Dental Health and Bridges
Dental bridges literally bridge the gap created by one or more missing teeth.
A bridge is made up of two crowns for the teeth on either side of the gap -- these two anchoring teeth are called abutment teeth -- and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain, or a combination of these materials. Dental bridges are supported by natural teeth or implants.
What Are the Benefits of Dental Bridges?
Restore your smile
Restore the ability to properly chew and speak
Maintain the shape of your face
Distribute the forces in your bite properly by replacing missing teeth
Prevent remaining teeth from drifting out of position
What Types of Dental Bridges Are Available?
There are three main types of dental bridges:
Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.
Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.
Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.
What Is the Process for Getting a Dental Bridge?
During the first visit for getting a dental bridge, the abutment teeth are prepared. Preparation involves recontouring these teeth by removing a portion of enamel to allow room for a crown to be placed over them. Next, impressions of the teeth are made, which serve as a model from which the bridge, pontic, and crowns will be made by a dental lab. Your dentist will make a temporary bridge to wear to protect the exposed teeth and gums while the bridge is being made.
During the second visit, your temporary bridge will be removed and the new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case. If the dental bridge is a fixed (permanent) bridge, your dentist may temporarily cement it in place for a couple of weeks to make sure it is fitting properly. After a couple weeks, the bridge is permanently cemented into place.
Why Is a Dental Crown Needed?
A dental crown may be needed in the following situations:
To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
To restore an already broken tooth or a tooth that has been severely worn down
To cover and support a tooth with a large filling when there isn't a lot of tooth left
To hold a dental bridge in place
To cover misshapened or severely discolored teeth
To make a cosmetic modification
For children, a crown may be used on primary (baby) teeth in order to:
Save a tooth that has been so damaged by decay that it can't support a filling.
Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.
Decrease the frequency of sedation and general anesthesia for children unable because of age, behavior, or medical history to fully cooperate with the requirements of proper dental care.
In such cases, a pediatric dentist is likely to recommend a stainless steel crown.
What Types of Crowns Are Available?
Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, all resin, or all ceramic.
Stainless steel crowns are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. The crown protects the tooth or filling while a permanent crown is made from another material. For children, a stainless steel crown is commonly used to fit over a primary tooth that's been prepared to fit it. The crown covers the entire tooth and protects it from further decay. When the primary tooth comes out to make room for the permanent tooth, the crown comes out naturally with it. In general, stainless steel crowns are used for children's teeth because they don't require multiple dental visits to put in place and so are more cost- effective than custom-made crowns and prophylactic dental care needed to protect a tooth without a crown.
Metals used in crowns include gold alloy, other alloys, or a base-metal alloy. Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
All-ceramic or all-porcelain dental crowns provide better natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
Temporary versus permanent. Temporary crowns can be made in your dentist's office, whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab.
What Steps Are Involved in Preparing a Tooth for a Crown?
Preparing a tooth for a crown usually requires two visits to the dentist -- the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.
How Should I Care for My Temporary Dental Crown?
Because temporary dental crowns are just that -- a temporary fix until a permanent crown is ready -- most dentists suggest that a few precautions. These include:
Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of the mouth.
Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.
What Problems Could Develop With a Dental Crown?
Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix the problem.
Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.
Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If a crown feels loose, contact your dentist's office.
Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit, a lack of cement, or a very small amount of tooth structure remaining that the crown can hold on to. If this happens, clean the crown and the front of the tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for the tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new crown will need to be made.
Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.
Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.
Health and Dentures
A denture is a removable replacement for missing teeth and surrounding tissues. Two types of dentures are available -- complete and partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.
Complete dentures can be either "conventional" or "immediate." Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about eight to 12 weeks after the teeth have been removed. Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. Therefore a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.
A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. A fixed (permanent) bridge replaces one or more teeth by placing crowns on the teeth on either side of the space and attaching artificial teeth to them. This "bridge" is then cemented into place. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position. A precision partial denture is removable and has internal attachments rather than clasps that attach to the adjacent crowns. This is a more natural-looking appliance.
Are There Alternatives to Dentures?
Yes, dental implants can be used to support permanently cemented bridges, eliminating the need for a denture. The cost is usually greater, but the implants and bridges more closely resemble the feel of real teeth. Dental implants are becoming the alternative to dentures but not everyone is a candidate for implants. Consult your dentist for advice.
How Are Dentures Made?
The denture development process takes about three to six weeks and several appointments. Once your dentist or prosthodontist (a dentist who specializes in the restoration and replacement of teeth) determines what type of appliance is best for you, the general steps are to:
- Make a series of impressions of your jaw and take measurements of how your jaws relate to one another and how much space is between them.
- Create models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made. You will "try in" this model several times and the denture will be assessed for color, shape, and fit before the final denture is cast.
- Adjustments will be made as necessary
Cast a final denture
What Do New Dentures Feel Like?
New dentures may feel a little odd or loose for a few weeks until the muscles of the cheeks and tongue learn to keep them in place and you get comfortable inserting and removing them. Also, it is not unusual for minor irritation or soreness to occur and for saliva flow to increase when you first start wearing dentures, but these problems will diminish as the mouth adjusts.
Will Dentures Make Me Look Different?
Dentures are made to closely resemble your natural teeth so there should be no noticeable change in appearance. In fact, dentures may even improve your smile and fill out your facial appearance.
Eating With New Dentures Be Difficult?
Eating with new dentures will take a little practice and may be uncomfortable for some wearers for a few weeks. To get used to the new denture, start with soft foods cut into small pieces. Chew slowly using both sides of your mouth. As you get used to new dentures, add other foods until you return to a normal diet. Be cautious with hot or hard foods and sharp-edged bones or shells. And, avoid foods that are extremely sticky or hard. You may want to avoid chewing gum while you adjust to the denture. Also, don't use toothpicks while wearing dentures.
Will Dentures Change How I Speak?
After getting dentures, you may have difficulty pronouncing certain words. If so, practice by saying the difficult words out loud. With practice and with time you will become accustomed to speaking properly with dentures. If dentures "click" while you're talking, contact your dentist. Dentures may occasionally slip when you laugh, cough, or smile. Reposition the dentures by gently biting down and swallowing. If any speaking problem persists, consult your dentist or prosthodontist.
Are Dentures Worn 24 Hours a Day?
Your dentist or prosthodontist will instruct you as to how long to wear dentures and when to remove them. During the first several days after receiving your denture, you may be asked to wear it all the time, including while you sleep. Although this may be temporarily uncomfortable, it is the quickest way to identify the areas on the denture that may need adjustment. Once adjustments are made, you should remove dentures before going to bed. This allows gum tissues to rest and allows normal stimulation and cleansing by the tongue and saliva. The denture can be put back in the mouth in the morning.
Should I Use a Denture Adhesive?
A denture adhesive may be considered under the following circumstances:
- To enhance satisfaction with a properly constructed denture. Adhesives enhance retention, stability, bite force, and an individual's sense of security.
- To assist individuals with dry mouth conditions that lessen denture adherence, such as individuals taking cold medications, those with neurologic disabilities including strokes, and the elderly.
- To provide added stability and security for those who place unusual demands on facial muscles, such as public speakers or musicians.
Endodontics (Root Canals)
Dental Health and Root Canals
What is a Root Canal?
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.
"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
Why Does Tooth Pulp Need to Be Removed?
When a tooth's nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:
What Damages a Tooth's Nerve and Pulp in the First Place?
A tooth's nerve and pulp can become irritated, inflamed, and infected due to deep decay, repeated dental procedures on a tooth, and/or large fillings, a crack or chip in the tooth, or trauma to the face.
What Are the Signs That a Root Canal Is Needed?
Sometimes no symptoms are present; however, signs you may need a root canal include:
Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
Discoloration (a darkening) of the tooth
Swelling and tenderness in the nearby gums
A persistent or recurring pimple on the gums
What Happens During a Root Canal?
A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
The first step in the procedure is to take an x-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypo chloride is used periodically to flush away the debris.
Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep out contaminants like saliva and food between appointments.
At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.
The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it to full function. Your dentist will discuss the need for any additional dental work with you.
What Should One Expect After the Root Canal?
For the first few days following the completion of a root canal, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as ibuprofen. Most patients can return to their normal activities the next day.
Until your root canal procedure is completely finished -- that is to say, the permanent filling is in place and/or the crown, it's wise to minimize chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored.
As far as oral health care is concerned, brush and floss as you regularly would and see your dentist at normally scheduled intervals.
How Successful Are Root Canals?
Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime.
Also, because the final step of the root canal procedure is application of a restoration such as a crown or a filling, it will not be obvious to onlookers that a root canal was performed.
Complications of a Root Canal
Despite your dentist's best efforts to clean and seal a tooth, new infections might emerge after a root canal. Among the likely reasons for this include:
More than the normally anticipated number of root canals in a tooth (leaving one of them uncleaned)
An undetected crack in the root of a tooth
A defective or inadequate dental restoration that has allowed bacteria to get past the restoration into the inner aspects of the tooth and recontaminate the area
A breakdown of the inner sealing material over time, allowing bacteria to recontaminate the inner aspects of the tooth
Sometimes retreatment can be successful, other times endodontic surgery must be tried in order to save the tooth. The most common endodontic surgical procedure is an apicoectomy or root-end resection. This procedure relieves the inflammation or infection in the bony area around the end of your tooth that continues after endodontic treatment. In this procedure, the gum tissue is opened, the infected tissue is removed, and sometimes the very end of the root is removed. A small filling may be placed to seal the root canal.
Dental Health and Tooth Fillings
To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material was removed. Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).
What Steps Are Involved in Filling a Tooth?
First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.
Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.
Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.
What Types of Filling Materials Are Available?
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and glass materials called composite resin fillings. The location and extent of the decay, cost of filling material, patients' insurance coverage, and your dentist's recommendation assist in determining the type of filling best for you.
Silver Fillings (Amalgams)
Advantages of silver fillings:
Durability -- silver fillings last at least 10 to 15 years and usually outlasts composite (tooth-colored) fillings.
Strength -- can withstand chewing forces
Expense -- is less expensive than composite fillings
Disadvantages of silver fillings:
Poor aesthetics -- silver fillings don't match the color of natural teeth.
Destruction of more tooth structure -- healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling.
Discoloration -- amalgam fillings can create a grayish hue to the surrounding tooth structure.
Cracks and fractures -- although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material -- in comparison with other filling materials -- may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures.
Allergic reactions -- a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations.
Advantages of composites:
Aesthetics -- the shade/color of the composite fillings can be closely matched to the color of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.
Bonding to tooth structure -- composite fillings actually chemically bond to tooth structure, providing further support.
Versatility -- in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.
Tooth-sparing preparation -- sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.
Disadvantages of composites:
Lack of durability -- composite fillings wear out sooner than amalgam fillings (lasting at least five years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgam fillings under the pressure of chewing and particularly if used for large cavities.
Increased chair time -- because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgam fillings to place.
Additional visits -- if composites are used for inlays or onlays, more than one office visit may be required.
Chipping -- depending on location, composite materials can chip off the tooth.
Expense -- composite fillings can cost up to twice the cost of amalgam fillings.
Are Amalgam-Type Fillings Safe?
Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams fillings. Because these fillings contain the toxic substance mercury, some people think they are responsible for causing a number of diseases, including autism, Alzheimer'sdisease, and multiple sclerosis.
The American Dental Association (ADA), the FDA, and numerous public health agencies say there's no proof that dental fillings cause harm to consumers. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.
Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth.
In June 2008, the FDA said, "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses."
And there's more. "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," according to the FDA.
The changes come in response to a lawsuit filed by consumer groups and individuals concerned about mercury exposure. To settle the suit, the FDA agreed to update its web site.
Problems With Dental Fillings
Tooth Pain and Sensitivity
Tooth sensitivity following placement of a filling is fairly common. A tooth may be sensitive to pressure, air, sweet foods, or temperature. Usually, the sensitivity resolves on its own within a few weeks. During this time, avoid those things that are causing the sensitivity. Pain relievers are generally not required.
Contact your dentist if the sensitivity does not subside within two to four weeks or if your tooth is extremely sensitive. He or she may recommend a desensitizing toothpaste, may apply a desensitizing agent to the tooth, or possibly suggest a root canal procedure.
Pain around the fillings can also occur. If you experience pain when you bite, the filling may be interfering with your bite. You will need to return to your dentist and have the filling reshaped. If you experience pain when your teeth touch, the pain is likely caused by the touching of two different metal surfaces (for example, the silver amalgam in a newly filled tooth and a gold crown on another tooth with which it touches). This pain should resolve on its own within a short period of time.
If the decay was very deep or close to the pulp of the tooth, you may experience a "toothache-type" pain. This "toothache" response may indicate this tissue is no longer healthy. If this is the case, a root canal may be required.
Sometimes people experience what is known as referred pain -- pain or sensitivity in other teeth besides the one that received the filling. With this particular pain, there is likely nothing wrong with your teeth. The filled tooth is simply passing along "pain signals" it's receiving to other teeth. This pain should decrease on its own over 1 to 2 weeks.
Treatments for Gum Disease
There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health.
Treatments range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.
Non-surgical Treatments for Gum Disease
Treatments for gum disease that don't involve surgery include:
Professional dental cleaning. During a typical checkup your dentist or dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and can only be removed with professional cleaning) from above and below the gum line of all teeth. If you have some signs of gum disease, your dentist may recommend professional dental cleaning more than twice-a-year.
Scaling and root planing. This is a deep-cleaning, nonsurgical procedure, done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your dentist or periodontist determines that you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.
Surgical Treatments for Gum Disease
Some treatments for gum disease are surgical. Some examples are:
Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
Bone grafts. This procedure involves using fragments of your own bone, synthetic bone, or donated bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
Bone surgery. Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
In some patients, the nonsurgical procedure of scaling and root planing is all that is needed to treat gum diseases. Surgery is needed when the tissue around the teeth is unhealthy and cannot be repaired with nonsurgical options.
Oral Surgery (Extractions)
A number of conditions may require oral surgery, including:
Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or "impacted" between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.
It's not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.
Dental Implants are an option for tooth loss due to an accident or infection or as an alternative to dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.
Unequal jaw growth. In some individuals, the upper and lower jaws fail to grow properly. This can cause difficulty in speaking, eating, swallowing, and breathing. While some of these problems -- like improper teeth alignment -- can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both into a new position that is more balanced, functional, and healthy.
Improve fit of dentures. For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help long-term denture wearers. Supporting bone often deteriorates over time resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains.
Temporomandibular joint (TMJ) disorders. Dysfunction of the TMJ, the small joint in front of the ear where the skull and lower jaw meet, is a common source of headache and facial pain. Most patients with TMJ disorders can be successfully treated with a combination of oral medications, physical therapy, and splints. However, joint surgery is an option for advanced cases and when the diagnosis indicates a specific problem in the joint.
Other Conditions Treated By Oral Surgery
Facial injury repair. Oral surgery is often used to repair fractured jaws and broken facial bones.
Lesion removal and biopsy. Oral surgeons can take a small sample of abnormal growth or tissue and then send it for laboratory testing for identification. Some lesions can be managed medically or can be removed by the oral surgeon.
Cleft lip and cleft palate repair. Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip and/or a split or opening in the roof of the mouth. Oral surgeons work as part of a team of health care specialists to correct these problems through a series of treatments and surgical procedures over many years.
Facial infections. Pain and swelling in the face, neck, or jaws may indicate an infection. Infections in this area of the body can sometimes develop into life-threatening emergencies if not treated promptly and effectively. An oral surgeon can assist in diagnosing and treating this problem. Surgical treatment, if needed, may include cutting into and draining the infected area as well as extracting any teeth that might be involved.
Snoring/sleep apnea. When conservative methods fail to alleviate this problem, surgery can be tried. Surgical procedures involve removing the soft tissues of the oropharynx (an area in the back portion of the mouth) or the lower jaw. Laser surgery is a newer treatment option. Depending on the surgical technique used, the laser is used to either slowly scar the palate, which tightens it, or to remove palatal tissue.
Invisalign Treatment Process
Talk to an Invisalign Provider
Your treatment begins after you select the experienced Invisalign Preferred Provider that you feel most comfortable with and schedule your initial consultation. Because you will be interacting with this doctor on a regular basis, you may even want to personally meet with a few providers in order to find one that is exactly right for you. This is an important medical and financial decision that's why choosing the right doctor and the right treatment plan is so essential. Keep in mind that not all dentists and orthodontists work with Invisalign, so it's important to find a doctor who has received the proper Invisalign training and can truly evaluate your needs and determine how Invisalign can help you.
During the consultation, you and your doctor will discuss your case in detail to determine if you're a good candidate for Invisalign. Invisalign now addresses many cases, from simple to more complex. Your doctor will determine if Invisalign is right for you. (Take the Smile Assessment ahead of time to see if you might be a good candidate.) This will also be your opportunity to ask any questions you have about the treatment: costs, dental/orthodontic insurance, or any other concerns. See which doctors in your area are Invisalign Providers.
Getting Started with Invisalign
Your doctor will take x-rays, pictures and impressions of your teeth, which Invisalign will use to create a digital 3-D image of them. From these images your doctor will map out a precise treatment plan, including the exact movements of your teeth. Using this same technology, your doctor will even be able to show you a virtual representation of how your teeth will move with each stage of treatment.
Getting Your Custom Invisalign Aligners
Based on your individual treatment plan, a series of custom-made, clear aligners are then created specifically for you. These aligners are made of a smooth, comfortable BPA-free plastic that won't irritate your cheeks and gums like traditional metal braces often do. Simply wear them throughout the day, and remove them when you eat or to brush and floss your teeth. As you wear each set of aligners, your teeth gently and gradually begin to shift into place. And because they're virtually invisible, most people won't even notice you're wearing them.
A Simple Process With Only Occasional Invisalign Checkups
Approximately every two weeks, you will begin wearing a new set of aligners, advancing you to the next stage of your treatment. To monitor your progress, you will also have occasional checkups with your doctor, usually only every six weeks or so. At every stage, you will be able to see how much closer you are to having the smile that reflects the real you.
Length of Time For Invisalign
While every case is unique to each patient, treatment typically takes approximately a year for adults. For teens, the length of treatment is comparable to that of braces, but since your teeth won't be covered by wires and brackets, you'll be able to see improvement much sooner. For best results and a timely outcome, you should wear your aligners for 20 to 22 hours per day, throughout your entire treatment.
Can Invisalign Help My Situation?
Here are some of the main conditions Invisalign currently treats. But if there is a specific dental problem that you do not see addressed here, please contact your Invisalign Provider for more information to see if Invisalign is right for you.
Gaps between teeth can occur with abnormal continued growth of the jawbone. Missing teeth can also cause the surrounding teeth to shift due to the extra space, creating gaps in your teeth. Spacing issues and gaps between teeth can lead to gum problems (due to lack of protection by the teeth), periodontal pockets and increased risk of periodontal disease.
What people commonly refer to as an "overbite" is known to dental professionals as "overjet." It occurs when the upper teeth bite over the lower teeth. Its typically caused by genetics, bad oral habits, or overdevelopment of the bone that supports the teeth. This can lead to gum problems or irritation, and/or wear on the lower teeth, and can cause painful jaw and joint problems.
Underbite can occur when the lower teeth protrude past the front teeth. Its usually caused by undergrowth of the upper jaw, overgrowth of the lower jaw, or both. It can also be caused by missing upper teeth. This can prevent the normal function of front teeth or molars, which can lead to tooth wear. It can also cause painful jaw and joint problems.
Open bite often occurs when some teeth are unable to make physical contact with the opposing teeth for a proper bite. Most often caused by a genetic abnormal jaw structure or excessive thumb-sucking, an open bite can cause poor or painful chewing, and even speech impairment. It can also lead to greater issues like thermo-mandibular joint disorder (TMJ).
Teeth crowding occurs when there is simply a lack of room within your jaw for all of your teeth to fit normally. When left untreated, overly crowded teeth can get worse over time, and result in severely crooked teeth. This crowding can lead to plaque accumulation, tooth decay and an increased chance of gum disease.
Crossbite can occur when the upper and lower jaws are both misaligned. It causes one or more upper teeth to bite on the inside of the lower teeth, and can happen on both the front and the sides of the mouth. This can cause wear of the teeth, gum disease and bone loss.
How Will Having Invisalign Affect Me?
The aligners are easily removable, so you can continue to brush and floss your teeth as you normally would. Cleaning your aligners is just as easy with the Invisalign cleaning kit. Or you can simply brush and rinse them in lukewarm water. Thats it! Achieving that great smile couldnt be easier!
You'll also remove the aligners each time you eat. This means you can continue to eat all the foods you love without any restrictions or worrying about food getting stuck in your wires and brackets. With other teeth-straightening methods, the simple act of eating can often be troublesome.
For those who are active in contact sports, Invisalign allows you to continue wearing your aligners without having to worry about any sharp brackets cutting your mouth. If your sport requires wearing a protective mouthguard, simply remove your aligners and you're good to go.
Your bedtime routine can continue as before, with the simple addition of cleaning your aligners. You wont be struggling with trying to floss and brush in between brackets and wires, which can be time-consuming.
Invisalign vs. Braces
With regular braces, you may experience some or all of the following: pain, discomfort, mouth sores or injuries caused by the brace wires, tooth decay (from inadequate brushing and flossing), plaque buildup, tooth discoloration, tooth/bracket breakage, or difficulty eating. As if that weren not enough, there are also the personal sacrifices - popcorn, chips, bagels, hard-crusted bread, pizza crust, pretzel, nuts, certain candies, plus apples, carrots, corn on the cob, and more.
Invisalign Comfort & Convenience
With Invisalign, the aligner trays are not only smooth and comfortable to wear, but they are also removable. That means you can continue doing all the things you normally would, from brushing and flossing, to eating whatever you like. With other devices, brushing and flossing properly can often take up to 30 minutes!
Special occasion coming up? No problem - just take your aligners out for that time and pop them back in when you're ready. Of course, even when you're wearing them, most people won't even know you're going through treatment, because they are virtually invisible!
Invisalign Health Benefits
Swollen, red gums can often be the result of having teeth that are crowded or too widely spaced. Unfortunately, these are also signs of periodontal disease. When teeth are properly aligned, it helps the gums fit more securely around the teeth, allowing for the strongest and healthiest defense against potential periodontal problems. That is where Invisalign comes in. The comfortable and clear aligners gently and gradually begin to move your teeth into the proper position - without unsightly brackets and wires.
What Is Zoom2 Tooth Whitening?
If you're looking for a fast way to dramatically whiten your teeth, Zoom2 Chair side Whitening System may be the answer for you.
In just 45 minutes, this safe and effective system can give you the instant results you've been wanting; an average of eight shades! A specially designed light activates the Zoom! Whitening Gel to gently break down stains on your teeth to put the sparkle back in your smile! Also with the new Zoom2 system, our patients experience up to 67% less sensitivity than with the previous Zoom! system. Zoom2 Whitening is very safe while under the supervision of a trained dentist. It is one of the safest procedures in cosmetic dentistry. However, we do not recommend this procedure for pregnant women or children under age 13.
You will be given some post-whitening care instructions after your procedure. It is important to maintain a good oral hygiene regimen post-whitening to preserve your bright, white smile. We also recommend occasional touch-ups with the Zoom! Take-Home Gel. Your smile will always be brighter than it was before the procedure, but by following these simple instructions, you can retain your results for a long time!
Although the Zoom2 System can help almost anyone, it may not be as effective in every case. Dr. Ambert can determine if tooth whitening is a possible option for your case.
Is Zoom2 Tooth Whitening Safe?
Yes. Extensive research and clinical studies indicate that whitening under the supervision of a dentist is safe. In fact, many dentists consider whitening the safest cosmetic dental procedure available. As with any tooth whitening product, Zoom! is not recommended for children under 13 years of age and pregnant or lactating women.
How Long Will Zoom2 Tooth Whitening Results Last?
By following some simple post-whitening care instructions, your teeth will always be lighter than they were before. To keep your teeth looking their best, we recommend flossing, brushing twice daily, regular dental cleanings and occasional touch-ups with Zoom! Take-Home gel. These are professional formula products designed specifically to keep your teeth their brightest. They are available only through your dental professional.