Resources

Tooth Decay

Tooth decay, known formally as dental caries, has been a serious health problem for all nations since time immemorial. For centuries, tooth decay was thought to be the handiwork of an elusive and, in some cultures, evil tooth worm that gnawed holes into the white, highly mineralized enamel and left all those in its wake in pain. But superstition has yielded to science and its explanation that certain oral bacteria discharge mineral-eroding acid onto the enamel, starting the gradual process of decay. Over the last several decades, dental researchers have made tremendous progress in defining and learning to thwart the decay process. This work has involved the three-pronged strategy of discovery, innovation, and prevention - and produced one of the major public health success stories of the 20th century.

• Few people were spared the ordeal of losing teeth, often early in life. The combination of tooth decay and periodontal diseases left 17 million people age 45 and older — about three out of 10 Americans — with none of their natural teeth. In fact, the most common cause of WWII draft rejection was too few teeth because of tooth decay. Until the 1970s, the cause of tooth decay continued to be a subject of debate, with some believing dietary deficiencies were the culprit and others focusing on oral bacteria. This uncertainty made effective prevention strategies difficult, if not impossible, to create. Moreover, brushing one's teeth each day was a fairly recent hygienic step forward in dental care, reportedly popularized by returning soldiers from World War II.
• The NIH completed the first water fluoridation study that established the benefits of fluoride in fighting tooth decay. Several years would pass before fluoride, the mainstay of modern prevention strategies, would become a common ingredient in water, toothpaste, and other products.

Periodontal Disease (Gum Disease)

There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them:

Gingivitis

Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication.

Chronic Periodontal Disease

Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality the gums are gradually recessing.

Aggressive Periodontal Disease

Aggressive periodontal disease is characterized by the rapid loss of gum attachment, and the rapid loss of bone tissue. The disease itself is essentially the same as chronic periodontitis but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis.

Periodontal Disease Relating to Systemic Conditions

Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes and respiratory disease are the most common cofactors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease.

Necrotizing Periodontal Disease

This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues and alveolar bone.

Oral Cancer

Oral cancer includes cancers of the mouth and the pharynx (the back of the throat). Oral cancer accounts for roughly two percent of all cancers diagnosed annually in the United States. Approximately 35,000 people will be diagnosed with oral cancer each year and about 7,600 will die from the disease. On average, 60 percent of those with the disease will survive more than 5 years. Oral cancer most often occurs in people over the age of 40 and affects more than twice as many men as women.

What Puts Someone at Risk?

Tobacco and alcohol use. Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use, or the use of both tobacco and alcohol together. Using tobacco plus alcohol poses a much greater risk than using either substance alone. HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to a subset of oral cancers. Age. Risk increases with age. Oral cancer most often occurs in people over the age of 40. Sun Exposure. Cancer of the lip can be caused by sun exposure. Diet. A diet low in fruits and vegetables may play a role in oral cancer development.

Possible Signs & Symptoms

See a dentist or physician if any of the following symptoms lasts for more than 2 weeks.

• A sore, irritation, lump or thick patch in your mouth, lip, or throat.
• A white or red patch in your mouth.
• A feeling that something is caught in your throat.
• Difficulty chewing or swallowing.
• Difficulty moving your jaw or tongue.
• Numbness in your tongue or other areas of your mouth.
• Swelling of your jaw that causes dentures to fit poorly or become uncomfortable .
• Pain in one ear without hearing loss.

Early Detection

It is important to find oral cancer as early as possible when it can be treated more successfully. An oral cancer examination can detect early signs of cancer. The exam is painless and takes only a few minutes. Your regular dental check-up is an excellent opportunity to have the exam. During the exam, your dentist or dental hygienist will check your face, neck, lips, and entire mouth for signs of cancer.

TMJ Disorders

Among the most common, irritating and difficult to diagnose problems with head and neck pain are temporal mandibular joint problems, more commonly known as TMJ problems. The joint is located near the ear where the top of the mandible or lower jaw meets the upper jaw at the base of the skull.

Like all other joints in the body, the TMJ is subject to inflammation and other chronic joint problems. Many of these issues may be caused by destructive bite habits like clenching or grinding. These actions cause pressure on the joint that can lead to inflammation and general breakdown of the joint itself.

What makes TMJ problems difficult to diagnose and treat properly is the fact that the symptoms vary widely in both location and severity. Symptoms can range from a slight clicking in the jaw with no pain to severe head and neck pain which is not relieved by medication.

Once diagnosed properly treatments include everything from simple placement of a nightguard, which prevents pressure on the joint to surgical intervention in more severe cases. A dental health professional is the person most able to diagnose this widely variable and very common issue.

Malocclusion

Malocclusion means the teeth are not aligned properly.

Causes

Occlusion refers to the alignment of teeth and the way that the upper and lower teeth fit together (bite). Ideally, all upper teeth fit slightly over the lower teeth. The points of the molars fit the grooves of the opposite molar.

The upper teeth keep the cheeks and lips from being bitten and the lower teeth protect the tongue.

Malocclusion is most often hereditary, which means the condition is passed down through families. There may be a difference between the size of the upper and lower jaws or between jaw and tooth size, resulting in overcrowding of teeth or in abnormal bite patterns.

Variations in size or structure of either jaw may affect its shape, as can birth defects such as cleft lip and palate. Other causes of malocclusion include:

• Childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle.
• Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth.
• Ill-fitting dental fillings, crowns, appliances, retainers, or braces.
• Misalignment of jaw fractures after a severe injury.
• Tumors of the mouth and jaw.

There are different categories of malocclusion.

• Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth.
• Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
• Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.

Symptoms

• Abnormal alignment of teeth.
• Abnormal appearance of the face.
• Difficulty or discomfort when biting or chewing.
• Speech difficulties (rare) including lisp.
• Mouth breathing (breathing through the mouth without closing the lips).

Exams and Tests

Most problems with teeth alignment are discovered by a dentist during a routine exam. The dentist may pull your cheek outward and ask you to bite down to check how well your back teeth come together. If there is any problem, the dentist will usually refer you to an orthodontist for diagnosis and treatment.

Dental x-rays, head or skull x-rays or facial x-rays may be required. Plaster or plastic molds of the teeth are often needed.

Amalgam Fillings

Used by dentists for more than a century, dental amalgam is the most thoroughly researched and tested restorative material among all those in use. It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials. For those reasons, it remains a valued treatment option for dentists and their patients.

Dental amalgam is a stable alloy made by combining elemental mercury, silver, tin, copper and possibly other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, some concern has been raised because of its mercury content. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

While questions have arisen about the safety of dental amalgam relating to its mercury content, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth where chewing load is greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line. Amalgam fillings, like other filling materials, are considered biocompatible—they are well tolerated by patients with only rare occurrences of allergic response.

Disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. The silver-colored filling is not as natural looking as one that is tooth-colored, especially when the restoration is near the front of the mouth, and shows when the patient laughs or speaks. And to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than for other types of fillings.

Composite Fillings

Composite fillings are a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth.

The cost is moderate and depends on the size of the filling and the technique used by the dentist to place it in the prepared tooth. It generally takes longer to place a composite filling than what is required for an amalgam filling. Composite fillings require a cavity that can be kept clean and dry during filling and they are subject to stain and discoloration over time.

Root Canals

Why do I need one?

The pulp, or soft inner tissue is important during the tooth's development. Once a tooth is fully mature, the tooth can survive without the pulp because the tooth is nourished by tissues surrounding it. The pulp is normally surrounded and protected by a layer of dentin.

Above the gumline, the dentin is protected by a layer of enamel; below the gum-line the dentin is covered by cementum. When a crack or cavity destroys these protective layers, the pulp is exposed to irritants and bacteria in your mouth. This can result in inflammation then infection, and, eventually, an abscess. Periodontal (gum) disease or a severe blow to the tooth can also damage the pulp. Endodontic therapy removes the damaged pulp and usually the tooth returns to a healthy condition.

If an abscess was present before treatment the healing process may take up to 2 years.

Dental Crowns and Caps

As far as a dental restoration goes, crowns and caps are used synonymously.

Crowns are synthetic caps, usually made of a material like porcelain, placed on the top of a tooth.

Crowns are typically used to restore a tooth's function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth is usually reduced in size to accommodate a crown. An impression is taken and a cast is made of the existing teeth. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.

Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.

If an abscess was present before treatment the healing process may take up to 2 years.

Caring For Your Crowns

With proper care, a good quality crown could last many years. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.

Non-Surgical Dental Treatments

Periodontal treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Periodontal Surgery

If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment.

Pocket Depth Reduction

When supporting tissue and bone is destroyed, "pockets" form around the teeth.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Crown Lengthening

Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the esthetics of your gum line.

You may have asked your periodontist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs crown lengthening.

During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Your dentist or periodontist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

What are the benefits of this procedure?

Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.

Soft Tissue Grafts

Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line.

Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids.

Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment your periodontist can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a sSoft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

What are the benefits of this procedure?

A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile. Whether you have a soft tissue graft to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.

Non-Surgical Periodontal Therapy

Non-surgical therapy removes plaque and calculus by controlling the growth of harmful bacteria and by treating conditions that encourage gum disease. This type of treatment may be all that's needed, especially when periodontal disease is caught early. You may also need to have certain procedures, such as replacing worn fillings or crowns with overhanging margins that can accumulate plaque, taken care of before periodontal therapy can begin.

Scaling and Root Planing

Scaling is a type of cleaning that removes plaque and calculus from the teeth at and slightly below the gumline. Root planing smooths root surfaces, so the supportive tissues can better reattach to the tooth surface. Often, this will be done with local anesthesia so you can relax and feel nothing as we rehabilitate your gums.

Antibiotics

Periodontal disease is a bacterial disease and the key to controlling or eliminating it is the effective reduction or elimination of the harmful bacteria. An adjunctive option to scaling and root planing may be provided in either pill form or applied directly to the infected area (gum pocket) in the form of antibiotic powder. An antibacterial mouth rinse also may be prescribed to help control the harmful effects of and reduce bacterial plaque.

Occlusal Adjustment

An improper bite or a traumatic occlusion may increase bone destruction attached to such offending teeth. We may either choose to adjust your bite so that your teeth meet properly and function better or construct a custom bite guard or splint- a removable device that fits over upper or lower teeth - to protect teeth surfaces and relax tense jaw muscles.

Dentures

A removable bridge, more commonly known as a denture, is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.

Types of Dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient`s jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

How are dentures made?

The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient`s final denture is placed, following any minor adjustments.

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum. You may want to avoid chewing gum while you adjust to the denture.

Adjustments

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which uses constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.

Fixed Bridges

• A fixed bridge replaces a missing tooth or teeth. It is called a fixed bridge because it is not removable.
• A bridge is a structure, supported by teeth on either side of a space. It h4s the gap between teeth, just as a bridge h4s a river

How is a bridge made?

• The first step is to prepare the supports for the bridge.
• Replacement crowns are placed over existing teeth as supports for a bridge.
  • The dentist pares down the teeth on either side of the gap, and takes an impression of the prepared teeth.
  • This is then sent to the dental technician where the bridge is made.
  • The technician will make a replacement crown for each prepared tooth.
  • These crowns are joined to an artificial tooth, which replaces the missing tooth.
  • The dentist will then cement the completed bridge over the prepared teeth.

How will my pared down teeth be protected until I receive my bridge?

• The dentist will make and install a temporary acrylic bridge that will protect the teeth and prevent sensitivity.
• You can eat normally with a temporary bridge. It will also look good.

What is the fixed bridge usually made of?

• The base or framework is made of precious or non-precious metal to which tooth-colored porcelain is fused.
• Since the development of new stronger ceramic materials, bridges can now be made entirely of porcelain.

Is the preparation of bridgework painful?

• The procedure is not painful, because a local anesthetic is used during the paring of the teeth, and the taking of the impression.
• It is seldom necessary to take an analgesic for pain relief after the treatment.

Will there be any sensitivity after the bridges are placed in the mouth?

• Sensitivity to hot and cold sometimes occurs after the bridge has been cemented, but this is usually temporary.

Will a fixed bridge look good?

• Fixed bridges can be made to look natural and to match the adjoining natural teeth.
• A bridge in the front of the mouth will restore and even improve the smile.

How well will I be able to chew with a fixed bridge?

• Eating with a fixed bridge should be as comfortable as with natural teeth.

How successful are fixed bridges?

• Fixed bridges have been used successfully to replace one or more missing teeth.
• They can last for many years.

Dental Implants

Dental Implants are a great advancement in dentistry as they permanently replace missing teeth in a way that no previous dental technique was able to accomplish. Implants are anchors made out of the strongest titanium materials, that are implanted into the bone and then covered with a cap or denture. They are stronger than a natural root and will never require a root canal or filling. An implant will help maintain the health and shape of the bone in the jaw area, and neighboring teeth do not need to be filed down to make room for it. It is imperative that the dentist performing the implant be experienced and skilled in all the proper techniques of implant dentistry. When done successfully, an implant will result in a comfortable and natural looking tooth, thereby providing a permanent solution to a missing tooth.

Dental Bonding

The dental bonding procedure utilizes a composite resin and is used for a variety of structural as well as cosmetic purposes. One can draw a parallel between dental bonding materials and a sculptor's clay. By using dental composite resin bonding your dentist can restore chipped or broken teeth, fill in gaps and reshape or recolor your smile.

A very mild etching solution is applied to your teeth to create very small crevices in the tooth's enamel structure. These small crevices provide a slightly rough surface permitting a durable resin to bond materials to your teeth. The resin is then placed on your tooth and high-intensity light cures the resins onto your tooth's surface - with each individual layer of resin hardening in just minutes. When the last coat has been applied to your tooth, the bonded material is then sculpted to fit your tooth and finely polished.

The resin comes in many shades so that we can match it to your natural teeth. Due to the layers involved, this procedure will take slightly longer than traditional silver fillings because multiple layers of the bonding material are applied. Typically bonding takes an hour to two hours depending on your particular case.

For small corrections

These fillings are color-matched to the tooth and are bonded to the surface for added strength. These are most appropriate for small fillings and front fillings as they may not be as durable for large fillings.

Teeth Whitening

Whitening of the teeth is performed for patients who desire a brighter smile. Tooth whitening can be performed to reduce discoloration and staining, or simply to provide the patient with whiter, brighter teeth.

Overview of Teeth Whitening

Teeth whitening is used to correct discoloration of the teeth by removing the brown and yellow staining. The term "teeth whitening" can refer to a number of techniques to improve the brightness of the patient's teeth. Among them are chemical whitening, mild acid whitening, abrasive teeth brightening and the newest technique, laser teeth whitening.

Teeth Bleaching

Teeth bleaching is a chemical process used to lighten the color of the patient's teeth. The procedure can be performed entirely in the dental office or it can be performed by the patient in their home, using materials provided by the dentist. The home method is often used because it saves the patient from having to make an office visit for each treatment.

Before the patient embarks on the home teeth whitening regimen, the cosmetic dentist creates a custom mouth tray for the patient. The custom tray is a critical component of the treatment. It ensures that the correct amount of whitening solution is used and that the patient's teeth are properly exposed to the whitening solution. The custom made mouth tray provides for a better fit than a one-size-fits-all mouth tray to help increase the margin of patient safety.

The steps in the home teeth whitening regimen are fairly straightforward. The cosmetic dentist's office provides the patient with the materials and instructions and also answers questions the patient may have about the routine.

A home whitening session can last for two to three hours, during which time you will have the tray and solution in your mouth. Depending upon your needs and desired results, your dentist may instruct you to keep the tray in your mouth overnight. Typically, you will follow your home teeth whitening regimen for two to three weeks, after which time you will return to your cosmetic dentist for a follow up visit.

How long does teeth whitening last?

Teeth whitening is not a permanent procedure. Results can last for one or more years, depending upon your personal habits. In most cases, the whitening procedure is very effective and the patient is pleased with the results.

Veneers / Porcelain Laminates

Porcelain veneers, sometimes called tooth veneers, can be used to correct both color and shape problems and make for a great smile makeover.

Overview of Tooth Veneers

Often an alternative to crowns, veneers are very thin pieces of specially-shaped porcelain or plastic that are glued over the front of your teeth with little or no anesthesia needed. They are the cure for teeth that are severely discolored, chipped, have small holes or pits, misshapen or crooked, or for the correction of unwanted or uneven spaces. Unlike crowns, veneers won't require the dentist to remove much of the tooth itself in most cases. It is important to ask your cosmetic dentist how much tooth will be removed. In some cases more tooth will need to be removed, which may increase the risk of trauma to the tooth. Veneers are created from an impression taken in your cosmetic dentist's office. Your custom veneer is then glued directly onto your tooth. Typically costing less than crowns, veneers won't stain, making veneers a very popular solution for many people seeking that perfect smile. Strong and very durable, veneers last from ten to fifteen years, and come in colors that will brighten dark teeth without the worry of them changing color.

How are Tooth Veneers Attached to your Tooth?

In your first appointment, it is important to initially discuss with your cosmetic dentist that you will want to "try in" your veneers with temporary cement that is the same color cement as will be used for the permanent attachment. During this "try-in" phase, be sure to look at your veneers in natural light in addition to the office light. Teeth are prepared for veneers by lightly buffing to allow for the small added thickness of the veneer. Veneers are thin like contact lenses, and will usually only need tooth reduction of 0.5mm to 1.0mm. If a drastic change is being made for the result you want, reduction may be 1.0mm to 2.0mm. A mold is taken of the teeth, from which the veneers are modeled after. Temporary veneers will be placed and worn until your permanent veneers are ready. While wearing the temporary veneers, advise your cosmetic dentist of any adjustments or changes you would like made, such as in shape or size. These changes will be translated into your permanent veneers, so good communication between you and your dentist is important in achieving your new smile.

Your dentist places the veneers with water or glycerin on the teeth to verify their perfect fit and the shade or color. The color cannot be changed after the veneers are adhered to your teeth. The tooth is then cleansed with chemicals to achieve a durable bond. Once the glue is between the veneer and your tooth, a light beam is used to harden the glue/cement.

Crowns

A crown is a type of dental restoration which completely encircles remaining tooth structure or a dental implant. It is necessary to fabricate a crown when there is not enough healthy tooth structure remaining to support filling materials or when restoring dental implants.

Crowns are made of porcelain fused to a metal substrate or can be completely made of ceramic materials.

Crowns are typically used to restore a tooth's function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth is usually reduced in size to accommodate a crown. An impression is taken and a cast is made of the existing teeth. The impression is sent to a special lab, which manufactures a custom-designed crown. A temporary crown is applied until the permanent crown is ready to be inserted.

Caring For Your Crowns

With proper care, a crown can last for many years. It is very important to follow the same oral hygiene instructions that are followed for natural teeth.

Braces

Orthodontics is a type of dentistry focused on the correction of improper bites and tooth irregularity. According to the Bureau of Labor Statistics, orthodontists make up the largest group of dental specialists. These dental professionals help patients of any age improve tooth and jaw problems and can also assist those who desire merely cosmetic improvements.

History

According to the American Association of Orthodontists [AAO], archaeologists discovered Greek and Etruscan dental appliances that indicate humans began practicing orthodontics as early as 1000 B.C. The Smithsonian Institute cites Edward Angle, founder the Angle School of Orthodontia in 1900, as the father of modern orthodontics. This American dentist’s work included establishing orthodontics as a dental specialty and classifying many teeth and jaw abnormalities. Angle also innovated the procedures and devices used to help correct such issues.

Types

Orthodontists specialize in correcting a variety of dental problems. Some of the issues revised by orthodontic procedures include: difficulty chewing, crowding of teeth, missing teeth, speech difficulties, protruding teeth, irregular bite and facial imbalances.

Methods

The most common form of orthodontic treatment is the installation of dental braces that help straighten teeth, remove gaps, and correct overbites. Braces are often used in conjunction with other orthodontic appliances such as headgear and expansion appliances to influence the growth of teeth in younger patients. Retainers are often worn to help ensure teeth remain in their new position after braces have been removed. The American Dental Association states that in some cases, orthodontists may choose to use surgery to modify the teeth and jaw.

Time Frame

We suggest that children have their first orthodontic consultation no later than 7 years of age. While many people have corrective orthodontic procedures done early in their lives, it is not uncommon for adults and even seniors to undergo orthodontic treatments. Depending on the specific problems of the patient and the methods used to correct them, orthodontic treatments can last as few as six months but may take three years or more to complete in severe cases.

Considerations

Straight teeth are easier to keep clean and are more effective in biting, chewing, and speaking than teeth with abnormalities. People who have had orthodontic treatments also report having fewer dental complications later in life.

Invisalign®

Invisalign® has changed the face of orthodontics. Instead of wires attached to your teeth, your teeth can now be straightened invisibly.

• Invisalign® is clear. You can straighten your teeth without anyone knowing.
• Invisalign® is removable. Unlike braces, you can eat and drink what you want during treatment. You can also brush and floss normally to maintain good oral hygiene.
• Invisalign® is comfortable. No metal brackets or wires to cause mouth irritation, and less time in the dentist’s chair getting adjustments.

The Invisalign® process has been proven effective in clinical research and in orthodontic practices nationwide. However, only a certified dentist like ours can undertake this procedure.

The Invisalign® Process

• A set of aligners are worn for about 2 weeks, removing them only to eat, drink, brush, and floss.
• As you replace each aligner with the next in the series, your teeth will move – little by little, week by week – until they have straightened to the final position the dentist has prescribed.
• You will visit us approximately once every 6 weeks to ensure that your treatment is progressing as planned.
• Total treatment time averages 11 months with the average number of aligners worn during treatment between 18 and 30. This of course will vary from case to case.

The Invisalign System combines advanced 3-D computer graphics technology with 100-year-old science of orthodontics. Invisalign aligners are designed to move your teeth in small steps to the desired final position prescribed by your orthodontist. Each aligner is precisely calibrated and manufactured to fit your mouth at each stage of the treatment plan. Your first step is to visit our office to determine if Invisalign is right for you. After sending precise treatment instructions, Invisalign uses advanced computer technology to translate these instructions in a sequence of finely calibrated aligners — as few as 12 or as many as 48. Each aligner is worn for about two weeks and only taken out to eat, brush and floss. As you replace each aligner with the next, your teeth will begin to move gradually — week-by-week until the final alignment prescribed is attained. Then you’ll be smiling like you never have before!

Toothaches

A "toothache" is pain typically around a tooth, teeth or jaws. In most instances, toothaches are caused by a dental problem, such as a dental cavity, a cracked or fractured tooth, an exposed tooth root, or gum disease. Sometimes diseases of the jaw joint (temporomandibular joint), or spasms of the muscles used for chewing can cause toothache like symptoms.

The severity of a toothache can range from chronic and mild to sharp and excruciating. It can be a dull ache or intense. The pain may be aggravated by chewing or by thermal foods and liquids which are cold or hot. A thorough oral examination, proper tooth testing and evaluation, along with appropriate dental x-rays, can help determine the cause. What we want to know is whether the toothache is really coming from a tooth or somewhere else.

Extractions (General Procedure)

When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, it may need to be pulled, or extracted.

Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has tooth pulled experiences little or no discomfort, and only minor bleeding.

Before a tooth is extracted, the area surrounding the tooth is numbed with a topical/and or injectable anesthetic such as Novocaine.

Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn't occur.

Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.

Wisdom Teeth

Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.

If wisdom teeth are causing a problem and are not pulled, they can sometimes become impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: severe discomfort, inflammation, and some kinds of infections.

Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one's ability to properly bite down, speak or eat.

If you experience any of the following symptoms, you may have an impacted wisdom tooth:

• Facial swelling
• Infection
• Pain
• Gum swelling

Traumatic Dental Injuries

Dislodged Teeth

Injuries to the mouth can cause teeth to be pushed back into their sockets. If the tooth is pushed partially out of the socket, your dentist may re-position and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. However, if the pulp becomes damaged or infected, root canal treatment will be required. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be placed and the canal will be sealed.

Avulsed Teeth

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you seek treatment immediately! It is important to keep the avulsed tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk or a glass of water (add a pinch of salt). Root canal treatment may be necessary based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored may influence the type of treatment you receive and how successful the outcome.