Whether you would like to learn more about how bleaching treatments work or how often to change your toothbrush, this is the place for answers!


  1. What is the best way to brush my teeth?
  2. How often should I replace my toothbrush?
  3. What is gum disease and how can I prevent it?
  4. What treatments are available for gum disease?
  5. Why do teeth become discolored?
  6. How do cavities develop?
  7. How does bleaching work?
  8. Why is it necessary to replace or save teeth?
  9. How important is flossing?
  10. Is restorative dentistry necessary?
  11. What is tartar?
  12. Why are my teeth sensitive?
  13. How should I care for my child’s teeth?
  14. What dental problems are common among older people?
  15. What are cold sores and how can I prevent them?
  16. What is sleep apnea?
  17. What is obstructive sleep apnea?
  18. What is snoring?



What is the best way to brush my teeth?


First, proper brushing requires at least 2 minutes. Most adults don’t come close to brushing that long. Dr. Hirsch and Rosen recommend that to get a feel for the time involved, try brushing your teeth for the length of time that a song plays on the radio.  Also try to find something in your daily routine a TV show or a book you are reading and floss every time your start this activity.


Use a toothpaste that contains fluoride. Always use and choose a soft or extra soft-bristled brush designed for effective plaque removal. Angle the bristles of your toothbrush so that they are angled towards the gum line at a 45-degree angle. Rather than brushing up and down or back and forth, just make small circles with the bristles so that the bristles actually flex in position, then move the brush towards the biting surfaces of the teeth. Always use very gentle pressure. Do this on both sides of the teeth. Biting surfaces can be brushed any way that is convenient for you. The idea is correct positioning of the bristles and not the strength of your brushing. Move on to the next tooth. This way you will effectively clean the teeth and the area of the tooth just under the gum line and not wear down the gum itself. Pay extra attention to the gum line, hard-to-reach back teeth and areas around fillings, crowns or other restorations. And for fresher breath, brush the back and top of your tongue.



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How often should I replace my toothbrush?


Dr. Hirsch, Rosen and their hygienists recommend that you replace your toothbrush approximately every three to four months. The toothbrush bristles should never appear worn or distorted in shape. This signifies that you are brushing with too much strength and may be wearing down your gums. A worn toothbrush will not clean effectively and may actually harm your gums. Some practitioners also recommend that you change your toothbrush after an illness, such as a head cold, as they feel that you may re-infect yourself with the germs on the toothbrush.



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What is gum disease and how can I prevent it?


Most gum disease is caused by bacteria that collect at and just under the gum line forming a soft sticky plaque on the teeth. This bacterial plaque releases toxins that irritate the soft tissues/gums around the teeth. When this plaque is present for a longer time period it can calcify and harden into calculus or tartar, which you cannot get off your teeth without a professional dental cleaning. Both the plaque and calculus act as a local irritant that causes gum irritation and inflammation that results in slow and progressive loss of the gum and bony attachment that holds the teeth in place if it is not routinely removed. Unfortunately, the signs of gum disease aren’t always easy to see and are usually painless. That’s why the earlier gum disease is discovered; the easier it is to treat.


Some signs of gum disease are:


  • Gums that bleed or are red, swollen and tender.
  • Gums that have pulled away from the teeth.
  • Pus that appears between the teeth and gums.
  • Teeth that are loose or have changed position.
  • Bad breath or a bad taste in the mouth


To determine if you have gum disease, Dr. Hirsch or his hygienist may probe your teeth and gums to assess your condition. The best prevention is good home care and routine dental cleanings at a quality and preventive oriented dental office such as ours. Scaling, a type of dental cleaning procedure, is usually the first and most effective treatment. Some preventative measures against gum disease are:


  • Brushing your teeth in the manner described above.
  • Using a soft or extra-soft toothbrush.
  • Routine dental cleanings at our office at an interval determined by your specific needs.
  • Do not use alcohol-containing mouthwashes.
  • Prescription oral rinse therapy is recommended in some circumstances.


See us regularly for checkups and professional cleanings.


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What treatments are available for gum disease?


The first approach usually is non-surgical intervention or treatment. This may involve a different or more extensive and expensive dental cleaning (scaling and root planning) that involves using a local anesthetic. This is done over at least two different appointments. A re-evaluation one month after treatment is standard practice. In many cases this may be the only treatment necessary although you may need more frequent cleanings in the future.


Gum disease that has progressed beyond this non-surgical treatment level needs to be referred to a periodontist, a dental specialist who only treats gum disease. Treatment at the dental specialists office may include Flap Surgery, gum and/or bone grafting, and/or regeneration of lost tissue.


In Flap Surgery, the gum is lifted from the tooth and bone, and the diseased tissue and debris (calculus or tartar) underneath it is removed. The infected bone may be reshaped or a bone graft may be placed. After surgery, the gum is repositioned and sutured (stitched) in place.


In some cases, destroyed tissue between teeth or roots can be partially regenerated. Once the damaged area is prepared and special membranes are placed, new tissue can grow into this area over a period of time.


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Why do teeth become discolored?


Teeth naturally darken as we age. Over time teeth absorb superficial surface stains from the food we eat and the beverages that we drink. Some everyday things that cause staining may include exposure to smoking, coffee, tea, soda, wine, chewing tobacco, and certain foods, such as berries. As we get older the outer surfaces of the teeth also get thinner and less translucent and therefore the darker inner coloration shows through. Discoloration can also occur because of certain childhood illnesses, medications, physical trauma, etc.


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How do cavities develop?



Cavities occur when food and bacterial buildup on teeth called plaque interact, producing acids that can eat away at the tooth surface. Brushing and flossing will remove this sticky, almost colorless layer of bacteria on teeth and needs to be done on a twice daily basis.


Cavities that are caused by the environment or our lack of excellent home care are most commonly located between the teeth where they meet the adjacent tooth or under and around older dental fillings or crowns. This type of cavity is usually found with routine radiographs (x-rays).


Developmental cavities are cavities that occur in the biting surface grooves of the back teeth and may be caused by the way these teeth develop or form. This type of decay or cavity is usually the type of decay that occurs during our early teen and pre-teen years. Cavities that are caused by the environment or our lack of excellent home care are most commonly located between the teeth.


Older adults usually develop gum line decay due to salivary changes in both quality and quantity. Many times this type of decay is caused by medications and aging. Dry mouth from either aging or medication is a prime cause of decay and necessitates topical fluoride treatments during dental cleaning appointments. In some instances I may recommend that the patient use a daily fluoride rinse as a supplement throughout the year. Decay and/or cavities also form around older fillings and/or crowns as these fillings age and deteriorate. When patients develop periodontal disease and there is recession of their gums and the bone underneath it they may find that more food gets impacted between their teeth and it is harder for them to remove it. Another contributing factor that we tend to ignore is that as we age our manual dexterity and eyesight deteriorate so we may think that we are doing a better job with our oral hygiene than we actually are doing. In these cases I recommend more frequent dental cleanings in my office.


As adults many of our cavities form in between the teeth and this is the reason for routine yearly dental radiographs that show these areas that are not easily visible during a routine dental examination alone.


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How does bleaching work?


Teeth naturally darken as we age. Over time, superficial staining is caused by exposure to coffee, tea, soda, tobacco, wine, and many foods. Discoloration can also occur because of certain childhood illnesses, medications, physical trauma, etc.


A tooth whitening system should remove discolorations with a gentle sustained release action of a peroxide material that will oxidize (bleach) or wash out stains within your teeth. Your tooth structure should remain unchanged.


Most bleaching systems work to some extent. The facts to keep in mind when choosing any bleaching system for your use is that the overall effect or results are directly related to the strength of the bleaching solution and the time that it is actually against your teeth. Many of the over the counter products, including toothpastes and whitening strips, need to have very low concentrations of bleaching ingredients so that they will not cause problems or irritation of tissues for the general public. They also are not against the tooth surfaces for any length of time. Think how long toothpaste is actually against your teeth before your saliva dilutes it or you rinse it out. This is not a very effective or efficient mechanism for bleaching. History and research does show that most patients experience some level of tooth whitening. Porcelain restorations and white fillings do not whiten with bleaching agents.


In-office whitening solutions can offer a higher bleaching solution concentration and a more effective and efficient mechanism for holding the bleaching agent against the tooth structure for a longer period of time. This results in a more consistent and better overall bleaching (whitening) outcome. We offer multiple bleaching solutions for our patients since only one system is not good for everyone.


Dr. Rosen will examine your teeth and gums to ensure good oral health. Old fillings may need to be replaced and/or decayed areas treated and filled. Dr. Rosen or one of his knowledgeable staff members can discuss with you which bleaching option would be best for your particular needs. We offer multiple choices that include the advertised 1-hour in-office procedures, Zoom Advanced (used in the TV makeover programs) or bleaching “pens”, and home tray systems for you to use at your discretion.


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Why is it necessary to replace or save teeth?


Whenever teeth are lost, over time the remaining teeth shift and move to try to close the space. This shifting and tilting of the teeth causes a change in the way that the upper and lower teeth meet and how the forces on these teeth are distributed on the teeth themselves. Teeth can support a great deal of pressure when they are upright. When they are tilted or angled, biting forces will continue to force or increase these angles and increase lateral shifting. Forces due to interferences during lateral sliding or biting can loosen these teeth further and increase the likelihood of the loss of the adjacent and opposing teeth. Food impaction in these areas also becomes a problem. This also increases stresses and biting forces on the remaining other teeth increasing the likelihood for the loss of more teeth in other areas of your mouth.


Shifting of the remaining teeth creates difficulty in your maintaining them and your ability to clean them effectively. This results in increased bacterial plaque buildup that hardens into tartar and increases gum disease and tooth decay. Loss of teeth creates irreversible changes and many more problems and expenses than treating the original missing tooth and space. The increased stress and shifting of the remaining teeth causes chewing to be impaired.


Also, when teeth shift so that the upper teeth no longer correctly mesh with the lower ones, chewing can be impaired and this can create stress on the jaw joint and other teeth. Shifting can cause the mouth to sink in and the face to change appearance. The lips may thin and straighten, the chin may jut out and upward, and pouches may appear on the sides of the jaw. Dentures, which can replace lost teeth, do not function like your own teeth. The best dentures are only approximately 20 – 25% as efficient and effective during chewing and eating as natural teeth. They are a poor replacement for natural teeth but in many cases they are the only alternative except for implant replacement or implant supported appliances.


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How important is flossing?


Some adults floss daily, but most don’t. If you are one of the latter, you’re leaving up to 35% of your tooth surfaces untouched and unclean.


Floss everyday, because toothbrush bristles cannot reach completely between teeth. Use a high-performance, shred-resistant floss designed to slide easily and comfortably into the tightest spaces. When sliding the floss in, take care not to snap it down on the gums. Instead, move it up and down along the sides of each tooth in a “shoeshine” or “C” shaped configuration, making certain to clean below the gum line. And take a moment to check your gums for symptoms of gum disease, such as soreness, puffiness, bleeding and redness. If you think any of these signs are present, see Dr. Rosen or his hygienist right away.


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Is restorative dentistry necessary?


Restorative dentistry is the process that occurs when the dentist restores an injured, decayed, or lost tooth, returning it to its normal function. Timely treatment can be the difference between retaining or losing your good oral health.


Not only does tooth repair help improve appearance, it also can correct many structural problems such as chipped, infected and decayed teeth – conditions that can ultimately lead to more serious damage unless this situation is treated early.


While injuries, such as chipping a tooth, creates the need for restorative dentistry, the most typical cause is decay. Filling a cavity is, perhaps, the most familiar restorative treatment. Other procedures include crowns and root canals. Dr. Rosen can fully explain each procedure and determine what treatment is needed in your specific situation.


Whether a tooth is lost through damage or disease, ignoring the space it leaves can cause serious problems for your other teeth. When one tooth is missing, others may drift into the empty space, affecting your appearance and jaw movement. There are many options for replacing missing teeth, including dentures, bridges and implants. Ask Dr. Rosen about the best choice for you.


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What is tartar?


Tartar is an accumulation of mineral deposits and hardened plaque, the substance that forms on everyone’s teeth daily. Studies have shown that plaque can become tartar within just 24 hours. That makes tartar, particularly below the gum line, an everyday problem that threatens the health of your teeth and smile.


Tartar makes it harder to maintain good oral hygiene because its irregular surface makes cleaning more difficult. Over time, tartar can build-up to such a degree that it begins to form under the gum line. When that occurs, the plaque that accumulates in this highly vulnerable area irritates the gums and causes gum disease that can result in the loss of the supporting bone holding the teeth in place. What’s more, tartar is a cosmetic problem due to its brown or yellow color. Tartar absorbs stains very easily, especially if you consume coffee or use tobacco.


Once tartar has formed, only Dr. Rosen or his hygienist can remove it. The process of removing tartar is called a dental prophylaxis or cleaning. During a prophylaxis, Dr. Rosen or his hygienist uses a special instrument to clean the tooth above and below the gum line. As with many health concerns, prevention is the key. Proper oral care at home can greatly reduce tartar build-up and also help make the next dental prophylaxis (cleaning) a little easier.


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Why are my teeth sensitive?


If you’ve ever felt a painful sensation in your teeth after drinking or eating hot or cold food and beverages, you’ve experienced tooth sensitivity. You are not alone. It’s a condition that affects one out of every four adults, often coming and going over time.


The most common cause of sensitive teeth is exposed root surfaces due to receding gums. These root surfaces are not covered by protective enamel. As a result, the root surface exposes thousands of microscopic channels leading directly into the pulp, the tooth’s nerve center. When heat, cold and pressure touch these channels, they direct the sensation into the pulp and cause pain.


The second major cause of tooth sensitivity is biting trauma or excessive forces on the teeth. This can be caused by many factors and needs to be individually evaluated and treated.


Ignoring hypersensitivity can lead to other oral health problems. Since exposed surfaces aren’t covered by protective enamel, they are more susceptible to decay and can result in dental abscesses or tooth loss. What’s more, the pain of hypersensitivity can cause you to brush poorly, putting your teeth and gums at further risk.


If you have pain, let Dr. Rosen know. Usually it can be treated through the use of a brush-on prescription fluoride gel or an anti-sensitivity toothpaste. Be sure to follow proper oral care at home.


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How should I care for my child’s teeth?


Even before you can see them, primary (baby) teeth are developing under the gums of an infant. Primary teeth begin to appear at six months. Even though they eventually fall out, taking care of primary teeth is important because they reserve space in the jaw for permanent teeth to come in correctly.


Permanent teeth usually start to appear at six to eight years of age, with most teeth in place by age thirteen. Third molars, also known as wisdom teeth, typically don’t appear until the late teens.


Even before your youngster’s first tooth appears, wipe his or her gums with a clean, wet cloth after each feeding. This will help remove excess food and bacteria, and will acquaint your child with daily oral care.


After teeth appear, usually around six months, use a soft bristled toothbrush and gently brush your child’s teeth with warm water. If you decide to use a toothpaste, please remember that you must use a children’s toothpaste and NOT your adult toothpaste.


By age three, your child should be able to brush alone with minor supervision. Make sure your child brushes each side of every tooth and be sure to use a toothpaste specifically formulated for young children.


Begin flossing you child’s teeth when there are enough teeth that are touching each other. Use an advanced, shred-resistant floss. By age eight, your child should be able to brush and floss unassisted.


Fluoride strengthens teeth and fights cavities. It can be found in many foods, community water supplies, toothpastes and mouth rinses. Be wary of many bottled waters as they do not contain fluoride and should not be used by children.


A dental sealant is a thin plastic coating applied to the chewing surfaces of the back teeth. It creates a barrier against decay that is highly effective. Ask Dr. Rosen for further information.


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What dental problems are common among older people?


As you age, changes happen to your body – subtle things like wrinkles, graying hair, aches and pains. And it’s no different with your mouth. With advancing age, you become more susceptible to conditions that can seriously affect your oral health. That’s why it’s important to understand these conditions and what you can do about them.


Gum disease is caused by bacterial plaque on the teeth, which releases toxins that irritate the tissue around the teeth. It is the major cause of tooth loss among older adults. Ill-fitting dentures, poor diet, poor oral hygiene and some medications can increase the severity of this condition. It’s critical that gum disease is detected early because the longer it goes untreated, the worse it can get.




  • Gums that bleed or are red, swollen and tender.
  • Gums that have pulled away from the teeth.
  • Pus that appears between the teeth and gums.
  • Teeth that are loose or have changed position.
  • Bad breath or bad taste in the mouth.


Saliva flow often decreases with age and also is a direct effect of many medications. This can result in a condition called xerostomia, or dry mouth. Proper saliva flow is important because saliva contains minerals that help strengthen the teeth, plus it helps neutralize the acids that cause decay. Saliva also washes food debris off the teeth during and after eating. Along with proper oral care, Dr. Rosen might prescribe an artificial saliva, a topical fluoride rinse or a non-alcoholic mouthwash.


Cavities aren’t just for kids. In fact, there are many types of decay that are especially common among adults, such as root cavities, decay around fillings, and cavities from dry mouth. Ask Dr. Rosen if you are at risk.


To determine if you have gum disease, Dr. Rosen or his hygienist will probe your teeth to assess your condition. Scaling is the most common initial treatment. Ask Dr. Rosen or his hygienist about what’s best for you, and exercise proper at-home oral care.


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What are cold sores and how can I prevent them?


There’s nothing minor about the pain and annoyance of so-called minor mouth irritations. While such irritations can take on many forms, the most common are fever blisters and canker sores.


Fever blisters, also called cold sores, are small sores that usually occur outside the mouth on the lip, chin or cheek areas. When fever blisters do appear inside the mouth, they usually are found on the gums or the roof of the mouth.


A virus called herpes simplex causes fever blisters. This virus is highly contagious when the blisters are present. Even though the blisters may disappear, the virus stays in the body. That explains why many people experience reoccurring bouts with fever blisters throughout their lifetimes.


Many things can trigger the reoccurrence of fever blisters. These include stress, fever, illness, injury and exposure to sunlight.


Right now, there is no known cure for fever blisters; however, researchers are working to someday create vaccines to help prevent the condition.


Canker sores occur only inside the mouth, on the tongue and inside linings of the cheeks, lips and throat. They are not contagious and are usually caused by stress or direct trauma (rubbing or irritation). These sores are usually larger than fever blisters. Both types of sores can take up to 2 weeks to heal completely.


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What is sleep apnea?


Sleep apnea is a sleep disorder characterized by having one or more pauses in breathing or shallow breathes during sleep. Each pause in breathing is called an apnea and can last from a few seconds to minutes. It may occur 5 to 30 times or more per hour. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram or “sleep study”. A person with sleep apnea is rarely aware of his or her own problem and/or difficulty breathing during sleep. Others who witness these episodes of interrupted breathing usually recognize it. Many times the individual with sleep apnea displays nighttime snoring, daytime sleepiness and/or fatigue. Many times these instances of interrupted breathing causes a lowering of circulating oxygen and can also increase your blood pressure leading to other health issues.


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What is Obstructive Sleep Apnea (OSA)?


Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat our airway is composed of collapsible walls of soft tissue and our tongue, which can obstruct our breathing during sleep. Severe obstructive sleep apnea requires treatment to prevent low blood oxygen levels and other complications. The risk of OSA increases with increased body weight, active smoking, age and snoring. People with diabetes and pre-diabetes are also at risk. Common symptoms are the same as sleep apnea and include loud snoring, restless sleep and daytime sleepiness. Treatments include lifestyle change, such as loosing weight, avoiding alcohol or muscle relaxants, and smoking cessation. The gold standard of treatment is the CPAP (continuous positive airway pressure) machine. Many people cannot or decide not to use the CPAP machine. They may be candidates for a dental appliance and/or corrective surgery.


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What is Snoring?


Snoring is the sound of turbulent air moving through the back of the mouth, nose, and throat. The loudness of snoring is not indicative of the severity of the obstruction. It may be an indication or sign of sleep apnea or obstructive sleep apnea.


Dr. Rosen and Hirsch are committed to assisting you in making the changes you need to achieve complete dental health. He has been practicing cosmetic and restorative dentistry in the Lincoln Park, Lakeview, Wrigleyville, Gold Coast, Old Town and Ravenswood neighborhoods for over 36 years.


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