Pik Pockets or the prescription mouth rinse”Periogard”. Children should use fluoride supplements based on their decay rate, age and home water fluoride levels. Fluoride may be in the form of drops, vitamins, pills, rinses, or gels.

Sports Mouthguards

There are 15 million sports injuries, over a million concussions and 5 million teeth lost a year in the U.S.  In  a single athletic season there is a 1 in 10 chance of tooth or facial injury and a 45% lifetime risk. The most likely sport for an oral injury from most to least is baseball, bicycling, hockey and basketball. The most likely sport for concussion from most to least is football, ice hockey and soccer. Children between the ages of 7 and 10 have 60% of oral injuries. Concussions most often occur from 10 to 19 years of age.  Most of these injuries could be prevented by wearing a sports mouthguard. 4 out of 10 Americans report that their child does not wear a mouthguard at soccer, basketball, baseball and softball practices or games.  There are 3 types of mouthguards stock, boil & bite & custom. High school football players are 2x more likely to suffer a concussion from over the counter than a custom sports guard.  Here at Delmarva Dental, we can make a custom mouthguard for your son or daughter.

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