Root Canal Therapy

When the nerve of your tooth is diseased or injured and unable to repair itself, the nerve dies. The most common cause of nerve death is a fracture or a deep cavity that exposes the nerve to bacteria, which causes the nerve to die. A root canal is a way to save your tooth if your nerve becomes infected by a cavity or exposed due to fracture. When this procedure becomes necessary, it may take 1-3 appointments to be completed depending on the level of infection and/or complexity of the situation. Here is what typically occurs when performing a root canal:
1. After the tooth is anesthetized, we make a small hole in your tooth. This exposes the root canal and the damaged nerve.
2. We remove the damaged nerve and enlarge the root canal by carefully cleansing it with precision instruments called files. This process gives us a predictable way to insure that the infected nerve has been completely removed.
3. Once the root canal has been cleaned of all damaged nerve, it is filled and sealed with a safe, rubber-like material to prevent recontamination of the root canal system. The root canal treatment is now complete. However, your tooth still needs to be restored to its normal function and appearance.
4. Some people may experience mild swelling or discomfort after root canal treatment, although this is rare. If this occurs, call us - we may prescribe medication or additional treatment.

Root canal treatment allows your tooth to remain in your mouth even though it is “dead”. This type of treatment can safely and comfortably save a tooth that otherwise would have to be removed. A crown must be placed on a tooth with a root canal due to the fact that the tooth no longer is receiving nutrients/blood supply and it has been weakened by a large cavity or hole. The tooth will become brittle over time making it more susceptible to fracture. Remember, a healthy restored tooth is always better than an artificial one. For more info, see Crowns.

Crowns

A crown completely covers your tooth thereby making an entirely new tooth. Crowns are indicated for various reasons: fractured tooth (either missing a large part of your tooth or fracture lines on your tooth making it sensitive to cold, pressure, or both); esthetic reasons, teeth with large fillings that compromise the strength of your tooth increasing the risk for fracture. There three types of crowns: gold, PFM (tooth-colored with metal substructure), all-ceramic (tooth-colored with no metal content). Gold crowns are best in areas that receive high impact and in areas where esthetics are not a consideration (lower molars, upper back molars.)

PFM's are usually performed in areas where esthetics is important. All-ceramic is usually reserved for highly esthetic areas like your front teeth. When this procedure becomes necessary, it will take 2 appointments to perform. Here is what typically occurs when fabricating a crown:

1. We make a preliminary impression or mold of your tooth that will allow us to prepare a temporary crown.
2. After administering a local anesthetic, we sculpt and shape your tooth to make room for the crown. Some tooth reduction is required. This process leaves your tooth looking like a post or peg.
3. An impression of the remaining tooth structure and the neighboring teeth is taken and sent to the laboratory to insure your permanent crown will fit perfectly.
4. A temporary crown is then constructed and placed over your tooth to protect it between visits while your permanent crown is being made. The temporary is exactly what it sounds like. It is not the final product and is used to maintain function during the fabrication of your permanent, final crown. Temporary crowns may not have the same shape or color as permanent ones.
5. On your next visit, we replace the temporary crown with the permanent crown, check it for fit, form, shape, and color. Then if all is well, we cement it in place. Your tooth is now restored to its proper function and appearance.

Crowns are a great way to maintain the stability of your mouth once a tooth becomes damaged beyond the help of a normal filling.
Bridges

A bridge is a restoration that replaces missing teeth by using the teeth around the space to form a bridge. A bridge is an artificial substitute that replaces one or more of your natural teeth. Also known as a fixed partial denture, it is permanently anchored to your neighboring natural teeth (or dental implants). The replacement tooth and adjacent anchoring crowns are constructed and placed in the mouth as one unit that is permanently cemented to your healthy neighboring teeth. It is not removable.

Why bridges?

Bridges are extremely durable and generally last for about 10 years, with good patient and dentist care. Replacing missing teeth prevents other teeth from drifting out of line, which can cause jaw problems and affect your bite (the way your teeth fit together with your mouth closed). Neighboring teeth can also become more susceptible to decay and gum disease.

Inlays/Onlays

A gold inlay or onlay is used when the cavity/fracture is too big for a normal filling, but isn't so big that a crown is required. When a cavity is present between two teeth, it sometimes is difficult to properly rebuild the tooth with a filling, if too much of the natural tooth is lost. This can lead to areas where food packs easily, setting up a situation where bacteria have an abundant supply of food leading to possible bone loss around the tooth or recurring cavities.

An inlay is a filling within the cusp tips of the tooth. Onlays (also known as overlays) will overlay one or more cusps in order to protect and strengthen the tooth. In both situations, the best advantage is the preparation of your tooth is done as conservatively as possible. Since not as much tooth is being lost, an inlay/onlay allows you to retain most of your natural tooth structure. They also make it easier to keep clean when brushing. Two appointments are needed to complete this procedure using the same guidelines when fabricating a crown.

Veneers

When teeth are severely stained, badly chipped, or very uneven, it may be recommended that a composite or porcelain veneer be used. Veneers are extremely thin, very strong shells that are attached to the front surfaces of teeth. In most cases, we recommend taking diagnostic models of your teeth so the patient and the doctor can visualize the final outcome. This way, the patient can have input as to how they want their smile to look. From there, the doctor and laboratory can fabricate beautiful veneers knowing exactly what the patient wants. Veneers are usually applied in two visits:

On the first visit, we will thin the natural tooth and take an impression of your teeth, so the veneers can be custom-made by a laboratory.

On the second visit, we apply a mild etch to your teeth to roughen them and help the veneers attach more securely. The veneers are then applied to your natural teeth, one by one, using composite resin cement and the bonding technique.

Bonding

Imagine a quick, painless way to fill in small chips, disguise cracks, bridge a gap, or cover discolored teeth. Bonding can do all this and more. Bonding is made possible by composite resin; a plastic that is semi-liquid at first, but that becomes hard and durable when cured with heat or light. This material can be tinted to match the color of natural teeth. Composite resin can be contoured and shaped to resemble the missing part of a chipped tooth. It can cover over a stained tooth. It can make a fractured tooth look whole and perfect. Composite resin can even build up the size of teeth so gaps between them are reduced or eliminated.

Whitening (AKA Bleaching)

Many types of stains and discoloration can now be removed from teeth using cosmetic whitening techniques. Bleaching can lighten teeth that have been discolored due to food or tobacco stains, root canal treatment, or even the normal darkening that comes with age.
There are many types of cosmetic whitening:

Ask your dentist what steps are needed to achieve a beautiful, uniform-color smile. Both you and the dentist will determine whether you are a candidate for tooth whitening and what type of whitening system will provide the best results. Sometimes only a few teeth may be discolored. In this situation, we offer chair side whitening for those particular teeth. More often than not, patients want to brighten their entire smile through the use of whitening trays. We will take impressions of your teeth to fabricate a tray for you. The tray is custom made for your mouth and is lightweight so that it can be worn comfortably. The tray is so thin that you should be able to talk and work while wearing your tray. Along with the tray, you'll receive the whitening materials. You'll be given instructions on how to wear the tray. Some whitening systems recommend whitening your teeth from two to four hours a day. Generally this type of system requires two to four weeks to complete, and works best on patients with sensitive teeth. Custom fitted whitening trays also allow you to do “touch-ups” in the future if you notice your teeth are becoming discolored.

Implant

An implant is like making a new tooth. They are devices that replace the roots of lost teeth, and are used to support crowns and dentures. Implants look like a small cylinder or screw made of titanium and is placed in your jawbone surgically. Most of the time, implants feel more natural and secure than other methods of replacing missing teeth, such as dentures. The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease. People who smoke are poor candidates for implants.

After the implant is placed in the jawbone, it eventually is connected to a metal collar called an abutment, which serves as a base for a crown, denture or bridge. The key to the success of implants is a process called osseointegration, in which the bone in the jaw bonds with the implant. This process can take 3-6 months to insure proper integration with your bone. Once healing is complete, a crown is fabricated for the implant in the same fashion as for a regular tooth.
Because implants are imbedded in your bone, they simulate your natural teeth better than bridges or dentures. People with no teeth can have implants placed to help retain their dentures thereby eliminating the need for denture adhesives or having dentures slip, click, or fall out when they speak. You should discuss with your dentist whether or not implants are a good alternative for you.

Periodontal (Gum) Disease
Periodontal (Gum) disease affects almost everyone at some level. It is the single largest reason that adults lose teeth, even more so than cavities. This is due to the fact that periodontal disease is usually asymptomatic. A person may notice increased bleeding when brushing, bad breath, or have a bad taste in their mouth but no pain may be present. The main cause of periodontal disease is plaque. When plaque is left on a tooth, the gums become irritated and bacteria have an abundant supply of food. At this point, the infection can start to take away the bone that surrounds your tooth. If left untreated the bacteria will destroy bone to the point where teeth become loose and eventually come out.
During your initial visit, we will determine the level of your periodontal status by using an instrument called a probe. We measure and record six areas around each individual tooth. This is done at every new patient exam and periodically at routine hygiene appointments. The unit of measurement is in millimeters. 1-3mm is considered healthy. Anything greater than 3mm are considered an area that has been infected. Bleeding is also an important determinant of the level of periodontal disease. During probing, we will measure the number of bleeding points you have in your mouth. Increased bleeding around your teeth is the first sign of infection in those particular areas.

When plaque has remained on our teeth for an extended period of time, an entirely new substance is formed called calculus (tartar). Calculus can form both above and below our gums. When below our gums, calculus is akin to having a sliver in your hand. Until you remove the sliver, the area is sore and inflamed. Once the silver is removed then your hand heals fine. Same thing with calculus. If it is allowed to remain, your gums will never heal properly leading to increased bleeding and further infection. Once removed, your gums are allowed to heal properly back to a healthy state.

Once your periodontal status has been established, we will then customize your treatment depending on your level of periodontal disease. The most important factor in treating gum disease is maintaining the gum tissue and bone level. Good home care is the best way to maintain a healthy mouth as well as coming in for routine cleanings as prescribed by us.

Gingivitis is the first level of perio disease. This condition is superficial and usually only affects your gums. Periodontitis is the next level and is broken down into early, moderate and severe levels. These levels are determined by the amount of bone loss surrounding a tooth as determined by radiographs (x-rays) and probing depths. It is usually painless, making it difficult for you to detect. It's always best to diagnose and treat periodontal disease early, before bone has been lost. Once bone is lost, it never grows back on it's own. Controlling periodontal disease, once bone loss has begun, only becomes more and more difficult.

Gum disease is a chronic, lifelong condition. You can never be immune to it. But you can minimize the chances of it becoming worse. Studies have shown that periodontal treatment with maintenance is very effective at preserving one’s teeth and dramatically reducing the incidence of tooth decay and gum disease recurrence. Studies have also shown that periodontal treatment without maintenance is of little value in the long run in preserving periodontal health.

Prevention
Sealants
Sealants usually placed in children and adolescents to help prevent cavities. Frequent brushing and flossing removes much of the plaque, but there are tiny grooves called pits and fissures on the chewing surfaces of your back teeth where toothbrush bristles can't reach. When applied to the pits and fissures of teeth, sealants create a smooth, slippery barrier that prevents plaque and bacteria from entering these tiny, unreachable-and therefore very vulnerable-areas. Sealants literally seal out decay!
Fluoride
Fluoride is a highly effective part of your tooth decay prevention program, no matter what your age. When children are young and their teeth are forming, fluoride joins with the enamel surface and makes it harder and more resistant to decay. For adults, fluoride can help relieve tooth sensitivity as well as protecting teeth that have crowns, making them less susceptible to decay. In the elderly population, fluoride helps prevent root decay, a very serious form of caries.

Temporomandibular Joint Dysfunction / Bruxism

Bruxism is the clenching or grinding of your teeth while you are asleep and sometimes you may find yourself clenching during the day in response to stressful situations. It is not just an annoyance; it exerts thousands of pounds of pressure on the biting surfaces of your teeth. If your bite is not in harmony with your jaw joints, you may unconsciously clench and grind your teeth, in an effort to wear down or break off the points of the teeth that are in the way – a situation that dentists term malocclusion. You may grind in order to eliminate a spot, which is too high, or so as to find a comfortable place to fit the upper and lower teeth together. This can be very rough on the teeth themselves, as well as the bone, which supports the teeth, the gums, and the jaw joints.

Clenching and grinding your teeth can create two negative results. It can:

1. Break, loosen or wear down your teeth, make your teeth sensitive and even cause gum recession and bone loss.
2. Cause muscle pain in the head, neck and face that you may think is due to stress or even been misdiagnosed as migraine, sinus or tension headaches or neck aches in the past.

Most people who clench or grind their teeth don't even realize they are doing it. For that reason, our routine procedure includes an examination to discover any pain or dental problems that may be due to tooth clenching or grinding. This examination includes not only looking for worn teeth or irregularities but also checking the external jaw muscles for pain and tenderness as well as the muscles of the head, neck, and shoulders. It may also include stethoscopic examinations of the jaw joints for abnormal sounds such as clicking, as well as observation of jaw deviation when the patient opens and closes his mouth.

If we detect any symptoms, we offer a complete screening which may include:

1. Dental history and examination for dental symptoms
2. Medical history for pain symptoms
3. Clinical evaluation of your bite
4. Diagnostic models of your teeth

You may recognize signs of night grinding as the top surfaces of your teeth gradually become worn down to flat, dull nubs. Bruxism can actually crack a tooth, chip the enamel, or even cause teeth to shift, thereby creating open spaces between teeth which collect food and encourage gum disease and tooth decay.

The enormous forces of bruxism can actually wiggle teeth loose. When you rock a tooth back and forth by clenching and grinding, the bone which holds the tooth in place, literally retreats from the root of the tooth.

Malocclusion can, in fact, cause the whole jaw to jiggle out of place. Muscles will move the jaw to get a high spot of a tooth into a place where it fits better. But when the jaw moves to a new position, however slight, some other high spot usually appears - sometimes on the other side of the mouth. The jaw then finds a new way to twist and turn to find a comfortable way to fit the teeth together. This locates parts of the jaw joint itself into new or compensating positions and can cause ligaments and muscles to be excessively stressed and strained. It can also cause clicking sounds in the jaw joint when you open and close your mouth, as well as headaches, earaches, facial pain around the jaw joint, and an inability to move the jaw. It can even cause dizziness and impaired hearing.

Moreover, there is a good deal of evidence today that such stresses in muscles that move the jaw are transferred to other muscles in the head and neck. This is because the head is positioned on the spinal column like a big ball precariously balanced on the end of a pole and stabilized only by an intricate system of muscles and tendons. When one part of the system is stressed, generalized stresses occur in the rest of the system. These stresses or tensions in the muscles can cause such remote ailments as soreness in the muscles of the neck and shoulders, stiff neck, and recurring headaches - even on the top or back of the head. The "catch" to bruxism is that it solves no problems. Instead of relaxing tensions, bruxism causes aches and pains, which make for greater tension. So you brux more. Bruxing thus leads to pain, which causes tension, which leads to more bruxing. A vicious cycle indeed.

Admittedly, some people can "live" with malocclusion and accommodate to it. Others will have no problem until a time of psychic stress arises to trigger bruxism. Some symptoms will go away spontaneously. But for the patient in distress, proper occlusal treatment can bring what one patient termed, "that wonderful peace I have in my face now".

A conservative approach is the best way to help relieve the stresses that bruxism causes. If you are showing any signs of bruxism i.e. Worn teeth, sore facial/neck/shoulder muscles, constant headaches; a nightguard will be fabricated to try to eliminate the symptoms. It is like doing physical therapy for your jaw. Impressions are taken of your upper and lower teeth and sent to a dental laboratory. They send back the finished nightguard and we then manipulate your lower jaw so as to a reprogram your jaw into the most natural, comfortable position possible. In the more severe cases, we may want you to return at 2-3 week intervals to adjust your nightguard until your symptoms have lessened or been totally eliminated. The advantages of a nightguard range from protecting your teeth from bruxism to helping eliminate constant facial and head discomfort. Careful attention to the proper meshing of the teeth then is the lasting answer, not only to relieving nighttime grinding, but also to preventing and alleviating the strain and pain and eventual loss of teeth, which can result from prolonged bruxism.

Many times in order to get the teeth to fit together properly, the dentist will make an occlusal adjustment by reshaping the chewing surfaces of the teeth. This procedure is called "occlusal equilibration". More and more dentists today, as part of their regular dental examination, give periodic occlusal relation examinations. In other words they check to detect minute or gross irregularities of the chewing surfaces of the teeth. Correcting the bite may be a simple matter of selective reshaping of an offensive ridge of a tooth or a too-high filling. The teeth are carefully marked and adjusted until the final position is achieved. This process is very intricate and can take 2-3 appointments to complete. However, many times in order to adequately treat the occlusion, the dentist may have to employ a combination of procedures which might include occlusal equilibration, orthodontics to locate teeth in more favorable positions, extraction of malaposed teeth, or restoration of the occlusion by means of crowns, inlays, bridges, and/or dentures.

Dentures

Dentures replace missing teeth and their adjacent tissues with a removable dental appliance made of acrylic resin and, in some cases, a combination of metals. There are four primary types of dentures:

Complete
This type of denture replaces all of the teeth and their adjacent tissues. Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth.

Partial
Partial dentures act as dental bridges as they "bridge" the gap between a missing tooth or teeth. Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps. Consult with your dentist to find out which type is right for you.

Overdenture
Overdentures are dentures which derive their support from one or a few abutment teeth by completely enveloping them beneath the fitting surface. The abutment teeth are usually root filled and either simply reduced or used in conjunction with stud or bar precision attachments. These types of dentures are advantageous because when a tooth is removed the bone that used to surround that tooth begins to shrink. This is called resorption. If the root of a tooth is kept in the bone, the bone will not shrink as readily. The root can also provide a more natural feeling when chewing.

Immediate
This type of denture does not allow a healing period after all of the teeth are removed. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient's jaws during a preliminary visit. An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. Healing may take at least 6-8 weeks. Once healing has occurred, you will either need a reline of your existing denture or the fabrication of an entirely new denture.

Dentures can be an effective way to replace some or all of your teeth. However, even the best denture only provides about 30% of what your natural teeth can provide for you when functioning. There will be a difficult transition phase while you get accustomed to your new “teeth”. We will do everything we can to make your transition go as smoothly as possible.

Tissue conditioning / Hard reline
Over time, dentures will need to be relined, rebased, or remade due to normal wear. You may notice that your denture does not fit as snugly as when it was first placed. This loss of retention is due to resorption, or shrinking, of bone because there are no teeth remaining to support your bone. As bone and gum ridges recede the jaws may align differently. Shrinking ridges can cause dentures to fit less securely. Loose dentures can cause health problems, including sores and infections. A loose denture also makes chewing more difficult and may change your facial features. It's important to replace worn or poorly fitting dentures before they cause problems.

When this procedure is necessary it will take 2-3 appointments to reline your denture. The first step is called tissue conditioning. The dentist places a viscous material within your existing denture to fill the gap present due to bone shrinkage. This allows your tissues to become healthier and also acts as our impression for the final hard reline. Once we are satisfied that your denture is fitting with more retention, we will need to send your denture to the lab. You will be without your denture while the hard reline procedure is being performed at the lab. We will do everything we can to insure that you are without your denture for the minimum time possible.