Dental Services

A comprehensive dental exam is required for all new patients and at least every three to five years for current patients according to the American Dental Association (ADA). The purpose of this exam is to find out what is healthy and what is not and examine the overall condition of the patients' oral health. Dental disease is very predictable with so much of it being very preventable. The actual exam normally consists of eight or more separate but interconnected exams that check conditions pertaining to:

Gums and bones supporting the teeth;	Periodontal exam
Teeth;	Dental exam
Soft mouth tissue, throat and surrounding areas;	Head & Neck
Bite analysis;	Occlusal exam
AW Joints;	TMJ exam
X-rays/scans;	Radiographic
Saliva quality and quantity;	Saliva function
Appearance of teeth and Gums;	Esthetic exam
Charting teeth, restoration & decay
Impressions/molds of teeth for analysis

A comprehensive exam by definition means that the dentist will know everything about the patients' oral health. Sometimes a specialist may have to be involved to complete the exam. This is never a problem because the total of all of the diagnostic steps taken in the beginning will result in the optimum treatment for the patient in the long run. This knowledge is critical since the mouth is really a window to your body. A comprehensive exam can detect medical conditions before symptoms show up elsewhere in your body. Some examples of diseases that will present them selves in your mouth include:

Oral Cancer

Cardiovascular Disease

Gum and Bone Disease

Blood Pressure

Systemic Disorders (Leukemia)

Diabetes

The dental industry refers to a dental cleaning as a "dental prophylaxis" or "prophy." For many patients it is likely to be the most important and valuable visit they may ever make to a dentist. The prophy should include:

Oral hygiene evaluation and recommendations

Brushing and flossing instructions

Scaling to remove plaque and tartar from tooth surfaces

Debridement of tartar beneath the gum line if necessary

Topical fluoride treatment

Polishing teeth

The dental exam is the foundation for a lifetime of good oral health. A crucial component of the prophy is the removal of calculus from teeth. Calculus, which is Plaque combining with saliva minerals forms a hard, rough sediment known as dental tartar or calculus. If the calculus is not removed, further calculi will buildup causing periodontal disease. Calculus can be removed by a licensed dental hygienist utilizing either a manual or ultrasonic device. If an ultrasonic scaler is utilized to remove heavy tartar and stains, caution must be exercised for patients with pacemakers as the ultrasonic sounds may interfere with the function of the pacemaker.

Fluoride is a mineral that occurs naturally in many foods and water. Everyday, minerals are added and lost from a tooth's enamel layer through two processes; demineralization and remineralization. Minerals are lost from a tooth’s enamel layer when acids, formed from plaque bacteria and sugars in the mouth, attach to the enamel. Minerals such as Fluoride, Calcium and Phosphate are redeposited to the enamel layer from the foods and water consumed. Too much demineralization without enough mineralization to repair the enamel layer leads to tooth decay.

Fluoride helps prevent tooth decay by making the tooth more resistant to acids attacks from plaque bacteria and sugars in the mouth. It also reverses early decay as well. In children under 6 years of age fluoride becomes incorporated into the development of permanent teeth making it more difficult for acids to demineralize the teeth. Fluoride also helps the reminerlization process as well, disrupting acid production in already erupted teeth in both children and adults.

Fluoride can also be applied directly to the teeth through fluoride toothpastes and mouth rinses. Mouth rinses containing fluoride in lower strengths are available over-the-counter with stronger concentrations requiring a doctors prescription. A dentist can also apply fluoride as a gel, foam, or varnish. These treatments contain a much higher dosage of fluoride then the amount found in tooth pastes and mouth rinses. Varnishes are painted on the teeth, foams are put into a tray which is applied to the teeth for one to four months; gels can be painted on or applied with a custom tray.

How critical is Fluoride treatment?

For children between six and sixteen years, fluoride treatments are very important because this is when permanent teeth come into place. However it is known that everyone benefits from fluoride treatments because of its ability to fight tooth decay. Additionally because some patients may have specific conditions that could increase their chances of acquiring tooth decay, fluoride treatments can be extremely important. Some of these conditions that fluoride can play a major role in prevention include:

Can Fluoride be dangerous?

When used as instructed fluoride is safe and very effective. However, high dosages can be hazardous. High dosage toxicity levels vary based on an individuals weight. For this reason it is very important that parents play an active role in supervising their children’s usage of all fluoride containing products, especially under the age of six.

Excess fluoride can cause defects in the tooth’s enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. These defects are known as fluorosis and occur when the teeth are forming, usually in children under six year’s of age. Fluorosis is usually associated with naturally occurring fluoride as found in well water for example. Although staining from fluorosis cannot be removed with normal hygiene, your dentist may be able to lighten or remove the stains with professional strength abrasives and bleaches.

However it should be noted that because home products contain fluoride in such low dosages, it would be extremely rare to reach hazardous levels.

Fluoride in Drinking Water

The American Dental Association suggests that most bottled waters do not contain optimal levels of fluoride that would normally be found in communities with fluoridated water. Check the back of the water bottle, contact the bottled water manufacturer or have you water tested to determine actual levels of fluoride.

Home water treatment systems can also affect fluoride levels. Steam distillation systems remove 100% of fluoride; Reverse osmosis between 65 to 95%; However water softeners and charcoal/carbon filters generally do not remove fluoride. One exception is some activated carbon filters that contain activated alumina which can remove 80% of fluoride.

Dry mouth conditions, caused by certain diseases, medications, and head and neck radiations treatments make a patient more prone to tooth decay.

Gum disease, also known as Gingivitis, can expose more of your teeth and tooth roots to bacteria increasing the chance of tooth decay.

A history of frequent cavities: If you have one or more cavities annually, fluoride treatments should be considered.

Crown, bridges, or braces: The risk of decay is more prevalent at the point where the crown meets the underlying tooth or around the brackets of orthodontic applications.

You Should Know

Oral Cancer often starts as a tiny, unnoticed white or red spot or sore anywhere in the mouth.

It can affect any area of the oral cavity including the lips, gum tissue, check lining, tongue and the hard or soft palate.

Other signs include:

A sore that bleeds easily or does not heal A color change of the oral tissues A lump, thickening, rough spot, crust or small eroded area Pain, tenderness, or numbness anywhere in the mouth or on the lips Difficulty chewing, swallowing, speaking or moving the jaw or tongue. A change in the way the teeth fit together

Oral Cancer most often occurs in those who use tobacco in any form.

Alcohol use combined with smoking greatly increases risk.

Prolonged exposure to the sun increases the risk of lip cancer.

Oral cancers can occur in people who do not smoke and have no other known risk factors.

Oral Cancer is more likely to strike after age 40.

Studies suggest that a diet high in fruits and vegetables may prevent the development of potentially cancerous lesions.

Regular Dental Check-ups Important

Oral cancer screening is a routine part of a dental examination. Regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions. You may have a very small, but dangerous, oral spot or sore and not be aware of it.

Your dentist will carefully examine the inside of your mouth and tongue and in some patients may notice a flat, painless, white or red spot or a small sore. Although most of these are harmless, some are not. Harmful oral spots or sores often look identical to those that are harmless, but testing can tell them apart. If you have a sore with a likely cause, your dentist may treat it and ask you to return for re-examination.

Dentists often will notice a spot or sore that looks harmless and does not have a clear cause. To ensure that a spot or sore is not dangerous, your dentist may choose to perform a simple test, such as a brush test. A brush test collects cells from a suspicious lesion in the mouth. The cells are sent to a laboratory for analysis. If precancerous cells are found, the lesion can be surgically removed if necessary during a separate procedure. It’s important to know that all atypical and positive results from a brush test must be confirmed by incisional biopsy and histology.

Facts about Oral Cancer

:: Incidence and Mortality ::

Oral cancer strikes an estimated 34,360 Americans each year. An estimated 7,550 people (5,180 men and 2,370 women) will die of these cancers in 2007.

More than 25% of the 30,000 Americans who get oral cancer will die of the disease.

On average, only half of those diagnosed with the disease will survive more than five years.

African-Americans are especially vulnerable; the incidence rate is 1/3 higher than White-Americans and the mortality rate is almost twice as high.

:: Risk Factors ::

Although the use of tobacco and alcohol are risk factors in developing oral cancer, approximately 25% of oral cancer patients have no known risk factors.
There has been a nearly five-fold increase in incidence in oral cancer patients under age 40, many with no known risk factors.
The incidence of oral cancer in women has increased significantly, largely due to an increase in women smoking. In 1950 the male to female ratio was 6:1; by 2002, it was 2:1.

:: Prevention and Detection ::

The best way to prevent oral cancer is to avoid tobacco and alcohol use.

Regular dental check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions.

Many types of abnormal cells can develop in the oral cavity in the form of red or white spots. Some are harmless and benign, some are cancerous and others are pre-cancerous, meaning they can develop into cancer if not detected early and removed. (American Cancer Society).

Finding and removing epithelial dysplasias before they become cancer can be one of the most effective methods for reducing the incidence of cancer.

Knowing the risk factors and seeing your dentist for oral cancer screenings can help prevent this deadly disease. Routine use of the Pap smear since 1955, for example, dramatically reduced the incidence and mortality rates for cervical cancer in the United States.

Oral cancer is often preceded by the presence of clinically identifiable premalignant changes. These lesions may present as either white or red patches or spots. Identifying white and red spots that show dysplasia and removing them before they become cancer is an effective method for reducing the incidence and mortality of cancer.

While traditional dentistry focuses on oral hygiene and prevention, diagnosing and treating oral disease, cosmetic dentistry focuses on improving the appearance of a person’s teeth, mouth and smile.

Cosmetic Treatments

Inlays/Onlays – Made from Porcelain or composite material are a long-lasting cosmetic way to provide a filling in teeth with tooth decay or structural damage. Whereas dental fillings are molded into place during a dental appointment inlays and onlays are created in a dental lab before being fitted and then adhesively bonded into place.

Composite Bonding – Chipped, broken, discolored or decayed teeth may be repaired or have their appearance corrected using composite bonding. The composite material which looks like enamel is applied into the cavity or onto the surface of a tooth where it is shaped, contoured and then hardened with a high-intensity light. This results in a restoration that binds naturally with the remainder of the surrounding tooth.

Teeth Whitening – The most commonly recommended procedure used on teeth stained from smoking, food, beverages, and poor oral hygiene.

Dental Veneers – Composite or porcelain laminates adhesively bonded to the surface to correct and repair chips and cracks and improve a worn appearance or severe discoloration. Also recommended for gaps between teeth that can not be whitened.

Dental Implants are artificial tooth replacements. Although your dentist can offer a number of restorative procedures for replacing missing teeth, the success rate of implants as compared to other procedures has been nothing short of excellent. Many implants are still performing well after 20 years since they were installed.

Implants offer a number of advantages. Implants are stronger and more durable than bridges and dentures. They can be a permanent solution to a lost tooth or teeth and can be utilized in conjunction with other restorative procedures requiring the use of crowns, bridges or dentures. Many patients who have selected implants have a quality of life which is much more comfortable and enjoyable than the type of lifestyle endured by patients with fixed bridges or removable dentures. Dentures can age a person, become a source of embarrassment in social settings and minimize the enjoyment of eating comfortably. Being able to eat and enjoy a varied diet, communicate effectively, and eliminate the typical problems associated with the deterioration of dentures over time affords the implant patient an opportunity to feel, look and live better.

Crowns are a type of dental restoration which, when cemented in place fully cups over the portion of the tooth that lies at and above the gum line. Since dental crowns encase the entire visible aspect of the tooth, a dental crown becomes in effect the tooth’s new outer surface.

Crown's can be made out of porcelain, metal, usually a gold or other alloy or a combination of both.

Since a dental crown that has been cemented in place essentially becomes the new outer surface of the tooth, it is easy to understand how the crown placement can restore a tooth to its original shape. A crown can also strengthen a tooth because the outer hard shell encases the tooth within. For both of these reasons, dental crowns are routinely made for teeth that are broken, worn excessively, have had large portions destroyed by tooth decay and improving the cosmetic appearance of teeth.

Preventative care is that branch of dentistry that deals with the preservation of healthy teeth and gums, and the prevention of cavities and oral disease. This includes the patients that have full upper and lower dentures, they should see their dentist at least once a year for an examination and cancer screening.

Dental bridgework involves the creation of a false tooth to replace the missing tooth. Bridgework was formerly considered as cosmetic dentistry since missing teeth can look unattractive. However, continuous research on this subject has clearly demonstrated that missing teeth can lead to faster gum disease and tooth decay if the area is left open. Missing teeth may also disrupt the alignment of other teeth placing the entire bite profile off axis.

Restorative dentistry includes those procedures involved in restoring and/or repairing broken or leaking fillings, creation and maintenance of crowns and bridges, placement and maintenance of implants, the fitting of partial and full dentures, realignment of the bite profile, periodontal therapy, and full mouth reconstruction. The ultimate objective for each and every one of these procedures is the complete restoration of the oral cavity to an optimal functioning condition. Today restorative dentistry offers many more comfortable alternatives than were available even just a few years ago.

Dental Implants – Artificial tooth root replacements used as part of prosthetic dentistry to compensate for tooth loss. Not only are smiles enhanced but a more youthful appearance is achieved since missing teeth cause the face muscles to collapse making you look older.

Full Mouth Reconstruction – Functional problems with patients bite, jaw points, muscle, teeth alignments and bone structure may need to be addressed in order to improve the esthetic appearance of your smile. Modern materials available to dentists now allow for attaining a functional yet natural look.

Whitening or bleaching treatments are available to satisfy every budget and personal schedule. The long and the short of it is that teeth-whitening works!

Bleaching vs. Whitening

According to the ADA the term "bleaching" can be used only when the teeth can be whitened beyond their natural color. This applies strictly to products that contain bleach such as hydrogen peroxide or carbamide peroxide.

On the other hand "whitening" refers to a tooth’s color by removing dirt and debris. So any product that cleans (like toothpaste) is a whitener.

Tooth Discoloration

There are 2 types of tooth discoloration, Extrinsic stains and Intrinsic stains. Extrinsic stains are those that appear on the surface of the teeth as a result of exposure to dark-colored beverages, food and tobacco and routine wear and tear. Superficial minor stains can be removed by brushing and by a professional cleaning from a licensed hygienist. Major stains can be removed with more involved efforts like teeth bleaching. Persistent stains must be dealt with promptly before they can penetrate into the dentine and become ingrained. Intrinsic stains form on the interior of the teeth. They result from trauma, aging, exposure to minerals and tetracycline during tooth formation and/or excessive ingestion of fluoride. Intrinsic stains can be removed through supervised take-home whitening technology administered for months or even a year or more.

Teeth Whitening Options

Three (3) whitening options are available. All three rely on varying concentrations of peroxide and varying application schedules. The three options include in-office whitening, professionally designed take-home whitening kits, and over-the-counter whitening kits. Consult with your dentist to ascertain which system suits your specific requirements.

Periodontal (gum) disease, including gingivitis and periodontitis are serious infections which, if left untreated, can lead to loss of one or more teeth. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect multiple teeth simultaneously. It begins when the bacteria in plaque causes the gums to become inflamed. Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swell and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Periodontitis

Untreated gingivitis can advance to periodontitis. Over time plaque spreads and grows below the gum line producing toxins that irritate the gums. The toxins stimulate a chronic inflammation response which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth forming pockets that become infected. As the disease progresses the pockets deepen and more gum tissue and bone are destroyed. Eventually teeth can become loose and may have to be removed. The following are the most common forms:

Aggressive Periodontitis – occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction with familial aggregation.

Chronic Periodontitis - results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent ion adults but can occur at any age. Progression of attachment loss usually occurs slowly but periods of rapid progression can occur as well.

Periodontitis – as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease and diabetes are associated with this form of periodontitis.

Necrotizing Periodontitis – is an infection characterized by necrosis of gingival tissues, ligament and alveolar bone loss. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Treatments for periodontitis can be either surgical or non-surgical depending upon the specific variety of periodontitis that you have. Non-surgical treatment involves scaling and root planning followed by therapy. Surgical options are only considered when it has become evident that regaining good periodontal health can not be attained by any other method.

Dentures are replacements for missing teeth that can be taken out and replace into your mouth. There are 2 types of dentures: Full and Partial. With full dentures a flesh colored acrylic base fits over your gums. The base of the upper denture covers the palate (the roof of your mouth) while the lower denture is shaped like a horseshoe to accommodate your tongue. Full dentures come as either "conventional full" dentures or "immediate full denture." A conventional full denture is placed in your mouth after any remaining teeth are removed and tissues have healed. This can take as long as 6 months during which you have no teeth. An immediate full denture is inserted immediately after the remaining teeth are removed. While immediate full dentures offer the benefit of never being without teeth they must be relined several months after being inserted.

Partial dentures rest on a metal framework that attaches to your natural teeth. Sometimes crowns are placed on some of your natural teeth and serve as anchors for the denture. Partial dentures offer a removable alternative to bridges.

Over time dentures will need to be relined, remade, or rebased due to normal wear. Rebasing means making a new base while keeping the existing denture teeth. Also as you age the shape of your mouth changes which can cause your denture to loosen which can irritate your gums. At a minimum you should have annual checkups with your dentist to ascertain the condition of your denture and the possible effects it is having on the supporting gum tissue.

The longer dentures are worn the more your gums change underneath the denture. A result the denture can become loose and begin moving over gum tissue possibly creating sores throughout the gum line. Therefore a denture should be relined every two years in order to restore the retentive qualities of the denture and prevent production of flabby gum tissue underneath and sore along the gum line. There are three (3) types of relines: Hard, Soft and Temporary.

Hard Reline

Hard relines are performed on all dentures every two years. Essentially the denture is reshaped to conform to the contours of your mouth maximizing tissue contact which in turn produces maximum suction.

Soft Reline

When patients can not wear ordinary dentures because of tender gums, the denture can be relined with a material that remains somewhat pliable for a year or two before requiring replacement.

Temporary Reliners (Therapeutic Reliners)

Patients who have neglected their dentures for long periods are always subject to red, swollen and misshaped gums, making it impossible to take an impression of them for a new denture. In cases like this, the dentist will frequently resort to a medicated reline material to allow the inflammation to subside. After a few months the patient is ready for his new denture or hard reline.

Rebasing the Denture

Rebasing the denture is similar to reline except the denture comes back with all the pink plastic above replaced. The only parts of the old denture that remains after a rebase are the teeth. A rebase is usually done when the denture has multiple cracks or repairs and does not fit well, but the teeth themselves are still in good condition and fit correctly with the teeth in the opposite arch.

Repairs

As dentures age they become more prone to breakage. With age the fit becomes looser allowing the denture to rock while it is worn. Repetitive flexing weakens the plastic and eventually it breaks. Additionally this flexing can cause the teeth in the denture to loosen and break out. If your denture breaks bring the pieces to your dentist, do not attempt to fix them yourself. Only a trained specialist will be able to ascertain whether or not they can be fixed and how they can be fixed in order to perform without causing damage to your mouth.