Fisher & Orfaly Blog


Why You Would Need an Implant

If you are self-conscious because you have missing teeth, wear dentures that are uncomfortable or don’t want to have good tooth structure removed to make a bridge, talk to your dentist to see if dental implants are an option for you.

Dental implants are an effective way to replace missing teeth. They are an excellent long-term option for restoring your smile.  The development and use of implants is one of the biggest advances in dentistry in the past 40 years.Dental implants are made up of primarily titanium which is compatible with the human body.

Dental Implants are posts that are surgically placed in the upper or lower jaw, where they function as a sturdy anchor for replacement teeth.  You can think of the implant as a “fake root.”

Dental implants are done in two phases: 1. Surgical and 2. Restorative.  At the surgical visit, the dentist will place the titanium fixture (fake root) into the jawbone. After this appointment, the implant fixture has to fuse to the bone.  This process is called osteointegration.  Osteointegration typically takes twelve weeks.  After this twelve week period, the surgical dentist will verify radiographically that the osteointegration process is complete.  Once the implant is fused to the jawbone, the implant is ready to be restored with a dental crown.  The restoring dentist will take impressions in order to have the crown fabricated by a dental laboratory.

In the case of someone missing all their teeth, implants can help greatly in connecting to a denture which will make a denture stable, retentive, and ultimately much more comfortable for a patient to wear.

Dental implants are a very good option to replace teeth and have a high success rate.  However, there are two situations that are common reasons why an implant may not be right for you: 1. Diabetes and 2. Smoking.  The diabetics sometimes have slow or compromised healing which would lead to an implant not integrating with the bone.  Smoking has a negative effect on healing as well which could lead to an implant failing.

If you are interested in dental implants, it’s a good idea to discuss it carefully with your dentist first. If you are in good general health this treatment may be an option for you. In fact, your health is more of a factor than your age.


How to Improve Your Smile

Teeth Whitening

There are several ways that you can whiten your teeth, from over-the-counter products to professional strength products.  In-store options include:  1. Whitening toothpastes, 2. Whitening mouthwashes, and 3. Whitening strips.  Regardless of which product you choose, all use products that have earned the ADA Seal of Acceptance. One reliable method you dentist can provide for you is whitening trays.  Your dentist would take impressions of your teeth in order to fabricate custom fitting trays.  You will be given the trays along with professional strength whitening gel.  Before starting any whitening treatment, you should visit your dentist to ensure your teeth and gums are healthy and disease free.


A crown is an excellent treatment option to reshape and/or change the color of a tooth. A crown slips over a tooth allowing your dentist to make the tooth look the way you want it.


Veneers are thin ceramic facings that are cemented to the front teeth.  Veneers allow your dentist to change the color and shape of your teeth.


Your dentist can help improve your smile by applying tooth-colored material to your teeth. This is typically done in one office visit and can dramatically improve the esthetics of your teeth.

Orthodontic Clear Aligners

While you may think of braces as something only for children, orthodontics is a great option for adults that want to straighten their teeth.  Orthodontic advancements have made it possible to straighten teeth without metal braces.  Now dentists have clear aligners as an option.


If you are missing teeth, it can greatly decrease the appearance of your smile.  Dental implants are an effective way to replace missing teeth.  Surgically placed in the upper or lower jaw, they act like a “fake root” which will support a crown that your dentist will make.  Implants are a long-term option for restoring your smile.

Brushing and Flossing

Brushing and flossing as directed by your dentist are the most important methods for keeping your mouth healthy.  Brush twice and floss at least one a day to prevent cavities, and improve your oral health.  A clean, healthy mouth is much more attractive than a mouth with plaque and red, puffy gums.  Good oral hygiene habits will go a long way in improving your smile.

Regular Dental Visits

It is important that you have your teeth examined by your dentist and cleaned professionally as instructed by your dentist so that you can keep your mouth healthy and looking great.






Why is My Tooth Sensitive to Cold or Hot?

Is the thought of having ice cream or a cup of hot coffee upsetting?  Does brushing your teeth with cold water make you wince occasionally?  If so, you may have sensitive teeth.

Possible causes of tooth sensitivity include: 

  • Tooth decay (cavities)
  • Exposed root surface from gum recession
  • Broken down fillings
  • Gum disease
  • Worn tooth enamel
  • Fractured tooth structure

In healthy teeth, the outermost layer is enamel which is the most dense substance in your body.  The enamel layer protects the crowns of your teeth—the part above the gum line.  Below the gum line is the root of the tooth.  The outer layer of the root is cementum.  Cementum is softer (or less dense) than enamel.  When the cementum layer is exposed due to gingival recession, cold and hot can irritate the nerve. Underneath both the enamel and the cementum is dentin. The dentin is the inner tooth layer which is less dense than enamel and cementum.  The dentinal layer contains microscopic tubules (small hollow tubes). When dentin loses its protective covering of enamel or cementum these tubules allow heat and cold to reach the nerves and cells inside the tooth. The result can be hypersensitivity.

If there is a fracture line within the tooth, the nerve can be irritated when you bite down on the area that has the fracture due to the movement of the fractured tooth structure.  If a tooth has a portion missing due to it fracturing off, the nerve is not as protected and can be aggravated.

Treatment for sensitive teeth

Your dentist will recommend treatment for your sensitive tooth depending on the cause of the sensitivity.  Your dentist may suggest one of the following treatments:

  • Desensitizing toothpaste. This contains compounds that help block transmission of sensation from the tooth surface to the nerve, and usually requires several applications before the sensitivity is reduced.  It typically takes three weeks of consistent use to start to relieve sensitivity.
  • Fluoride gel. An in-office technique which strengthens tooth enamel and reduces the transmission of sensations.  Your dentist will apply the gel with a small brush to the sensitive area.
  • A crown.  A crown is used when a large portion of the tooth is missing due to decay or fracture.  Also, a dental crown is placed on a tooth that has a symptomatic fracture line to immobilize the segment that is fractured.
  • Root canal. If sensitivity is severe and persistent and is diagnosed to be irreversible, your dentist may recommend root canal therapy to treat the problem.

Poor oral hygiene contributes to many of the causative factors behind tooth sensitivity.  If plaque is not removed properly and consistently, it can lead to tooth decay and/or gum recession.  It is important that you maintain good oral hygiene habits and visit your dentist regularly.


Why You Would Need A Root Canal

If you have a tooth that is fractured, severely decayed or has an infection (abscess), your dentist may recommend root canal therapy (often times the word “therapy” is dropped and the procedure is commonly referred to as just “root canal”). Root canals are used to repair and save your tooth instead of extracting it.

What’s Involved in a Root Canal

Every tooth has a root canal system which houses the blood vessels and nerve fibers of the tooth. The blood vessels and nerve fibers are referred to as the pulp of a tooth. Tooth structure is living tissue so it requires oxygen so that’s why there are blood vessels inside each tooth. The pulp can become infected if you have:

  • A deep cavity that goes to the pulp (the bacteria that creates the cavity is now in the root canal system).
  • A cracked or fractured tooth
  • Blunt trauma to a tooth causing injury to the blood vessels entering the roots.

If untreated, the tooth can become infected. If this happens, you may develop pain and swelling and an abscess may form in the bone around the end of the root of the tooth. The bacteria in the bone can break down the bone matrix which could lead to lose of the tooth.

What You Should Expect

Root canal therapy can take 1 or 2 office visits to complete. Since your dentist will use local anesthetic (Novocaine), the procedure is typically pain-free.

Before Treatment Begins, Your Dentist Will:

  • Take X-rays to see the apex of the root and surrounding bone.
  • Numb the area around and including your tooth so you are comfortable during the treatment.

During treatment, Your Dentist Will:

  • Create an opening (access to the pulp) through the biting surface of the tooth.
  • Remove the blood vessels and nerve fibers from inside the root canal system of the tooth.
  • Irrigate the root canal system with germ-killing medicine.
  • Fill the root canals with a rubber-like material called gutta percha to seal the apex of the roots.
  • Cover the access with a temporary filling until a permanent filling or crown can be placed.

What Happens After Root Canal Treatment:

  • The tooth and surrounding area may be a little tender for a few days. Your dentist will talk to you about what you can do to lessen the discomfort.
  • Your dentist may prescribe antibiotics due to the nature of the infection.

How Long Will a Tooth That Had a Root Canal Last?

A tooth that has had root canal therapy can last a lifetime. It is always important to maintain good oral hygiene habits and visit your dentist regularly to ensure optimal oral health.


Oral Anti-Snoring Guard

There are over 90 million American adults that snore.  Snoring does not only affect the snorer but often times their loved ones as well.  It is estimated that over 185 million Americans are negatively affected by snoring.  I often hear from patients that snoring has caused them and their spouse to sleep in separate rooms.

Snoring occurs when there is an obstructed airway.  Often times, when we sleep, our tongue slides to the back of our mouth and our jaw relaxes both of which contribute to the airway becoming obstructed. The noise of snoring is caused by the air we breath in trying to pass through this obstructed airway; the air vibrates off if the tongue, soft palate, and tissue of the throat.

At Fisher and Orfaly Dental, we fabricate an anti-snore guard called a mandibular advancement device.  This custom designed appliance moves the jaw in a forward position bringing the tongue forward as well.  This increases the size of the airway which in turn reduces air velocity, vibration, and snoring.

The anti-snore guard is fabricated from impressions of your mouth and requires only two appointments.

The device consists of two soft plastic forms which seat over your upper and lower teeth.  These are attached by short connectors that bring the lower jaw in a forward position during sleep preventing snoring.  To demonstrate this, I ask you now to try and make the snoring noise.  Once you do that, move your jaw forward and try making the snoring sound.  I imagine that you had great difficulty making the noise with your jaw forward.

If the airway is blocked completely for longer than 10 seconds, you may have sleep apnea and we suggest you see a medical doctor.


February is National Children’s Dental Health Month

The team at Fisher & Orfaly Dental want to help make taking care of your children’s teeth fun.  Here are some tips.

1.  Make brushing your teeth twice a day for two minutes each time an event.  Play your child’s favorite music for two minutes (you can even make up a fun dance to go with the music).  Or, read from your child’s favorite book for the two minutes.

2. Reward good brushing.  Maybe you let them pick the book you read at bedtime or make a sticker chart.  Or, simply ask to see their pearly whites and give them a high five.

3.  Go shopping together and let them pick out their toothbrush and toothpaste.  We at Fisher & Orfaly Dental recommend buying products that have the American Dental Association Seal of Acceptance.

4.  All of the products have popular children characters on them.  This makes it fun and exciting for kids.

5.  If they cannot find a character they like, make up a story in which they are the superhero fighting the “bad guys” that want to start cavities.

6.  Make brushing a family affair.  Remember, your children learn from you so set a good example.

7.  Start a routine and stick to it.  You may be tempted to let them skip brushing their teeth after a long day but do not.  The more brushing becomes second nature the easier it will be for them to maintain good oral hygiene habits for a lifetime.



Why Would You Need a Dental Crown

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for Dental Crowns:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.
  • Tooth has a root canal.

What Does Getting a Dental Crown Involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.  At Fisher & Orfaly Dental, you will be given care instructions and encouraged to have regular dental visits to check your crown.


Mouthwash for Better Oral Health

Mouthwash should not be viewed as a replacement for daily brushing and flossing, but as a helpful addition to your daily oral hygiene routine.

Some benefits of mouthwash are: reducing bad breath, help to prevent cavities, fight against gum disease, and relief of dry mouth.

Mouthwashes are divided into two categories:  cosmetic and therapeutic.  Cosmetic mouthwash may combat bad breath temporarily and leave a pleasant taste.  Therapeutic mouthwash has active ingredients that help fight against gingivitis, plaque, dental decay and bad breath.

A mouthwash that is formulated to fight against gingivitis and plaque will likely have antimicrobial ingredients such as chlorhexidine, cetylpyridinium, and essential oils.

Mouthwashes that are designed to be anti-cavity will have fluoride ions which help remineralize broken-down enamel.

There are also whitening mouthwashes. These mouth washes will usually contain carbamide peroxide or hydrogen peroxide as an active ingredient.

A few important thought to end this blog.

  1. Using mouthwash does not mean you do not need to brush and floss. It is used in conjunction with a proper oral hygiene regimen.
  2. Always use mouthwash that has the ADA Seal of Acceptance.
  3. Use prescription mouthwash as directed.



Dental Cavities and the Role Sugar Plays

With Halloween around the corner, and our dental office being in Salem, MA, the Halloween capital of the world, we wanted to talk about dental cavities and the role sugar plays.

A cavity by definition is an empty space within a solid object.  So, a dental cavity is an empty space within a tooth.  The empty space is first created by destruction of a tooth’s enamel.  The enamel is the hard, outer layer of a tooth.

How does the enamel breakdown?  Plaque, a sticky film of bacteria, constantly forms on teeth. When we eat and drink foods containing sugars, the bacteria in the plaque produce acids that attack enamel.  Because plaque is sticky, it keeps the acid in contact with the teeth and over time, if not removed, the enamel will erode.  This erosion of enamel is when a cavity is formed.

With Halloween, comes eating of candy which has a high sugar content.  It is important that we do not allow the sugar and the plaque to stay on our teeth for long periods of time. What we recommend is:

  1. Brushing twice a day and even throw in an extra time on days such as Halloween, when you consume a lot of sugar.
  2. Floss daily.
  3. Eat nutritious and balanced meals.
  4. Visit your dentist regularly for professional cleanings and exams.


Proper Toothbrushing Technique

The American Dental Association recommends that you brush your teeth twice a day for two minutes each time with a soft-bristled toothbrush.

To review the proper brushing technique, here are the essentials.

  1.  Place your toothbrush at a 45-degree angle to the gums.
  2. Move the brush back and forth in gentle, short strokes.
  3. Tilt the brush vertically and make several up-and-down strokes to clean the inside surface of the front teeth.
  4. Brush your tongue to help fight against bad breath by removing bacteria that hide in the bumps and grooves of your tongue.
  5. Replace your toothbrush every 3 months or sooner if the bristles become frayed.