About Preventative Dentistry

Preventative dentistry is the practice of good oral hygiene to prevent tooth decay and gum disease and includes home care, nutrition, and regular dental checkups and cleanings. You dentist can help you and family members with recommendations to obtain and properly use a variety of home hygiene support devices and products that strengthen teeth, keep your teeth and gums clean and healthy, and help prevent cavities and gum disease. Your dentist can also recommend and perform in-office treatments like applying tooth sealants and fluoride treatments to help prevent cavities.

A good tooth brush recommended by your dentist and a good tooth paste, dental floss, and a dental rinse are all part of a good oral hygiene regimen. Brushing frequently, especially after meals is a must. Rinsing your mouth with water after drinking acid drinks or eating also helps to prevent the growth of bacteria called plaque that can damage your teeth and make your gums bleed easily. Limiting sugary foods and acid drinks also helps. Sugar feeds bad bacteria that attaches to your teeth. These bacterial colonies, called plaque will multiply to the point where they become too thick for the layer closest to the tooth surface to breath. To survive, these bacteria go into a state of anaerobic respiration, which means they live without using oxygen. Anaerobic respiration unfortunately produces acid and it is this acid production that eats away at the enamel of your teeth and causes cavities. The better care you use to prevent this process, the better the health of your teeth and gums are likely to be.

Preventative dentistry doesn’t just stop with preventing cavities; it is also an important part of an oral health regimen for patients who have had previous dental work done. Fillings last a long time but not a life time. They can expand and contract with hot and cold foods and may need to be replaced to help protect your teeth throughout your life. As you get older, proper care of the gums is even more important. Reduction of plaque and proper oral hygiene for bridges or other dental procedures like implants will reduce the chances of a receding gum line, which could lead to gum disease, loose teeth, or other dental problems.

Frequent dental checkups, usually every six months, can greatly help in the prevention of dental problems and with the aid of a dental hygienist, you can have your teeth professionally cleaned and cared for.

Benefits of White Fillings

White fillings are also called composite fillings. They more closely match the color of your teeth and may even appear to be invisible. Composite fillings are not generally considered to be as strong as amalgam and gold fillings but do have an advantage over the weakening affect an amalgam filling can have to a tooth. This is because composite fillings are bonded to the tooth. Teeth restored with white fillings are also less sensitive to hot and cold than teeth restored with amalgam or gold. Another advantage is that generally, less of the tooth needs to be removed, especially with small cavities.

White fillings are more expensive than amalgam and a special bonding technique is required to make the composites adhere to the tooth properly. The tooth must be isolated and kept free from contact with saliva throughout the bonding procedure. This makes adding composite fillings to back teeth, where salvia is more apt to accumulate, a bit more difficult.

White fillings are usually recommended for front teeth, where the wear from chewing is less and the cosmetic appearance may be more important to the patient.

 People who use alcohol should inform their dentists. Excessive use of alcohol can seriously weaken the bond in the composite fillings and cause them to prematurely fail over time.

About Crowns

Metal crowns are preferred for strength but acrylic resins and porcelain crowns will have more of a natural appearance. In general, acrylic and porcelain crowns are preferred for front teeth while gold or other metal amalgams are recommended for back teeth where increased strength and durability are required.

A crown requires an impression (mold) of the area to properly fit the crown in place and to maintain a proper bite between the upper and lower teeth. A small amount of enamel will be removed from the tooth to provide a surface for the crown. A wax or plaster impression will then be made and sent to a dental laboratory. A temporary crown will then be cemented on your tooth until the crown is ready. On your next visit, the temporary crown will be removed and your new crown will be cemented in place and adjusted to achieve a proper bite. The crown may require a finishing coat to seal it and improve its natural appearance. Such coatings are typically acrylic polymers. The polymer can be painted on as a thin film, which hardens to a durable finish.

If a crown ever needs to be removed due to a traumatic injury to the tooth, a cavity, infection, etc. a special removal tool can be applied that places a precision vertical channel in the surface of the crown and simply threads the surface until the bond is broken. The crown can then be easily removed without force.

Benefits of Fixed Bridges

• Fill space of missing teeth.
• Maintain facial shape.
• Prevent remaining teeth from drifting out of position.
• Restore chewing ability.
• Replace a removable partial denture.

A dental bridge may be recommended to replace missing teeth. Unlike a partial denture, a bridge is fixed, meaning it is not removable. Bridge materials include gold, porcelain, or porcelain fused to metal. Although porcelain bridges may look the most natural, they will only be recommended in areas where there is sufficient reason to believe they can function without undue stress, which could cause failure. Porcelain fused to metal will add some strength while maintaining a good cosmetic appearance. Gold is more durable but is less cosmetically aesthetic.

A bridge is anchored to the adjacent teeth to hold it in place. To accomplish this, a mold of the patient's mouth is required to accurately measure this space. First, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made and sent to a dental laboratory, unless the office has a lab on site. If not, a temporary bridge will be fabricated to wear until the new bridge is completed. At the second visit, you permanent bridge will be checked, adjusted, and cemented into place. In some cases, your dentist may want to temporarily cement the bridge to allow your gums and teeth to get used to the bridge and permanently cement the bridge in place at a later date. Your dentist will also discuss the care of your new bridge, including proper brushing, flossing and checkups to add longer life to your new bridge.

Benefits of Veneers

• Fix crooked or misshapen teeth.
• Be rid of severely discolored or stained teeth.
• Fix teeth that are too small or too large.
• Get rid of unwanted or uneven spaces.
• Fix worn or chipped teeth.
• Create a uniform, white, and beautiful smile.

A dental veneer consists of a thin layer of composite material or porcelain, which is placed over a tooth surface. A veneer is used to either improve the way a tooth looks or to protect a damaged tooth surface. A composite veneer may be added directly in the mouth or fabricated in a dental lab and then bonded to the tooth, usually with resin based cement. A porcelain veneer may only be fabricated in a lab and then bonded to the tooth.

Due to improved bonding agents, veneers have longer use expectancy than they did when they were first made available in the 1980's. Today veneers typically last between 10 to 15 years.

Veneers may be recommended to produce a slight straightening affect or help equal spacing and size differences between teeth. A dentist may also recommend a veneer to restore a single tooth that may have been fractured or discolored. For teeth that have been worn away at the edges, veneers offer a way to close the spaces and lengthen the teeth that have been shortened by wear.

Of the choices of porcelain or composite veneers, the porcelain are generally considered the best looking but are not as durable as the composite veneers. Porcelain veneers are also more expensive. Alternatives to veneers are crowns and resin bondings.

Getting veneers require two visits and there is generally little or no anesthesia or drilling required. The teeth are prepared by lightly buffing and shaping the surface to hold the thickness of the veneer. A mold or impression of the mouth is made and a shade (color) chosen by you and the dentist is needed for the lab to make the veneers. On the second visit a special fluid is applied to your teeth to achieve a durable bond. Bonding cement is then applied between the tooth and veneer. A light beam is then applied to the veneer to harden the bond.

Benefits of Tooth Bonding

Tooth bonding is a cosmetic dentistry technique to help improve your smile. The process involves using a composite mixture of silicon or quarts bound with resin. This composite is blended to produce different shades and toughness to match your existing teeth and provide adequate strength. Tooth bonding can be used to close gaps between your teeth, fill cavities, or eliminate spots, chips, or areas of tooth discoloration. Bonding can even be used to repair a chipped front tooth. 

Your dentist can perform the bonding process in the office without the use of a lab, as is the case when veneers are desired. Bonding is a simple process of lightly roughing the area, which usually does not require anesthesia, applying the bonding resin, applying the composite, and sculpting it to fit. A high intensity light may be used to help dry the composite, especially if it is being used as a white filling. The composite is then polished and the procedure is complete.  

Tooth bonding generally lasts several years without any noted discoloration. It helps to avoid foods that tend to stain teeth and it is usually recommended to brush with a mild toothpaste if extensive bonding was done. Using a harsh polishing toothpaste will often dull the surface of the composite material over time. The good news is that touchup work is fairly easy to do if dulling or discoloration becomes a problem in time.

Benefits of Teeth Whitening

• Get rid of stains on teeth.
• Remove discoloration from excessive use of fluoridation.

Tooth whitening usually requires two visits. The first visit involves making impressions (molds) of your upper and lower teeth to fabricate custom, clear plastic, trays. At your second visit these trays will be fitted in your mouth and adjusted, if necessary. You will need to fill these trays with specially formulated whitening solution and wear them as directed by your dentist, usually either twice a day for 30 minutes or overnight for a couple of weeks, depending on the degree of whitening desired. This whitening process will usually create increased tooth sensitivity during the whitening process that should subside shortly after the whitening process is finished.

About Gold Fillings

Gold fillings may be recommended to replace worn amalgam fillings. A cast gold filling won't corrode and for small cavities, gold foil is used. Another advantage with gold is that it is a somewhat softer metal and has a tendency to have a longer life. Gold is considered a low-reactive metal and because of this, it also provides a much stronger base for bridges or crowns. Although gold wears better it does conduct heat and cold more; so, people with extreme problems with temperature sensitivity may not respond to gold dental work. 

About Nitrous Oxide

Nitrous oxide, also called laughing gas, is an odorless and colorless gas that removes the sensation of discomfort during certain dental procedures such as filling a cavity. Interestingly enough, one of the pioneers in the field of Nitrous Oxide development, Humphrey Davy (1778-1829), described the effects of nitrous oxide on himself following self-administration for a toothache and gum infection. Davy wrote:

 "On the day when the inflammation was the most troublesome, I breathed three large doses of nitrous oxide. The pain always diminished after the first four or five inspirations; the thrilling came on as usual, and uneasiness was for a few minutes swallowed up in pleasure."

 For people who are overly anxious about dental procedures, nitrous oxide may be a recommended option to help put you at ease as well as numb any discomfort associated with your condition or your dental procedure. Although unlikely to make you 'laugh' during the administration of the gas, it can create a sedative and anti-anxiety affect, which can help promote relaxation and a feeling of general well-being.

 Nitrous oxide has very few side effects and wears off quickly when the procedure is over. This makes it suitable for patients of all ages. The gas is easily administered through a tube attached to a small rubber face mask. The flow of the gas will be adjusted to your individual needs. Nitrous oxide is not meant to put you to sleep, as higher doses needed to accomplish sleep would lower the oxygen in your bloodstream too much. Rather, the gas is used to produce a "conscious sedation." Think of it as being in a somewhat aware but you really don't care. A local anesthetic to numb your tooth may be applied after the gas takes affect because nitrous oxide is not classed as an actual pain reliever.

About Dental Extractions

Tooth extraction is generally a procedure of last resort when a tooth becomes too unsound to repair or presents a structural problem such as an impacted wisdom tooth. Extraction involves either the use of multiple local anesthetics to numb the area as thoroughly as possible or your dentist may recommend in the use of general anesthesia, which allows you to sleep through the procedure.

Depending on your sensitivity to dental procedures, nitrous oxide gas or other forms of IV medication can be used to help reduce anxiety. I general, excessive infection and inflammation in a tooth about to be extracted will make it more difficult for a local anesthetic to perform well and being asleep through the procedure may be recommended for that reason. Without the interference of excess inflammation, the local anesthetics used today can make the extraction process itself, painless.

A tooth is satisfactory structural condition can usually be extracted by loosing the bond with the gum with a quick back and forth motion and them simply removing the tooth. If your dentist feels your tooth will not be able to remain intact by this extraction method, your tooth can be removed in sections. Dental instruments are used to section the tooth into two or more pieces and then each sectioned piece can be removed.

Bleeding after the procedure is usually mild and responds well to the use of sterile gauze held with compression against the removal area. Your dentist will explain the proper care of the post-operative area including foods to avoid, proper changing of the gauze material, how often to rinse and what to rinse with, and instructions on food preparation to allow the area to recover. Other recommendations may include the use of moist heat and cold compresses and things to avoid like drinking through a straw (sucking action discourages proper clotting.)

Bridges, dental implants, partial or full dental plates (dentures) are often recommended to replace the tooth or teeth that were removed. Your dentist will discuss the proper healing time needed to begin these restorative procedures. If wisdom teeth were removed, there is no need for restorative dentistry.

About Dental Implants

Dental implants provide an alternative to bridges, partial plates, and dentures. To help determine if you are a candidate for implants, your dentist will take a panoramic x-ray of your mouth to see all the teeth on one film. This helps your dentist to determine if the space between the roots of your teeth and sinuses above them are sufficient enough to support the posts required to support the implant. Implants can also be recommended and used to support bridges where two implants are made and a bridge is placed between them to fill the gap of several missing teeth.

If your bone structure is determined to be suitable for implants, the actual procedure can usually be done while under general anesthesia in under an hour. After the implant is set in place, a period of integration with your surrounding bone is required before the procedure is completed. This integration process is where the dental implant root becomes anchored to the bone of the jaw. The time it takes for this bone integration varies. Usually between three to six months is required for full integration and healing. The process should be carefully monitored because if osseointegration (the formation of new bone) does not occur, the implant will fail; however, if successful, the integration with your own bone tissue is the reason why these 'osseointegrated implants' are the most commonly used and successful type of dental implants available. After complete healing is obtained, your dentist will finish the procedure by placing a crown on the implant or if an implant was set in place to accept a bridge, that work can then be started.

A dental implant is commonly composed of a titanium screw and a crown. A small pilot hole is drilled at into the jaw in order to guide the titanium screw that holds a dental implant in place. After the pilot hole has been drilled, the hole is slowly widened to allow for placement of the implant screw. Following this placement, a protective cover screw is placed on top to allow the implant site to heal and the dental implant to anchor (begin osseointegration).

After several months, the protective cover is removed and a temporary crown is placed on top of the dental implant. The temporary crown serves as a template around which the gum grows and shapes itself in a natural way. The process is completed when the temporary crown is replaced with a permanent crown.

There is no guarantee that an implant procedure will be successful, but studies have shown a five-year success rate of 95% for lower jaw implants and 90% for upper jaw implants. The success rate for upper jaw implants is slightly lower because the upper jaw (especially the posterior section) is less dense than the lower jaw, making successful implantation and osseointegration potentially more difficult to achieve. Lower posterior implantation has the highest success rate for all dental implants.

Dental implants may fail for a number of reasons. The cause is often related to a failure in the osseointegration process. For example, if the implant is placed in a poor position, osseointegration may not take place. Dental implants may break or become infected (like natural teeth) and crowns may become loose.

If you are a smoker who is considering a dental implant, your dentist will likely advise you to give up smoking before undergoing the process because smokers face a higher risk of implant failure.

On the plus side, dental implants are not susceptible to the formation of cavities; still, poor oral hygiene can lead to the development of peri-implantitis around dental implants. This disease is tantamount to the development of periodontitis (severe gum disease) around a natural tooth.

About Root Canals

A root canal may be recommended by your dentist if the cavity is too deep to fill with a normal dental filling. A root canal may also be recommended to repair a deep lost filling, a crown that has failed, or other tooth damage or decay where a standard filling would not be indicated. The reason a standard filling cannot be used is because the damage to the tooth results in bacteria infiltrating into the pulp of the tooth resulting in an infection. Generally swelling is present in the gum above the tooth when such infection occurs.

With an oral examination and x-ray of the tooth, your dentist can determine if your tooth has become infected and would benefit from a root canal procedure.

A root canal is an eudemonic procedure that removes the infected tissue and treats the infected area to prevent further bacterial growth. To accomplish this, the dentist applies an oral mask to isolate the tooth and keep the area clean. The oral anesthesia used today is very effective in numbing the area and the discomfort formerly associate with a root canal has be significantly reduced. The drilling takes longer, because the pulp cavity must be reached, but other than the extra time required, the drilling procedure is much like that used for a standard filling. In some cases, if the infection is not too extensive, a single visit is all that is needed to perform a root canal. More extensive cases of infection require a second visit.

Once the drilling is completed and the tooth is treated, your dentist will determine what support the tooth requires to hold the crown. (An exception is when a crown already exists and can be drilled through and repaired.) If your tooth needs support to hold the crown, your dentist will cement a temporary crown in place to protect your tooth and schedule another visit. Usually, a titanium post can be inserted into the tooth to strengthen it in preparation for the crown on the next visit. Once your new crown is cemented in place and adjusted to fit your bite properly, the procedure is finished.

 You may experience some residual discomfort until the swelling from the infection is fully reduced. There may also be some residual sensitivity from the drilling. Your dentist will usually prescribe some pain killers, which can be taken if needed to relieve the discomfort. In most case any discomfort remaining after an infected tooth has been successfully treated with a root canal procedure only lasts for a short period of time. Follow your dentist’s instructions on use of all pain medication and other recommendations to reduce discomfort and to take proper care for your root canal.

About TMJ Disorders (The Jaw)

TMJ or the temperomanbibular joint can cause an extensive variety of problems when the joint is not functioning properly such as: 

• Jaw pain and/or stiffness 
• Headaches, usually at the side of head or headaches that feel like sinus headaches
• Migraine headaches
• Vague tooth pain or sensitivity which often moves around the mouth
• Tenderness in the jaw
• Difficulty opening the mouth
• Difficulty chewing, especially hard or chewy foods
• Clicks, pops, or grinding sounds in the jaw
• Ear pain
• Cervical neck tension and pain
• Grinding or clenching the teeth while sleeping or awake
• Tooth wear or breaking/cracking teeth

A dental exam can help determine if any of these symptoms are being caused by a problem in your jaw. The severity of the condition can vary from mild symptoms of discomfort to debilitating pain of dysfunction. The condition can caused from inflammation of the muscles that open the jaw, the jaw joint itself, or a combination of both. Misalignment of the jaw or improper growth and development of the jaw may also be cause problems with the TMJ. TMJ problems can also be caused or aggravated by emotional conditions. Stress not only lowers our resistance to pain but also increases muscle tension, especially in the jaw.