Did you know tooth decay is not only the most common disease, but it comes in second to the common cold? Both tooth decay and gum disease can be transferred from one person to another. You should avoid kissing infants and children on the lips since this can potentially transfer bacteria that can cause tooth decay and gum disease. Sharing eating utensils as well as licking clean your baby’s pacifier should never be done as this encourages the transmission of bacteria! Your Child’s oral health is related to yours. Early detection is extremely important in preventing potential problems. Keeping up with your dental visits, will help ensure optimal dental and oral health for both you and your children. Call Dr. Nichols office today to schedule an appointment and we will help you implement strategies to keep your teeth decay free!

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Acidic Beverages and Your Teeth

by on January 17, 2019 | Posted in Blog

Drinking too many drinks that are acidic can be damaging to your teeth. With so many drink choices it can be hard to determine which ones are good for you. You may be saying, “I’m ok I drink flavored water”. The truth is flavored water can be just as harmful as drinking soda or juices. To determine the acidity, we need to look at the pH, the lower the pH, the more acidic, and the likelier to cause harm and tooth erosion. The American Dental Association recommends minimizing the amount of these drinks we consume, instead the best drink would be plain water. When that thirst kicks in, think healthy teeth and reach for some refreshing water!

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The Smile You Want

by on December 11, 2018 | Posted in Blog

When it comes to our teeth many of us only want one shade white. The whiter the better! Unfortunately, the color of our teeth may not always be the color we want them to be. Teeth come in many shades and the color can change from a variety of causes. There is hope for those who wish to have whiter teeth! We offer our patients many options to help give them the smile they want. From veneers to bonding to at home professional tooth whitening, we can help you achieve the smile you desire! Call Dr Nichols office and set up an evaluation today! Let us show you what we can do for you!

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Putting Off Dental Treatment

by on November 13, 2018 | Posted in Blog

According to a recent study by the American Dental Association, one in five Americans, about 23%, is avoiding dental treatment in the next twelve months. Almost half of them say that the cost is the number one reason why.
Putting off dental treatment is not good for your health or wallet. Avoiding treatment can lead to infection, tooth loss and more dental work which can end up costing more money.
At Dr. Nichols office the fees are not only fair and competitive; we also offer a payment plan through Care Credit to help patients comfortably manage their dental costs. With Care Credit’s no Interest if paid in full payment options offered, we can help you keep your mouth healthy!

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Halloween is quickly approaching. Which means your child will be bringing home a bag full of candy! Although Halloween is fun for children it can be of concern to parents for both safety and health reasons. With so much candy being handed out during this time you need to be aware of the ones that can cause the most harm to your child’s teeth. The American Dental Association is reporting citrus flavored and sour candies to be among the worst for your teeth. These candies are not only sticky and filled with sugar, but they contain acid that can weaken and damage the outer shell of your tooth making it more likely to get a cavity. Other candies to avoid are caramels, taffies, gummies, and any chewy candies because these are sticky and adhere to your teeth for long periods of time also increasing the risk of tooth decay! The good news is your child can enjoy a sweet treat without too much concern, the top candy on the list is chocolate! Chocolate unlike the other candies washes off the teeth quickly. Keep your teeth healthy Don’t forget to brush your teeth after eating your Halloween candy. Go ahead get dressed and enjoy Halloween!

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Gum Disease and Infertility

by on September 12, 2018 | Posted in Blog

It is very important that woman trying to get pregnant keep there gums healthy! A new study has revealed woman with periodontal disease take three times longer to get pregnant than woman without and, woman with symptoms of periodontitis-disease of the gum and bone took four times longer to get pregnant. According to research it is believed the infection in the gums and jawbone lead to inflammation in the body. This inflammation may prevent ovulation or may even stop the embryo from implanting. Woman if you are planning on expanding your family, make an appointment for a teeth cleaning and check-up! Healthy gums are imperative for a healthy body!

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Bottled Water vs. Tap Water

by on August 13, 2018 | Posted in Blog

Did you know drinking bottled water can affect your teeth and health? If you are drinking a lot of bottled water, and it’s acidic, it could be bringing harm to your teeth! The acidity erodes tooth enamel causing tooth decay. The best beverages to drink for good oral health should contain fluoride. Studies have shown drinking beverages with fluoride reduces tooth decay both in children and adults by up to 25 percent. If you are only drinking bottled water and not public water you may not be getting the fluoride needed to keep your teeth healthy!

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In an effort to quit smoking, many people are turning to e-Cigarettes. Unfortunately, they are just as bad for your health! Studies have suggested the flavorings used in the e-cigarettes are causing harm to blood vessel cells which can damage your heart. Five flavorings were tested in the lab: menthol (mint),acetylpyridine (burnt flavor),vanillin (vanilla),cinnamaldehyde (cinnamon),and eugenol (clove). Upon testing these flavors, they found them to cause damage to the cells that line the inside blood vessels, the layer of the heart. It has been proven, e-cigarettes contain toxic substances and irritants. With all these studies proving e-cigarettes to be extremely harmful to your health we hope you think twice before using them!

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Did you know the more you smile the younger you look? Studies have shown people who smile are perceived as more youthful and attractive thus making it harder to guess their age! People with worn teeth, receding gums or discolored teeth tend to look older. As we age our teeth change causing us to smile less. Have you noticed you are not smiling as much? Maybe you have become self-conscience or lost your confidence. Have noticed yourself not socializing much due to the way your smile looks? Your smile can affect your social and professional life! It does not have to be that way for you! Cosmetic Dentistry can help you achieve that beautiful smile you desire in turn reversing any age revealing dental issues. Come see what we can do for you, schedule your appointment today with Dr. Nichols!

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Study by: Dr. Ana Ferro

A 23-year-old patient with a severely degraded dentition came to the MALO CLINIC in Portugal, under its pro bono program. He had no oral hygiene habits and poor oral health. He had severe deterioration in the upper jaw, and in the lower jaw both quadrants’ molar teeth required extraction. His remaining teeth showed no sign of periodontal loss and/or mobility.

Full-arch rehabilitation of young patients is always demanding, not so much anatomically (e.g. reduced bone availability) but rather functionally and esthetically. Given the irreversible damage to most of his teeth and large apical lesions, we decided to perform full extractions, clean all granuloma lesions and treat the patient with implant surgery and Immediate Function.

We selected the All-on-4® treatment concept for this case since it is proven to be a predictable surgical option in the long-term1,2 and in demanding clinical situations.3 Use of the NobelParallel Conical Connection (CC) implants and the new Multi-unit Abutment Plus allowed us to deliver immediate, fixed rehabilitation even in the post-extraction sites – thus restoring the complete function of the upper jaw in one surgery.


Surgery was performed under local anesthesia. The procedure started with the extraction of the remaining teeth. A full-thickness flap was opened and elevated following a crestal incision and two releasing incisions in the first molar area. Through a photo showing the maximum smile line bone was reduced in order to hide the prosthetic transition, allowing for a more regular bone platform and a smooth gingival profile, making it easier for the patient to maintain after the surgery.

Implant surgery started with a mid-line osteotomy perpendicular to the bipupillary line, enabling the placement of the All-on-4® Guide.

Once the guide was in position and adapted to the maxilla’s size, the anterior wall of the sinus was identified in order to start placing the posterior implants as close to the cortical bone as possible, with an angulation of 45°. An under-preparation drilling protocol was used with the intention to achieve sufficient primary stability to allow for Immediate Function.

With the posterior implants stabilized and in position, the new Multi-unit Aligning Instrument was used to choose the most appropriate abutment angulation and prosthetic setting.


Anterior implant placement followed, also achieving adequate primary stability.

Suture and splinted impressions were then executed and the pre-made, all-acrylic bridge was then relined in the mouth and finalized in the lab. The patient returned to the clinic 10 days after the operation to remove the sutures and control the healing.


Despite the advanced deterioration of the upper jaw, the final result was very satisfactory for both the patient and myself.

The patient was able to immediately recover function and esthetics – which can be life-changing given the patient’s age – without having to go through additional, time-consuming and costly surgeries, instead benefiting immediately from this long-term predictable solution.

Top 5 tips

  1. Accurately extract the teeth and clean all the infections and granuloma tissue in order to make sure that your implants are placed in the best bone available.
  2. Use an underpreparation drilling sequence according to the bone density in order to achieve good primary stability.
  3. Use an implant that allows for bone condensation.
  4. Try to get bicortical anchorage in low-quality bone for better primary stability.
  5. Avoid delivering long cantilevers in the provisional all-acrylic prosthesis.


In this case the All-on-4® treatment concept allowed for immediate rehabilitation of function and esthetics. This patient had no need for additional surgeries such as bone grafting or sinus lifting. The All-on-4®treatment concept is time saving and cost efficient,4 while increasing patient satisfaction by providing immediate high esthetics5 and easy hygiene maintenance.6

This evidence-based treatment concept allows clinicians to effectively treat different types of patients and provide fast and predictable outcomes.7 The high implant and prosthetic survival rates of the All-on-4® treatment concept make it a predictable procedure for clinicians.1,2,7 I highly recommend that clinicians adopt this treatment concept in their daily practice, and avoid other demanding and time-consuming approaches.

The All-on-4® treatment concept is a team approach and I would like to thank all my MALO CLINIC colleagues involved in treating this patient: Ana Abadia (Oral Hygiene Department), Dr. João Botto (Oral Surgery Department), Dr. Raquel Lucas (Prosthodontic Department), Dr. Rodrigo Gonzalez (Prosthodontic Department) and Helena Alexandre (MALO CLINIC Ceramics Laboratory).

Why I use Nobel Biocare products

The manufacturer matters: the likelihood of predictable, long-term results is increased with the use of high-quality, original products from Nobel Biocare.8-11 All the products used in the present case were designed to work together as part of the All-on-4® treatment concept. In particular, by using the Multi-unit Aligning Instrument it was easier to identify the correct angulation for the abutment and adjust the implant position for the final Multi-unit Abutment placement. This reduces the need to make changes and substantially decreases chair time and discomfort for the patient. Together with appropriate training, these new products can help surgeons make the most out of the All-on-4® treatment concept.

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