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Resin Tooth-colored Fillings

Bonded composite fillings closely match your own natural tooth color and actually bond right to your tooth. It can seal up the cracks to minimize future decay problems and reinforces the tooth structure.  ‡

Tooth Decay

Tooth decay is caused by a variety of things. Cavities are called caries, which are caused by destructive forces acting on tooth structures such as enamel and the tooth's inner dentin.

These forces include frequent exposure to sugars and carbohydrates, soda, candy, juice, ice cream and milk, etc. Left undisturbed by not brushing and flossing, these materials break down quickly, allowing bacteria to do harm in the form of a colorless, sticky substance called plaque.

The plaque works with the leftover food particles in your mouth to form harmful acids that destroy enamel and other tooth structures.

If cavities are not treated early enough, more serious dental problems can occur such as the need for root canal therapy or extraction.

Crowns

A crown is a dental restoration that covers or "caps" a tooth to restore it to its normal shape, size and function. Its purpose is to strengthen or improve the appearance of a tooth. A crown can:

• Restore a tooth when there isn't enough tooth remaining to provide support for a large filling.
  

• Protect a weak tooth from fracturing.
  

• Cover a badly shaped or discolored tooth.
  

• Cover a dental implant.

The look and function of a crown are considered when choosing the material most suitable for you. The location, position of the gum tissue, the amount of tooth that shows when you smile, the color or shade of the tooth and the function of the tooth are all considerations when choosing the material.

We want to create a crown that looks natural and feels comfortable. To achieve that, several factors are considered, including the color, occlusion or "bite," the shape and length of your natural teeth and your artificial crown.

How is a crown placed?

Several steps are involved and two dental visits generally are needed to complete the treatment. The tooth is prepared by removing the outer portion to accommodate the thickness of the crown.

An impression is made to provide an exact model of the prepared tooth. The impression is sent to a dental lab. A dental lab technician will use the model, following written instructions, to cast and develop the shape and size of the crown.

A temporary cap is placed while the final crown is being made. When the crown is ready, the temporary crown is removed, and the permanent crown is put in place and any necessary adjustments made. When we are satisfied with how it looks and feels, the crown is cemented in place.  ‡

Bridges

A fixed replacement of one or more missing teeth. The teeth beside the gap are reshaped to support the bridge. A bridge may be made of gold, other metals, porcelain, or porcelain fused to metal.

Why do I need a bridge?

Your appearance, dental health and the proper functioning of your mouth are all important reasons for a bridge. A bridge helps maintain the natural shape of your face and may help support your lips and cheeks. The loss of a back tooth may cause your mouth to sink and your face to look older.

More important, though, your dental health may suffer when missing teeth are not replaced. Teeth work together. When a tooth is lost, the nearby teeth may tilt toward the empty space, or the teeth in the opposite jaw may shift up or down toward the space. This can alter your bite and place unusual stress on both the teeth and tissues in your mouth.

In addition, due to the increased stress, the gum tissues and the bone that hold teeth in place can break down from the resulting gum disease. Teeth that have tipped are difficult to clean, making them more likely to decay. As a result, even more teeth may eventually be lost.

What is the process?

For a conventional bridge, the teeth next to the gap are prepared. This involves shaping them and reducing their size, as for a crown. An impression is then taken of the prepared teeth and their opposing teeth. A shade is selected for the new bridge which will match the teeth around it.

It will usually take two weeks for the lab to make your new bridge. In the meantime, a temporary will be placed. Once the bridge is returned from the lab, the temporary will be removed. The permanent bridge will be set loosely in place to check the fit and the bite. Any necessary adjustments will be made. If he is satisfied, he will then cement the bridge in place permanently. You will be shown how to keep the space under it clean, since it is very important to keep the teeth clean, along with the supporting structures.  ‡

Root Canals

Natural teeth are meant to last a lifetime. Years ago, diseased or injured teeth frequently were extracted. But today, even if the pulp in one of your teeth becomes injured or infected, the tooth often can be saved through root canal (endondontic) treatment.

What if the pulp is injured?

When the pulp is diseased or injured and unable to repair itself, it loses its strength. The most common causes of the pulp dying are a cracked tooth, a deep cavity requiring large fillings, or traumatic injuries to the tooth, all of which may allow bacteria and their products to enter into the pulp.

Why should the pulp be removed?

If the injured or diseased pulp is not removed, the tissues surrounding the root of the tooth can become infected, resulting in pain and swelling. Even if there is no pain, certain substances released by bacteria can damage the bone that anchors the tooth in the jaw. Without treatment, the tooth may have to be extracted.

Removing a tooth can cause problems

There are downsides to losing a natural tooth. When a tooth is removed and not replaced, the nearest teeth may begin to shift from their normal position. This may cause the teeth to become crooked or crowded, which makes biting and chewing more difficult. Crooked or crowded teeth are more likely to have gum disease because they are harder to keep clean than straight teeth. A replacement tooth (an implant or bridge) is usually more expensive than endondontic treatment and can involve more extensive dental procedures on nearby teeth. A natural tooth is normally better than an artificial tooth.

What does the treatment involve?

Treatment can usually be done in one visit, although occasionally it may involve additional steps. First, local anesthesia is usually given so that you will be more comfortable.

The pulp or remaining tissue is then removed carefully from both the pulp chamber and root canal(s). Each root canal is cleaned and shaped to allow it to be filled. A tooth can have between one and four canals.

If the canals are clean and dry, the next stage of treatment can be completed. The root canal(s) are usually filled with gutta-percha, a rubber-like material. Root canals normally have a very high success rate, halting the spread of infection and restoring and saving a problem tooth.

Will the tooth require any other restoration?

After the root canal is completed, it may need to be restored by doing a post buildup and crown. A crown strengthens the tooth which, due to the lost blood supply, will become more brittle. A crown may be made of porcelain or a metal alloy.  ‡

Implants

An implant is an artificial (metal) root in your jawbone. Replacement teeth supported by implants look, feel and work just like natural teeth. Implants tend to cost more than other treatments. The entire implant process can take many months. We work in conjunction with an oral surgeon. The actual implant is done by an oral surgeon. A period of time is allowed for bone growth. After that, we would place an abutment, which is a link between the implant and the artificial tooth it supports. A replacement tooth is then made to fit over the abutment.  ‡

Removable Partial

A partial denture is made up of one or more porcelain or plastic replacement teeth. Gum-colored plastic attaches these teeth to a metal framework. The partial is removable. It is held in your mouth with either metal clasps or precision attachments.

Before getting a partial, you may need to have some teeth removed or reshaped. An impression will be taken and sent to a lab. They will return a framework that is tried in to check the fit and the bite. It is then returned to the lab to complete. Once your final partial is made, we may need to make several adjustments before it feels comfortable. You will learn how to put it in and take it out and how to take care of it.  ‡

Dentures

A denture is a removable replacement for missing teeth and adjacent tissues. It is usually made of an acrylic resin, sometimes in combination with various metals.

Complete dentures are called "conventional" or "immediate," according to when they are made and when they are inserted into the mouth.

Immediate dentures are inserted immediately after removal of any remaining teeth. However, since the bone and gums shrink over time, a reline is normally necessary after time has been allowed for those changes to occur.

Conventional dentures are made once the healing has occurred. We often will suggest the insertion of a temporary denture first at the time of the extractions. An allowance of about six months is given, and then a permanent conventional denture is made.

Overdentures are an option where the removable denture is made to fit over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide the stability and support of the overdenture.

How are dentures made?

The process of constructing a denture takes about five appointments spanning over one month. The first visit is when the initial diagnostic impression is taken, the bite is determined, and the shade, color, shape and size of the teeth are determined. The denture is custom made for your mouth. There will be additional visits where we will do a bite registration and also a "wax try-in." A try-in is where the lab sets the actual teeth in wax so we can see if any adjustments or changes are required prior to the lab completing the denture. We then get you back the next week to insert the denture. We schedule an adjustment appointment the day after the insertion. At that visit, we evaluate if there are any pressure areas that need to be reduced. It is not uncommon for the need to have additional adjustment appointments.

Getting used to a denture

This will usually take some time. At first, you may be asked to wear your denture all the time. Although this may be uncomfortable, it is the quickest way to identify pressure areas. Normally, you will experience sore spots on those particular areas. Adjustments are then made to relieve those areas. Later, we may suggest you take your dentures out before going to bed and replacing them in the morning. This is a good time to clean your denture as well.

Start out by eating soft foods that are cut into smaller pieces. Chew on both sides for even pressure on the denture. Hard or sticky foods should be avoided.

Talking may be affected at first. Pronouncing certain words may require practice. Reading out loud and repeating trouble words may help. If there is "clicking" while you are talking, speak more slowly. Eventually these speaking problems should be resolved.

Caring for your denture

We suggest you take care when handling your denture to avoid accidentally dropping it. It is best to do so over a folded towel. (It is often a good idea to have a spare denture made in case an accident would occur where damage is done to the denture, requiring a repair and leaving you without your denture for a period of time.) Brush your denture with a denture brush to remove plaque and stains. Use denture cleaners that are approved by the American Dental Association since other cleansers may be too abrasive and could damage your denture. At night, the denture should be placed in a soaking solution or water, unless we indicate not to do so in the case of some dentures with special gaskets.

Even with full dentures, it is necessary to take care of your mouth. It is important to brush your gums, tongue and palate. It is also very important to still come for a yearly exam. We check the denture and the surrounding tissue. We also should continue to do a yearly screening for oral cancer.

As you age, your mouth will continue to undergo changes which will eventually affect the fit of the denture. It may mean that a reline is necessary or even a new denture may be required if it becomes very loose.  ‡