Comprehensive Dental Services and Procedures

First, we examine the tooth and determine the appropriate treatment. It could be a simple filling, or a full crown, depending on how much healthy tooth structure is remaining and our clinical judgment. Next, we administer an anesthetic and prepare your tooth for restoration, removing decayed and weakened tooth tissue. This preparation is just like we would do for many other restorative techniques.

We take an Optical Impression of the prepared tooth. Instead of filling a tray with impression “goop” that you must bite into and hold in your mouth until it hardens, we coat the tooth with a non-toxic, tasteless powder. A camera is then used to take a digital picture of your tooth. This whole Optical Impression process only takes a minute or two.

Next, we use the CEREC machine to create the restoration for your tooth. The CEREC 3D software takes the digital picture and converts it into a 3-dimensional virtual model on the computer screen. We then employ our dental expertise to design the inserting block using the CEREC 3D computer program. Within a few minutes, restoration design data is sent to a separate milling machine in the office. A ceramic block that matches your tooth shade is placed in the milling machine. About 10 – 20 minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place. Finally, we try the restoration in your mouth to ensure proper fit and bite. The restoration is then polished and bonded to the prepared tooth. Your tooth is restored with no “temporary” or return trip necessary. All of this is done in a single appointment! Ask us about CEREC today.

*Harvard Health Letter, March 2000; NIDR of NIH, Dental Amalgam Study, 1993.

• Reviewing and updating medical history, including heart problems, cancer treatment, pregnancy, diabetes, joint replacement, medications, surgeries, or any other major changes in health history
• Blood pressure check
• Oral cancer examination and screening
• Evaluation of gum tissue
• Checking biting, chewing, and swallowing patterns
• X-rays, examination of teeth to detect decay
• Treatment planning
• Referral to specialists for specific treatment

• Removal of plaque and tartar
• Stain removal
• Fluoride application
• Sealants
• Polishing of fillings or crowns

• Tooth brushing and flossing instructions
• Nutritional counseling
• Recommendations for future treatment: when to return for following hygiene treatment, periodontal (gum) concerns, restorative options, etc.
• Evaluation of possible cosmetic enhancements
• Evaluation of self-care effectiveness
• Tobacco-cessation counseling

Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea, or smoking. Teeth darkened with the color of yellow, brown, or orange respond better to bleaching. Gray stains caused by fluorosis, smoking, or tetracycline use can be lightened, but the results are not as dramatic. Your dentist may discourage bleaching if you have very sensitive teeth, periodontal (gum) disease or teeth with worn enamel.

First, the dentist will determine whether you are a candidate for tooth bleaching and what type of bleaching system would provide the best results.

If you’re in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. Your dentist will use either an in-office bleaching system or laser bleaching while you sit in the dental chair. Some patients choose dentist-supervised at-home bleaching, which is more economical and provides similar results.

If you don’t choose laser bleaching, your dentist or hygienist will make impressions of your teeth at your next appointment to create a mouthguard appliance. The mouthguard is custom-made for your mouth and lightweight so that it can be worn comfortably while awake or sleeping. The mouthguard is so thin that you should be able to talk and work while wearing it. Along with the mouthguard, you’ll receive the bleaching materials and be given instructions on how to wear the mouthguard.

Some bleaching systems recommend bleaching your teeth for several hours a day. Generally, this type of system requires two to four weeks to complete. Other systems recommend bleaching at night while you sleep. This type of system usually requires only 10 to 14 days to complete.

Over-the-counter bleaching systems are also available and are generally safe and effective, although it is best to check with your dentist before using these products. These systems, which come in the form of strips and gels, usually contain a lower strength of bleaching agent than products used in the dentist’s office. For this reason, they must be used longer to achieve the desired effect, but they are also cheaper.

Lightness should last from one to five years, depending on your personal habits, such as smoking and drinking coffee and tea. At this point, you may choose to get a touch-up. The retreatment time is much shorter than the original treatment time.

The active ingredient in most whitening agents is carbamide peroxide; when water comes into contact with this white crystal, the release of hydrogen peroxide lightens the teeth.

Several studies have proven bleaching to be safe and effective. The American Dental Association has granted its seal of approval to some tooth-bleaching products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement, as seen on a dentist’s shade guide. The success rate depends upon the type of stain involved, the type of bleaching procedure, and your compliance. Bleaching can only provide a shift in color from gray to a lighter shade of gray, for example. Bleaching does not lighten artificial materials such as bonding or veneers.

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. While questions have risen 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 the 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, we may need to remove more tooth structure to accommodate an amalgam filling than for other types of 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 we prepare 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 us to make a more conservative repair to the tooth.

The cost is moderate and depends on the size of the filling and the technique we use 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

Glass ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that may be beneficial for patients who are at high risk for decay. When we prepare the tooth for a glass ionomer, less tooth structure can be removed; this may result in a smaller filling than that of an amalgam.

Glass ionomers are primarily used in areas not subject to heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load-bearing fillings (those between the teeth) or on the roots of teeth.

Resin ionomers also are made from glass fillers with acrylic acids and acrylic resin. They also are used for very small, non-load-bearing fillings (between the teeth) on the root surfaces of teeth, and they have low to moderate resistance to fracture.

Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

Indirect Restorative Dental Materials (Two or more visits)

Sometimes the best dental treatment for a tooth is to use a restoration that is made in a laboratory from a mold. These custom-made restorations, which require two or more visits, can be a crown, an inlay, or an onlay. A crown covers the entire chewing surface and sides of the tooth. An inlay is smaller and fits within the contours of the tooth.

An onlay is similar to an inlay, but it is larger and covers some or all chewing surfaces of the tooth. The cost of indirect restorations is generally higher due to the number and length of visits required and the additional cost of having the restoration made in a dental laboratory. Materials used to fabricate these restorations are porcelain (ceramic), porcelain fused to a metal-supporting structure, gold alloys, and base metal alloys.

All-porcelain (ceramic) dental materials include porcelain, ceramic, or glass-like fillings and crowns. They are used as inlays, onlays, crowns, and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. The strength of this type of restoration depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear, but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.

Another type of restoration is porcelain-fused-to-metal, which strengthens a crown or bridge. These restorations are very strong and durable.

The combination of porcelain bonded to a supporting structure of metal creates a stronger restoration than porcelain used alone. More of the existing tooth must be removed to accommodate the restoration. Although they are highly resistant to wear, porcelain restorations can wear opposing natural teeth if the porcelain becomes rough. There may be some initial discomfort with hot and cold.

While porcelain-fused-to-metal restorations are highly biocompatible, some patients may show an allergic sensitivity to some types of metals used in the restoration.

Gold alloys contain gold, copper, and other metals, resulting in a strong, effective filling, crown, or bridge. They are primarily used for inlays, onlays, crowns, and fixed bridges. They are highly resistant to corrosion and tarnishing.

Gold alloys exhibit high strength and toughness that resists fracture and wear. This allows us to remove the least amount of healthy tooth structure when preparing the tooth for restoration. Gold alloys are also gentle to opposing teeth and are well tolerated by patients. However, their metal colors do not look like natural teeth.

Base metal alloys are non-noble metals with a silver appearance. They are used in crowns, fixed bridges, and partial dentures. They can be resistant to corrosion and tarnishing. They also have high strength and toughness and are very resistant to fracture and wear.

Some patients may show allergic sensitivity to base metals, and there may be some initial discomfort from hot and cold. However, base metal alloys do not look like natural teeth due to their metal color.

Crowns, inlays, and onlays can be made in the laboratory from dental composites. These materials are similar to those used in direct fillings and are tooth colored. One advantage to indirect composites is that they do not excessively wear opposing teeth. Their strength and durability are not as high as porcelain or metal restorations, and they are more prone to wear and discoloration.

Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

Talk with your dentist about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

The dentist must perform surgery to anchor the “artificial root” into or on your jawbone. The procedure is done in the dental office with local anesthesia. The gum is then secured over the implant, which will remain covered until it fuses with the bone. The dentist then uncovers the implant and attaches an extension, or post, to the implant. With some implants, the implant and post are a single unit placed in the mouth during the initial surgery. Finally, the dentist makes an artificial tooth, or crown, that is attached to the implant post.

The process can take up to nine months to complete. Each patient heals differently so that times will vary. After the implant and posts are placed surgically, the healing process can take up to six months, and the fitting of replacement teeth is no more than two months. Sometimes, if a patient has good bone quality, posts can be placed and replacement teeth fitted in one appointment.

The success rate for implants depends on the tooth’s purpose and location in the mouth, as well as a patient’s overall health.

Poor oral hygiene is a big reason why some implants fail. It is important to floss and brushes around the fixtures at least twice a day. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

Since implants involve surgery and are more involved, they cost more than traditional bridgework. However, some dental procedures and portions of the restoration may be covered by dental and medical insurance policies. Your dentist can help you with this process.

1. First, an opening is made through the tooth's crown into the pulp chamber.
2. The pulp is then removed. The root canal(s) is cleaned and shaped into a form that can be filled.
3. Medications may be put in the pulp chamber and root canal(s) to help eliminate germs and prevent infection.
4. A temporary filling will be placed in the crown opening to protect the tooth between dental visits. We may leave the tooth open for a few days to drain. You might also be given medicine to help control infection that may have spread beyond the tooth.
5. The temporary filling is removed, and the pulp chamber and root canal(s) are cleaned and filled.
6. In the final step, a gold or porcelain crown is usually placed over the tooth. If an endodontist performs the treatment, he will recommend that you return to your family dentist for this final step.

Veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth’s color, size, or shape. Veneers can mask undesirable defects, such as teeth stained by tetracycline and damage due to an injury or a root canal procedure. They are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.

Patients may need up to three appointments for the procedure: diagnosis and treatment planning, preparation, and bonding.

You must take an active role in the smile design. Spend time planning the smile. Understand the corrective limitations of the procedure. If necessary, have more than one consultation to feel comfortable that your dentist understands your objectives.

To prepare the teeth for the veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about half a millimeter of the tooth is removed, which may require a local anesthetic. Composite resin veneers are generally done in one appointment. After the tooth is prepared, the dentist carefully bonds and sculpts the composite material onto your teeth. For ceramic veneers, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This may take several days. If the teeth are too unsightly, a temporary veneer can be placed at an additional cost.

When your ceramic veneers are ready, the dentist places the veneers on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, view the results, and pay particular attention to the color. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. The color cannot be altered after the veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a light beam hardens the cement.

For about a week or two, you will go through a period of adjustment as you get used to your “new” teeth that have changed in size and shape. Brush and floss daily. After one or two weeks, your dentist will ask you to return for a follow-up appointment.

Following preparation, the dentist places the composite in layers, typically using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.

Prices vary, but composites can cost up to two times the price of a silver filling. Most dental insurance plans cover the cost of the composite up to the price of a silver filling, with the patient paying the difference. As composites continue to improve, insurance companies are more likely to increase their coverage of composites.

Aesthetics are the main advantage of composites since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

After receiving a composite, a patient may experience postoperative sensitivity. Also, the shade of the composite can change slightly if the patient consumes tea, coffee or other staining foods. The dentist can put a clear plastic coating over the composite to prevent the color from changing if a patient is particularly concerned about tooth color. Composites tend to wear out sooner than silver fillings in larger cavities, although they hold up as well in small cavities.

Wisdom teeth are the third molars. Normally people have three permanent molars that develop in each quadrant of the mouth; upper, lower, right, and left. The first molars usually grow into the mouth at around six years of age. The second molars grow at around age 12. The third molar usually will try to grow at around age 17 to 21 years. Since that is considered to be the age when people become wiser, third molars gained the nickname “wisdom teeth.” Actually, they are no different than any other tooth except that they are the last teeth to erupt or grow into the mouth. They are just as useful as any other tooth if they grow in properly, have a proper bite relationship and have healthy gum tissue around them. Unfortunately, this does not always happen.

When wisdom teeth are prevented from erupting into the mouth properly, they are referred to as impacted. Teeth that have not erupted are not necessarily impacted. It may be that it is still too early in someone’s dental development, and if time passes, they might grow in properly. A dentist must examine a patient’s mouth and his or her X-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems, such as infection, decay of adjacent teeth, gum disease, or formation of a cyst (fluid-filled sac) or tumor from the follicle, which is the tissue that forms the crown of the tooth. Many dentists recommend the removal of impacted wisdom teeth to prevent potential problems.

Erupted wisdom teeth may also need to be removed. The dentist may recommend this if the tooth is nonfunctional, interfering with the bite, badly decayed, involved with or at risk for periodontal disease, or interfering with the restoration of an adjacent tooth. Once again, every case is different, and only your dentist can determine if there is a reason for you to have a tooth removed.

The following symptoms may indicate that the wisdom teeth have erupted and surfaced and should be removed before they become impacted. In other words, the teeth have surfaced and have no room in the mouth to grow. However, each individual may experience symptoms differently.

• Symptoms may include:
• Pain
• Infection in the mouth
• Facial swelling
• Swelling of the gumline in the back of the mouth

Many oral health specialists will recommend the removal of wisdom teeth before they are fully developed, usually in the adolescent years, as early removal will help to eliminate problems such as an impacted tooth that destroys the second molar.

Wisdom tooth extraction involves accessing the tooth through the soft and hard tissue, gently detaching the connective tissue between the tooth and the bone, and removing the tooth. Extractions can be performed under local anesthesia.

Following the extraction, you may experience some swelling and discomfort, a normal part of the healing process. Cold compresses can help decrease the swelling, and your dentist may prescribe medication to help relieve discomfort.

Dry socket, the most common postoperative complication from tooth extractions, delays the normal healing process and results when the newly formed blood clot in the extraction site does not form correctly or is prematurely lost. The blood clot lays the foundation for new tissue and bone to develop over a two-month healing process. Women who take oral contraceptives are at a higher risk of developing dry sockets after wisdom teeth extraction due to high levels of estrogen.

• Schedule extractions during the last week of the menstrual cycle when estrogen levels are lower.
• Avoid drinking through a straw, as the suction may interfere with clotting.
• Avoid smoking which can irritate the extraction site.
• Avoid excessive mouth rinsing, which may interfere with clotting.