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Sal Longo D.D.S.

Northridge Professional Building
77 Quaker Ridge Road, Suite 211
New Rochelle, NY 10804
(914) 636-3366

Frequently Asked Questions

Stooges What is fluoride and why is it controversial?

Can my teeth be whiter?

What are implants?

Why should I replace a missing tooth?

Is flossing really important?

Should I replace my silver fillings?

What are wisdom teeth?

When should I take my baby to the dentist?

What is the difference between a cap and a crown?

What is bonding?

Can I get AIDS from a dental visit?

What exactly is a root canal?

Q. What is fluoride and why is it controversial?

A. Fluoride is a substance that strengthens the enamel (outer coating) of teeth. It can be administered in a number of ways. In many communities fluoride is added to the drinking water so that every time you have a glass of water you get a small amount of fluoride internally. Most toothpastes contain fluoride and there are over-the-counter mouthrinses that contain fluoride. In addition many dentists will give their patients fluoride treatments as part of a standard recall appointment. In communities where the water supply is not fluoridated many pediatricians will prescribe fluoride supplements to their young patients.

Fluoride is controversial because like many substances it can be harmful in large doses. If a child swallows a significant amount of toothpaste or a fluoride mouthrinse it can make them sick and discolor their teeth. Also, many extremists believe that water fluoridation by the government is an unethical way to mass medicate the population against its will.

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Q. Can my teeth be whiter?

A. Hardly anyone is born with pure white teeth and so most everyone can have whiter teeth. There are many ways of achieving this. One of the easier and more cost-effective methods is teeth-bleaching. There are two general ways of doing this. One is called Nightguard bleaching or home bleaching and it involves wearing a thin plastic form over your teeth (usually while you sleep) containing the bleaching material. This method usually takes about two to three weeks but sometimes the full effect won't be realized for several months. The second method is usually referred to as in-office or laser bleaching. This type of bleaching is done in the dental chair and consists of several visits of about 45 minutes in length. A more potent bleaching material is placed on the teeth and activated by a laser or high-intensity light. Since the bleaching material is very strong, the lips, gums and tongue must be protected by a dental dam. This procedure is also a little more costly than home bleaching.

Another way of whitening the teeth is through porcelain laminate veneers. These are very thin layers of porcelain which are bonded to the fronts of teeth to whiten and sometimes even correct some other abnormalities like chipped teeth or slightly crooked teeth. The advantage to veneers is that the outcome is much more predictable than bleaching. The disadvantages are that veneers are more costly and they do involve some minor drilling, though often the drilling can be done without an anesthetic.

A third mode of teeth whitening is cosmetic bonding. Bonding is the placement of a white filling material over the faces of the teeth similar to veneering. The difference is that the bonding material does not last as long as porcelain and does not have the same luster. An advantage is that it takes less time and is less costly.

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Q. What are implants?

A. Implants are tooth replacements that are anchored right into the jawbone. Unlike bridges, which are fastened to adjacent teeth or dentures which are removable, an implant is a tooth replacement that feels more like a natural tooth. The disadvantage to getting an implant is that it is a surgical procedure so there is healing time to take into account, and they tend to be very costly. However the end result tends to look and feel more like a natural tooth than other replacements. Implants can also be used to anchor bridges and dentures.

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Q. Why should I replace a missing tooth?

A. Many people feel that it is unnecessary to replace missing teeth especially if they are in the back of the mouth. This isn't so. When there is a space in the mouth other teeth tend to drift into that space. Teeth behind the space drift forward. Teeth above drift down. And teeth below actually drift up. This can cause problems with your bite and your gums and can also create a situation where cavities are more likely. Wisdom teeth are the only teeth that do not need to be replaced.

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Q. Is flossing really important?

A. Flossing is very important because it helps remove plaque and food particles from between the teeth and under the gums. These are places that toothbrushes generally have a hard time reaching. This is important in controlling gum disease and avoiding cavities between teeth. New studies have found that flossing may be even more important in maintaining the health of other parts of the body. When plaque accumulates between teeth it contributes to gum disease. The gums become inflamed and this causes them to bleed easily. The bacteria in the plaque can then get into your bloodstream and travel to other parts of the body like the lungs, heart and brain. This is thought to contribute to heart disease, stroke, lung problems and even memory loss.

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Q. Should I replace my silver fillings?

A. Some dentists advocate the removal of silver fillings because of the presence of mercury in the fillings. These fillings are called amalgams and are the subject of lots of controversy. Certain studies have linked mercury levels in the blood with all sorts of diseases and disorders from arthritis to multiple sclerosis. However the ADA (American Dental Association) has done studies and has not found any evidence linking amalgam mercury to any systemic problems. Although the blood level of mercury does rise when a person has several silver fillings, it is generally thought that this increase is insignificant. It is believed that the wholesale removal of amalgam fillings is unnecessary. However since white bonded fillings are now very strong and durable, it does make sense to replace defective old silver fillings with white fillings. It also makes sense to replace some silver fillings with white fillings for cosmetic reasons.

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Q. What are wisdom teeth?

A. Wisdom teeth are the third molars. They are the last teeth in the mouth. There are four of them: one upper left, one lower left, one upper right, one lower right. They're called wisdom teeth because they usually come in much after the rest of the teeth, in the late teens or early twenties. The reason that so many people run into trouble with them is that through evolution our faces got flatter and our mouths often can't accomodate those last four teeth. So they become impacted. That means that they are either partially or fully under the gums, wedged behind the second molars, or even fully embedded in the jawbone. Many times these impacted teeth can cause serious infections, and so they are usually pulled. Another reason that wisdom teeth can cause problems, even if they are not impacted, is because they are so far back in the mouth, most people have a hard time keeping them adequately clean and that can cause big cavities or gum problems.

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Q. When should I take my baby to the dentist?

A. It used to be thought that a good age to begin taking kids to the dentist was between three and four years old. Now the thinking is that sooner is better than later. If minor problems are noticed they can be corrected before they worsen. Younger children don't necessarily need to have a full formal visit but it's a good idea for them to come to the office and experience the sights and sounds of a dentist office. Early visits where no major work is done can accustom them to later appointments where they may need a filling or more. At that point they will be desensitized to the dental environment and it will prove to be less traumatic for patient and parent. It is also important for young children who do not live in fluoridated communities to get fluoride supplements. (see "What is fluoride...?")

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Q. What is the difference between a cap and a crown?

A. Generally speaking, a cap and a crown are just different words for the same thing, although there are different types of crowns. One type is called the porcelain-metal crown which has a metal framework for strength and a porcelain coating for esthetics. The all-gold crown used to be very popular but is not very common these days. Gaining in popularity, due to the advent of stronger, more durable porcelains, is the all-porcelain crown. In the old days, they were called Porcelain Jackets or PJ's and they were only done on front teeth. Nowadays they can be used anywhere and we even make all-porcelain bridges.

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Q. What is bonding?

A. Bonding is a term that is used for white fillings that are bonded to a tooth. Metal fillings are held in teeth mechanically but white fillings, also called composites are chemically bonded to the tooth (usually by use of a high-intensity blue light). Bonding can be done on any tooth, but when many people talk about bonding they are referring to cosmetic bonding which is the placement of composites on the front teeth either to whiten or to improve their look. (see "Can my teeth be whiter?")

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Q. Can I get AIDS from a dental visit?

A. Your chances of contracting AIDS from a dental visit are extremely slim perhaps even zero. In order for a person to be infected with HIV (Human Immunodeficiency Virus) there must be either blood to blood or semen to blood contact. For you to catch AIDS from your dentist he must somehow cause himself to bleed then transfer enough blood into an open wound in your mouth. This is an extremely unlikely occurrence to happen by accident. Even if the doctor did not practice good sterilization techniques and there were traces of blood on an instrument from a previous patient, the virus that may have been in the blood would have died already from exposure to air. Even if the dentist bleeds into your mouth and you swallow some blood, the virus is killed by stomach acids.

Several years ago there was a celebrated case of a dentist in Florida who evidently infected a few of his patients. After exhaustive studies of the case the CDC (Center for Disease Control) ultimately decided that there was something more to the story; perhaps the dentist actually infected the patients purposely. Before and since there have been no other instances of AIDS being passed from a dentist to a patient.

Dentists (as well as all other health care providers) routinely use what is known as "Universal Precautions". This means that they assume that any patient or staff member can theoretically be carrying an infectious disease and therefore all precautions are taken, with every patient, to prevent any spread of disease. This involves the use of disposables where applicable and the sterilization of all non-disposable instruments.

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Q. What exactly is a root canal?

A. A root canal or more precisely root canal therapy is basically the removal of the nerve from the root or roots of a tooth. The reason for this is that the nerve is either dead, dying or infected. The procedure consists of gaining access to the nerve by drilling through the top or back of the offending tooth and then physically removing the nerve from the tooth. Once the nerve is gone the canal is cleaned and shaped with small instruments so that it is wider and smoother. Then a root canal filling is placed within the canal.

Root canals vary in many ways. Some teeth have only one canal while molars typically have three or more. A root canal procedure can take one visit or many and sometimes a dentist may use what is called a dental dam to isolate the tooth. Many times a general dentist will do the root canal therapy but sometimes you may be referred to a specialist in root canal treatment called an endodontist. In some cases antibiotics may be necessary. Many people breeze through root canals without any discomfort, while a few may experience severe pain. This usually depends on how badly the tooth has been infected prior to starting the treatment.

Once the root canal therapy is completed oftentimes a post and a crown need to be made for the tooth. The reason for this is that after a root canal the tooth is compromised both by loss of tooth structure and by loss of the blood supply to the tooth. This makes the tooth more brittle and more likely to fracture. Sometimes a tooth will discolor after a root canal procedure.

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Sal Longo, DDS; http://www.sallongo.com/faq.html