Restorative dentistry
Fillings
Several factors influence the performance, durability, longevity and expense of dental restorations, including:
The components used in the filling material
The amount of tooth structure remaining
Where and how the filling is placed
The chewing load that the tooth will have to bear
The length and number of visits needed to prepare and adjust the restored tooth
Before your treatment begins, your doctor will discuss with you all of your options and help you choose the best filling for your particular case. In preparation for this discussion it may be helpful to understand the two basic types of dental fillings — direct and indirect.
Direct fillings are fillings placed immediately into a prepared cavity in a single visit. They include glass ionomers, resin ionomers, and composite (resin) fillings. The dentist prepares the tooth, places the filling, and adjusts it in one appointment.
Indirect fillings generally require two or more visits. They include inlays, onlays, veneers, crowns, and bridges fabricated with gold, base metal alloys, ceramics, or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The dentist then places a temporary covering over the prepared tooth. The impression is sent to a dental laboratory, which creates the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.
Root Canal
In the past, if you had a tooth with a diseased nerve, you would probably lose that tooth. Today, with a special dental procedure called root canal treatment, your tooth can be saved. Root canals are a relatively simple procedure involving one to three office visits. Best of all, having a root canal when necessary can save your tooth and your smile!
What is the purpose of a root canal?
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
When a tooth is cracked or has a deep cavity, bacteria can enter the pulp tissue and germs can cause an infection inside the tooth. If left untreated, an abscess may form. If the infected tissue is not removed, pain and swelling can result. This can not only injure your jawbones, but it is detrimental to your overall health. Without the proper treatment, your tooth may have to be removed.
What are the signs that a root canal is needed?
Teeth that require root canal therapy are not always painful. However, signs you may need a root canal include severe toothache, pain upon chewing or application of pressure, prolonged sensitivity or pain in response to hot and cold temperatures, a dark discoloration of the tooth, and swelling and tenderness in the nearby gums. If you experience any of these symptoms, contact your doctor.
What happens during a root canal?
Root canal treatment involves one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems with the nerves of the teeth) removes the affected tissue. Next, the tissue will be removed and the interior of the tooth will be cleaned and sealed. Finally, the tooth is filled with a dental composite. If your tooth had extensive decay, your doctor may suggest placing a crown to strengthen and protect the tooth from breakage. As long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups, your restored tooth can last a lifetime.
Extractions
There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk of decay, so your doctor may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.
When it is determined that a tooth needs to be removed, your dentist may extract the tooth during a regular checkup or may schedule another visit for this procedure. The root of each tooth is encased within your jawbone in a "tooth socket," and your tooth is held in that socket by a ligament. In order to extract a tooth, your dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with your doctor any concerns or preferences for sedation.
Once a tooth has been removed, neighboring teeth may shift, causing problems with chewing or with your jaw joint function. To avoid these complications, your dentist may recommend that you replace the extracted tooth.
Wisdom Teeth Removal
Wisdom teeth are types of molars found in the very back of your mouth. These teeth usually appear in late teens or early twenties but may become impacted (fail to erupt) due to lack of room in the jaw or angle of entry. The most common type of impacted wisdom tooth is “mesial”, meaning that the tooth is angled forward toward the front of your mouth.
When a wisdom tooth is impacted, it may need to be removed. If it is not removed, you may develop gum tenderness, swelling, or even severe pain. Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections, and even gum disease.
Each patient's situation is unique. Your dentist will usually take a panoramic X-ray to determine whether your wisdom teeth will need to be removed. If your dentist recommends removal of your wisdom teeth, it is best to have them removed sooner rather than later.
Wisdom teeth are typically removed in the late teens or early twenties because there is a greater chance that the teeth's roots have not fully formed and the bone surrounding the teeth is less dense. These two factors can make extraction easier, as well as making the recovery time much shorter.
To remove a wisdom tooth, your dentist first needs to numb the area around the tooth with a local anesthetic. Your dentist can use additional medication to safely sedate you during the extraction if you are feeling nervous about the procedure. Since the impacted tooth may still be under the gums and imbedded in your jaw bone, your dentist will need to remove a portion of the covering bone to extract the tooth. To minimize the amount of bone that is removed with the tooth, your dentist will often “section” your wisdom tooth so that each piece can be removed through a small opening in the bone.
Once your wisdom teeth have been extracted, the healing process begins. Healing time varies depending on the degree of difficulty related to the extraction. Your dentist let you know what to expect and will provide instructions for a comfortable, efficient healing process.
Gum Disease
Gum disease is also known as periodontal disease, and is an infection of the gums surrounding your teeth. Gum disease is one of the top reasons for tooth loss in adults, and because it is virtually pain free, many patients do not know they have the disease. During each regular checkup, your dentist will check for signs of periodontal disease by measuring the space between your teeth and gums.
What Causes Gum Disease?
Gum disease is caused by a buildup of plaque (a sticky form of bacteria that forms on the teeth). If the plaque is not removed (by flossing, brushing, and regular dental checkups), it will continue to build up and create toxins that can damage the gums. Periodontal disease forms just below the gum line and creates small pockets that separate the gums from the teeth. Periodontal disease has two stages: gingivitis and periodontitis.
Gingivitis — This is the early stage of gum disease, when the gums become red and swollen, and bleed easily. At this stage, the disease is treatable and can usually be eliminated by daily brushing and flossing.
Periodontitis — If left untreated, gingivitis will advance into periodontitis, and the gums and bone that support the teeth will become seriously and irreversibly damaged. Gums infected with periodontitis can cause teeth to become loose, fall out, or be removed by a dentist.Certain factors can increase a patient's risk of developing periodontal disease, including:
Smoking or using chewing tobacco
Diabetes
Certain types of medication such as steroids, anti-epilepsy drugs, cancer therapy drugs, calcium channel blockers, and oral contraceptives
Bridges that no longer fit properly
Crooked teeth
Old fillings
Pregnancy
While it is possible to have periodontal disease and not know it, some symptoms can include:
Gums that bleed easily
Red, swollen, tender gums
Gums that have pulled away from the teeth
Persistent bad breath or bad taste
Pus between your teeth and gums
Permanent teeth that are loose or separating
Any change in the way your teeth fit together when you bite
Any change in the fit of partial dentures
Treating Gum Disease
Treatments for gum disease can vary depending on the severity of each individual case. Typical treatments include:
Non-surgical treatments such as at-home periodontal trays, and scaling and root planing (deep cleaning)
Periodontal surgery and laser gum surgery
Dental implants
Preventing Gum Disease
Regular dental checkups and periodontal examinations are important for maintaining your health and the health of your smile. You don't have to lose teeth to periodontal disease, and by practicing good oral hygiene at home, you can significantly reduce your chances of ever getting gum disease. Remember to brush regularly, clean between your teeth, eat a balanced diet, and schedule regular dental visits to help keep your smile healthy.
Temporomandibular Disorder (TMD)
Millions of Americans suffer from chronic facial and neck pain as well as recurring headaches. In some cases, this pain is due to Temporomandibular Disorder, or TMD.
Your temporomandibular joints (TMJ) connect your lower jawbone to your skull. These joints get a lot of use throughout the day as you speak, chew, swallow, and yawn. Pain in and around these joints can be unpleasant and may even restrict movement.
Symptoms of TMD include:
Pain in the jaw area
Pain, ringing, or stuffiness in the ears
Frequent headaches or neck aches
Clicking or popping sound when the jaw moves
Swelling on the sides of the face
Muscle spasms in the jaw area
A change in the alignment of top and bottom teeth
Locked jaw or limited opening of the mouth
Should you notice any of these symptoms, let your doctor know. Your dentist can help indicate the presence of TMD and create an effective treatment just for you.
There are a few simple steps you can take at home or work to prevent TMD from becoming more severe, or to prevent it from occurring:
Relax your face — remember the rule: "Lips together, teeth apart"
Avoid grinding your teeth
Avoid constant gum chewing
Don't cradle the phone receiver between your head and shoulder — either use a headset or hold the receiver to your ear
Chew food evenly on both sides of your mouth
Do not sit with your chin rested on your hand
Practice good posture — keep your head up, back straight, and shoulders squared
Crowns, bridges & Implants
Crowns
Crowns are a cosmetic restoration used to strengthen a tooth or improve its shape. Crowns are most often used for teeth that are broken, worn, or partially destroyed by tooth decay.
Crowns are "cemented" onto an existing tooth and fully cover the portion of your tooth above the gum line. In effect, the crown becomes your tooth's new outer surface. Crowns can be made of porcelain, metal, or both. Porcelain crowns are most often preferred because they mimic the translucency of natural teeth and are very strong.
Crowns or onlays (partial crowns) are needed when there is insufficient tooth strength remaining to hold a filling. Unlike fillings which apply the restorative material directly into your mouth, a crown is fabricated away from your mouth. Your crown is created in a lab from your unique tooth impression which allows a dental laboratory technician to examine all aspects of your bite and jaw movements. Your crown is then sculpted just for you so that your bite and jaw movements function normally once the crown is placed.
Bridges
A bridge may be used to replace missing teeth, help maintain the shape of your face, and alleviate stress on your bite.
A bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been. Your bridge can be made from gold, alloys, porcelain, or a combination of these materials and is bonded onto surrounding teeth for support.
The success of any bridge depends on its foundation — the other teeth, gums, or bone to which it is attached. Therefore, it's very important to keep your existing teeth, gums, and jaw healthy and strong.
Implants
If you have missing teeth, it is crucial to replace them. Without all your teeth, chewing and eating can destabilize your bite and cause you discomfort. When teeth are missing, your mouth can shift and even cause your face to look older. Implants are a great way to replace your missing teeth and, if properly maintained, can last a lifetime!
An implant is a new tooth made of metal and porcelain that looks just like your natural tooth. It's composed of two main parts: One is the titanium implant body that takes the place of the missing root, and the second part is the tooth-colored crown that is cemented on top of the implant. With periodontal treatment, you can smile confidently knowing that no one will ever suspect you have a replacement tooth.
In addition to tooth replacement, implants may be used to anchor dentures, especially lower dentures that tend to shift when you talk or chew. For patients with removable partial dentures, implants can replace missing teeth so that you have a more natural looking smile
Veneers
You no longer need to hide your smile because of gaps, chips, stains, or misshapen teeth. With veneers, you can easily correct your teeth's imperfections to help you have a more confident, beautiful smile. Veneers are natural in appearance and are a perfect option for patients wanting to make minor adjustments to the look and feel of their smile.
Veneers are thin, custom-made shells made from tooth-colored materials (such as porcelain) designed to cover the front side of your teeth. To prepare for veneers, your doctor will create a unique model of your teeth. This model is sent to a dental technician who creates your veneers. Before placing your new veneer, your doctor may need to conservatively prepare your tooth to achieve the desired aesthetic result.
When placed, you'll be pleased to see that veneers look like your natural teeth. While veneers are stain resistant, your doctor may recommend that you avoid coffee, tea, red wine, and tobacco to maintain the beauty of your new smile.