Bonding
The concept of bonding involves the adhesive attachment of a ceramic filled composite resin material to the tooth. Bonding is performed to repair a fracture of a tooth due to an injury, alter the alignment of the teeth, close spaces between the teeth, or to change the color of a tooth. First, we assess the shade, and specific type of our materials needed to accomplish our goals. The surface of the tooth may be roughened or shaped as needed. We then apply several layers to the tooth to clean, etch, desensitize, prime, and bond the composite material to the tooth. An intense light is used to harden and cure the material. The restoration is then shaped and polished to a lustrous finish.

  Bridges
A bridge is a prosthetic replacement for the space created by a missing tooth. A bridge replaces a missing tooth, both functionally and cosmetically. It also serves to stabilize the position of surrounding teeth. The bridge utilizes the adjacent teeth to anchor and support the replacement tooth. This part of dentistry is as much an art as it is a science. The shape, color and position of the teeth must be carefully chosen to make the new ones look, feel, and work as they should.

It is important to consider replacing a missing tooth for several reasons. Your appearance, chewing ability, stability of your teeth, and a comfortable bite can all be affected by a missing tooth. These problems will become more severe over time. The timely replacement of missing teeth can help maintain your mouth in its normal condition.

  Cosmetic Dentistry
We enjoy helping people to improve the appearance of their teeth and their smile. At our office a wide variety of cosmetic options are available. Some of these options are whitening, bonding, veneers, ceramic/porcelain crowns, or recontouring the shape of your teeth. At times, orthodontic treatment is a good way to improve your appearance. When extensive cosmetic changes are being considered, we may take some time, before we start any treatment, to redesign your smile. We may make a sample of proposed changes to your teeth for you to see before we decide on what works best. We use the “X-Rite Shade Vision” system to evaluate the colors of your existing teeth. We can transmit this information electronically to our lab technician, to provide assistance in creating your restorations.

  Crowns
A crown is protective covering for a tooth. It is used to restore the shape, function and strength to a broken tooth. They can also be used to rebuild a tooth that is likely to break in the near future. Teeth with very large fillings or severe decay are candidates for a crown restoration. Crowns are often needed for teeth after the completion of root canal therapy. A tooth with a very large filling can be weakened, when compared to another tooth. The sides of the remaining tooth structure are sometimes too thin to withstand the forces that we can generate with our bite. The molars in the back of your mouth are exposed to the greatest forces when chewing, clenching or grinding your teeth. A crown can allow you to bite normally, without the worry of cracking your tooth or a large filling. A severe fracture of a tooth can result in the loss of the tooth. We try to intercept these problems in time to save teeth from being lost.

We usually need two appointments to restore a tooth with a crown. At the first visit, any decay and old restorations will be removed to evaluate the tooth. A core restoration is sometimes necessary to fill in deep areas or voids. We then prepare the tooth to the desired shape. An impression of the tooth is made to help the lab form the crown. A temporary crown is created to protect the tooth, hold the tooth and gums in position, and to provide a normal appearing tooth. The temporary crown is worn for a few weeks while the permanent crown is fabricated at the laboratory. The laboratory technician builds the crown using gold alloys, ceramics, or a combination of materials. A custom prescription directs the lab to create the correct shape, color, and fit of the crown. The patient returns for a second visit to remove the temporary and evaluate the new crown. Adjustments, if needed, can usually be accomplished at the office. The crown is then cemented into place, ready for several smiling years of use.

  Dentures
Dentures are still a viable and valued restorative solution for those with several missing teeth. Dentures can be made in many different configurations. They can be used to replace all the teeth- with close contact to the gum tissue to hold them in place. Dentures can replace some of the teeth- connecting to the remaining teeth with a clasp or attachment, which holds the appliance in the mouth. Some are designed to fit over the last few remaining teeth. Some patients elect to have implants placed in the areas of missing teeth, which can hold a denture more securely in their mouth.

Dentures can allow a person to function again, after the loss of several teeth. However, the need for routine dental care continues. We suggest that those people with no remaining teeth should still visit for a yearly examination. We check the fit, function, and comfort of your dentures. It is important to have a good fitting appliance to prevent injury to your gum tissues and the supporting jaw bone. We also examine the head and neck area for any signs of infection or changes in the tissues that my lead to oral cancer. We may make small adjustments to your dentures to allow them to fit better or feel more comfortable.

  Fillings
Fillings are used to restore a hole or cavity in a tooth. Typically, a dentist prepares the cavity to remove decay or caries that have been identified on the tooth. Once the filling is placed, the tooth no longer has a “cavity”. This is good news for those wishing to qualify or continue membership in our “no cavities” club!

We use both silver, amalgam and tooth colored, composite filling material for our restorations. An amalgam filling is an economical choice for an area of the mouth that is not very visible. They are used in areas that are difficult to isolate and keep dry, which is a critical requirement for placing composite restorations. Tooth colored fillings are made from a ceramic filled, acrylic resin, which can be bonded to the prepared tooth structure. The obvious benefit to this material is the ability to match the color of the filling to the tooth. Composite fillings also provide a better seal to the tooth. The non-metallic nature of this filling allows for less transmission of temperature changes to the center of the tooth, so sensitivity to hot or cold should be less of a problem, when compared to a new amalgam filling. We have found that composite restorations have become more useful, and more durable with the availability of better materials. They are the preferred material in most situations.

Older fillings can breakdown after years of service. It is possible for decay to leak underneath a filling. Ordinary wear and tear from chewing can cause a filing to fracture or wear away. We try to intercept these problems at an early stage, in order to be able to replace the filling with a new one. If the problem is allowed to remain untreated, decay can destroy more tooth structure over time. This can increase the odds of needing more extensive treatment, such as a larger, deeper filing, a crown, or even the loss of the tooth.

  Implants
The replacement of missing teeth with dental implants is a more common treatment choice than ever before. There are more options for the dentist to apply in more situations, making the possibility of a new tooth a reality, for patients who were not candidates for this procedure in the past.

While once considered a new or experimental treatment, implants for replacing a single tooth have now been in use for 40 years. We feel that at this stage of development, an implant is a very solid, predictable long lasting treatment option. Implants can be used to replace a single missing tooth, several missing teeth, or they can be used as a foundation for holding a complete denture in place.

There are so many exciting reasons to consider this type of tooth replacement. The possibility of replacing teeth and not having to wear a removable denture is a blessing to many people. The idea of replacing a single tooth without altering the neighboring teeth is by nature, a very conservative mode for treating a patient. Teeth that are severely weakened can require extensive, costly treatment with a sometimes poor expectation for longevity. Now, we consider abandoning further efforts to save these problematic teeth, when, we can instead remove the tooth and place an implant root replacement, which will function for many years. The possibilities are continuing grow all the time! This is truly an exciting era for dentistry!

An implant can be viewed as a “root replacement” for a missing tooth. A specialist in oral surgery or periodontics will place a threaded, titanium screw in the desired location for the new tooth. After a period of time for healing, the patient will visit our office to fabricate a temporary crown to help this part of the mouth adapt to a new tooth. When the time is right, we will proceed to make the permanent crown. When treatment is completed, the implant crown will look and feel as good as a natural tooth.

You will find access to more information on our links page.

  Oral Surgery
We make a concentrated effort at saving teeth, but there are times when a tooth is beyond repair or the treatment just is not practical for the patient. We are able to accomplish many of our patient’s needs for the removal of hopeless teeth. The need for removal may arise from severe decay, advanced periodontal [gum] disease, a fractured tooth that is unrestorable, or a tooth that is crowded into a position that is unfavorable for a healthy mouth.

In our office we are able to remove most hopeless teeth with the use of a local anesthetic, however there are situations where the use of sedation, (either nitrous oxide or I.V. sedation ) may help an anxious patient tolerate the procedure with confidence and comfort. In this situation we can make a referral to an oral surgeon. They have specialized training in advanced, dental surgical procedures and medicine. They help us with the evaluation and treatment of more complex dental reconstruction. They can also help to coordinate any treatment of the mouth for a medical condition.

  Periodontal [Gum] Disease
Since periodontitis [gum disease] is the main reason for tooth loss in adults, we take every step needed to educate, motivate, and provide care to help to control this condition. At some stage in life, the majority of adults will develop some form of gum disease.

There are several factors leading to the progression of periodontitis. The problem starts with the accumulation of plaque on the teeth. Plaque can cling to the teeth, especially between the teeth and just under the gums, on the root surface. Bacteria in the plaque can grow, causing an infection. Toxins from the bacteria are very irritating to gum tissue and your jaw bone. Toxins can destroy these tissues if they remain for a long time. The environment in your mouth can be more or less resistant to the effects of gum disease. The type and amount of saliva, alignment of your teeth, your overall health and strength of your immune system, and factors with your genetic makeup can influence whether or not plaque will be more or less damaging to your dental health.

Gum disease is slow developing, but persistent in nature. It can become active, then subside. There is usually no pain in the early phases, perhaps just some redness, swelling or bleeding from the gums. As the disease advances, and becomes more established, you may have a bad taste in your mouth, see deposits on your teeth that can’t be removed by brushing, and may develop painful, swollen gums. In the later stages, teeth can become loose, change alignment- gaps develop between teeth, and eventually teeth are lost. It requires continual reevaluation to detect any changes, requiring a refocus on one’s treatment.

At our office we usually take a conservative approach to periodontal care. First we gather information, evaluate radiographs, examine and measure the areas where the gums attach to the teeth, in order to determine the extent of any gum disease present. We thoroughly clean your teeth to remove all foreign deposits. This can be completed in one to four appointments, depending on the severity of your condition. At this point you should have a clean set of teeth. The next phase is to let your gums heal. Your daily oral hygiene care at home is very important to maintain a clean environment in your mouth that will contribute to improved gum health. We can provide the education and a little motivation to help you get healthy.

We evaluate the results of our initial treatment to assess your response within the next three months. By this time we should be able to determine the appropriate interval between cleaning visits, to allow the gums to heal as much as possible. If there are areas in your mouth that are not responding to treatment, we have several options. We may continue to scale and evaluate your gums over a longer time. We may choose medications to assist in controlling gum disease. Referral to a periodontal specialist may be appropriate for some individuals.

It is important to remember that periodontitis is an infectious disease that cannot be cured. Our best efforts will allow for the control of this disease. Patients with periodontal disease require regular care in order to have the greatest chance for achieving success in controlling gum disease.

There is much more information on this topic available on our links page, such as; www.perio.org

  Preventive Care
We offer many different ways to prevent dental disease. The most common is the routine dental examination. We review your past care and medical history. A thorough evaluation of your mouth for caries, periodontal disease, other infections, cancer or any other types of pathology is completed. As appropriate we will evaluate for growth and development as related to the teeth and jaws. The existing restorations are evaluated visually, and with radiographs, as needed.

A dental cleaning, or prophylaxis, is a vital component in the prevention of dental problems and in keeping the teeth looking their best. A prophylaxis will help prevent the development of gum disease and tooth decay.

Oral hygiene information from our dental hygienist will help you to understand how to take care of your dental health, and use the various dental care products available on the market. We have links to web sites for several reputable companies in our links section.

  Root Canal Treatment
We often refer to this procedure as “root canal therapy” or “endodontic therapy”. This treatment is needed in order to save a tooth with an unhealthy, painful nerve or “pulp”. The pulp in the center of the tooth may be dead. Decay is the primary reason for this occurrence, however, trauma to a healthy tooth, or trauma from very large restorations existing near the pulp can cause pulp problems. The tooth or surrounding area of the jaw may be infected with bacteria which will form an abscess. The presence of pain, swelling of the gums, extreme sensitivity to biting, hot or cold temperatures are all reasons to look for a diseased tooth that may require root canal therapy. There may be periods of time when the tooth is comfortable or the tooth may not have any symptoms at all. If this condition is left untreated, the infection can spread to adjacent areas, eventually the bacteria will spread into the bloodstream. A person in this situation can develop a fever, most people will feel ill. This is a severe challenge to your immune system, and can be dangerous to your health, if not treated. The only other option to RCT is to have the tooth removed.

The process of completing a root canal treatment starts with anesthetic to numb the tooth. A hole is created into the hollow canal space at the center of the tooth that contains the nerves and pulp. All of this dying or infected material inside the tooth is removed. The tooth is treated with a disinfectant. The space inside the tooth is shaped to accept a rubber root canal filling [gutta percha, similar to the core of a golf ball] to seal the tooth from future leakage. A temporary filling is placed until the root canal sealer cement has hardened. A final restoration is needed within a month to prevent leakage into the treated tooth. Many times a crown is needed to strengthen a tooth that has become weakened from decay and large previous restorations. We have come to expect years of service from teeth that are properly treated with root canal therapy.

We encounter some teeth with unusual circumstances; difficult canals to locate or access for treatment, symptoms that are not consistent with a definite diagnosis, or teeth requiring retreatment for reinfection. We often refer patients to see an endodontic specialist, who has advanced training in this specialized field, in order to successfully evaluate and treat more challenging conditions.

  Sealants
As teeth develop in the early stages of life, four tooth buds fuse together to form the crown of the tooth. The pits, grooves or fissures on the biting surface are a result of the joining of these tooth buds. Some teeth fuse these parts together better than others. The “others” can have deep, narrow fissures which are prone to collecting food and plaque. These areas are susceptible to decay and difficult to clean. A sealant can be placed over this part of the tooth to protect it. It is a very simple procedure. We clean the tooth with a technique called air abrasion, essentially a miniature sandblaster used to clean out the deep fissures. An etching gel conditions the tooth for a few seconds and it is rinsed away. The sealant material is a flowable, liquid composite that covers the fissure. We use an intense light to harden the sealant onto the tooth. Sealants provide years of service for a tooth which otherwise is likely to need a filling soon.

  TEMPOROMANDIBULAR JOINT [TMJ] Disorders
We are able to help provide relief for symptoms related to disorders of the jaw joint, when caused by a dental condition. Please review the information on dental care that we have posted in the EDUCATION section. It can be very helpful for understanding your condition and finding ways to provide relief from minor symptoms.

  Whitening
Many people today would like to have whiter teeth. We have many ways of improving the color of your teeth. The simplest, easiest way to accomplish this goal is to have your teeth bleached. This is a time tested and appropriate treatment option for most people. Bleaching can lighten your teeth several shades in a short time.

There are a few ways to bleach your teeth:

  1. whitening toothpaste- suitable for removing surface stains on teeth, somewhat better than normal toothpaste.
  2. whitening strips- these are able to lighten your teeth, but with some limitations. Most strips do not cover all the teeth that you would like to lighten. The strips are unable to flex enough to deliver bleaching material to all the recesses between the teeth. The strips can work well when you just need a little improvement in the color of your teeth.
  3. in office bleaching- this involves the application of bleaching gel to your teeth during one or more visits to the dental office. Some offices use a light assisted method to accelerate the action of the bleaching material. Most often, the patient is sent home with bleaching material and custom fitted mouth trays to complete the process at home. This method seems to be the most thorough way to lighten teeth, especially in more difficult situations.

In our office we use a technique that involves bleaching in the office and at home. We evaluate the teeth for their potential to look better after bleaching treatment. We also consider the colors of any existing restorations, as dental restorations will not bleach. We may need to discuss expectations and options for making all the teeth a similar color. Tooth sensitivity can be an issue. We use materials with the reputation of causing the least sensitivity. Most often the sensitivity is temporary. It should resolve when you stop your treatment. We can also provide strategies to reverse or minimize tooth sensitivity during treatment.

We will start with making a custom mould of your mouth, to provide bleaching trays with the best fit. A visit to the office for initial bleaching and instructions will get you started. The remainder of your treatment can be accomplished at your convenience while at home. We advise spending 30-60 minutes per bleaching session, once or twice a day. Most people will notice a difference within a week. The total elapsed time to complete your bleaching will depend on several factors; amount of time you invest each day, color change desired, darkness of teeth, and sensitive teeth which may require a slower approach .

Some people have heard about light assisted bleaching, such as “zoom”. We have decided not to use this technique, due to the added expense to patients. The initial bleaching in the office will show better results, but the final results achieved after completing the treatment will be the same. The total elapsed time will be the same… so we have just been unable to justify the added cost to our patients for using a bleaching system , such as “zoom”.

In some situations, where the teeth are severely discolored, decayed, or have problems with poor alignment, bleaching may not be the complete answer to all your needs. This is where a careful, coordinated approach in planning your treatment will help to achieve the results your desire.

  Veneers
Veneers are a dental procedure in which a covering is placed over the outside (visible area) of the tooth. Veneers are usually only done to the part of the teeth that are visible when talking or smiling. The procedure can be direct or indirect.

The direct technique usually involves placing composite resin on the outside of the tooth using bonding. This method is usually referred to as bonding.

The indirect technique usually involves two appointments because the veneers will be fabricated at a dental laboratory. At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In two to three weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic, and are very esthetic.

Veneers are a good option for teeth that are chipped, discolored, have a poor shape, have previous small restorations, or surface defects that are an aesthetic problem. Veneers are not usually recommended for teeth that have had very large fillings, previous root canal treatment, or extensive destruction of the tooth. A crown may be a stronger option in these situations.

  X-Rays
This is a focused beam of energy that passes through the bone, teeth and soft tissues of the body to produce an image on a special film. This gives the familiar black and white images that doctors and dentists use to diagnose problems. X-Rays are a necessary part of the diagnostic process, and not using them could lead to undiagnosed disease. Periodic X-rays of the whole tooth, supporting bone and gum tissue are needed to detect infection or decay that would require further treatment. Four bitewing or cavity check X-rays are usually taken annually while a more extensive series of films is recommended every five years. The interval for taking these radiographs is adjusted at times, to allow for considering the individual needs of our patients. Some people have a history of few or no problems; in this case we would be inclined to reduce the frequency of taking routine x-rays.

In our office digital radiography is used, this allows us to us less radiation than conventional X-rays. Digital images are stored in each patients chart in our computer system enabling us to easily access past films and make comparisons that are often used for diagnosis. The use of digital radiographs allows us to reduce our patient’s exposure to radiation, which is a huge improvement. We can also display the images on our monitor so the images are easier to see. We no longer need a dark room for processing films. This is a great time saver for our staff. The environment will benefit from the fact that we no longer use or need to dispose of processing chemicals. The use of this new technology is a winning solution for everyone!