A comprehensive dental exam will be performed by your dentist at your initial visit. At regular check-up exams your dentist and hygienist will perform the following procedures:
- Examination of diagnostic x-rays: This is essential for detection of decay, tumors, cysts and bone loss. X-rays also determine tooth and root positions.
- Oral cancer screening: Examine the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
- Gum (periodontal) disease evaluation: Evaluate the gums and bone around the teeth for any signs of periodontal disease.
- Examination of tooth decay: All tooth surfaces will be assessed for decay with special instruments and existing restorations, such as crowns and fillings, will be evaluated for any recurrent decay.
Professional Dental Cleaning
Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists and are performed on patients who are periodontally healthy. If you are a candidate, your cleaning appointment will include a dental exam and the following:
- Removal of calculus (tarter): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface. Calculus forms above and below the gum line, and can only be removed with special dental instruments.
- Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation (gingivitis) is the start of periodontal disease.
- Tooth polishing: Remove stain and plaque that is not otherwise removed during scaling.
This is a focused beam of X-Ray particles through bone which produces an image on special film, showing the structure through which it passed. This gives the familiar black and white images that doctors and dentists use to diagnose problems. X-rays are a necessary part of the diagnostic process, and not to use them could lead to undiagnosed disease. Without an X-ray of the whole tooth, and supporting bone and gum tissues, there is no other way to detect infection or pathology that requires attention.
The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not properly removed within about 24 hours, it hardens and becomes known as calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums. Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages.
Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other systemic diseases such as stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Smoking also increases the risk of periodontal disease. Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
Treatment methods of periodontal disease depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.
Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums get filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth.
If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time with local anesthetic. In this procedure, tarter, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (root planing). This procedure helps gum tissue to heal and pockets to shrink.
Medications, special antibacterial mouth rinses, and an electric tooth brush may be recommended to help control infection and promote healing. If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gum and supporting bone).
It only takes twenty four hours for plaque that is not removed from your teeth to turn into tarter. Daily home cleaning helps control plaque and tarter formation, but those hard to reach areas will always need special attention. Once your periodontal treatment has been completed your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment may also include:
- Examination of diagnostic x-rays (radiographs): This is essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Examination of tooth decay and evaluation of existing restorations for recurrent decay.
- Oral cancer screening: Examine the face, neck, lips, tongue, throat, check tissues, and gums for any signs of oral cancer.
- Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, antibacterial rinses, etc.)
- Tooth polishing: Remove stain and plaque that is not otherwise removed during scaling. Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control.
Fillings are done to remove decay, and replace the affected tooth structure. It is called a filling because new a material fills hole that decay left. We offer both amalgam (silver) and composite (tooth colored) fillings. Caught early enough, cavities can be treated easily and painlessly. If not treated decay can lead to tooth pain and/or infection, and the tooth could need root canal treatment or extraction.
Bonding involves adhering composite resin material onto the face of the tooth and matching the color of the tooth. This is done to repair damage done to the tooth by decay or for other cosmetic reasons. The tooth surface is roughened in order to accept the bonding and a gel is applied to micro etch the tooth surface. A primer/bond agent is applied so the material adheres to the surface. The material is then placed on the tooth and hardened with intense light. The composite resin material is shaped and polished to get a lustrous finish.
Root Canal Treatment
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is necessary when a cavity is permitted to reach the pulp (nerve) of a tooth. (Regular cleanings and checkups prevent and detect problems early) Occasionally, deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy. Once this occurs the pulp becomes infected, and possibly extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). When the pulp becomes infected, it must be treated since the tooth will not be able to heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup.
A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. Once the infection is resolved, the canal(s) are filled to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy.
Crowns are full coverage restorations that are used to cover a tooth that is likely to break, or is too broken down to be restored with a filling. They are most commonly done after root canal treatment, or when a large filling wears out. The larger the hole made by a cavity that has to be treated, the more likely a crown will be needed. Even after a filling is put in a large cavity, a tooth is more likely to break. Keep in mind that the jaw muscles are the strongest in the human body therefore, teeth are subjected to tremendous pressures. Crowns sit over the weakened tooth, providing strength and protecting the tooth against breakage. A broken or cracked tooth is a far more serious matter and much more difficult to treat. Crowns prevent this, as well as making for a nice smile.
It takes two appointments to restore a tooth with a crown. During the first visit, any decay is removed from the tooth and it is shaped (prepared) to accept the crown. Then an impression is made of the tooth for use in fabricating the crown. Between the two visits the crown is made, usually of high-strength porcelain over gold alloy, all ceramic material, or gold. During this time a temporary crown is worn. During the second visit, the temporary crown is removed, and the permanent crown is cemented in place and adjusted as necessary.
Full and Partial Dentures
There are different types of dentures, but they share a common function, they replace missing teeth. When bone loss around the roots of teeth is great enough to loosen them or teeth become fractured due to trauma or extensive decay, a full or partial denture may be the answer. Relax. No one enjoys losing their natural teeth, but you can still eat and talk regularly.
The entire mouth is examined and a determination is made as to which teeth will have to be removed, and which will remain. The affected teeth are then extracted. Dentures are fitted to go over or around whatever teeth remain in the mouth, depending on the type. There is an adjustment period after dentures are placed in the mouth, but once accustomed to the dentures, all the normal functionality and appearance return and one just carries on as usual. Often implants can used to further stabilize the dentures.
A dental implant is an option to replace a missing tooth. In this procedure, a small titanium shaft is surgically implanted into the bone and allowed to set. The bone grows around it forming a tight connection, which additionally slows or stops the bone loss that occurs when the root of a natural tooth is missing. Once the implant is firmly set in the mouth, the dentist then works to attach the replacement tooth onto the top of the shaft. This permanent solution has the advantages over bridge work that it does not stress the surrounding teeth for support, and should the tooth wear out, another can simply be replaced on the shaft.
Implants can also be used as support as part of an implant bridge. This is an alternative to partial dentures, and has several advantages. First, there is no adjustment period to acclimate the patient who, once the work is done, only feels teeth, not metal supports intruding into the mouth. Second, this slows the bone loss occasioned by missing teeth. Third, there is no discomfort or difficulty in eating, and they don’t have to be taken out all the time.
This is an option for filling the space created by a missing tooth. It is formed to look like the missing tooth, and it takes its place in the mouth. The sides of a bridge use the two surrounding teeth for support, hence the name. A bridge replaces the missing tooth, both functionally and cosmetically. Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material. The choice of material depends on requirements for strength, wear, and/or aesthetics.
It is important that a missing tooth be replaced as soon as possible for several reasons. If not treated the teeth surrounding the gap begin to shift inward since teeth use their neighbors for support. When one is missing, they start to “fall”. As this becomes worse, the bite changes in response to the pressure. This can eventually result in problems with the entire jaw or TMJ. The surrounding teeth deteriorate and it is just a matter of time before they also become problematic. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.
This can be anything done to correct imperfections in the appearance of the mouth. Anyone who is unhappy with their smile can have it fixed. The upper teeth usually show when smiling, while the lower teeth remain hidden. This is reversed when talking, where the upper teeth remain hidden and the lower teeth show. The color, alignment, spacing as well as regularity of the teeth are the characteristics that give the overall appearance. Any of these can be repaired to give a stunning look to the mouth.
We offer a wide variety of cosmetic options. Some of these options are whitening, re-contouring of the shape of the teeth, veneers, bonding, and all ceramic/porcelain crowns.
This is the procedure of making teeth whiter, and therefore more attractive. Our office uses two methods: Zoom! chair side whitening and at-home tray whitening.
Zoom! is a revolutionary tooth whitening procedure. It’s safe, effective and fast. In about two hours, your teeth will be dramatically whiter. The convenience of Zoom! in comparison to days of using strips or wearing trays makes it the perfect choice for the busy individual. The Zoom! Whitening procedure is simple. It begins with a short preparation to isolate your lips and gums. The clinician then applies the proprietary Zoom! whitening gel that is activated by a specially designed light. You’ll be amazed with the results. In most cases, teeth get even whiter the first few days after the procedure. Trays with gel are recommended afterward for maximum whitening and maintenance.
The tray method involves having impressions taken from which custom vinyl trays are made. A carbamide peroxide gel is placed in these trays and the trays with gel are worn for about 3 hours, or overnight. The entire process takes 3-4 weeks of daily use. For maintenance of whitened teeth the trays should be used every several months.
Veneers are a dental procedure in which a covering is placed over the face (visible area) of the tooth. Veneers are usually only done to the part of the teeth that are visible when talking or smiling. The procedure can be direct or indirect.
The direct technique usually involves placing composite resin on the outside of the tooth using bonding. This method is usually referred to as chair side bonding.
The indirect technique usually involves two appointments because the veneers will be fabricated at a dental laboratory. At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In two to three weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic, and are very esthetic.
The advantage of veneers versus crowns is that much less tooth material is removed, and the procedure is generally less uncomfortable. Veneers are recommended for teeth that have large fillings or little tooth structure.