When teeth are missing a series of changes that can impact your overall dental health and jaw function may be initiated. The adjacent teeth may start to drift or tilt into the space, and teeth in the opposing jaw may start to shift toward the area of the missing tooth. It is therefore important to replace the single tooth or multiple teeth that have been lost. One of the best options to prevent the consequences of shifting teeth and to restore full function to a small edentulous section in the mouth is a dental bridge.
A dental bridge replaces the missing teeth with artificial teeth called “pontics,” and is supported on the ends by prepared natural teeth. Once fabricated and fitted a dental bridge will be permanently “fixed,” or cemented into place. Like crowns, bridges can be made of either porcelain baked on to a metal substrate or many of the new ceramic materials that have been developed.
Cone-beam computed tomography systems are radiographic systems used by dental professionals to analyze and reconstruct 3D images of a patient’s teeth, jaws and surrounding anatomy. The information obtained by means of CBCT imaging is useful in both diagnosis and precise treatment planning when two-dimensional diagnostic films are insufficient. Dental CBCT is useful for multiple types of analyses as well as the assessment of maxillofacial disorders or pathology. It is also most useful in surgical planning, including the accurate placement of dental implants.
The terms dental crowns and caps are synonymous. If dental decay, cracked fillings, root canals, clenching or grinding the teeth have caused extensive damage to the underlying tooth structure a dental filling may not be a sufficient restoration. The only way to completely restore the cosmetic appearance and function of this tooth is often full coverage with a dental crown. The good news is that a completed dental crown looks and feels like a natural tooth.
In addition to restoring a single natural tooth, crowns can be used in other situations including being the supporting ends of dental bridge, covering dental implants, or as coverage for a cracked tooth to prevent further breakdown. A crown may also be indicated when a discolored or stained tooth needs to be restored to its natural appearance. Crowns can be made of either porcelain baked onto a metal substrate, all-porcelain, or many of the new ceramic materials that have been developed.
Dental Fillings are the most common type of dental restoration used to replace sections of teeth that are missing, damaged or decayed. While traditional dental materials like gold, amalgam, porcelain, and composite successfully restore teeth; recent advances in dental technology have made a wider and improved selection of restorative choices available. Some of the newest state-of-the-art filling materials including ceramic and the latest composite materials, are not only strong and durable, they offer the most aesthetically pleasing and natural looking results.
Whether from disease, malnutrition, genetic disorders, or an accident sometimes it is necessary for an individual to have some or all of their teeth extracted. While this can be devastating, partial or full dentures can be fabricated to restore an attractive smile, provide needed support for normal facial contours and reestablish a highly functional occlusion.
A denture consists of natural looking artificial teeth set in a supportive base. It may be fabricated to replace either a small group of teeth, an entire upper arch, an entire lower arch, or used to restore both dental arches.
A complete denture refers to the replacement all of the teeth in a dental arch. It can be inserted either of two ways. It can be inserted some weeks after the extraction sites and all of the surgical procedures have had a chance to heal, or as an “immediate” denture placed the same day the last remaining teeth are extracted. Although an immediate denture offers the advantage of not having to go without teeth for any period of time, it can require multiple adjustments as the tissues remodel and heal following dental extractions or other surgical procedures.
In situations where some sturdy teeth remain, partial dentures can be fabricated. Partial dentures can achieve adequate retention and stability by having clasps on the teeth surrounding the edentulous areas.
In some cases added stability for the dentures can be provided by strategically placed implants.
Digital radiography utilizes computer technology and digital sensors for the acquisition, viewing, storage, and sharing of radiographic images. It offers several advantages over the older traditional film based methods of taking x-rays. The most significant of these advantages is that digital radiography reduces a patient’s exposure to radiation. Other benefits are that images can be viewed instantly after being taken, can be seen simultaneously as needed by multiple practitioners, and can be easily shared with other offices. Digital x-rays are also safer for the environment as they do not require any chemicals or paper to develop.
An electronic pad, known as a sensor is used instead of film to acquire a digital image. After the image is taken, it goes directly into the patient’s file on the computer. Once it is stored on the computer, it can be easily viewed on a screen, shared, or printed out.
Sometimes it is necessary to extract a tooth. This can happen for a variety of reasons. Extractions are commonly performed in cases where a deciduous “baby” tooth is reluctant to fall out, a severely broken down and non-restorable tooth is present, or “wisdom tooth” is poorly positioned and unable to fully erupt into place.
To reduce any anxiety and insure patient comfort whenever a tooth extraction is necessary, the procedure, the post surgical instructions, as well as any restorative follow-up care will be carefully and completely explained.
Losing a tooth due to injury, dental decay, or gum disease can happen. However, in order to avoid causing problems for the adjacent teeth and your overall dental health, it is important to replace the tooth that has been lost. This can be done a number of ways including fixed bridges, removable partial or full dentures as well as a more recent procedure known as dental implants.
One of the most significant dental innovations in recent times, an implant is a small surgical fixture made of biocompatible metal or ceramic materials that is placed into the jawbone and functions in the same manner as the root of a tooth. In the same way that natural root supports the natural crown of your tooth, an implant once it fully integrates with the surrounding bone, provides a stable and durable foundation for a replacement tooth. Implants often support a crown for an individual tooth, but can also be used as abutment teeth for a dental bridge, or strategically placed to help stabilize a denture.
Out of all of the restorative choices available today an implant comes the closest to replicating the look, feel and function of a natural tooth. Furthermore, it is the only method of tooth replacement that does not require the involvement or preparation of the adjacent teeth. A dental implant also stimulates bone remodeling to prevent shrinkage in areas where teeth are missing and helps to restore facial contours in areas where significant bone loss has occurred.
Your first visit to our office is very important with regard to establishing your oral health baseline. We will begin by carefully reviewing your medical and dental histories and taking special note of all of your dental concerns, as well as any symptoms that you may be experiencing. This will be followed by a thorough clinical examination, including an oral cancer screening, periodontal evaluation, an analysis of your occlusion (bite) plus a thorough examination of your teeth, their supporting structures, and the complete orofacial area. Any needed diagnostic dental films will be taken at this time.
Chronic jaw clenching and grinding one’s teeth is called bruxism. While it can happen any time of day, it often occurs at night causing an individual to wake up with any number of symptoms including jaw pain, headaches, and sore teeth that may feel loose. Although, stress and anxiety are the most common causes of bruxism there may be other contributing factors such as a sleep disorder, an abnormal bite, as well as teeth that are missing or poorly aligned.
To alleviate the symptoms of bruxism, wearing a night guard while sleeping is frequently recommended. This appliance is designed to fit over the teeth and to keep the jaws slightly apart. Wearing a night guard prevents a number of damaging events including muscle strain, excessive pressure on the jaw joint (the TMJ), and such dental damage as chipped or cracked teeth resulting from the teeth grinding against each other.
In addition to preventing damage to the soft and hard tissues surrounding the orofacial cavity, a custom night guard fabricated at the dental office can help curb a bruxism habit and give the wearer a better night’s sleep.
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
- 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.
At our office we take pride in creating and maintaining beautiful and healthy smiles for our younger patients in an environment that is lighthearted and fun. With an emphasis on establishing oral health habits that last a lifetime, our primary tools are education and a comprehensive preventive care program.
As part of an effort to guard against childhood dental decay we recommend periodic fluoride treatments and dental sealants placed on the biting surfaces of the back teeth.
Periodontal disease damages the surrounding soft tissues and bone that support the teeth. It is predominantly caused by the accumulation of bacteria, mucus and other particles in the form of plaque or tartar that sit between the teeth and the gums. Periodontal disease can range in severity from a simple gum inflammation, known as gingivitis, to a more serious inflammation of the periodontal tissues. Left untreated periodontal disease can result in significant tissue damage and eventual tooth loss.
The problem with periodontal disease is that often the progression is painless. As a result the affected individual may not be aware of an ongoing disease process. This is why it is so important to recognize the signs of the earliest stage of periodontal disease, which is gingivitis. The symptoms of gingivitis typically include red, swollen and bleeding gums. Treatment instituted at this point is often sufficient to reverse the course of the disease and to avoid any permanent damage to the periodontal tissues. A series of deep dental cleanings, an improved home care regimen, and a commitment to regular maintenance may be all that is required to prevent this stage of periodontal disease from progressing.
Left untreated, gingivitis can escalate into periodontitis. However, there are other factors that can contribute to the escalation of periodontal disease, including smoking, genetic tendencies, and unchecked diabetes. In either case, when periodontal disease has progressed to a more advanced stage there is usually clinical and radiographic evidence of damage to the bone and soft tissues supporting the teeth. Periodontal treatment in this phase is designed to halt the progression of the disease and to restore tooth support as possible. This may involve medications to control the bacteria and reduce the size of the pockets between the teeth and gums, gum surgery, as well as bone and tissue grafts.
Endodontics, or root canal therapy, is employed when the nerve supply to a tooth has been irreversibly affected by damage or decay. It is a way to prevent or help resolve a dental infection and save a natural tooth from extraction. A root canal is performed when there is enough sound root and crown structure remaining to eventually restore form and function to the involved tooth.
Inside every tooth is either a single central chamber or multiple ones that contain connective tissue, a nerve supply, and blood vessels. These core tissues, known as the dental pulp, help your tooth to grow and mature before it emerges into the mouth. A root canal procedure is required when this dental pulp is irreversibly damaged or has died.
Root canal therapy involves cleaning and shaping each canal, and then filling them with a special inert material. Following this they are sealed to prevent any subsequent infection. Once root canal therapy has been completed, the tooth should be fully restored as recommended.
Sedation dentistry offers individuals with general anxiety about going to the dentist or fears about a specific dental procedure the opportunity to have a stress free and more comfortable experience. Utilizing safe and controlled sedation techniques prior to the dental procedure the patient is eased into a state of complete relaxation. This eliminates any discomfort, pain, and preoperative anxiety that may be associated with a particular dental visit. With sedation dentistry patients typically feel more at ease post-operatively as they have little or no memory of the actual moment-to-moment dental procedure.
Commonly referred to as “laughing gas,” nitrous oxide is used as a mild sedative to reduce anxiety and allow a level of relaxation during a procedure. Nitrous oxide is inhaled through a small mask over the nose. It is administered for the duration of the procedure and is turned off as the procedure is coming to an end. The effects of this method of sedation wear off very quickly.
Oral Sedation means that you will be given a prescription for an oral medication prior to you appointment. Taken at the recommended time before your appointment, this medication allows you to fully relax by the time your procedure begins. When receiving oral sedation, a patient must have an escort on the day of the procedure to drive them to and from the office.
IV Sedation involves a sedative that is administered intravenously, or directly into a vein. It is indicated when deeper sedation is required. This type of sedation can be quickly modified to your state of consciousness and can be continued as long as necessary for the procedure.
IV Sedation requires an empty stomach. Patients receiving this type of sedation will be instructed as to how many hours prior to their surgical procedure they should stop eating or drinking. In addition to this, patients receiving IV sedation will need to have an escort present for the appointment and to be able to drive them home when the appointment is completed.
Sleep apnea is a serious and potentially life threatening disorder involving repeated pauses in breathing while asleep. The most common form of this condition is obstructive sleep apnea. This occurs when there is an obstruction of an individual’s airway that interferes with the flow of oxygen through the nose or mouth during sleep. In someone afflicted with obstructive sleep apnea, the muscles of the throat and mouth relax during sleep to the point where they fall back into the upper airway and create a blockage that restricts breathing.
The signs and symptoms of this disorder during sleeping hours may include, loud snoring, episodes of breathing cessation, abrupt awakenings, episodes of gasping for air, along with difficulties getting a good night’s sleep. An individual with sleep apnea will exhibit problems during the day as well. Sleep apnea can lead to a morning headache, excessive daytime sleepiness, difficulty concentrating, and irritability.
A sleep study is typically conducted to determine the severity of the disorder. The results of this study along with other medical findings will play a role in determining the recommended therapy. The most common form of therapy is a CPAP machine that is worn when sleeping. This device provides a steady stream of pressurized air into the respiratory system through a mask.
In situations of mild to moderate sleep apnea, a dental appliance may be deemed the appropriate treatment. Worn in a similar fashion to a mouthguard or an orthodontic retainer, it is designed to help keep the tongue and soft tissues in the back of the throat from collapsing, thereby enabling the airway to stay open during sleep. An oral appliance is easy to wear, easy to care for, comfortable, and portable. Oral appliances are individually fabricated, and customized for both maximum effectiveness and comfort.
Every year millions of cases of dental and facial injuries occur as the result of sport-related trauma. While all sports have some risk of oral injury, it is especially prevalent in recreational activities that involve frequent body contact with other players or the ground, as well as the possibility of being struck by other objects such as, balls, bats, or sticks.
One way to significantly reduce the risk of damage to your teeth, cheeks, lips, tongue, face, or jaw as the result of a sports-related injury is to wear a mouthguard. A mouthguard is a removable appliance made of a sturdy plastic that sits comfortably over your teeth. Typically, mouthguards are designed to cover just the top teeth but may also be fabricated to include the lower teeth as well depending on your particular situation. Individuals who wear braces or have some types of dental work may require a specific type of mouthguard that provides more coverage.
There are three types of sports mouthguards on the market, including pre-formed and ready to wear stock mouthguards, boil and bite mouthguards, and custom mouthguards fabricated by your dentist. Our office will help you to select just the right sports mouthguard to protect your smile. While the first two choices offer some level of protection, the best and most comfortable mouthguards to safeguard your smile are the ones individually designed and customized by your dentist.
Teeth that have been stained or darkened by food, tobacco use, age, medications or injury can be lightened and brightened by means of a non-invasive process known as teeth whitening.
Teeth whitening or bleaching simply refers to any process that will make the teeth appear whiter. While there are many over the counter options for teeth whitening, the most effective and safest teeth whitening systems are the professional strength ones available at the dentist’s office. A dental professional whitening system offers a higher concentration of whitening components and delivers them to the teeth in the most efficient manner to achieve optimal results.
At our office we offer a professional take home system. Our professional strength take home system produces excellent results.
According to recent studies good oral hygiene is essential not only for your dental health, it is important to your overall health and well-being. Our comprehensive dental hygiene program is designed to preserve your teeth and the supporting structures by preventing the onset, progress, and recurrence of dental disease.
To maintain your optimal oral health we recommend periodic professional dental cleanings. Removing plaque and debris from teeth, especially from places where a toothbrush can't reach, like underneath the gum line and in-between teeth is extremely important.
It is also important to keep in mind that in conjunction with periodic dental professional cleanings, a good dental home care regimen is necessary. As part of the preventive program at this office your current home care practices will be reviewed. Following that, we will make recommendations as to what areas require improvements, and instruct you in the proper methods of brushing and flossing.
Additional preventive services may be indicated for individual patients. An integral part of our preventive program for pediatric patients includes periodic fluoride treatments and the application of dental sealants.
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.
If your teeth suffer from gaps, chips, stains, or discolorations you may be a candidate for porcelain veneers, a highly effective and minimally invasive cosmetic procedure that can achieve beautiful results.
Porcelain veneers are thin facings custom-made of the highest quality ceramic materials that are designed to fit perfectly over the front of your teeth. One of the most conservative cosmetic treatments available, veneers can mask a host of dental imperfections to give you the smile that you have always wanted. Porcelain veneers not only enhance and improve the shape of your teeth, they are able to create an overall whiter and brighter smile.
One of the most appealing aspects of the process of fabricating porcelain veneers is that they involve minimal tooth preparation and take just a few visits. Porcelain veneers, once they are fabricated and fitted, are permanently bonded to the underlying teeth. The result is a naturally pleasing smile that is both strong and durable.