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Welcome to W. Michael Princell, DDS

Oral Health Care and Prevention

The Importance of Preventive Dental Care

Enjoying the benefits of a vibrant smile in tip-top condition is not something to be taken for granted. To maintain optimal oral health requires establishing an effective oral hygiene regimen at home along with making periodic visits to your dentist for a program of preventive care.

The following are helpful recommendations:

  • Making a Commitment to Routine Checkups and Teeth Cleanings at the Dentist
  • Maintaining an Effective Oral Hygiene Routine of Tooth Brushing and Flossing at Home
  • Avoiding Harmful Oral Habits
  • Eating a Balanced Diet
  • Limiting Sticky, Sugary Sweets
  • Fluoride Treatments
  • Dental Sealants

Dental Checkups

By scheduling a periodic appointment for a checkup and professional dental cleaning, your dentist can help to keep your smile looking good and functioning at its best. At every checkup visit, your medical and dental histories are carefully reviewed and a comprehensive examination of your mouth, jaws, and surrounding areas of the head and neck is performed. While checking for the development of common dental conditions such as tooth decay and gum disease and doing a screening for oral cancer, your dentist will also make note of any signs of problematic health issues that may have originated elsewhere in the body. Experiencing dry mouth, bad breath, gum problems, ulcerations or other oral lesions may be indicative of a serious underlying systemic condition. As part of a comprehensive clinical exam, the dentist will assess the function of your temporomandibular joint (TMJ) and your bite (occlusion) for any impairment or misalignment. The consequences of various dietary choices, eating disorders, harmful habits, certain medications and inadequate oral hygiene practices may also be detected at this time.

Dental Cleanings and Oral Hygiene

Although these two conditions are largely preventable, dental decay (caries) and periodontal disease, which is more commonly known as gum disease, represent the two biggest threats to your oral health. As part of an effective program of preventive care, thorough periodic cleanings at the dental office along with guidance in the best methods of brushing and flossing at home, play an essential role in warding off the development of cavities as well as the onset and progress of periodontal disease.

A routine dental cleaning as performed by the dentist or dental hygienist involves the thorough removal of any accumulated plaque and tartar from areas that your toothbrush and floss have not reached. Since dental plaque harbors the bacteria that are responsible for cavities and gum disease, its removal prevents these disease processes from occurring. Following a dental cleaning and polishing, which is performed to remove any superficial stains from your teeth, your mouth will feel fresh and clean.

Checkup and cleaning visits also represent an important opportunity to educate patients in the best oral hygiene homecare methods and routines to maintain a healthy smile. Your dental team will carefully explain and demonstrate proper techniques for brushing, flossing and other oral care practices at your initial dental appointment and subsequent recall visits.

Brushing Your Teeth

Maintaining a healthy smile depends upon keeping your teeth and gums clean with a daily routine of brushing and flossing. According to the recommendations of the American Dental Association, it is important to brush your teeth at least twice a day for two minutes each time with a soft bristled toothbrush. Remember to use a soft bristled toothbrush and apply gentle pressure so as not to cause damage to your teeth or gums. Brushing your teeth with a fluoride containing toothpaste that has been awarded American Dental Association seal of acceptance helps to keep your smile healthy and vibrant. Remember to change your toothbrush every three months or when the bristles are frayed.

To brush your teeth:

  • Place your toothbrush at a 45-degree angle to the gums. While maintaining this angle, move your toothbrush back and forth in short strokes. Make sure to brush along the outsides and insides of the teeth as well as the biting surfaces of the back teeth.
  • To brush behind the upper and lower front teeth, tilt your toothbrush vertically and brush in up and down strokes.
  • It is a good idea to brush your tongue at the completion of your routine to help keep your mouth fresh and clean.

How to Floss Your Teeth

To help prevent tooth decay and gum disease, it is also important to remove plaque and food particles from between the teeth and under the gumline on a daily basis. By taking a few minutes to gently floss the teeth once a day, children and adults can reduce their risk of dental disease.

At a routine checkup visit, the dentist or dental hygienist will demonstrate the proper technique for flossing between the teeth. There are a number of varieties of dental floss and all can effectively remove plaque and food from between the teeth. According to a study published in the Journal of Periodontology, the type of dental floss selected is often a matter of personal choice. However, in certain circumstances one kind of dental floss may be preferable over another. In cases where the teeth are crowded, a waxed dental floss may work best. However, if there are spaces between the teeth, dental tape or super floss may be more comfortable and effective. Some people prefer disposable flossers with a plastic handle and a section of attached dental floss, while others use floss threaders or electric flossers to clean between the teeth.

The Proper Technique For Flossing Your Teeth

Whatever type dental floss is selected, proper technique is important to effectively remove plaque and food particles without injuring the delicate tissues around the teeth.

For floss that is taken off a roll or from a dispenser, a good length to use is about 18 inches.

  • Wind the floss around the index fingers of each hand until a few inches of floss remains between them.
  • Holding the floss between the index finger and thumb, glide it gently between the teeth and down to the gumline. Hugging the side of one tooth in a “C” shape, slowly move the floss up and down along the base of the tooth to remove any trapped plaque and food particles.
  • Do the same to the adjacent side of the next tooth and continue around the mouth until all of the teeth as well as the space behind the last tooth are all flossed.
  • Release clean floss from one hand, while winding the used floss around the index finger of the other hand.

The Application of Dental Sealants

As part of a pediatric dental program of preventive care, the dentist may recommend the application of dental sealants. These thin, plastic-like coatings painted onto the biting surfaces of the newly erupted permanent back teeth provide your child with an added level of protection through the cavity-prone years. Covering the pits, fissures and grooves in the hard to reach back teeth, dental sealants prevent decay-causing bacteria and food particles from accumulating in these vulnerable areas. Sealants may also be useful in areas of incipient dental decay to stop further damage from occurring.

The value of dental sealants is well documented. According to the American Dental Association, they reduce the risk of cavities in school-age children by approximately 80%. Furthermore, children who do not receive dental sealants develop almost three times more cavities than children who do have them.

Having a healthy smile is essential for your child’s comfort, function, self-image and overall well being. Good dental routines established in youngsters provide a strong foundation for maintaining a lifetime of optimal oral health.

Periodic Fluoride Treatments

According to the National Institute of Dental and Craniofacial Research, tooth decay is the single most common chronic childhood disease. Over 50 percent of 5 to 9 year old children have at least one cavity or filling, with that proportion increasing to 78 percent among 17-year-olds. Additionally, more than 51 million school hours are lost each year to dental-related illness.

As an added level of protection against dental decay, it is recommended that children receive periodic fluoride treatments as part of a program of preventive dental care. Fluoride is a naturally occurring mineral that helps to prevent cavities by making the hard outer enamel of the teeth more resistant to the acids produced by the harmful sugar processing bacteria in dental plaque. It can also help to remineralize the teeth to reverse incipient decay.

During a periodic checkup visit, the dentist may recommend the application of a topical fluoride to help strengthen and protect both a child’s baby teeth and the permanent ones. Topical fluorides can be applied as a foam, gel or varnish. Whatever type is selected, the procedure is quick and painless. Once the teeth are cleaned the fluoride is simply painted on the surfaces of the teeth or placed in a small tray to sit over the teeth for a brief period of time. Some types of fluoride treatment require no eating or drinking for half an hour as the fluoride is absorbed into the surface of the teeth. The dentist and dental hygienist will provide specific and detailed instructions as needed.

Fluoride treatment may also be indicated in adults who are at a higher risk for developing tooth decay.

Diseases and Conditions Affecting the Oral Cavity

Tooth Decay

Tooth decay, also known as dental caries, is one of the most prevalent diseases affecting both children and adults and is second only to the common cold in frequency. According to the World Health Organization 60-90% of children worldwide, and nearly 100% of adults have dental cavities. Although tooth decay is a worldwide epidemic, it is also a condition that is largely preventable with effective oral hygiene practices, a healthy diet as well as routine checkups and professional dental cleanings.

What causes cavities?

Tooth decay is the result of a process that causes progressive damage to tooth structure. The culprit behind all of this is dental plaque, a sticky film that accumulates on teeth and harbors harmful bacteria that thrive on sugar. As these bacteria metabolize sugar, they produce acids, which over time can de-mineralize or eat away at healthy tooth structure. A cavity begins as a simple pinpoint defect on the outermost enamel layer of the tooth but if left untreated will continue to compromise healthy tooth structure, eventually working its way through the inner layer of dentin to the nerve and vital tissues inside the tooth. Depending on the extent of the damage to the tooth, a cavity can cause anything from periodic, mild tooth sensitivity to extreme and continuous discomfort. Seeing a dentist for the treatment of tooth decay is essential to prevent damage to the nerve of the tooth, a dental infection, tooth loss, or more serious consequences to one’s overall health.

Factors that can increase one’s risk of developing tooth decay include the following:

  • Poor oral hygiene
  • A diet high in sugar
  • Dry mouth
  • Bruxism
  • Enamel defects and deeply grooved teeth
  • Receding gums

For patients at a higher risk of developing tooth decay, special toothpastes and fluoride rinses and other supplemental measures may provide an added level of protection.

Periodontal (Gum) Disease

The two most common forms of dental disease, caries (tooth decay) and periodontal disease (gum disease) are caused by the presence of bacterial communities in dental plaque, which is a sticky film that is constantly accumulating in the mouth. While in the case of tooth decay the acidic products of the plaque bacteria progressively erode tooth structure, in gum disease an inflammatory response is provoked in the periodontal tissues that surround and support the teeth. If left untreated, periodontal disease can lead to gingival pocket formation, gum recession and diminishing alveolar bone with the eventual loosening and loss of teeth.

According to the Centers for Disease Control and Prevention (CDC), one out of every two adults aged 30 and over in the United States is affected by periodontal disease. Furthermore, that number increases to over 70% for individuals 65 and older. Since gum disease is the main cause of tooth loss in adults and there is an increasing association with systemic diseases such as heart disease, stroke, diabetes, respiratory problems and adverse pregnancy outcomes, periodontal disease represents a serious public health concern.

Although inadequate oral hygiene practices, infrequent dental checkups and few if any professional teeth cleanings are the main reasons for the development of gum disease, there are other factors that can contribute to the risk. An individual may be predisposed to periodontal disease because of genetic factors, smoking and tobacco use, harmful oral habits, misaligned teeth, poor nutrition, and stress as well as the fluctuating hormones in pregnancy. Diseases such as diabetes, rheumatoid arthritis and HIV infection can also increase the risk and severity of periodontal disease. Additionally, certain medications for the therapeutic treatment of systemic disease can lay the groundwork for periodontal problems by producing side effects such as dry mouth (xerostomia) or causing the gums to enlarge.

What are the signs and symptoms of gum disease?

Since much of the course of periodontal disease is not painful, there may be little awareness by an affected individual that a condition, which is harmful to oral health as well as one that is linked to larger systemic problems, is present.

Some of the signs and symptoms of gum disease to be aware of include the following:

  • Inflamed and red gums
  • Bleeding when brushing or flossing
  • Receding gums and exposed root surfaces of the teeth
  • Sensitivity to hot or cold temperatures
  • Bad breath or a bad taste in the mouth
  • Teeth that feel loose
  • The development of new spaces between the teeth or a change in the bite
  • Change in the fit of existing partial dentures
  • Discharge around the teeth and gums
  • Sharp or dull pain when biting down or chewing food

While gum disease is a progressive condition, if treated early in its onset it can be reversed to restore oral health. At more advanced stages, the disease can be managed to halt its progression and prevent the most severe consequences.

The earliest stage of gum disease is known as gingivitis, which is caused by the buildup of dental plaque at the gumline. Gingivitis is extremely common and is typically associated with bleeding when brushing or flossing. With gingivitis there is no evidence of bone loss or significant periodontal pockets between the teeth and gums. Gingivitis can be successfully treated and reversed with a series of professional dental cleanings and an improved regimen of oral hygiene at home.

If gingivitis is allowed to progress, it can advance to the next stage, which is known as periodontitis. When periodontitis is present, the tissue damage extends beyond the gums to include the loss of the collagen attachment of the tooth to the surrounding bone, the development of deep periodontal pockets and the loss of supporting alveolar bone. In this stage the connective tissue and bone that hold the teeth in place begin to break down. Without proper treatment, periodontitis will progress from a mild to moderate loss of supporting tissue to the complete destruction of the alveolar bone around the teeth. As periodontal treatment advances, more extensive procedures are required to halt its progression. The dentist may recommend a series of deeper cleanings involving root planing and scaling, surgical procedures to reduce pocket depth, bone or tissue grafts, laser dentistry procedures, or antimicrobial medications.

By far, the best approach to care is the prevention of periodontal disease. By maintaining an effective regimen of brushing and flossing at home, following a healthy lifestyle and seeing the dentist for routine checkups and professional dental cleanings, gum disease and its consequences are largely preventable.

Dry Mouth

Dry mouth, also known by its medical name, “xerostomia” is a condition characterized by either a lack of saliva or a decrease in its flow. Since saliva plays an important role in aiding digestion and maintaining good dental health, the consequences of xerostomia can be significant.

Three pairs of major salivary glands along with hundreds of minor salivary glands inside your mouth produce approximately 2-4 pints of saliva every 24 hours. Composed of 99% water and 1% electrolytes, enzymes and proteins; saliva washes over the teeth and surrounding soft tissues to cleanse and protect them from germs, tooth decay, and gum disease. Saliva also plays a key role in keeping the mouth lubricated and comfortable, so that food can be moved through the mouth easily for purposes of chewing, tasting and swallowing.

A lack of saliva makes simple oral functions more difficult and causes germs to increase in your mouth. More germs lead to bad breath, dental decay, gum disease, and provide the groundwork for a host of oral infections.

Common reasons for the condition include the following:

  • Age - Dry mouth is frequently seen in the elderly
  • Medication
  • Disease
  • Cancer treatment
  • Injury or Surgery
  • Tobacco use
  • Dehydration

What is the treatment for dry mouth?

Treatment of dry mouth depends on the underlying cause of the problem. If it develops as a side effect of a particular drug, the physician may be able to prescribe an alternative medication. In some cases dry mouth may respond to drugs that promote an increased salivary flow. If not, artificial saliva can be used to keep the mouth moist and lubricated. As added protection, the dentist may recommend a prescription strength fluoride gel to help prevent tooth decay from developing. Patients can help alleviate some of the effects of dry mouth, by drinking water more often and avoiding drinks with caffeine or alcohol. They can also help to stimulate the flow of saliva by chewing sugarless gum or sucking on a sugarless candy. With dry mouth, it is essential to see the dentist on a regular basis for care.

Bad Breath/Halitosis

Bad breath, which is also known as halitosis, is a common and embarrassing condition. According to recent estimates, 75 million people in the United States are affected by bad breath and 10 billion dollars are spent annually on oral hygiene products to address the problem.

While it is perfectly normal to experience an acute bout of bad breath after eating certain pungent foods such as spices, onions or garlic, being plagued by constant bad breath is a different story. Chronic halitosis can be attributed to a variety of different underlying causes including inadequate oral hygiene, dental disease, oral infections, smoking and tobacco habits, dry mouth, medications, diets, certain metabolic disorders or other systemic problems that affect an individual’s overall health.

Treating Bad Breath Related to Oral Hygiene and Oral Health Issues

Since many instances of chronic bad breath can be attributed to oral health issues, seeing the dentist is a good first step in care. In the absence of an effective regimen of oral hygiene, the odor-causing bacteria responsible for bad breath and dental disease can proliferate throughout the mouth and on the tongue as well as on dentures that have not been properly cleaned and maintained. With routine dental checkups, thorough dental cleanings and improvements in brushing, flossing and denture or appliance care at home, these types of bad breath issues can be effectively resolved.

Other sources of bad breath related to oral health issues can include chronic dry mouth (xerostomia), gum disease, tooth decay, mouth sores, oral wounds or post-operative surgical sites. When the cause of bad breath is related to dental disease, an ulceration, or injury, the dentist will provide the appropriate treatment to address the condition or to promote tissue healing. In cases of bad breath due to chronic dry mouth, the dentist may recommend methods of self-care or medications to increase salivary flow, artificial saliva and other therapeutic measures. It is important to keep in mind that dry mouth may be a side effect of essential medications to address a systemic condition.

Mouth Ulcers

One of the most commonly occurring lesions in the oral cavity is a mouth ulcer. While mouth sores can be annoying, uncomfortable and unsightly, they are often harmless, and will resolve within a few days without requiring any medical treatment. However, when these lesions do not get better after a couple of weeks, frequently recur, or if new symptoms begin to appear, it is important to get a more comprehensive evaluation by a dentist or other qualified healthcare provider.

While often the result of an actual injury like biting the cheek or the irritation of a sharp orthodontic wire, a mouth ulcer can also be caused by certain drugs, chemical sensitivity, diseases, or as a side effect of medical treatment like chemotherapy. A mouth ulcer such as a canker sore, which is also known as an aphthous ulcer, may even be triggered by stress and anxiety or hormonal changes.

According to statistics, up to 1 in 5 people get recurrent mouth ulcers. There are several underlying health conditions that can lead to the development of mouth ulcers including the following:

  • Nutritional problems like vitamin B12, zinc, folic acid or iron deficiency
  • Gastrointestinal tract diseases such as Crohn’s disease & coeliac disease
  • An impaired immune system due to diseases such as HIV or Lupus
  • Reactive arthritis
  • Certain viral infections such as cold sore virus, chickenpox, as well as hand, foot, and mouth disease in young children

It is important to be aware that occasionally, a long-lasting mouth sore may be a sign of oral cancer. A biopsy or tissue sample may be recommended when suspicious lesions in the oral cavity are present. Early detection and treatment are the best ways to ensure the most favorable outcome of care.

How are mouth sores and ulcerations managed?

Since a mouth ulcer involves the loss or erosion of a section of the delicate tissue lining the oral cavity, it can make the simple acts of eating, drinking or even talking quite uncomfortable. Treating the underlying cause (if there is one) and managing the symptoms is the best way to reduce the risk of complications until healing can take place. To ease the discomfort of mouth ulcers and promote healing, it is helpful to reduce or eliminate any sources of continuing irritation and avoid hot and spicy foods, drink plenty of fluids, use rinses or medication as recommended by a dentist or physician as well as brush and floss the teeth as gently as possible to keep the mouth clean.

TMJ Disorders

The Prevalence of Temporomandibular Joint Problems

According to the National Institute of Dental and Craniofacial Research (NIDCR), temporomandibular joint disorders (TMJ), also referred to as temporomandibular disorders (TMD), are the most common source of chronic facial pain and jaw dysfunction. It is estimated that more than 10 million people in the United States are affected by temporomandibular joint problems.

What is the Temporomandibular Joint?

There are two temporomandibular joints that connect the left and right sides of the lower jaw to the temporal bone. Both joints and their associated muscles, ligaments and tendons work together to allow for all manner of oral function as the jaw moves up and down, front to back and from side to side. Containing a shock-absorbing, soft disc that sits between the rounded condyles of both sides of the lower jaw and the corresponding concavities in the skull’s temporal bone, the TMJ makes chewing, speaking, yawning and all jaw movements possible.

Since the TMJ is a joint with both up and down hinge-like movements, as well as side to side and front to back sliding motions to perform, it is often considered one of the most complicated joints in the body and one of the most difficult to treat when problems arise.

Types and Symptoms of TMJ Disorders

TMJ disorders can fall into one or more of the following three categories:

  • Myofascial pain- Refers to pain in the area of the jaw joint due to various causes of increased muscle tension and spasm
  • Internal derangement-Involves displacement of the disc, jaw dislocation or trauma to the condyles of the jaw
  • Degenerative joint disease - Arthritis

The risk for developing a TMJ problem is greater in the presence of long-term teeth grinding or bruxism, a jaw injury or various types of arthritis such as rheumatoid arthritis and osteoarthritis. Furthermore, the manifestations of a TMJ disorder can vary from person to person with a wide range of symptoms possible, including earaches, ringing in the ears (tinnitus), headaches, back and neck pain, vertigo, muscle spasms and joint tenderness as well as jaw pain, popping or grating sounds with jaw movement, jaw locking and limited jaw movement. For some people a TMJ disorder can be resolved within a relatively short period of time, while for others it will continue to persist despite extensive therapy.

Diagnosis and Treatment

When evaluating for the presence of a TMJ disorder, the dentist will perform a thorough clinical assessment of joint symptoms and function. Special radiographic imaging and other diagnostic tests will be ordered as needed. The treatment of a TMJ disorder may include oral appliances such as night guards or stabilization splints to alleviate strain on the joints. Other types of therapy may include steroid injections, occlusal adjustments as well as orthodontic or prosthodontic treatment to improve occlusion. In cases of persistent and serious TMJ problems, surgery may be recommended.

Methods of self-care can be helpful in alleviating some of the symptoms of a TMJ disorder. Patients are typically advised to eat soft foods, avoid extreme jaw movement such as wide yawning and gum chewing, to practice stress reduction and relaxation techniques and applying ice packs or moist heat as directed. If recommended, a patient should follow the dentist or therapist’s instruction for gentle stretching exercises. The short-term use of over-the-counter, non-steroidal, anti-inflammatory drugs and pain medications may provide relief. If not the dentist or physician may prescribe stronger pain or anti-inflammatory drugs, muscle relaxants or anti-depressants.

Malocclusion

A healthy occlusion refers to teeth and jaws that are well aligned and in functional harmony. When a malocclusion, more commonly referred to as a “bad bite” is present, either the teeth, the jaws or both are not in the correct positions or proper relationships.

There are many dental issues, which can affect the positions of the teeth and jaws that require orthodontic treatment to resolve. A malocclusion may be due to crowding, spacing, problems with jaw development, or the failure of certain teeth to erupt into their proper positions. Harmful oral habits such as finger sucking or tongue thrusting can also cause bite problems as well as the drifting of teeth into the unrestored spaces left by dental extractions or tooth loss. Sometimes, teeth develop in the jawbone facing in directions that prevent them from erupting at all. These teeth are referred to as impacted.

Both genetic and environmental factors contribute to the development of a malocclusion. Injuries that cause a misalignment of the jaws and diseases such as oral tumors can also play a role in changing the occlusion.

In children, most problems involving the alignment of the teeth and the growth of the jaws can be detected by the time they are in the first or second grade. That is why the American Association of Orthodontists recommends that all children have a check up with an orthodontic specialist no later than age 7. For children, most orthodontic treatment begins between the ages of 9 and 14. However, earlier and interceptive care is sometimes required at a younger age. Likewise, in cases of significant problems involving jaw relationships, orthodontic care may involve treatment throughout growth and development.

It is important to note that a malocclusion can be treated at any age. Today greater numbers of adults are actively seeking treatment for either crooked teeth or jaw problems that have bothered them since childhood, as well as to address teeth that have shifted over time due to extractions, habits, or abnormal bite patterns.

While malocclusions can be observed with a clinical exam, a more comprehensive assessment is required to make a complete diagnosis and to develop the most appropriate plan of care.

Types of Malocclusions

Malocclusions typically fall into three major types based on the kinds of discrepancies in alignment and bite that are present. They can be either due to issues of dental alignment or skeletal jaw disharmonies, or even a combination of both problems.

  • Class I: This is the most common type of malocclusion and is characterized by a normal bite with problems of tooth alignment
  • Class 2: This malocclusion is characterized by an “overbite” where the top teeth are positioned ahead of the bottom teeth and demonstrate a more extensive overlap
  • Class 3: This malocclusion is characterized by an “underbite” or mandibular prognathism, causing the lower jaw and anterior teeth to be in front of the upper teeth.

While most malocclusions will respond to the appropriate orthodontic treatment, some require a combination of orthodontic treatment and orthognathic surgery to improve the skeletal jaw relationships.

Oral Cancer

Oral cancer accounts for 2.9% of all diagnosed cases of cancer in the United States. According to the American Cancer Society it is estimated that 51,000 people across the country will develop oral cancer this year and that 10,000 fatalities are expected from the disease.

Oral cancer can occur anywhere in the orofacial complex but is most often found on the tongue, the tonsils and oropharynx, the gums, floor of the mouth, lips, cheek lining or the hard palate. While the disease can affect anyone, men are twice as likely to develop oral cancer as women. Those particularly at risk for oral cancer are men over the age of 50 who are heavy smokers and frequently drink alcohol. Additional risk factors may include UV exposure from the sun or sunlamps, GERD (gastro-intestinal reflux disease, prior head and neck radiation treatment, exposure to certain chemicals and poor diet. While the death rate from oral cancer has been decreasing in the past several decades thanks to early detection and advanced methods of treatment improving the outcomes of care, there has been a recent rise in the incidence of oropharyngeal cancer due to increased transmission of the sexually transmitted human papillomavirus (HPV).

What are some of the signs and symptoms of oral cancer?

As part of a comprehensive exam, the dentist will perform a screening for oral cancer. To start, the dentist will review the patient’s medical and dental histories and ask if there have been any changes to his or her oral health or overall health. The dentist will then carefully check in and around the oral cavity as well as the head and neck area for any of the following signs or symptoms that may indicate the presence of a problem:

  • Mouth ulcers or sores that do not heal
  • Lumps
  • Red or white patches
  • Persistent swelling of unknown origin
  • Pain when swallowing, a painful tongue or a continuing ear or neck ache
  • A constant feeling that something is stuck in the throat
  • Tenderness or numbness in the mouth or lips
  • Loose teeth
  • Jaw pain or stiffness

If a suspicious lesion, tissue abnormality or unusual symptoms are present, the dentist will refer the patient for a more comprehensive assessment. Early detection of oral cancer offers the most favorable outcomes of care.

Repairing and Restoring Decayed or Damaged Teeth

Amalgam Fillings

For many years, amalgam fillings, more commonly referred to as “silver fillings,” have represented the standard of care in rebuilding the form and function of a tooth that has been treated for dental decay. Composed of a combination of metals that include silver, tin, mercury and copper, dental amalgam has both the strength to withstand the heavy forces generated during chewing as well as the durability to retain its integrity over time. Although not as aesthetically pleasing as other types of restorations, amalgam fillings are less likely than some other types of fillings to break or wear down over time.

While dental amalgam contains elemental mercury, based on extensive studies and thorough reviews of scientific evidence, the American Dental Association (ADA), The Center for Disease Control and Prevention (CDC), the FDA, and the World Health Organization have all stated that amalgam is a safe and effective dental restoration that does not pose a risk to health. However, individuals with allergies or sensitivities to the metals in dental amalgam are advised to pursue other restorative options with their dentists.

Composite or “Tooth Colored” Fillings

With advances in dental materials and science, restorative materials that are aesthetically pleasing as well as strong and durable are widely available for the filling and repair of teeth that have been affected by tooth decay or dental injuries.

Composite fillings, which are frequently referred to as either “tooth colored fillings” or “white fillings,” are a combination of biocompatible resins and finely ground, glass-like filler materials. Composite fillings, which are manufactured in a complete range of natural looking shades, provide a more cosmetically pleasing alternative to traditional “silver” fillings. Often used to fill a tooth by replacing tooth structure that is missing due to injury or decay, dental composites can also be placed to modify a tooth’s color or shape to dramatically improve its appearance as well as repair dental defects and close gaps between the teeth.

The composite systems used by dentists today integrate the highest quality of microfill particles and resin materials to produce restorations that can withstand the forces generated by all manner of oral function, while achieving attractive, natural looking and long-lasting results. Composite restorations are adhered to the underlying tooth structure through a bonding process, which also serves to seal and strengthen the tooth. Once a composite restoration is placed and is “set” or “cured”, the dentist can refine its shape as well as smooth and polish it to maximize patient comfort. This also helps to prevent the restoration from staining and to avoid premature wear. Besides providing a pleasing match to your natural tooth color, a composite restoration has other advantages over other types of restorations. Composite fillings do not require the removal of as much tooth structure to facilitate placement, nor are they subject to expansion or contraction with temperature changes as is the case with dental amalgams. However, the one drawback is that composite restorations may be more vulnerable to wear and stains over time and can require replacement down the road.

Inlays/Onlays

Dental inlays and onlays offer an excellent alternative to “direct” amalgam or composite fillings to restore teeth that have sustained some damage, but not enough to require a full coverage crown. While “direct” fillings such as dental amalgam and composite fillings are placed immediately after the decay or damage is removed and the tooth is prepared, inlays and onlays are known as “indirect” fillings. This means that they are fabricated outside of the mouth prior to final bonding or cementation.

While in the past, many inlays and onlays were caste from gold; today’s dental inlays and onlays are typically custom made of either the highest grade of dental porcelain or composite resins. In addition to providing an exact match to the color of tooth for a cosmetically pleasing result, inlays and onlays have the distinct advantages of being more durable than other fillings, preserving more underlying tooth structure and actually strengthening the tooth so that it can bear up to 50 to 75 percent more chewing forces.

Inlays and onlays only differ from each other in the amount of tooth structure they cover. An inlay is fabricated when the replacement of tooth structure does not require coverage of any cusp tips. If the damage from decay or injury is more extensive and involves more of the tooth’s chewing surface, including one or more cusp tips, an onlay is required.

Both inlays and onlays are fabricated outside of the mouth based upon the exact specifications provided by an impression of the prepared tooth. The final inlay or onlay is then custom made by either a dental laboratory or in-office with a same day system.

Dental Crowns or “Caps”

If a tooth has been significantly damaged by decay or injury or if it is too misshapen, undersized, or darkly stained to be restored with fillings, dental bonding or veneers, a full coverage restoration is typically required. Known as a dental crown or “cap,” a full coverage restoration is custom designed and fabricated by the dentist to fit over the damaged tooth to recreate a healthy and natural appearance and to reestablish the function of the tooth. Beyond restoring the form and function of the tooth, a dental crown serves to strengthen and preserve the underlying tooth so that with proper care it can be maintained for many years.

Dental crowns are typically recommended as the restoration of choice when a tooth has undergone a root canal procedure. They are also used to cover the abutment teeth next to an edentulous space to provide support for a fixed bridge and are used for the restoration of dental implants to serve as a permanent replacement for a lost or missing tooth.

Crowns can be fabricated from a variety of materials including porcelain or dental ceramics, porcelain fused to metal, composite resin and metal alloys. Which type of crown is fabricated depends upon the aesthetic and functional requirements of the case, patient preferences, and budget.

How are dental crowns fabricated?

Tooth preparation and crown fabrication is a multistep process:

1. The dentist prepares the tooth by removing the outer layers of the tooth as well as any damaged tooth structure. If there is not enough tooth structure remaining, the core of the tooth can be built up with restorative materials as needed to provide sufficient retention for a crown.
2. A detailed impression is taken and a model of the prepared tooth is constructed.
3. A custom crown is fabricated based upon the exact specifications of the model.
4. If the crown is not to be placed the same day, a temporary crown is placed to cover and protect the prepared tooth as well as maintain its appearance.
5. The final crown is checked for fit and appearance. Once any final adjustments are made, the crown is cemented or bonded into place.

With proper care and maintenance, a dental crown can last for many years.

Root Canal Therapy

A root canal procedure is considered one of the most effective methods of saving and retaining a tooth that has been severely compromised by dental decay or injury.

According to the most recent American Dental Association Survey of Dental Services, almost 41,000 root canals are performed every day in the U.S. and close to 15 million are done over the course of a year. Since the success rate of endodontic treatment is well over 90%, and because maintaining a patient's natural dentition is essential to overall oral health, root canal therapy as opposed to having the involved tooth extracted is a widely recommended option in care.

A root canal procedure is indicated when the vital tissues, which are referred to as the “pulp,” become inflamed or infected in response to an injury, deep dental decay or an advanced case of periodontal disease. Every tooth has either a single, central canal or multiple ones that contain the blood vessels, nerves, and connective tissue, which comprise the dental pulp. These pulp tissues are essential for a tooth to develop, mature and erupt into place. Once a tooth has emerged, the dental pulp provides nourishment to keep the tooth vital and serves to alert an individual that decay or some other type of damage is affecting the tooth. Having sensitivity to various stimuli like biting down and eating or drinking hot or cold items is a warning from the nerves inside your tooth that dental disease or trauma is taking a toll on the tooth, or infection is brewing. The degree of pain that you experience depends on the extent of the damage and nerve involvement.

When Is A Root Canal Procedure Recommended?

A root canal procedure is recommended when the dental pulp has become irreversibly damaged or has died, but enough healthy tooth structure and bone support remains around the tooth to save and maintain it. Since a fully developed tooth does not require the dental pulp to remain functional, a natural tooth can be effectively preserved with a root canal. During this procedure, the dentist removes the diseased dental pulp, cleans the internal portion of the tooth, and then fills all the prepared canals with a biocompatible filling material. Once the canals have been sealed and the tooth is symptom-free, the tooth will need a suitable restoration to reestablish its appearance and function and to strengthen it to withstand the forces generated in the mouth. With proper care, a tooth that has received a root canal therapy and restoration can be maintained for many years.

Modern technology and advanced methods of care make getting a root canal procedure as comfortable, and no more complex, than getting a routine dental filling. While some root canals can be completed in one visit, others may involve 2 or 3 appointments. How many visits it takes to complete a root canal procedure depends on factors such as the number of canals in a tooth, their anatomy and whether an active infection is present.

When root canal therapy is recommended, it is important to get timely care. If left untreated, the damage to a tooth and the risk of infection increase, as do the consequences to oral health and overall well being.

Treating Periodontally Involved Teeth

Non-Surgical Periodontal Treatment

When periodontal disease is detected early in its onset, conservative or non-surgical methods of care in combination with improved hygiene routines can restore periodontal health. While periodic, professional cleanings are sufficient to maintain periodontal health in patients that do not have gum disease, once gingivitis is present, deeper cleanings and possibly other non-surgical methods of care are recommended to treat the condition.

The American Academy of Periodontology emphasizes achieving periodontal health by means of the least invasive and cost effective treatment approaches to care. Deeper cleanings, which include Scaling and Root planing, are non-surgical procedures that are considered the first line of defense against the progression of periodontal disease.

With scaling and root planing, any plaque and tartar (hardened dental plaque) that have accumulated below the gumline are carefully removed and then the root surfaces of the teeth are smoothed. Since, periodontal disease is an inflammatory response to plaque, tartar and bacterial toxins, by simply mechanically eliminating these agents, the progression of gum disease can be halted. In addition to removing plaque and tartar with a scaling and root planing procedure, antimicrobial medication placed under the gumline or systemic medications can be used as adjuncts to care to further reduce the bacterial population.

If non-surgical approaches to managing periodontal disease do not achieve the desired outcome, surgery may be recommended to halt its progression and repair damage as possible.

Periodontal Surgery

When gum disease has advanced beyond the initial stage, periodontal surgery is often recommended to effectively remove bacteria and tartar from around the teeth, reduce gingival pocket depth, restore lost tissue as possible and halt the disease process. Untreated gum disease is a progressive condition, which will continue to compromise the appearance of one’s smile, dental health, oral function and overall well being if the appropriate measures are not taken.

With proper surgical treatment and maintenance care, the chances of tooth loss, further damage to the bone and soft tissues supporting the teeth, and complications from health problems that are linked to periodontal disease can be decreased.

Gum disease is typically the result of inadequate or ineffective oral hygiene practices that lead to the accumulation of dental plaque, which is sticky film that is colonized by oral bacteria. The harmful bacteria and the products they produce provoke a defensive, inflammatory response in the gums. When this inflammation is not resolved, tissue damage ensues and spaces between the gums and teeth that are known as periodontal pockets develop. As the periodontal pockets deepen, the bacteria become more difficult to remove and the gaps between the surface of the teeth and gums get larger. When pocket depth increases to the point of being beyond the reach of deep cleanings and other conservative methods of care (5mm or more), gum surgery to clean and treat the damage to gums and underlying bone is recommended.

By performing pocket reduction surgery the following is accomplished:

  • Sub-gingival bacteria beneath the gums and from the surfaces of the roots of the teeth is removed
  • Damage to the underlying bone is halted and affected bone is re-contoured
  • Effective oral hygiene to clean the teeth and gums is made easier

While a surgical procedure known as flap surgery during which the tissue is surgically reflected away from the teeth and bone so that the area can be treated before the tissue is sutured back into place, is typically performed, some practitioners are now using soft tissue laser procedures to reduce pocket depth.

Crown Lengthening

Crown lengthening is a common procedure that is routinely performed to re-contour gum tissue and bone, as needed, with the intent of making more tooth structure available for the placement of a dental crown or dental bridge. This is often the case when a tooth is decayed or otherwise damaged below the gum line.

Alternatively, a crown lengthening procedure can also be performed for reasons that are purely aesthetic to reduce the appearance of a “gummy smile” when too much of the gums and far too little tooth structure is displayed when smiling. It can be performed on a single tooth to make the gum line appear even with the other teeth or on several teeth to improve a smile’s overall appearance.

Soft Tissue Grafts or “Gum Grafts”

In addition to the development of pockets and bone loss, periodontal disease can cause the gums to recede, thereby exposing the roots of the teeth. When the root of a tooth loses its overlying soft tissue, it becomes more vulnerable to decay, sensitivity and additional bone loss. Gum recession also takes a toll on smile aesthetics. Having front teeth affected by this problem can make a broad smile less aesthetically appealing as uncovered root structure is displayed. While gum recession is often a consequence of gum disease, aggressive tooth brushing and other habits can also wear away gum tissue.

By performing a gum graft procedure, which is also known as a “gingival graft or soft tissue graft,” the dentist replaces the soft tissue over the exposed area of the tooth to address the problems created by receding gums. Gum tissue for grafting procedures can be harvested from a nearby site in the mouth or obtained from another donor source. A gum graft may be performed on a single tooth or multiple ones. And, based upon the needs of the case, the dentist will determine which type of gum graft to employ.

The three types of gum grafts include the following:

  • Free gingival graft-This graft utilizes a small piece of tissue that is taken from the palate. It is often indicated when extra thick tissue is needed to prevent further recession.
  • Connective tissue graft- This frequently used graft is harvested from a sub-layer of connective tissue located under the uppermost tissue layer on the roof of the mouth.
  • Pedicle graft-This type of graft is created from a flap of tissue that is adjacent to the area of the gum recession.

Following a gum graft procedure, the dentist will provide detailed post-operative care instructions as well as set up appointments to make sure the surgical site is healing properly and to check that the graft is successful.

Osseous Grafts or “Bone Grafts”

Bone loss in the jaws and around the teeth can be the result of missing teeth, periodontal disease, or trauma. This bone loss is more than a detriment to oral health and function; it can also alter facial appearance as the support for the natural contours of the face is diminished.

When a tooth is extracted, the natural stimulation to the underlying bone that is generated by the forces of biting or chewing is lost. In fact, bone width can be reduced by as much as 25% in the first year following tooth loss.

With grafting procedures, the dental bone can be restored to its original dimensions to maintain facial esthetics, repair the damage caused by periodontal disease as well as facilitate the success of procedures such as the placement of dental implants. A bone graft provides a platform or “scaffolding” for new bone growth and the material for a bone graft can be derived from the patient, other donor sources or be comprised of synthetic, bone-like materials.

There are several types of grafting procedures that can be performed with the particular approach depending upon the needs of the case.

A bone graft can be placed immediately upon the extraction of a tooth or some time after tooth loss. Placing a bone graft at the time of tooth removal reduces the amount of bone loss in the area to maintain the hard tissue support that is required for the future placement of a dental implant. When a bone graft is placed awhile after tooth loss, a separate surgical procedure is required to reflect the soft tissue, expose the underlying bone, place a graft and then suture the soft tissue back into place.

For patients lacking a sufficient amount of bone for a dental implant to replace a maxillary back tooth (upper back tooth), a procedure known as a “sinus lift” may be performed. During this surgical procedure, the sinus membrane is lifted and bone graft material is added between the jaw and the floor of the sinus to provide the needed bone height to successfully support a dental implant.

In addition to bone grafting for purposes of ridge preservation or augmentation to allow for dental implants, an aesthetic ridge augmentation procedure to restore the natural contours of the bone is sometimes performed in preparation for fixed bridgework to achieve a more cosmetically pleasing result.

To guide tissue regeneration as well as protect the graft and promote healing, special membranes and biologically active materials may be placed over the grafting material.

Replacing Missing Teeth

Full or Partial Dentures

According to the National Institute of Dental and Craniofacial Research (NIDCR), 3.75% of adults 20 to 64 in the United States are completely edentulous. For the overall population in this age group, the average number of remaining teeth is 24.92 out of a total of 32 permanent teeth.

One of the ways to replace missing teeth to restore oral function and appearance is with dentures. Depending upon the needs of a case, dentures can be used to replace either a few teeth that have been lost or all of the teeth in the upper or lower jaws. In addition to reestablishing the look of a complete and natural smile, dentures also restore support to the natural contours of the face to eliminate the “sunken” appearance that results from losing multiple teeth. Whether teeth have been lost for reasons of tooth decay, gum disease, a medical condition, congenital anomaly, or trauma, dentures are an effective method of care.

Dentures are removable appliances that are designed to precisely and comfortably rest on top of the gums that cover the jawbones. They can be taken out of the mouth for brief periods of time to fulfill the oral hygiene requirements of maintaining the underlying tissues, cleaning the dentures, and sleeping.

Types of Dentures

The two main types of dentures are: full dentures and partial dentures. Both types are custom fabricated based on the exact specifications obtained from dental impressions and detailed functional as well as esthetic information provided by the dentist.

Full Dentures

Full dentures, which can also be referred to as, “complete Dentures,” are designed to replace all of the upper or lower teeth. A complete maxillary denture, more commonly known as a, full upper denture, typically consists of a base that covers the roof of the mouth with a full complement of artificial teeth set around the section covering the dental arch. On the other hand, a complete mandibular denture, or full lower denture, is designed to accommodate the tongue and is horseshoe shaped with teeth set along the portion that covers the underlying dental arch.

  • Conventional Full Denture - A conventional full denture is fabricated and placed after all of the remaining teeth have been removed and the tissue is healed. It takes several weeks for extraction sites to heal and for all of the surrounding bone and gum tissues to fill in and remodel. By allowing this process to reach completion before taking the final impressions for a new denture, the most precise and comfortable fitting prosthesis can be fabricated.
  • Immediate Denture - An immediate denture is one that is inserted on the day the remaining teeth are removed. With this method of care, a patient does not have to be without teeth while waiting for complete healing of the extraction sites. Immediate dentures offer the distinct cosmetic advantage of not having to be without teeth. However, since the healing of the extraction sites is occurring while wearing the denture, a reline or new denture may be required later for improved comfort and fit.
  • Overdenture - An overdenture is a type of complete denture that receives added stability and support from special attachments that are secured to the remaining underlying teeth or strategically placed dental implants.

Partial Dentures

A partial denture is a type of removable prosthesis that is designed to restore a complete and functional smile in cases where multiple teeth are missing or require extractions, while some healthy teeth remain in the dental arch. Custom fabricated for a precise fit and cosmetically pleasing appearance, partial dentures are typically secured and stabilized with clasps or precision attachments to select teeth adjacent to the edentulous areas. Depending upon the number of teeth being replaced as well as the functional and aesthetic requirements of the case, a partial denture can be fabricated from a combination of cast metal and acrylic materials, acrylic alone, or thermoplastic resins such as ValplastTM, Flexite®, Duroflex® and tcs®.

Fixed Bridgework

Fixed dental bridges involve the preparation and crowning of teeth on either side of an area missing teeth to support artificial teeth to span the edentulous area.

A fixed bridge is a non-removable appliance fabricated to replace missing teeth, which closely resembles a patient’s natural dentition. Besides serving to restore the appearance and performance of a complete smile, a fixed bridge also prevents teeth that are adjacent to or opposite the edentulous area from shifting to protect the integrity of the occlusion. Fixed bridges are strong, durable and natural looking restorations, which once they are permanently cemented into place allow all manner of normal oral function.

How are fixed bridges fabricated?

Fixed bridges are typically fabricated over the course of multiple visits and involve the preparation of the adjacent supporting teeth, impression taking, the placement of a temporary bridge as well as the try-in and cementation of the permanent restoration. The teeth located on either side of the edentulous area that are crowned to provide support for the bridge are referred to as the “abutment teeth,” while the artificial tooth (or teeth) spanning across the empty space are known as “pontics.”

With the dental technology available today, bridges can also be completely supported by implants without any preparation or crowning of the adjacent natural teeth required. Depending upon the aesthetic and functional needs of a case, fixed bridges can be fabricated from different dental materials including porcelain, porcelain fused to metal, or engineered ceramic-like products such as zirconia.

Dental Implants

Dental implants represent the most recent and advanced method of replacing lost or missing teeth. Invented in 1952 by a Swedish surgeon named Per-Ingevar Branemark, dental implants today offer a highly effective, long-term solution for replacing missing teeth to reestablish a fully functional and attractive smile. Dental implants can be used to replace a single tooth, multiple teeth or all of the upper and/or lower teeth.

A dental implant is a small, biocompatible post that is surgically positioned by means of a minimally invasive procedure into the jawbone beneath the gums. Once healing takes place and the implant integrates with the bone, it behaves in much the same way as the root of a natural tooth to provide support for an aesthetically appealing dental crown or bridge. A period ranging from 3 to 6 months is required for the jawbone to fuse with the implant via a process known as osseointegration.

What are the benefits of replacing lost or missing teeth with dental implants?

Dental implants offer several advantages over traditional methods of tooth replacement including:

  • Dental implants come the closest to replicating the look, feel, and function of natural teeth.
  • With precise placement, good oral hygiene and routine care, dental implants can last for many years.
  • Dental implants provide continued stimulation to the underlying bone to prevent the bone loss that occurs when teeth are missing to preserve natural facial contours.
  • Since implants behave like natural teeth, there is no chance that they will slip or dislodge like removable dentures when speaking or eating.
  • With dental implants, it is possible to speak with ease as well as eat and taste all types of food with virtually no restrictions.
  • Dental implants do not decay and will not develop cavities.
  • Unlike a fixed bridge, dental implants do not require any preparation or crowning of teeth adjacent to the edentulous area.

Who is a candidate for a dental implant procedure?

According to clinical studies, dental implants have a demonstrated long-term success rate of well over 95%. One key to the success and longevity of a dental implant is that sufficient bone is present to provide stable support for the implanted surgical post. If insufficient bone is present, a bone grafting procedure is often recommended prior to the placement of a dental implant. Additionally, candidates for dental implants should be free of periodontal disease and be aware that a continued, effective oral hygiene routine and care is necessary to maintain a strong and functional implant.

Treatment Planning for Dental Implants

Treatment planning a patient for the precise placement of a dental implant involves advanced scanning technology and software to map out the details of care from both a prosthetic and surgical prospective. In this way a case can be planned and meticulously executed from the beginning with the final restoration in mind. With advances in implant dentistry multiple approaches to care are now being offered. In certain cases an implant can be placed at the same time a dental extraction is performed. This procedure is known as, “immediate dental implant placement.” Additionally, it is also sometimes possible to place “same-day dental implants.” With this procedure a temporary crown or bridge can be attached to the implants at the same time they are placed. In all cases, complete healing and osseointegration is required before the placement of the final prosthesis.

Types of Dental Implants

Most dental implants are made of titanium but are also available “metal-free” zirconia. Both titanium and zirconia are biocompatible materials, which integrate well with the hard and soft tissues in the jaw. Depending upon the requirements of the case, a single dental implant can be restored with a crown to replace one missing tooth, or multiple implants can be used to support a fixed bridge. In cases where all of the upper and/or lower teeth are missing a full-arch, implanted supported bridge can be placed. Special implants can also be placed for added support and stability for removable overdentures or as anchorage devices in orthodontics called “TAD’s” or Transitional Anchorage Devices.

Cosmetic Dentistry

Dental Bonding

Dental bonding is a procedure that is often used to restore teeth affected by decay as well as for the repair of chipped or fractured teeth and masking a range of dental imperfections such as stains, discolorations, gaps, misshapen, or undersized teeth. A popular method for restoring and improving the appearance of a person’s smile, dental bonding qualifies as a cosmetic procedure by virtue of the fact that the composite resins used for the procedure are tooth-colored and come in a range of shades that blend seamlessly with natural tooth structure.

A dental bonding procedure, which is performed to fill a cavity or to cosmetically repair a chip, fracture, enamel defect or gap between teeth is known as a “direct composite restoration.” For a direct composite restoration, both artistry and precision are required as the dentist places the selected shade of composite resin and carefully sculpts it to rebuild or improve the appearance of a tooth.

In terms of the cosmetic repair of dental defects, the masking of discolorations or the closure of gaps between teeth, a dental bonding procedure is considered the most economical and quickest method of care out of all the cosmetic solutions available for these types of corrections. Unlike porcelain veneers or ceramic crowns, dental bonding is a minimally invasive, one-visit cosmetic procedure. Moreover, unless a cavity is being cleaned and prepared prior to a dental bonding procedure, no drilling of tooth structure and no anesthesia is required.

How is a dental bonding procedure performed?

When performing a bonding procedure, it is important to enable the composite resin to firmly adhere to the underlying tooth structure. To do this the surface of the tooth is etched and then painted with a liquid bonding agent just prior to the placement of the filling or cosmetic bonding. As the dentist places the composite resin, it is carefully sculpted to achieve the desired shape and then cured with a special light or allowed to set. Once hardened, the newly bonded restoration is polished and buffed for a smooth finish. Some dentists may offer composite veneers as an alternative to porcelain veneers, artistically bonding and blending successive layers of composite resin to transform the appearance of a tooth.

Caring For Bonded Teeth

While a bonding procedure offers an excellent and cost-effective method of care for the treatment of minor cosmetic dental issues, there are a couple of considerations with this approach. Teeth that are restored or cosmetically enhanced with a dental bonding procedure are as a rule more susceptible to staining and chipping than with other types of cosmetic treatments. For this reason, highly pigmented foods and drinks are to be avoided along with tobacco products. As dental bonding can easily chip and break, it is also important not to bite into hard objects or foods and to avoid oral habits such as biting one’s nails or chewing on pens. However, with proper hygiene and care, a bonded restoration can last for many years.

Teeth Whitening

A teeth whitening procedure or bleaching simply refers to any process that will make the teeth appear whiter. It is considered a non-invasive procedure that is designed to whiten and brighten teeth that are stained, discolored, darkened, or yellowed. First introduced to the public in the 1980’s, the popularity of teeth whitening products and procedures has soared. According to a survey conducted by the American Academy of Cosmetic Dentistry, when respondents were asked, “What would you like to improve most about your smile?” The most common response was: whiter and brighter teeth.

How white a tooth appears depends upon how light is reflected and scattered off the enamel, the outermost layer of the tooth. Teeth can look dark or discolored for a variety of reasons, with an imperfect appearance the result of outer surface stains or discoloration from within the tooth. While external tooth stains are typically due to certain foods and tobacco, internal tooth discoloration is mainly the result of hereditary factors, certain medications, tooth decay, restorations, or trauma. Additionally, the aging process can influence the color of a tooth. This is because over time the outer layer of enamel becomes thinner showing more yellowish tones from the underlying layer of dentin.

What are the advantages of a professional teeth whitening procedure performed by a dentist?

Although over the counter teeth whitening systems purchased in stores or online have become popular, there are health concerns and limitations with these products. If the manufacturers protocol is not correctly followed, certain products can damage the teeth and soft tissues in the mouth, and may not deliver the results as promised. Teeth whitening systems contain varying concentration of either hydrogen peroxide or carbamide peroxide, which act as the bleaching agents. When sensitive teeth, exposed roots, cavities, broken fillings, cracked teeth, or loose dental work are present, a teeth whitening procedure may be contraindicated. Also, since whitening systems do not have an effect on the color of dental fillings, crowns or bridges the presence of restorations is an important cosmetic consideration in treatment planning.

In general, individuals with yellow tones to their teeth respond best to teeth whitening procedures. Brown and grayish tinted teeth bleach respond less well and may require significantly longer dentist supervised tooth whitening regimens or alternative cosmetic treatments. Finally, teeth whitening may not be recommended in the presence of sensitive teeth, worn enamel and significant gum disease.

As a rule the healthiest and most effective methods of teeth whitening are the ones managed and supervised by the dentist. An in-office teeth whitening procedure as performed by the dentist is the most reliable and safest way to get the maximum results quickly. In as little as one hour a prescription-strength, in-office whitening procedure can dramatically whiten and brighten the natural teeth by several shades, while the surrounding tissues and any sensitive areas of the teeth are carefully isolated and protected from the bleaching agents.

A home whitening system from the dentist along with custom trays that have been fitted to the teeth is also an excellent option. Custom trays keep the bleaching agent in maximum contact with the teeth and away from the other areas of the mouth. With a take-home teeth whitening system, maximum results are less rapid than an in office procedure and are typically achieved over a longer period of time. A home whitening system can be used by itself or as recommended by the dentist as a follow up to an in office procedure in order to perfect or maintain the results.

Veneers

For teeth with imperfections that cannot be addressed with teeth whitening procedures, but are not so flawed as to require full coverage crowns, dental veneers can provide the desired cosmetic improvements.

Dental veneers are custom-fabricated facings that offer a conservative and cosmetically pleasing way to improve the appearance of teeth that are chipped, gapped, worn, slightly crooked, misshapen or darkly stained. With dental veneers, the color, shape, size, and length of the teeth can be changed for the better. Bonded to the front surfaces of the teeth, veneers can be used to enhance the appearance of a single tooth or multiple anterior teeth.

The two most common types of veneers are porcelain veneers, which are also known as porcelain laminates, and composite veneers. While porcelain veneers are the most commonly offered option in care, composite veneers can also achieve excellent results. Starting with a smile makeover consultation and a comprehensive assessment of a patient’s oral health as well as a discussion of the cosmetic goals, the dentist will determine a treatment plan to achieve the most pleasing outcome of care.

Porcelain Veneers

Porcelain veneers are ultra-thin facings that are custom fabricated from the highest grade of dental ceramics and offer the following benefits:

  • Require very little preparation of underlying tooth structure
  • Can be fabricated from start to finish in just a few visits
  • Porcelain reflects light in much the same way as teeth for a naturally beautiful looking smile
  • Once bonded, porcelain veneers are strong and durable and can last for many years with proper care
  • Resistant to stain and discoloration
  • Well tolerated by surrounding periodontal tissues

Composite Veneers

When direct composite veneers are the selected method of care, the dentist applies carefully selected shades of tooth-colored composite resins to the fronts of the involved teeth. As the composite resin is placed, it is meticulously sculpted to create the desired shape, length and overall form of each tooth. Each layer of applied composite is then cured with a special light, and additional layers of composite are placed as required to achieve an aesthetically pleasing and functional result. Once the final result is completely set, the dentist will smooth and polish the direct composite veneers to a naturally brilliant finish.

While composite veneers frequently offer the advantages of being a single visit procedure, easy to repair and an economical alternative to porcelain veneers, they are not as strong or resistant to staining and wear as dental ceramics. However, by avoiding certain dietary choices and habits, practicing good oral hygiene and getting routine dental care, direct composite veneers can offer an effective and long lasting cosmetic smile improvement.

Ceramic Crowns

Once commonly referred to as, “porcelain jackets,” today’s all-ceramic crowns are fabricated from advanced generations of aesthetically appealing, lifelike materials affording strength and durability approaching that of tradition metal and porcelain fused to metal crowns (PFM).

When a tooth requires a full coverage restoration to rebuild its structural integrity and appearance, how good the crown will look and how well it will withstand the forces of oral function are major considerations in choosing the type of crown. In the past, only metal crowns or ones fabricated out of porcelain fused to an underlying substructure of metal offered the strength required to bite and chew without breaking. While porcelain fused to metal crowns to this day remain a popular choice for strong, attractive and long-lasting restorations to rebuild teeth that are damaged, decayed, misshapen, worn down, undersized, or have had a root canal procedure, there are some drawbacks. For one thing, the thin metal margin at the collar of a PFM crown may be visible at the gumline (especially in the presence of receding gums). Also, due to the presence of an underlying metal shell, porcelain fused to metal crowns do not come close to handling light in the same way as natural tooth structure or dental ceramics.

Advantages of Ceramic Crowns

While the trade off between appearance and strength used to mean that porcelain or all-ceramic crowns looked better but did not have the strength and durability of porcelain fused to metal crowns that is no longer the case. All-ceramic crowns are not only capable of producing incredibly lifelike results, but thanks to the range of materials available today, all-ceramic crowns are stronger and more reliable than ever before.

Some of the advantages of all-ceramic crowns include:

  • All-ceramic crowns interact with light in much the same way as natural teeth and can closely mimic their translucency and luster
  • All-ceramic crowns can be made thinner and require less tooth reduction
  • All-ceramic crowns are kinder to the surrounding tissues, for potentially healthier long-term results
  • All-ceramic crowns are resistant to stain and discoloration
  • All-ceramic crowns are metal-free and safer for individuals with allergies or sensitivities to metal

With the range of engineered dental ceramics available today, which material is selected for crown fabrication depends upon the location of the tooth, the stresses on that tooth and the esthetic requirements of the case. Certain all-ceramic crowns are more suited for back teeth, while others are able to fulfill the aesthetic requirements presented by a front tooth. Some of the all-ceramic crowns used today include Feldspathic porcelain crowns, Empress crowns, Procera crowns, Lava crowns, Zirconia crowns, and Emax crowns.

Orthodontics

Braces

A healthy, functional and attractive smile requires teeth that are straight and jaws that are well aligned. A good bite with teeth that are straight not only looks good, it contributes to overall oral health and well being.

Braces are orthodontic devices that are used to address problems such as crooked, gapped or crowded teeth, overbites or underbites and improper jaw relationships. With advances in orthodontic technology and systems of care, a wide selection of braces is available today. Providing effective and efficient care, these choices are far less bulky, much less noticeable, and more comfortable than previous generations of braces.

The type of braces the dentist recommends for a patient’s case depends on several factors including:

  • The severity of the bite problems
  • The degree of crowding or spacing of the teeth
  • If there is a need for extractions
  • The relationship of the upper and lower jaws and if a surgical correction is also required
  • How long the braces need to be worn to achieve the best outcome of care
  • If any supplementary appliances are needed to support orthodontic correction
  • A patient’s cosmetic concerns

Metal Braces

The most common type of braces worn today, remain “metal braces”. Made of high-grade stainless steel these braces are significantly smaller and have a lower profile than their predecessors from years ago. Each brace, which is known as an orthodontic bracket, is individually bonded to the front of each tooth. Metal braces allow for efficient and highly controllable tooth movement.

Ceramic Braces

When conventional braces offer the best approach to care, but a more cosmetic appearance is desired, ceramic braces provide an excellent alternative to traditional metal brackets. Ceramic braces, or clear braces, blend in with the natural color of your teeth, making it less obvious to others that you are wearing orthodontic appliances. While being far less visible, they still function in very much the same way as metal braces.

Lingual Braces

Today, there are even metal braces that can be placed on the “tongue side” or lingual of every tooth, so that they are in effect completely hidden from the outside world. These braces work in the same way as the metal or ceramic braces affixed to the front of the teeth, but can be more uncomfortable and more difficult to keep clean due to where they are located.

Orthodontic Aligners

One of the most recent options in orthodontic treatment that has provided a more discreet, convenient and comfortable method of care is a custom sequence of removable clear aligners that gradually move the teeth into their correct positions.

Invisalign

Invisalign® is a form of orthodontic treatment that works to correct many different types of malocclusions through the use of a series of clear plastic trays called aligners. As a more discreet, comfortable and completely removable method of care, Invisalign aligners provide an effective alternative to traditional orthodontic braces and metal wires for certain types of malocclusions.

Developed by a team of Stanford University students, the advanced 3D imaging, modeling, and aligner technology that defines the Invisalign system of care was introduced to the public in the year 2000. Since that time, it has become an extremely popular option in care.

Invisalign uses advanced 3-D computer imaging technology to formulate a sequence of custom-made clear aligners. The aligners, each of which is worn for a couple of weeks, incrementally move the teeth into place until the final desired corrections are reached. The advantage and appeal of the Invisalign method are that the clear aligners are more cosmetic, comfortable and convenient than other orthodontic appliances and operate with minimal interference to daily activities. Invisalign allows teens and adults to enjoy eating all of their favorite foods, and engage in sports without the fear of breaking their orthodontic appliances or sharp poking wires. Moreover, as the aligners are completely removable, tooth brushing and flossing are much easier as there is no need to clean in between any attached orthodontic brackets or wires.

*Invisalign is a registered trademark of Align Technology, Inc.

Dental Emergencies

Toothaches

A toothache is the most common reason for oral pain. It is an uncomfortable, distressing and debilitating situation that if left untreated can result in serious consequences to an individual’s oral health as well as overall well-being. Depending upon the underlying cause of a toothache and the degree of damage to the tooth and involvement of the surrounding tissues, the type and severity of symptoms can vary. While mild symptoms of discomfort are easy to dismiss and ignore, waiting until toothache pain is more consistent or severe is not advised. The best option is to make a timely appointment with the dentist for a professional assessment and care.

Although the reason for most toothaches is cavities (tooth decay/dental caries), a toothache or what may feel like pain related to the teeth can be due to any number of underlying conditions including:

  • A Cavity
  • Dentin Hypersensitivity (Sensitive teeth)
  • Dental Trauma resulting in chips, fractures, cracks or nerve damage to the tooth
  • Infection or Abscess
  • Periodontal Disease (Gum Disease)
  • Bruxism
  • Erupting or Impacted Teeth (wisdom teeth are often problematic)
  • Sinus or Ear Infections
  • Other medical conditions with referred pain to the jaw

Different types and degrees of toothache pain can point to different underlying causes and help in the diagnosis of the problem. Sharp and stabbing pain when eating or drinking hot and cold foods may be due to the presence of a cavity or exposed dentin and sensitive teeth. Pain with pressure or biting down may indicate a cavity or even a broken filling, a cracked tooth or periodontal problem. If the pain is continuous or throbbing, it is a sign that tooth decay or trauma has affected the nerve of a tooth or that an infection requiring prompt care is present. Localized swelling around the tooth or more generalized tissue and facial swelling and fever must be taken care of as quickly as possible.

Treatment of a toothache depends upon the diagnosis of the underlying problem, the degree of damage to the involved tooth or surrounding tissues and if any infection is present. Once the dentist has performed a comprehensive evaluation of the case, the appropriate recommendations and care to alleviate the symptoms and restore oral health will be provided.

Traumatic Injuries

Traumatic oral injuries can range from dental injuries to the teeth and their supporting tissues to lacerations in and around the mouth as well as more complex and severe damage to the soft tissues and bones of the face. These injuries are often caused by direct physical trauma to the teeth, mouth and face that may be the result of a fall, sports or work related incidents, motor vehicle accidents or assaults.

Chipped, Fractured or Cracked Teeth

It is not uncommon for a tooth to sustain a chip, crack or fracture. It may happen simply from biting down on a piece of ice, chewing on a pencil, or sustaining trauma such as a direct blow to the face and mouth. The damage to a tooth can range from a minor craze line or a small chip of the dental enamel to a more extensive fracture of the tooth that can even go so far as to fracture the root or split the tooth. Based upon the extent of damage to the fractured or cracked tooth, treatment may simply involve placing a suitable restoration such as a filling or crown or a root canal procedure along with a restoration. When the damage is extensive, an extraction is sometimes required.

Dentoalveolar Injury

Dentoalveolar injuries refer to traumatic injuries involving the teeth and the bone surrounding the teeth. These injuries can include teeth that have been dislodged or moved partially out of their sockets, with or without a segment of the adjacent bone, or an avulsion, which means that a tooth has been completely “knocked out” of its socket. In these situations, immediate dental care to reposition and stabilize the involved teeth and/or put the bone back into the correct anatomical positions is required. Beyond the routine post op care to check for tissue healing, the involved teeth are typically followed for a longer period of time to check for subsequent nerve involvement or other issues that may require additional care.

Soft Tissue Injuries

Soft tissue injuries in and around the oral cavity include lacerations within the mouth (intra-oral) and facial lacerations. If possible clean the area gently with water and apply a cold compress. For puncture wounds, tissue tears, and lacerations to the lips, cheeks, tongue or any other tissues in and around the oral cavity, prompt emergency care is required.

Dislocated or Fractured Jaw

Facial trauma that has resulted in a suspected dislocation or jaw fracture requires immediate care as problems with eating and breathing can ensue. Prompt care can minimize complications and accelerate healing. For a fractured jaw, treatment depends upon the extent of the injuries. While some clean breaks may only require immobilization, multiple fractures of the jawbone or displaced breaks involve more complex surgical care. If on the other hand the jaw has been dislocated as a result of a traumatic incident or opening the mouth too widely, it will need to be manipulated back into the correct position. For people who have had more than one dislocation, surgery may be needed to reduce the risk of further dislocations.