Air abrasion uses a process where pressurized air prepares a cavity with the use of fine, non-toxic abrasive powder (aluminum oxide) instead of using a conventional drill. Air abrasion is quiet and faster than a drill. Anesthetic is not necessary so multiple teeth can be worked on during one visit. Air abrasion can only be used on small cavities. It cannot be used for crowns or cavities between teeth. A tooth colored filling is used to fill the preparation.
Amalgam fillings are also known as "silver" fillings. Amalgam fillings have been in use for many years and still are a good and stable type of filling. They require a deeper more extensive preparation than other types of fillings and lays into a tooth with no retention. Amalgam fillings cannot be used on front teeth due to the low esthetic value and, for the same reason, are being used less frequently on other teeth as well. Some patients are concerned about the mercury that is incorporated in the amalgam filling, although research has not yet conclusively shown that amalgam filings are a danger to the body. In response to concerns about the mercury, researchers are developing new types of amalgam that do not incorporate mercury. Amalgam fillings, like composite fillings, may have to be replaced in time depending on a patient's oral habits (i.e., teeth clenching, grinding, ice chewing, etc.). See also "Composite Fillings."
Depending on the type of treatment a patient is to receive, a dentist may recommend some type of dental anesthesia. Local anesthesia involves the numbing of the teeth and gums. Topical anesthetic may be used to help make the injection more tolerable. Most dental work falls under this type of anesthesia (i.e., fillings, crowns, root canals and gum surgery) and may cause the patient to feel a temporary numbness. Nitrous Oxide or "laughing gas" may be used in combination with local anesthetics or alone if the patient cannot tolerate a local injection. Nitrous Oxide is an anti-anxiety agent that helps relax both children and adults. Patients wear a mask to breathe in the nitrous air. The effects soon dissipate once the nitrous is turned off and the patient begins to breathe oxygen through the mask. There are very few known side effects with Nitrous Oxide. General anesthesia is used during more complex procedures or for those that experience a high level of anxiety and wish to be asleep during the treatment. An anesthesiologist or a dentist who has received special training administers general anesthesia. Sometimes oral medications are used to relieve dental pain or anxiety. These analgesics may be used in combination with the above types of anesthesia or alone to help relieve post treatment discomfort.
Bonding is a process in which tooth-colored material is applied to the tooth's surface and contoured into the proper shape. A variety of color resins are blended so the bonded teeth will look natural and will match your other teeth. Bonding will close gaps between teeth, cover discolored teeth, or repair cracked, chipped or poorly shaped teeth. The bonding procedure typically involves minimal discomfort and can be accomplished in a single visit.
Composite fillings are sometimes referred to as "white fillings". Almost every dentist uses composite fillings at this time on the front or back teeth. The material used in a composite filling is colored to match the patient's natural teeth. Composite fillings are bonded in place with a high intensity light, thereby causing the filling to "stick" to the tooth for improved strength. Most composite fillings also have fluoride incorporated into the material, which is released into the mouth. This gives the tooth added protection against decay. Composite fillings look and feel better on the tooth, require less tooth preparation by the dentist, and generally last longer than amalgam fillings. Composite fillings, like amalgam fillings, may have to be replaced in time depending on a patient's oral habits (i.e., teeth clenching, grinding, ice chewing, etc.). See also "Amalgam Fillings."
A crown is a permanent restoration that covers a tooth to strengthen and protect a decayed tooth from further fracture. A crown also may be used to support a large filling when there is little tooth remaining. A crown can be made of different types of materials (gold, composite resin, porcelain or a combination of these materials) depending on the location and condition of the problem tooth. If properly cared for, a crown can last over 25 years.
A denture or a complete denture as it is often called, is an appliance that is inserted in the mouth, replaces natural teeth and provides support for the cheeks and lips. Most dentures are made of acrylic and can be fabricated two different ways. A conventional denture is made after all teeth have been extracted and the tissues (gums) have healed. An immediate denture is fabricated and inserted immediately after the teeth are extracted and the tissues are allowed to heal under the denture. An upper denture has acrylic, usually flesh colored, that covers the palate (roof of the mouth). A lower denture is shaped like a horseshoe to leave room for the tongue. The teeth are made of plastic, porcelain or a combination thereof. Dentures can be fabricated to fit over endodonticly treated teeth (See "Root Canals") and a complete denture can be attached to implants (See "Implants") to allow for a more secure fit of the appliance. Dentures over a normal course of time will wear and need to be replaced or relined in order to keep the jaw alignment normal. The alignment will slowly change as the bone and gum ridges recede or shrink due to the extraction of the teeth. Regular dentist examinations are still important for the denture wearer so that the oral tissues can be checked for disease or change. See also "Partial Dentures."
If your teeth have small chips or wear spots, are crowded, uneven or too long, enamel shaping can change the tooth's appearance to create more balance in the mouth. Enamel shaping can be performed without anesthetic. This procedure may be used in combination with bonding or orthodontics if the crowding is too severe.
A fixed bridge replaces or spans the space where one or more teeth have been lost. A fixed bridge is attached to natural teeth (abutments). It is cemented into place and can only be removed by a dentist. The abutment teeth are crowned to provide strength. The ponic, or artificial tooth, is the part of the fixed bridge that replaces the missing tooth or space between the abutments. The ponic is fused to the abutments to form one piece that is cemented or bonded into place in the mouth. These restorations prevent collapse of the mouth and movement of teeth. Fixed bridges have special instructions for proper home care, which will be explained by the dentist or dental assistant upon completion of treatment. See also "Maryland Bridge."
Dental Implants are titanium inserts that are surgically placed into the jawbone by an oral surgeon or a periodontist, and then allowed to integrate into the bone. This process may take up to six months. The implants then can be restored with a post and an artificial tooth that is either screwed into the implant or cemented onto the implant. Implants are more costly than crowns, dentures or bridges and are appropriate only for patients who demonstrate good oral hygiene. Implants enable the dentist to provide the patient with artificial teeth that look and function much more like natural teeth and are as secure as natural teeth. Implants also may be attached to a denture to allow denture wearers a more secure and functional option. Patients must follow the proper home care instructions and visit the dentist at the recommended intervals or the implants can fail or fracture. There are no strict age limitations as to who can receive implants; in fact, implants have been placed on children, adults and the elderly.
Inlays and onlays are more permanent types of restorations similar in longevity to crowns. A more conservative tooth preparation is done which allows a tooth to maintain more of its original characteristics. A mold is made with a special plaster and from that model the inlay or onlay is custom made. Inlays and onlays can be fabricated from gold, porcelain or a composite resin. The inlay or onlay is then cemented or bonded into place to give the tooth superior support. An inlay differs from an onlay in that the onlay material covers one or more cusps of a tooth and generally is a better choice if the tooth has a fracture.
Recently high intensity light (lasers) has been developed for use in the dental field. Dental lasers allow for an easier and cleaner way to cut soft tissue and recently have been improved to enable the dentist to cut hard tissue (enamel) as well. The lasers used in dentistry come in three different variations. The greatest difference is in the laser beam and the depth of cut and temperature at the surface of the cut being made by the laser. The two most common types of soft tissue lasers are the CO2 laser and the YAG laser. The CO2 cuts more on the surface and does not raise the temperature very high on the surface to be treated which allows the tissue a better response to healing. The YAG laser will cut deeper and at a higher temperature so it can overheat some of the underlying structures below the tissue surface. The third type of laser is the newly developed laser for cutting hard tissue (enamel) called the erbium laser. An attribute of the erbium laser is that it does not overheat the tooth so that the tooth pulp (nerve) will not die. The erbium laser is currently being utilized in a small number of dental practices in the United States but may be more generally available in the near future.
Sometimes a situation arises where a missing tooth is abutted by healthy teeth on each side. If an implant (See "Implants") is not being used to restore the missing tooth, then a more conservative, less expensive alternative treatment like the Maryland Bridge can be used. Unlike conventional fixed bridges, the Maryland Bridge does not require the use of crowns or extensive tooth preparation. The bridge is bonded (or attached) directly to the abutment teeth. A Maryland Bridge is not as strong as a conventional bridge or implants and may not last as long before needing replacement. See also "Fixed Bridge."
Orthodontic procedures are most commonly done on children but in recent years have become very popular for adults. Orthodontics treats patients with bite and teeth positioning problems that cannot self-correct with growth or other interceptive procedures. The orthodontist may use either a removable or a fixed appliance. Removable orthodontic appliances are easier to wear and care for and are advantageous in that it is easier to check the patient's progress and oral health. Fixed orthodontic appliances are attached to the teeth and can only be removed by the dentist. In determining whether to use a removable or fixed orthodontic appliance the dentist will factor in the nature of the problem and the tooth movement required to obtain a good result. In children, the child's ability to cooperate with the dentist and maintain good oral hygiene also will be considered. Orthodontics cannot only improve one's smile, but also improve the function of the teeth so they can last a lifetime.
A partial denture replaces missing teeth so that the remaining teeth, oral tissues and cheeks have support. A partial denture also will allow the patient to chew and speak properly and smile with confidence. A partial denture, like a complete denture, is made out of acrylic but unlike a denture it also uses a metal framework that attaches to the remaining teeth by use of clasps or precision attachments, which attach to crowns and give a partial denture a tighter fit and a more natural look. A partial denture is fabricated by taking impressions after the necessary work has been done on the remaining natural teeth. A partial denture will be checked for any discomfort or pressure. If a partial denture does not fit properly, a clasp or tooth can break as an end result. A partial denture must be removed before proper brushing can be accomplished. The teeth, gums and partial denture must all be cared for by the patient. Like a complete denture, regular examinations by a hygienist and dentist are important to check the supporting teeth for decay and periodontal disease and to check the continuing fit and comfort of the partial denture. See also "Dentures."
Periodontal surgery is usually reserved for patients who have gum problems that cannot be addressed by more conservative treatment (See "Scaling and Root Planing"). One sign of periodontal problems is having excessively large pockets between the gum and the teeth (normal pocket depth is typically 3mm or less). Patients who have excessively deep pockets usually cannot keep these pockets free of the bacteria that causes gum disease and periodontal deterioration. There are various surgical techniques that a dentist or periodontist can use to reach the affected area and treat the disease. Surgery may consist of lifting the gum away so the plaque and bacteria can be more easily removed, the roots are scaled smooth and then the gum is laid back down in a position that should make it easier to clean. Sometimes surgery involves bone grafting and the use of membranes to help stabilize and make mobile teeth firm in the bone again. If there is extensive gum loss a gingival (gum) graft may be used from tissue elsewhere in the mouth. After surgery, a periodontal pack is placed over the surgical area and the tissues are allowed to heal. Antibiotics and a mild pain reliever may also be used to help combat infection and reduce swelling. After surgery, a program of good oral hygiene and proper home care will be established for the patient to help maintain the new healthy smile. Patient recall appointments with the hygienist will also be made in shorter intervals. In recent years some periodontal surgery has been performed with the use of soft tissue lasers (See "Lasers").
Root Canal Therapy
When a tooth abscesses or has a pulp (nerve) exposure due to decay or trauma, root canal therapy or endodontic treatment is performed so that the damaged tooth may remain in the mouth and be saved. Years ago, if a tooth abscessed, it had to be extracted. Today dentists can save teeth by removing the pulp, the soft tissue in the root, cleaning and shaping the canal or canals and filling the root to seal out recontamination of the root system. This procedure is usually done in one to three visits with relatively little pain. If the abscess is severe, antibiotics may be used to help heal the infection. In almost all cases a crown and post (See "Crown") will be needed to restore the tooth to proper function and appearance. Root canal teeth can last a lifetime with proper care of the teeth and gums.
Scaling and Root Planing
Scaling and root planing is usually performed after the dentist has diagnosed some periodontal disease. Scaling and root planing involves removal of the sticky plaque and tartar that builds up on teeth. The procedure may be performed under local anesthetic with an ultrasonic scaler, which can reach below the gum line and into the effective pocket to remove bacteria and the toxins they release. After this procedure, the dentist or hygienist will plane the root surface thereby allowing the gum to reattach to the tooth. Depending on the severity of the case, scaling and root planing may not cure the affected pockets and further periodontal treatment may be needed.
Sealants protect the chewing surfaces of teeth from decay. Brushing will remove plaque and food from the smooth surfaces of your teeth, but the bristles cannot effectively reach into all the grooves of the back teeth. Sealants are plastic materials that are applied to the back teeth, usually the premolars and molars. A dentist or hygienist will place these resin materials in the grooves of the teeth acting like a barrier protecting the enamel from plaque and food. This procedure is most commonly done for children as their permanent teeth erupt. However, some decay-prone adults are beginning to see the benefits of this treatment as well. Sealants can last for 4 to 5 years or even longer. They will be monitored at the patient's regular check-ups and may be reapplied if they become worn.
Temporomandibular Disorder / TM
Sometimes called "TMJ disease" or TM dysfunction, this is a painful condition of the jaw joint which can cause a variety of symptoms such as headaches, facial pain, tenderness or ringing in the ears, clicking or popping of the jaw, or pain when opening and closing the mouth. These problems are referred to as TM disorders. The causes of TM are not well understood and there are varying opinions on how to most effectively diagnose and treat these conditions. The causes of TM disorder may include trauma, arthritis and stress, or a combination thereof. Oral habits such as clenching or bruxing the teeth especially at night when a patient is asleep can slowly cause the muscles to fatigue and spasm without the awareness of the patient. Treatment is usually done in a step-by-step plan, as only minor corrective treatment may be necessary. If pain persists some patients may need more advanced treatment such as medication, psychological intervention, physical therapy or splint therapy. In some severe cases surgery may be needed to correct the joint.
Veneers are thin, custom-made laminates consisting of porcelain or composite material that covers the surface of a tooth. The dentist will prepare the tooth's surface to a depth of about 1mm to 2mm (the thickness of a fingernail), make an impression of the tooth, and send the impression to a dental laboratory technician for fabrication. Veneers have a longer life than bonding. Veneers are used to close gaps between teeth, cover discolored teeth, or repair cracked, chipped or poorly shaped teeth. Porcelain veneers are very natural looking and even the most severely stained or discolored teeth can be covered to match other teeth.
Tooth whitening is a safe, simple and comfortable procedure that lightens the tooth enamel. The patient's dentist will fabricate custom appliances for the patient to wear on the upper and lower arches of the mouth. A mild bleaching gel is placed into the mouth pieces and the mouth pieces are worn a minimum of one to four hours a day/night for one to four weeks depending on the severity of the discoloration. Teeth can begin to lighten after the first day. Proper home care is needed and sometimes sensitivity of the gum tissue can result from the bleaching gel. Periodic renewal bleaching may be necessary in six to twelve months, although the teeth will almost always be lighter than before the whitening process.
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