Being able to restore your teeth with fillings, crowns and the like means nothing if we can’t keep them and the surrounding tissue healthy. That’s why the dental cleaning – known as prophylaxis in industry terms – we provide all of our patients is so critical to your oral health, not to mention your overall well-being. Many of the bacteria found in dental plaque and calculus have been directly implicated in many serious, often times fatal maladies such as heart attack, stroke, liver disease, kidney disease, pancreatic disease, low birth weight, and Alzheimer’s disease.
What is a dental cleaning?
A dental prophylaxis is the removal of plaque, bacteria, calculus and extrinsic stains by a qualified dental hygienist. This cleaning is not under the gums or “sub-gingival, which for the average, healthy patient is not necessary. In our office, we’ll pair your regular cleanings (usually recommended every 6 months) with oral examinations by the dentist and updates on x-rays as warranted. We also check the health of your gums and surrounding tissues at these visits, which take approximately one hour.
Fillings do just what the name implies — they seal a small hole in your tooth, i.e., a cavity, caused by decay. This prevents the decay (a bacteria-induced infection) from spreading further into the dentin layer of your tooth and entering the sensitive inner root canal — a condition that requires root canal treatment.
To fill a tooth, we first clinically examine it and review x-rays to determine the extent of the decay. Then we carefully remove the decayed area of the tooth. In most cases, your tooth will be anesthetized first, so you won’t feel any unpleasant sensation. If numbing injections normally provoke anxiety for you, you will be comforted in knowing that we utilize a state of the art instrument which emits a gentle “vibration” in the area where the injection will occur. This sensation decreases your ability to sense “tactile” sensations like a dental injection. The result is a “pain-free” or nearly “pain-free” injection. After the area is “numb”, we gently remove the decay, all debris is cleaned from the tooth, and then the filling material is applied. The result is a healthy tooth with a beautiful, natural and undetectable esthetic mercury-free tooth colored restoration.
There are times when the damage done to a tooth by decay is too extensive to be treated with a simple filling, yet not significant enough to need a full-coverage crown. In these cases, the best option for restoring the tooth may be an inlay or onlay.
Both inlays and onlays are considered “indirect” fillings, meaning that they are fabricated outside the mouth (usually by a dental laboratory) and then bonded to the tooth by the dentist. This is in contrast to a “direct” filling, which is applied directly to the cavity by the dentist in one office visit.
An indirect filling is considered an “inlay” when it fits within the little points or “cusps” of a back (premolar or molar) tooth. It is an “onlay” if it covers one or more of these cusps. Either way, the procedure for placing an inlay or onlay is identical.
Dentistry is an art as well as a science; dental crowns offer a perfect example of this. A dental crown or “cap” is a covering that fits over a damaged, decayed or unattractive tooth. It can even replace a missing tooth as part of a dental bridge
A crown completely covers a tooth above the gum line. This is in contrast to a dental veneer, which only covers a tooth’s front surface and needs natural tooth structure to support it. Therefore, if a tooth is missing a significant amount of structure above the gum line, a crown would be the restoration of choice.
Crowns strengthen damaged teeth, allowing them to function normally again. When crafted from today’s high-tech porcelains (dental ceramics), crowns are virtually indistinguishable from natural teeth. In many instances, crowns are placed to improve upon a tooth’s original appearance, giving the patient that “hollywood” smile. Today’s Family Dental excels in providing the most natural, esthetic crowns and bridges. Our restoration of choice it Zeno Zirconia, which is milled at our partner laboratory, by a Cad Cam machine out of a solid block. It is then detailed by a master ceramist to create a restoration that is incredibly durable stunningly life like.
Other materials which may be used for crowns and bridges include porcelain-fused-to-metal crowns (PFM), and gold. We would be happy to discuss the pros and cons of these various options with you.
3 unit Zeno Zirconia Bridge (pictured above)
Crowning or Capping a Tooth
Crowning or capping a tooth will usually takes two visits. At the first visit, we will prepare your tooth to receive its new crown. First we will shape it to fit inside the new covering. This will involve some drilling to give the tooth a uniform shape. We will numb the tooth and the surrounding area beforehand. If there is very little tooth structure left to begin with, we may have to build up the tooth with core material, rather than remove tooth structure, to support the crown.
After the tooth is prepared, we will take impressions of your teeth, and send them to the dental laboratory. There, the impressions will be used to make models of your teeth for the creation of a crown. The models will serve as guides to the highly skilled lab technicians, who will ensure that your new crown is designed to enhance your smile and function well within your bite.
Before you leave the office, we will fabricate and place a temporary crown to your tooth to protect it until the permanent crown is ready. At the second visit, your permanent crown will be inserted onto your tooth and permanently cemented.
Creating a Bridge
Crowns can also be used to create a lifelike replacement for a missing tooth. This is done with bridgework, which spans the space of the missing tooth and requires at least three crowns. Two of those crowns will be placed over healthy teeth on either side of the missing tooth; these healthy teeth are referred to as abutment teeth. The two crowned abutment teeth become supports for a third crown placed in between them; that third crown is referred to as a pontic. If more than one tooth is missing, more crowns will be needed to bridge the gap in between the abutment teeth.
The number of abutment teeth necessary to replace missing teeth is influenced by the number of missing teeth, the size and length of the abutment tooth roots, the amount of bone support each abutment tooth has, as well as where in the mouth the missing tooth is located. For example, if you have three missing teeth, four abutment teeth may be necessary, thereby creating a seven-tooth bridge. Engineering and designing of the bridge requires an understanding of how to replace teeth, as well as the biology of the supporting gum and bone tissue.
Caring for Your Crowns & Bridgework
Crowns and bridgework require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the buildup of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of cleanings here at Today’s Family Dental. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment.
Root canal treatment — also called endodontics (“endo” – inside, “dont” – tooth) — is a set of specialized procedures designed to treat problems of the soft pulp (nerve) tissue inside the tooth. While some mistakenly think of it as an unusually painful treatment, in most cases the procedure is no more uncomfortable than getting a filling. It’s actually one of the most effective ways of relieving some kinds of tooth pain.
A root canal procedure becomes necessary when infection or inflammation develops in the pulp tissue of the tooth. Pulp tissue consists of blood vessels, connective tissue and nerve cells — which explains why a problem here may cause you to feel intense pain. In time, the pain may go away… at least temporarily. Without treatment, however, the infection won’t. It can lead to a dental abscess, and may even contribute to systemic problems in other parts of the body. At Today’s Family Dental, we understand the apprehension that may be associated with root canal therapy. We take special care in your comfort before, during and after the procedure, and ensuring a successful result.
While you may think that some loss of teeth is inevitable as we age, it is actually possible for all of your teeth to last a lifetime. One of the ways you can achieve this goal is to avoid periodontal disease (“peri” – around; “odont” – tooth), which is caused by bacteria that attack the tissues around the teeth. Unfortunately, you may not even realize you have gum disease as the signs and symptoms are not always as apparent to you as they are to us at the time of an oral examination.
Nearly all people who do not maintain good daily oral hygiene will develop gingivitis. If left untreated, this bacterial gum infection can progress from gingivitis (“gingival” – gum; “itis” – inflammation) to periodontitis, which results in bone loss around your teeth. As the bone tissue is lost, the gum tissues detach from the teeth and form little pockets that provide an even better place for bacteria to live — where your brush and floss can’t reach. As periodontal disease advances leading to more bone loss, tooth loss can result. Part of this has to do with genetics, as periodontal disease tends to run in families. The good news is that periodontal disease can be controlled, even at more advanced stages.
Signs and Symptoms of Periodontal Disease
It’s important to understand that you can have periodontal disease with no obvious symptoms, especially if you are a smoker (nicotine reduces blood supply preventing bleeding and swelling of the gum tissues). Still, there are some important things to look for:
- Bleeding gums — Some people think that when their gums bleed, it simply means they’re brushing too hard. While brushing too hard is bad for the gums, it should not cause bleeding. Any bleeding of the gums should be considered a warning sign of gum disease.
- Bad breath — It’s very easy for plaque to collect in the spaces between the teeth, creating the perfect living conditions for bacteria that produce odorous, sulfur-containing compounds, resulting in bad breath.
- Redness or swelling of the gums — Inflammation of the gums is usually the first visible sign of periodontal disease.
- Receding gums — If you notice that your teeth look longer than they used to, it may be that your gum tissue has receded (away from the enamel), exposing some of your tooth roots.
- Sensitivity — If there is gum recession, the exposed roots may become sensitive to hot or cold.
- Periodontal abscess — Bacteria can become enclosed in a periodontal pocket and the area will fill with pus, becoming swollen and painful.
- Loose teeth — When periodontal disease results in bone loss, teeth can become loose or migrate. Tooth loss can result and may be accelerated if you are applying excessive biting forces from clenching or grinding your teeth.
All periodontal therapy starts at Today’s Family Dental with the evaluation of your oral hygiene techniques and instruction for improving them, followed by the mechanical removal of plaque and any calcified deposits (tartar or calculus) that are present on the root surfaces. This is accomplished with a cleaning technique known as scaling, root planing or debridement using hand instruments and/or ultrasonic (high frequency vibrational) instruments. Locally applied antimicrobial products or antibiotics might also be recommended during various parts of periodontal treatment to assist in healing and pocket-depth reduction, hopefully eliminating the need for periodontal surgery. Sometimes surgical procedures may be necessary to remove the deep pockets that form between inflamed gum tissue and teeth. There are many different types of surgery to handle a variety of problems. And many times, combinations of procedures are used to attempt to reduce the number of surgeries as well as the cost of treatment.
Dr. De Rosso’s is pleased to offer patients a non-surgical treatment option for gum disease. Today’s Family Dental offers the Perio Protect method, which is the most non-invasive treatment option available.
Learn more about Perio Protect+
Periodontal Disease & Your Overall Health
Periodontal disease starts in your mouth but has actually been linked to more serious conditions, such as cardio-vascular disease (CVD), diabetes and preterm births. Research has suggested two plausible mechanisms for how gum disease and these other serious medical concerns could be related: moderate to severe periodontal disease increases the level of systemic (bodily) inflammation — a characteristic of all chronic inflammatory diseases. Also, the same bacterial strains that are commonly found in periodontal pockets surrounding diseased teeth have been found in blood vessel plaques of individuals with CVD. Therefore, it may be helpful to reduce periodontal inflammation to reduce systemic inflammation.
The best way to prevent periodontal disease is to brush and floss your teeth effectively every day. In fact, regular dental checkups and professional cleanings every 3 or 6 months are also an important part of maintaining periodontal health; we can reach into areas that your toothbrush and floss can’t.
We can also detect early forms of gum disease by evaluating your gingival (gum) tissues, both visually and by examining their attachment levels to the teeth. And we can assess the health of your tooth-supporting bone by taking dental radiographs (x-rays pictures).
There are other steps you can take: Eating right, reducing stress in your life, and giving up unhealthy habits like smoking will also help ensure that you keep your teeth for a lifetime.
Full or partial tooth loss, if left untreated, doesn’t just affect a person’s self-image — it can also increase the risk of developing nutritional problems and other systemic health disorders. Fortunately, there’s a reliable and time-tested method for treating this condition: full or partial dentures.
Dentures are just one option for replacing missing teeth; some of the others include fixed bridgework and dental implants. Each method has its particular pluses and minuses, which should be carefully considered. There are also several varieties of dentures available to address specific issues, from partial dentures to implant-supported overdentures. During a consultation, we can explain the available options and help determine which is best in your individual situation.
People don’t generally think of a dentist as the healthcare professional to see for recurring headaches or even migraines; yet we can play a role in diagnosing and even treating your condition. That’s because quite often, recurring pain that is felt in the area of the temples on the sides of the head is actually caused by unconscious habits of clenching and/or grinding the teeth. These habits, which often manifest during sleep, put tremendous pressure on the muscles that work your jaw joint, also called the temporomandibular joint (TMJ).
The fan-shaped temporalis muscles located over your temples on either side of your head are two of several muscles involved in jaw movement. You can easily feel them working if you put your fingertips on your temples while clenching and unclenching your jaw. When temporalis muscles go into spasm from too much clenching, headache symptoms may result. This is not to say that headaches and migraines are always caused by TMJ problems, also known as temporomandibular disorders (TMD). But given the established link between them, it definitely bears looking into — especially if a diagnosis remains elusive in your case.
If you experience ongoing pain in the area near your ear, your jaw or the muscles on the side of your face, possibly accompanied by a clicking or popping sound or restricted jaw movement, you may be suffering from TMD — an abbreviation for Temporomandibular disorders. Sometimes people incorrectly use the term TMJ to refer to these problems, when in fact TMJ is the abbreviation for the temporomandibular joint — or jaw joint — itself. So while you definitely have a TMJ (two of them in fact), you may or may not have TMD.
TMD, then, describes a group of conditions characterized by pain and dysfunction of the TMJ and/or the muscles surrounding it. It’s not always so easy to figure out exactly what’s causing these symptoms, but the good news is that most TMD cases resolve themselves with the help of conservative remedies we will recommend for you to do at home. In fact, it’s important to exhaust all such reversible remedies before moving on to anything irreversible, such as bridgework or surgery.
The two TMJs that connect your lower jaw, the mandible, to the temporal bone of the skull on either side, are actually very complex joints that allow movement in three dimensions. The lower jaw and temporal bone fit together as a ball and socket, with a cushioning disk in between. Large pairs of muscles in the cheeks and temples move the lower jaw. Any of these parts — the disk, the muscles or the joint itself — can become the source of a TMD problem. If you are in pain, or are having difficulty opening or closing your jaw, we will do a thorough examination to try to pinpoint the problem area and suggest appropriate remedies.
In many cases, we will recommend a T.M.J.D. appliance such as an N.T.I. for your clenching / bruxism habit. We will take simple impressions, and then record a measurement of your jaw’s relationships Afterwards, your appliance will be fabricated by one of our partner labs. These appliances are worn at night, where most destructive grinding and clenching habits take place. Sports guards
Vibrasthetic SystemAt Today’s Family Dental your comfort and well being is extremely important when you are in our care. Each patient has their own level of tolerance for discomfort. To help minimize any discomfort to patients, we offer the Vibrasthetic System. This device is used for “pain-free” injections. The device uses a vibration to block the sensation of pain so patient perception of the dental injection is markedly reduced. Our patients love the Vibrasthetic system. It’s gentle, fast, and safe.