Preventive Dentistry

The keystones of Preventive Dentistry are good oral hygiene, a balanced diet and regular dental visits.  In addition, it is important to understand a thorough dental examination to detect problems early is the first step to prevent the onset, progress, and recurrence of dental diseases and conditions.  Prevention helps avoid serious and costly dental treatment and is the key to having a beautiful and healthy smile.

Dental X-Rays

Dental X-ray examinations provide valuable information that your dentist could not collect otherwise.  With the help of radiographs (the proper term for pictures taken with X-rays), your dentist can look at what is happening beneath the visible oral tissues.  They pose a far smaller risk than many undetected and untreated dental problems.

Dental x-rays produce a low level of radiation and are considered safe.  Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays.  These precautions include using lead apron shields to protect the body and using modern, fast films that cut down the exposure time of x-rays.

The need for dental x-rays depends on each patient’s dental health.  A full mouth series of dental x-rays is recommended for new patients.  A full set is usually good for three to five years.  Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

Dental Exam

A comprehensive dental exam that will be performed at your initial dental visit will include the following:

• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• TMJ evaluation:  check your jaw joints for any clicking, popping or discomfort.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.

Professional Dental Cleaning

Professional dental cleanings (dental prophylaxis) are usually performed on patients with healthy gums.  Your cleaning appointment will include the following:

• Removal of calculus (tartar):  This is either done manually or with an ultra sonic instrument called a cavitron, or sometimes a combination of the two.  Both techniques loosen and remove plaque and tartar build-up.
• Removal of plaque:  a rotary machine that looks much like a toothbrush with toothpaste on it is used.  This removes any remaining plaque around or under the gums.  It also helps to polish the outer surface of your teeth which reduces future plaque build-up.  The last step is flossing to remove any and all remaining plaque between the teeth.

Fluoride Treatment

Fluoride is effective in preventing and reversing the early signs of dental caries (tooth decay).  Researchers have shown that there are several ways through which fluoride achieves its decay-preventive effects.  It makes the tooth structure stronger, so teeth are more resistant to acid attacks.  Acid is formed when the bacteria in plaque break down sugars and carbohydrates from the diet.  Repeated acid attacks break down the tooth, which causes cavities.  Fluoride also acts to repair, or remineralize, areas in which acid attacks have already begun.  The remineralization effect of fluoride is important because it reverses the early decay process as well as creating a tooth surface that is more resistant to decay.

Fluoride is obtained in two forms: topical and systemic.  Topical fluorides strengthen teeth already present in the mouth making them more decay-resistant.  Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride therapies.

Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures.  Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth.  Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.

Sealants

A sealant is a plastic material that is usually applied to the chewing surfaces of the back teeth—premolars and molars.  This plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth.  The sealant acts as a barrier, protecting enamel from plaque and acids.

Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth.  However, toothbrush bristles cannot reach all the way into the depressions and grooves to extract food and plaque.  Sealants protect these vulnerable areas by "sealing out" plaque and food.

Custom Mouth Guards

A mouth guard is a plastic device that fits over your teeth.  It protects them from grinding damage.  It's worn when you are most likely to grind your teeth.  Although teeth grinding (bruxism) may happen at any time, people often grind their teeth in their sleep.  The causes are not just stress and anxiety but sleep disorders as well.

Symptoms include a dull headache or a sore jaw.  People could have teeth that are painful or loose from severe grinding.  This can lead to fractures in their teeth.

If stress is the cause you need to find a way to relax!  Physical therapy, muscle relaxants, counseling and even exercise may help reduce tension.  Don't make your teeth the brunt of your stress.

Home Care

Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums.  Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly.  Good oral health is important to your overall well-being.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night).  Use a toothbrush with soft, nylon, round-ended bristles that will not scratch and irritate teeth or damage gums.

1. Place bristles along the gumline at a 45-degree angle.  Bristles should contact both the tooth surface and the gumline.
2. Gently brush the outer tooth surfaces of each tooth using a vibrating back & forth rolling motion.  Move brush to the next tooth and repeat.
3. Maintain a 45-degree angle with bristles contacting the tooth surface and gumline.    Gently brush using back, forth, and rolling motion along all of the inner tooth surfaces.
4. Tilt brush vertically behind the front teeth. Make several up & down strokes using the front half of the brush
5. Place the brush against the biting surface of the teeth & use a gentle back & forth scrubbing motion. Brush the tongue from back to front to remove odor-producing bacteria.

Remember to replace your toothbrush every three to four months.  A worn-out brush will not clean your teeth properly.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, one tooth at a time.

Flossing – Flossing is an essential part of the tooth-cleaning process because it removes plaque from between teeth and at the gumline, where periodontal disease often begins.  Daily flossing is the best way to clean between the teeth and under the gumline.

1. Wind 18" of floss around middle fingers of each hand.  Pinch floss between thumbs and index fingers, leaving a 1"- 2" length in between.  Use thumbs to direct floss between upper teeth.
2. Keep a 1" - 2" length of floss taut between fingers.  Use index fingers to guide floss between contacts of the lower teeth.
3. Gently guide floss between the teeth by using a zig-zag motion.  DO NOT SNAP FLOSS BETWEEN YOUR TEETH.  Contour floss around the side of the tooth.
4. Slide floss up and down against the tooth surface and under the gumline.  Floss each tooth thoroughly with a clean section of floss.
5. Don't forget to floss behind back teeth or where there is no adjacent tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to choose products that carry the American Dental Association Seal of Acceptance – an important symbol of a dental product's safety and effectiveness.

Use other dental aids as recommended by your dentist: interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

Periodontal Disease

Periodontal disease is an infection of the tissues that support your teeth.  Your gum tissue is not attached to the teeth as high as it may seem.  There is a very shallow v-shaped crevice called a sulcus between the tooth and gums.  Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and its supporting tissues to break down.  As the tissues are damaged, the sulcus develops into a pocket: generally, the more severe the disease, the greater the depth of the pocket.

Periodontal diseases are classified according to the severity of the disease.  The two major stages are gingivitis and periodontitis.  Gingivitis is a milder and reversible form of periodontal disease that only affects the gums.  Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis.

Some factors increase the risk of developing periodontal disease:

• Tobacco smoking or chewing

• Systemic diseases such as diabetes

• Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

• Bridges that no longer fit properly

• Crooked teeth

• Fillings that have become defective

• Pregnancy or use of oral contraceptives

Several warning signs that can signal a problem:

• Gums that bleed easily

• Red, swollen, tender gums

• Gums that have pulled away from the teeth

• Persistent bad breath or bad taste

• Permanent teeth that are loose or separating

• Any change in the way your teeth fit together when you bite

• Any change in the fit of partial dentures

It is possible to have periodontal disease and have no warning signs.  That is one reason why regular dental checkups and periodontal examinations are very important.        Treatment methods depend upon the type of disease and how far the condition has progressed.  Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring.  You don’t have to lose teeth to periodontal disease.  Brush, clean between your teeth, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.

Treatment

Periodontal treatment methods depend upon the type and severity of the disease.  Your dentist will evaluate for periodontal disease and recommend the appropriate treatment.

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 half of the mouth at a time while the areas are numb.  These are non-surgical procedures in which the dentist removes plaque and tartar from below the gum line.  Tooth root surfaces are cleaned and smoothed with specially designed instruments.  It is important to remove the plaque and tartar from the pockets, because aside from the bacterial toxins that irritate the gums, plaque and the rough surfaces of tartar make it easier for bacteria to get a foothold.

If the pockets do not heal after scaling and root planning, 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 gums and supporting bone).

Maintenance

Maintenance or supportive periodontal therapy is an ongoing program designed to prevent periodontal disease from recurring in patients who have undergone periodontal treatment.  This ongoing phase of treatment will allow your dentist to assess your periodontal health and make sure infection stays under control.  During maintenance therapy, your mouth is examined, new calculus and plaque are removed, and, if necessary your teeth are polished and your bite is checked.

How often do I need maintenance therapy?

The answer varies from person to person.  Your dentist will recommend a schedule that best that is tailored to protect your periodontal health.  The intervals between visits may range from three to four times per year.

Restorative Dentistry

Restorative Dentistry is indicated when teeth must be restored to the original structure by the use of direct and indirect dental materials.  Our goal is to maximize preservation of sound tooth structure and to maintain the vitality of the teeth to be restored.

Composite Fillings

A composite filling is a tooth-colored plastic and glass mixture used to restore teeth that  are affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.  As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.

Inlay Restorations

Inlays are used to treat teeth that have decay or damage lying within their indented top surfaces.  An inlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain.  It is made by a professional dental laboratory and is permanently cemented into the tooth by your dentist.

Inlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma.  They are more conservative than crowns because less tooth structure is removed in the preparation of inlays.

Onlay Restorations

Whereas inlays are designed to treat decay within the cusps, or top projections, of a tooth, onlays are used to treat decay that extends to one or more of the cusps.  An onlay restoration is a custom made partial crown made of composite material, gold, or tooth-colored porcelain.  It is made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.

Onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma.  Onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of onlays.

Crowns (Caps)

A dental crown is a tooth-shaped "cap" that is placed over a tooth – covering the tooth to restore its shape and size, strength, and/or to improve its appearance.  A crown protects tooth structure that cannot be restored with fillings or other types of restorations.  The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Root Canal Therapy

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected.

Root canal procedures are performed when the nerve of the tooth becomes infected or the pulp becomes damaged.  During a root canal procedure, the nerve and pulp is removed and the inside of the tooth is cleaned and sealed.

Root canal procedures have the reputation of being painful.  Actually, most people report that the procedure itself is no more painful than having a filling placed.  The discomfort experienced in the period leading up to a seeking of dental care is truly the painful period of time, not the root canal procedure itself.

Dental Implants

Conventional bridges or dentures may not be your only options when replacing missing teeth.  For some people, dental implants offer a smile that looks and feels very natural.  Surgically placed below the gums over a series of appointments, implants fuse to the jawbone and serve as a base for individual replacement teeth, bridges or a denture.

Implants offer stability because they fuse to your bone.  Integration of the implants into your jaw also helps your replacement teeth feel more natural and some people also find the secure fit more comfortable than conventional substitutes.  Candidates for dental implants need to have healthy gums and adequate bone to support the implant.  A thorough evaluation by your dentist will help determine whether you are a good candidate for dental implants.

Fixed Bridges

Dental bridges literally bridge the gap created by one or more missing teeth.  A bridge is made up of two crowns for the teeth on either side of the gap – these two anchoring teeth are called abutment teeth – and a false tooth/teeth in between.  These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials.  Dental bridges are supported by natural teeth or implants.

Removable Partial Dentures

Removable partial dentures are used when some natural teeth remain.  A partial denture usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth.  Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position.

Complete Dentures

Complete dentures are used when all of the teeth are missing.  Complete dentures can be either "conventional" or "immediate."  Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.

Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed.  As a result, the wearer does not have to be without teeth during the healing period.  However, bones and gums shrink over time, especially during the healing period following tooth removal.  Therefore a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.

Cosmetic Dentistry

A smile can be the most eye-catching feature of a face.  With dentistry's many advances, you no longer have to settle for stained, chipped, or misshapen teeth.  You now have choices that can help you smile with confidence.

Cosmetic dental treatments can:

• Change the size, shape, and alignment of certain teeth.
• Fill in unattractive spaces between teeth.
• Improve or correct bites.
• Lighten or brighten the color of teeth.
• Repair decayed, broken, cracked, or chipped teeth.
• Replace missing teeth.
• Replace old, unattractive dental treatments.

Porcelain Veneers

Veneers are thin, translucent shells made out of porcelain.  They are applied to the front teeth to improve their color, size, or shape.  Veneers can help you achieve the smile you want.

Veneers can correct many dental problems.  These include:

• Crooked teeth.
• Misshapen teeth.
• Severely discolored or stained teeth.
• Teeth that are too small or large.
• Unwanted or uneven spaces.
• Worn or chipped teeth.

Lumineers

Lumineers are thin Cerinate porcelain shields that are bonded to the front of your teeth to improve your smile.  Unlike traditional veneers, lumineres require little to no tooth preparation.

Lava Crowns and Bridges

3M™ ESPE™ Lava™ All-Ceramic System is an innovative CAD/CAM technology for all-ceramic crowns and bridges on a zirconium oxide base. The esthetics and biocompatibility of Lava restorations represent the optimum in all-ceramic systems.  Colorable frameworks that are thin and translucent ensure a natural and vital appearance. Lava All-Ceramic System provides one of the most durable and esthetic all-ceramic restorations available today.

Lava zirconia restorations provide the translucency and beauty of your natural teeth.  They are an ideal alternative to porcelain-fused-to metal (PFM) restorations.  They could also be an alternative for those who have concerns about metal as well.

Snap-on Smile

Snap-on Smile is a resin removable dental appliance that fits right over your own teeth.  It is an excellent choice for:

• Gaps, crooked, stained or missing teeth
• Those who are not candidates for bridges or implants
• Anyone who would like a Hollywood smile without the expense and discomfort of complex and invasive dental procedures
• Anyone who has an old-fashioned removable partial denture and wants a beautiful, more comfortable alternative.

Snap-on Smile is thin and strong with the look of natural teeth.  You can eat and drink with your Snap-on Smile.  It's easy to care for and can be a temporary or permanent solution.  It's available for upper and lower teeth.

At-Home Teeth Bleaching

Bleaching brightens teeth that are discolored or stained.  Bleaching is tough on stains, but gentle on your teeth.  It can remove many stains that are in the outer layers of the tooth.  If your teeth have yellowed with age or are stained from tobacco, tea, coffee, or food, bleaching may restore their natural whiteness.  Antibiotic (tetracycline) stains and discoloration caused by an injury may take longer to bleach and not respond as well.  Bleaching will not change the color of fillings and crowns; and it’s not advised if you’re pregnant or breastfeeding.

How Is Bleaching Done?

Bleaching is a simple process that you do at home --following your dentist’s instructions.  Your dentist examines your teeth first. Then molds are made of your teeth; and finally you’re given your bleaching trays and gel.  How long home bleaching takes depends on the method and the gel your dentist uses.