Procedures

A comprehensive dental exam will be performed by your dentist at your initial dental visit. At regular check-up exams, your dentist and hygienist will include the following:

• 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.

• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.

• 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 by Registered Dental Hygienists. Your cleaning appointment will include a dental exam and the following:

• Removal of calculus (tartar): 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 is the start of periodontal disease!

• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Dental x-rays may reveal:

• Abscesses or cysts.
• Bone loss.
• Cancerous and non-cancerous tumors.
• Decay between the teeth.
• Developmental abnormalities.
• Poor tooth and root positions.
• Problems inside a tooth or below the gum line.

Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!

Are dental x-rays safe?

We are all exposed to natural radiation in our environment. The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources.

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 film that cuts down the exposure time of each x-ray.

How often should dental x-rays be taken?

The need for dental x-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.

A full mouth series of dental x-rays is recommended for new patients. A full series is usually good for 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 every two years to detect new dental problems.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

1. Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
2. Brush the outer, inner, and biting surfaces of each tooth.
3. Use the tip of the brush to clean the inside of the front teeth.
4. Brush your tongue to remove bacteria and freshen your breath.

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, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

1. Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
2. Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
3. Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each 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 consult with your dentist or dental hygienist on its appropriateness for you.

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

There are many types of filling materials available, each with their own advantages and disadvantages. You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

• Chipped teeth.
• Closing space between two teeth.
• Cracked or broken teeth.
• Decayed teeth.
• Worn teeth.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.
• Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

Tooth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile.

Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth.  The most popular method is using a home tooth whitening system that will whiten teeth dramatically.  Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc.  Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.

Tooth whitening is not permanent.  A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.

Reasons for tooth whitening:

• Fluorosis (excessive fluoridation during tooth development).
• Normal wear of outer tooth layer.
• Stained teeth due to medications (tetracycline, etc.).
• Yellow, brown stained teeth.

What does tooth whitening involve?

This type of tooth whitening usually requires two visits.  At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays.

At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary.  The trays are worn with a special whitening gel for 20-30 minutes once or twice a day until the desired whiteness is achieved.  It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.

You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis

Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.

Advanced Periodontitis

The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

Periodontal treatment methods 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 gets 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 while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and 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 gums and supporting bone).

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar 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 will usually include:

• 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.

• Examination of existing restorations: Check current fillings, crowns, etc.

• Examination of tooth decay: Check all tooth surfaces for decay.

• Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek 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, rinses, etc.)

• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

• Chipped teeth.
• Closing space between two teeth.
• Cracked or broken teeth.
• Decayed teeth.
• Worn teeth.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.
• Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures – complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks.  During this time the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments will have to be made.

Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear.

Reasons for dentures:

• Complete Denture – Loss of all teeth in an arch.
• Partial Denture – Loss of several teeth in an arch.
• Enhancing smile and facial tissues.
• Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks.  Highly accurate impressions (molds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

• Fill space of missing teeth.
• Maintain facial shape.
• Prevent remaining teeth from drifting out of position.
• Restore chewing and speaking ability.
• Restore your smile.
• Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits.  While the teeth are numb, 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 which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed.  Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.

Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

• An abscess (or pimple) on the gums.
• Sensitivity to hot and cold.
• Severe toothache pain.
• Sometimes no symptoms are present.
• Swelling and/or tenderness.

Reasons for root canal therapy:

• Decay has reached the tooth pulp (the living tissue inside the tooth).
• Infection or abscess have developed inside the tooth or at the root tip.
• Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment.  Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.