Our office is well versed and can deliver a wide range of cosmetic techniques, which include bonding, porcelain veneers, and tooth whitening or bleaching of the teeth, and porcelain crowns, inlays, onlays, and other non-metallic restorations.
Bonding is simply adding a tooth colored resin to the outside of a tooth, after first chemically treating the surface. Almost all are done on the front six teeth, usually the uppers. This procedure can help correct chips and other defects, slightly rotated or crooked front teeth, close gaps or diastemas, and even change the color of the smile to give a brighter look. The advantages are that little or no tooth structure is removed (the work could be reversed if desired), and the desired change can usually be done in one visit. The disadvantages are that the bondings can chip with certain foods or hard bite contact (although this can easily be repaired in most cases), and they can pick up stain over time, especially with people that smoke or drink coffee. They sometimes are not as translucent as porcelain work, although this is not as critical for most.
Porcelain veneers have application in the same areas as bondings do. They are very thin shells of porcelain that are chemically bonded to the teeth. As such, they require some degree of tooth preparation, therefore are not a reversible procedure. However, they are more color stable and resistant to staining than bondings. One visit involves preping and shaping the teeth for the veneers (after a consultation visit) and impressions, then one visit to cement them to place. The results are quite dramatic in most cases.
We can achieve some good results in more complex cases with full coverage, that is, with crowns or “caps”. See that heading for more detail about crowns and bridges. Inlays and onlays are cosmetic replacements for the older gold variety. More detail can be found under the “filllings” heading.
We offer tooth whitening or “bleaching” as a conservative cosmetic approach. If the patient is satisfied with his/her basic tooth size, shape and arrangement, the teeth can be safely brightened. There are two ways to go�in house and home bleaching. The in-house is done at the office by the dentist and uses a more powerful peroxide solution applied directly to the teeth. The tissues are protected by a barrier of rubber or cotton gauze. Advantages are that immediate results can be obtained in one visit, with only slight “rebound” of the lightened teeth. Disadvantages are that there can be a bit more sensitivity than the home kits due to the higher peroxide concentrations, and it may take 3-5 applications to get a desired result. The home kit starts with a mouth impression, usually starting with the upper, after which a mouthguard is made. The patient applies the solution from a syringe into the guard and wears it on the teeth, usually overnight. Results take 2-3 weeks.
It should be noted that is not a “paint job”; the bleaching agent gets into the interior of the tooth and brightens it from within, thus the results are “permanent”. Occasional touch ups may be required. Bleached teeth can stain just like regular teeth, but a good polishing usually brings back the shine. Teeth with yellowish stain bleach better than gray or brown teeth. The office bleaching has a higher fee because it requires more of the dentist�s time.
Although some results can be dramatic, most cases improve slightly to moderately, but there is always some lightening. We show patients that the average case usually improves 1-3 shade guides within the same range. Greater results are rare and usually products of wishful thinking. Best results (brightest whitening) is still starting with the home bleaching trays then finishing with the in-office treatment. However, if one or the other is chosen, we find the home kit to be slightly more effective (and less cost!). A few patients just do the uppers, but the best results is to do both.
This service should be very obvious. If a tooth has decay that penetrates the outside layer-called enamel, the decay is removed and a filling placed. If we can get to the situation before this happens, a sealant can be placed. We generally use anesthetic for our fillings when the decay gets into the second layer to any extent.
Our office switched in 1996 from silver fillings to composite resin restorations. Silver was not a bad material, but the “tooth colored” fillings have advantages. The fact that they obviously look better is only a small part of the story. The new materials allow for more conservative cavity preparations with less tooth structure removed. They bond to tooth structure and thus strengthen the tooth, resulting is less fractured teeth and fillings. In addition, the technique used and the fact that the material is non-metallic gives overall less post-operative sensitivity. In fact, if these fillings remain sensitive to temperature and /or bite for more than a few days, we appoint the patient to check the bite. At times, the patient may not have closed properly at the filling appointment due to the numbness. If, however, the bite is or is made proper, and the tooth continues to hurt, a root canal is needed. Not all nerves in all teeth can be healed just by doing a filling, especially of the decay reaches the pulp.
The new restorations take a bit longer and are harder to place, the results are well worth it. We haven�t many people that would want a silver filling after we explain the difference. A great “proving ground” for these tooth-colored fillings for us has been children. As you know, children can have a quite varied diet, and it would not be unusual to see broken primary teeth, fillings, or both when we used silver. After we switched, so far we haven�t had one “baby” tooth or filling break on any of our recalls! Of course, there will always be a first time, but the results seem extremely promising! ALso, the baby tooth will come out and the filling will be intact.
Most dental patients know what cleaning services either the hygienist or dentist provides. The use of a scaler to remove plaque and tartar (calcified plaque) followed by a polishing with a rubber cup and prophy paste is common knowledge. We also add the advantage of a mechanical ultrasonic scaler to achieve a better result. Routine cleanings usually require topical anesthesia at most.
What is not so commonly known is that not everyone fits into the “twice a year” mold! We screen every patient over 18 years old with a periodontal probe that measures the gum “pocket” around each tooth. The measure is from the gum crest to where the tooth enters the bone. It is a relatively painless procedure, but tells us much. If your “numbers” average 2-3 mm, you most likely have good tissue and bone and can come in every six months. However, numbers around 4 -5 mm may require more frequent visits, and numbers 6 and above most likely will require a treatment called “root planing” (usually done under local anesthesia), especially if there is a lot of tartar under the gumline. There may be need for antibiotic therapy and possible surgical intervention by a periodontist (gum specialist).
The treatments listed above are described in simple and general terms, each case may require more involved explanation and varied treatment options. Patients overall health can have a bearing on their gum/bone condition, as well as taking certain medications, especially hormonal therapy, blood pressure and heart medications. Smokers can really negatively effect their periodontal condition; 90% of gum disease cases that don�t respond to conventional therapy are smokers.
By now, most have you have heard that having bad gum disease can increase your risk of heart attack, stroke and diabetes. All the more reason to brush, floss, and have your teeth and gums professionally cleaned regularly!
Root Canals (RCT)
There is probably no procedure in dentistry that strikes so much fear in the hearts of patients than this service. This is very unfortunate, because the vast majority of root canal goes smoothly with little or no discomfort.
Root canal is needed whenever a nerve gets so “sick” that is can�t recover. Decay getting into the nerve and causing an infection is the most obvious, but trauma, fractures, and “overworking” the tooth are others. Let�s explain overworking. If your nerve is a bathtub, and every time something happened to the tooth (decay, trauma, fillings, etc.) a bucket of water was added to the tooth, eventually the tub would overflow. It�s not quite this simple, but some teeth (and some people) have smaller “bathtubs” than others.
Do not use pain as the sole criteria for need for RCT! The classic symptoms are pain in chewing, radiating pain to eyes, ears, temples, etc., pain that gets you up at night, symptoms that get worse towards evening when you lay down, and more sensitive to hot than cold. The extreme case of a constant, throbbing ache usually indicates that the infection has moved into the surrounding bone. The point is that the tooth may have needed a root canal long before these symptoms occur, and unfortunately people associate this pain with the RCT procedure! It is true that some of these cases are hard to manage pain-wise, but with proper medication, it is possible. Also, only about 40% of root canals can be diagnosed from x-ray. Many times, a nerve goes necrotic (dies) and the patient is unaware until the infection gets going. We check teeth with large restorations and/or fractures for nerve vitality with an ice stick test. The stick is placed on the tooth. A normal tooth will feel it slightly, and this will go away upon removal of the ice. However, if the sensation lingers or nothing is felt at all, this could be sign for RCT long before symptoms present!
Chances for successful RCT therapy are best at this point, before extreme symptoms present themselves. Most endodontics (RCT) can be performed in one to two visits. A crown build-up and a final crown are required after a successful outcome, which statistics show is over 90% in the non-extreme cases. If a case warrants it, we refer the patient to our endodontic specialists.
Remember, the only alternative to root canal therapy is extraction! Please keep this in mind the next time somebody exaggerates that they would rather have a baby or scrape paint than have a root canal!
A crown is a dental restoration that provides full coverage. The other term that is commonly used is “cap”. Crowns are done if there has been severe damage to the tooth due to decay or fracture, or after root canal. These teeth are weakened due to the great loss of tooth structure and need the added strength that a crown can give.
The procedure usually takes two to three appointments. First, the tooth is built up to get a strong foundation for the crown. This is especially important after a root canal. The tooth is then prepared with a handpiece, resulting in a scaled-down version of the original tooth. This to allow adequate thickness of the materials used to make the crown, especially the biting surface. An impression is then made, and a temporary crown is put on the tooth. A shade of the teeth is picked to match the natural teeth as closely as possible.
Before the patient returns to seat the new crown, a lab constructs a custom-fitting crown to fit the model poured from the impression. This takes about two weeks to return to the office. Most crowns on back teeth are gold covered with tooth-colored porcelain, all gold crowns can be made if the patient requests or the bite is such that gold would be a better choice�such as in people who grind their teeth or close bite tolerances.
At the cementation appointment, the temporary is removed, the new crown is place on the tooth, fit and bite are evaluated clinically and with X-ray, and adjustments made if needed. If all looks well and patient and doctor are satisfied, the crown is then seated with permanent cement.
Even though most of our crowns on front teeth are gold overlaid with porcelain, all ceramic crowns are available. Although strength and longevity are only recently been improved, they are very nice and hold promise. Both methods give us good results, with the ceramics being a bit more translucent and “lifelike”. We use them mostly on the front 6 teeth.
Crowns, properly done, can last a long time and do a great job protecting teeth. Your home care is the same as for your natural teeth. Don�t eat anything with your crown that you would not eat on your other teeth.
Bridgework , simply put, involves putting crowns on the teeth adjacent to the empty space and connecting the replacement teeth directly to them in one unit. Implant crowns are crowns specially designed to fit over implant fixtures. Please see those headings for more information.
Sealants are a coating that is applied to the grooves of the back teeth, usually molars, that keeps plaque from forming in the grooves and causing decay.
The old method chemically treated the tooth and basically just flowed a resin material in the grooves. It was somewhat effective, but would often chip out, mainly due to the fact that it many times was inadvertently placed over organic debris, or worse, initial decay.
Now, with newer technology and materials we place sealants differently. The groove system is normally very deep and trench-like to begin with, which is why decay forms easily in it. We now open up the grooves on the tops of the teeth with a very small bur. This is done almost always without anesthetic. Also, we check the grooves first with a laser detector to see if decay exists. Then, we can actually stain decay now with a dye called a caries indicator. If no decay is present, the tooth is chemically treated and a flowable composite is placed and cured with a light. If decay is present, sometimes we can remove it in the same procedure and place a composite filling without anesthetic. If the tooth gets sensitive or the decay is deep, we can stop and numb the area.
The newer sealants can last 5-10 years. When sealants wear out, they can be replaced easily. There is close to a 90 percent chance of avoiding decay in the grooves of the teeth if sealants are placed successfully, assuming good oral hygiene. Optimum time to place sealants on first molars is in 6-8 yr. old children, and 12-13 yr. old for the second molars. We seal premolars on an as needed basis, especially in cavity prone individuals.
Teeth can be sealed at any age, but the chances for decay increase with how long the tooth was in the mouth and sugar habits.
As the name implies, a bridge spans a “gap”, which in the mouth means a missing tooth or a series of teeth. Traditional fixed bridges involve crowns (caps) on the teeth adjacent to the missing tooth which serve as an anchor for the pontic, which replaces the lost tooth or teeth. At times, these abutment or “anchor” teeth will need root canal therapy before the bridge is accomplished depending on nerve conditions, pain, fracture, excessive loss of tooth structure, or need to change the angle of the prepared teeth to more easily fit the bridge, or sometimes even to make the bridge look better. Please look under the Root Canal heading for more info. Also, refer to the Crowns heading to find out more about how teeth are prepared to receive them.
Lately, the need for traditional fixed bridgework has been diminished by the increasing use of dental implants to replace missing teeth. This is generally a good thing, since one of the drawbacks of a bridge was cleaning underneath it, which required the use of a floss threader. Please see the heading ” Implants” for more info.
Some bridges can be done now with no metal or gold and with less cutting down of the teeth, although the technology does not have a long track record. Also, a type of bridge called a “Maryland bridge”, which looks like a replacement tooth with “wings” can be used at times on the front teeth�areas with low bite forces. These usually involve minimal reduction of tooth structure, but have the drawback of being less retentive and sometimes loosening and coming out. Bridges can also be totally implant supported in areas of multiple tooth loss.
The bridges described above are all fixed, they don�t come out. Some people call a removable partial denture a “bridge”. This is not accurate and can lead to confusion.
We make every attempt to get an emergency patient in the same working day, or at least within 24 hrs. Of course, we may not be able to complete the work at the emergency visit, but our office will try to get the “chief complaint” resolved, and appropriate medication dispensed, if needed.
An emergency constitutes: severe pain and/or swelling, tooth knocked out, fractured front tooth (especially if it hurts), broken upper denture or one that will not stay in by any means (and no spare), missing or broken filling �only if there is severe pain, loss of a crown on a front tooth, recently done restoration that patient cannot eat with at all.
Other pressing concerns, like loss of a crown on a back tooth, broken filling with no pain, slightly chipped denture tooth, and so on we will appoint as soon as possible, but not on an emergency basis.
Please understand our office policy: we have people already on the books when we try to fit an emergency in These people will almost always understand a delay for a true emergency, but put yourself in their shoes if someone comes in for something that can wait. Of course, if we have a change in schedule, and thus more time, we may be able to do more complete treatment.
This office is well versed in the art of making dentures�the construction of which seems to be as much an art as it is a science. Basically, impressions are made of the ridges in the mouth, wax rims are made to establish the bite, mid and lip line. The shade, size and shape of the teeth are selected, and teeth are set in the wax for a try-in. If the try-in is acceptable for both patient and doctor, the dentures are sent to the lab to be processed and finished. The dentures are then delivered to the patient, and adjustments made. Usually, there will be a period of time for the patient to become accustomed to the new teeth, especially if they are new wearers.
We also offer relining and repair services in-house. If the damage is great, our labs can help also. It is a common misconception that once you receive your dentures, you never need to bother with them again. Tissues change (usually shrink) under the plates, mostly due to wear and tear, but sometimes due to weight loss. Dentures should be relined by a professional, not by home over-the counter techniques or a wad of adhesive. Sore spots, fractures, and broken teeth can be caused by ill-fitting dentures. Do yourself a favor and have your mouth and teeth checked regularly.
It is no secret that the lower denture is the troublesome one 9 of 10 times! This is mainly due to the fact that it lacks what the upper has�a palatal area for suction. Sometimes, however, a bite or flange adjustment or reline can help. Occasionally, a new denture or set needs to be made. Making a spare upper is always a good idea!
If a patient really has trouble with the lower, is in good overall health and has adequate bone in the jaw, an implant-borne prosthesis could save the day. The implants could be used to clip the denture to keep it stable, or more implants could be placed to support a fixed bridge. See the heading ” Implant crowns ” for more information on implants.
The service should be very obvious. While we do our best to save teeth, sometimes teeth are still lost mainly due to large decay going through the bottom of the tooth, root fractures, severe bone loss due to periodontal disease, or infection that root canal therapy and antibiotics can�t control.
This office can remove some teeth, depending on normal root shape, depth of fracture, and degree of infection or swelling. Complicated cases will be sent to our oral surgeon referral base. Most wisdom teeth and other multiple extractions will also be referred out. Cases where there will be a future denture or implants may be sent to the surgeon. In addition, any patient requiring sedation will be referred, since we only use local anesthesia.
We can remove most primary (baby) teeth if needed, depending mostly on patient temperament. We do have referrals to pedodontists if necessary.
A removable partial denture (RPD) is made to replace teeth and aid in form and function where there are still some teeth left. Basically, it involves a metal framework that fits and clasps the remaining natural teeth at strategic points. The replacement teeth are imbedded in dental acrylic on the “saddle” areas. It is not a “bridge” in the classical sense since it can be removed.
RPDs can be done in both the upper and lower arch. Every effort is made, especially with the upper, to show as little metal as possible. However, the patient can choose different designs which may involve crowns and special attachments that show little if any metal.
Good oral hygiene is important when wearing partial dentures, both with the prosthesis (see the denture heading) and especially with the teeth that hold the RPD. These teeth are more prone to decay due to the nature of the partial system. Doing crowns on the teeth holding the partial may be required to achieve better fit and strengthen the project. Generally, these RPDs are a second choice to implants or fixed bridgework.
This service is our recall system. Basically, when we finish your initial gum and tooth treatment, we set you on a schedule to return for follow-up care. At that time, we check the condition of the teeth, gums, restorations, other mouth tissues, and take any necessary radiographs. We also address any concerns you may have, and then we present a strategy to try to keep your mouth the best it can be!
Please see the ” Cleanings ” section for more info.
Our office restores implants placed by our oral surgeon. Implants are the man-made tooth roots put into the bone of the upper or lower jaws. After four to six months, the bone grows in around these fixtures, and they are uncovered at the second stage surgery. At this point, abutment types are chosen. These abutments are the substructure upon which crowns, bridges, or even dentures can be placed on.
Please see the headings of Crowns , Bridge Work , and Dentures for more information. As a final comment, implant success is well over 90% and is fast becoming the number one choice for tooth replacement!