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Whether your dental needs are a complete exam and cleaning, a full-mouth restoration, or anything in between, we promise to provide you with exceptional care as we enhance the natural beauty of your smile.  Below are just some of the many procedures and services we regularly provide to our patients – with a gentle touch, and stunning results.  Your smile is our first priority, and we’ll give you something to smile about.  If you have any questions, concerns, or would like to schedule an appointment, please contact us today.  We look forward to providing you with the personal care you deserve.

                                                                                               Sincerely,

                                                                                               Dr. Wayne Lariviere
                                                                                               Your Waterboro Dentist, Waterboro, Maine

 

Cleanings & Prevention

    Digital X-Rays
    Dental Exams & Cleanings
    Dental X-Rays
    Home Care

How to Properly Brush & Floss

    Cosmetic Dentistry
    Composite Fillings
    Porcelain Crowns (Caps)
    Porcelain Fixed Bridges
    Tooth Whitening

Periodontal Disease

    Mouth - Body Connection
    What is Periodontal (Gum) Disease?
    Diagnosis
    Treatment
    Maintenance

Restorations

    Composite Fillings
    Crowns (Caps)
    Dentures & Partial Dentures
    Fixed Bridges
    Root Canal Therapy

 

 

Cleanings & Prevention


A preventive program is a cooperative effort by the patient, dentist, and dental staff to preserve the natural dentition and supporting structures by preventing the onset, progress, and recurrence of dental diseases and conditions.  Preventing dental disease starts at home with good oral hygiene and a balanced diet.  It is continued in the dental office by the efforts of your dentist and dental hygienist to promote, restore, and maintain your oral health.  Prevention also includes regular dental exams, cleanings, and x-rays. Sealants and fluoride are also great preventive treatments that help protect the teeth.  Prevention helps avoid serious and costly dental problems and is the key to having a healthy, confident, beautiful smile.


Digital X-Rays

Digital radiography (digital x-ray) is the latest technology used to take dental x-rays.  This technique uses an electronic sensor (instead of x-ray film) that captures and stores the digital image on a computer.  This image can be instantly viewed and enlarged helping the dentist and dental hygienist detect problems easier.  Digital x-rays reduce radiation 80-90% compared to the already low exposure of traditional dental x-rays.

Dental x-rays are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam.  Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan.  Without x-rays, problem areas may go undetected.

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Dental x-rays may reveal:

    Abscesses or cysts.
    Bone loss.
    Cancerous and non-cancerous tumors.
    Decay between the teeth.
    Developmental abnormalities.
    Poor tooth and root positions.
    Problems inside a tooth or below the gum line.

Detecting and treating dental problems at an early stage may save you time, money, unnecessary discomfort, and your teeth!

 

Are dental x-rays safe?

We are all exposed to natural radiation in our environment.  Digital x-rays produce a significantly lower level of radiation compared to traditional dental x-rays.  Not only are digital x-rays better for the health and safety of the patient, they are faster and more comfortable to take, which reduces your time in the dental office.  Also, since the digital image is captured electronically, there is no need to develop the x-rays, thus eliminating the disposal of harmful waste and chemicals into the environment.

Even though digital x-rays produce a low level of radiation and are considered very safe, dentists still take necessary precautions to limit the patient’s exposure to radiation.  These precautions include only taking those x-rays that are necessary, and using lead apron shields to protect the body.

How often should dental x-rays be taken?

The need for dental x-rays depends on each patient’s individual dental health needs.  Your dentist and dental hygienist will recommend necessary x-rays based upon the review of your medical and dental history, a dental exam, signs and symptoms, your age, and risk of disease.

A full mouth series of dental x-rays is recommended for new patients.  A full series is usually good for three to five years.  Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

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Dental Exams & Cleanings

 

Dental Exam

A comprehensive dental exam will be performed by your dentist at your initial dental visit.  At regular check-up exams, your dentist and hygienist will include the following:

    Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.

    Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.

    Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.

    Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.

    Examination of existing restorations: Check current fillings, crowns, etc.

Professional Dental Cleaning

Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists.  Your cleaning appointment will include a dental exam and the following:

    Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line and can only be removed with special dental instruments.

    Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!

    Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

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Dental X-Rays

Dental radiographs (x-rays) are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam.  Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan.  Without x-rays, problem areas may go undetected.

Dental x-rays may reveal:

  •     Abscesses or cysts.
  •     Bone loss.
  •     Cancerous and non-cancerous tumors.
  •     Decay between the teeth.
  •     Developmental abnormalities.
  •     Poor tooth and root positions.
  •     Problems inside a tooth or below the gum line.

Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!

Are dental x-rays safe?

We are all exposed to natural radiation in our environment.  The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources.

Dental x-rays produce a low level of radiation and are considered safe.  Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays.  These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each x-ray.

How often should dental x-rays be taken?

The need for dental x-rays depends on each patient’s individual dental health needs.  Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.

A full mouth series of dental x-rays is recommended for new patients.  A full series is usually good for three to five years.  Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

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Home Care

A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.  Your personal home care plays an important role in achieving that goal.  Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

    1. Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
    2. Brush the outer, inner, and biting surfaces of each tooth.
    3. Use the tip of the brush to clean the inside of the front teeth.
    4. Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

    1. Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
    2. Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
    3. Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Use other dental aids as recommended by your dentist or dental hygienist: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

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How to Properly Brush & Floss

 

Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle and prevent serious diseases.

Reasons why proper brushing and flossing are essential:

    Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.

    Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession and jawbone recession.  Periodontal disease is caused by the toxins found in plaque, and can lead to serious health problems in other parts of the body.  Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush, and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.

    Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing; leaving the mouth healthier, and breath smelling fresher.

    Prevention of staining – Staining or the yellowing of teeth can be caused by a wide variety of factors such as smoking, coffee and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.

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The Proper Way to Brush

The teeth should be brushed at least twice a day; ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles and no more than three months old.  The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval; stating that those with rotating or oscillating heads are more effective than other toothbrushes.

Here is a basic guide to proper brushing:

    Place the toothbrush at a 45-degree angle where the gums and teeth meet.
    Use small circular motions to gently brush the gumline and teeth.
    Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
    Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
    Use back and forth strokes to brush the chewing surfaces.
    Brush the tongue to remove fungi, food and debris.

The Proper Way to Floss

Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.

Here is a basic guide to proper flossing:

    Cut a piece of floss to around 18 inches long.
    Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
    Work the floss gently between the teeth toward the gum line.
    Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
    Carefully move the floss up and down several times to remove interdental plaque and debris.
    Do not pop the floss in and out between the teeth as this will inflame and cut the gums.

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Cosmetic Dentistry
Composite Fillings  |  Porcelain Crowns (Caps)  |  Porcelain Fixed Bridges  |  Tooth Whitening

In the past decade there has been a dramatic interest in cosmetic dentistry.  We all realize that having a healthy, bright, beautiful smile enhances our appearance and allows us to smile with confidence.  Thanks to the advances in modern cosmetic dentistry, we are able to improve our teeth and smiles with quick, painless and surprisingly affordable treatments.

Cosmetic dental treatments can:

  •     Change the size, shape, and alignment of certain teeth.
  •     Fill in unattractive spaces between teeth.
  •     Improve or correct bites.
  •     Lighten or brighten the color of teeth.
  •     Repair decayed, broken, cracked, or chipped teeth.
  •     Replace missing teeth.
  •     Replace old, unattractive dental treatments.

Remember, your smile speaks before you even say a word!

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Composite Fillings

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth.  Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

  •     Chipped teeth.
  •     Closing space between two teeth.
  •     Cracked or broken teeth.
  •     Decayed teeth.
  •     Worn teeth.

How are composite fillings placed?

Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as necessary.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

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Porcelain Crowns (Caps)

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

  •     Broken or fractured teeth.
  •     Cosmetic enhancement.
  •     Decayed teeth.
  •     Fractured fillings.
  •     Large fillings.
  •     Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

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Porcelain Fixed Bridges

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  Porcelain fixed bridges are most popular because they resemble your natural teeth.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

  •     Fill space of missing teeth.
  •     Maintain facial shape.
  •     Prevent remaining teeth from drifting out of position.
  •     Restore chewing and speaking ability.
  •     Restore your smile.
  •     Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of your treatment.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

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Tooth Whitening

Tooth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile.

Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth.  The most popular method is using a home tooth whitening system that will whiten teeth dramatically.  Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc.  Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.

Tooth whitening is not permanent.  A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.

Reasons for tooth whitening:

  •     Fluorosis (excessive fluoridation during tooth development).
  •     Normal wear of outer tooth layer.
  •     Stained teeth due to medications (tetracycline, etc.).
  •     Yellow, brown stained teeth.

What does tooth whitening involve?

This type of tooth whitening usually requires two visits.  At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays.

At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary.  The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening.  It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.

You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.

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Periodontal Disease
Mouth - Body Connection  |  What is Periodontal (Gum) Disease?  |  Diagnosis  |  Treatment  |  Maintenance

The word periodontal means “around the tooth”.  Periodontal disease attacks the gums and the bone that support the teeth.  Plaque is a sticky film of food debris, bacteria, and saliva.  If plaque is not removed, it turns into calculus (tartar).  When plaque and calculus are not removed, they begin to destroy the gums and bone.  Periodontal disease is characterized by red, swollen, and bleeding gums.

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.

Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy.  Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions.  Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease:

  •     Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  •     Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  •     New spacing between teeth – Caused by bone loss.
  •     Persistent bad breath – Caused by bacteria in the mouth.
  •     Pus around the teeth and gums – Sign that there is an infection present.
  •     Receding gums – Loss of gum around a tooth.
  •     Red and puffy gums – Gums should never be red or swollen.
  •     Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

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Mouth - Body Connection

Research studies have shown that there is a strong association between periodontal disease and other chronic conditions such as diabetes, heart disease, pregnancy complications and respiratory disease.

Periodontal disease is characterized by chronic inflammation of the gum tissue, periodontal infection below the gum line and a presence of disease-causing bacteria in the oral region.  Halting the progression of periodontal disease and maintaining excellent standards of oral hygiene will not only reduce the risk of gum disease and bone loss, but also reduce the chances of developing other serious illnesses.

Common cofactors associated with periodontal disease:

Diabetes

A research study has shown that individuals with pre-existing diabetic conditions are more likely to either have, or be more susceptible to periodontal disease.  Periodontal disease can increase blood sugar levels which makes controlling the amount of glucose in the blood difficult.  This factor alone can increase the risk of serious diabetic complications.  Conversely, diabetes thickens blood vessels and therefore makes it harder for the mouth to rid itself of excess sugar.  Excess sugar in the mouth creates a breeding ground for the types of oral bacteria that cause gum disease.

 

Heart Disease

There are several theories which explain the link between heart disease and periodontitis.  One such theory is that the oral bacteria strains which exacerbate periodontal disease attach themselves to the coronary arteries when they enter the bloodstream.  This in turn contributes to both blood clot formation and the narrowing of the coronary arteries, possibly leading to a heart attack.

A second possibility is that the inflammation caused by periodontal disease causes a significant plaque build up.  This can swell the arteries and worsen pre-existing heart conditions.  An article published by the American Academy of Periodontology suggests that patients whose bodies react to periodontal bacteria have an increased risk of developing heart disease.

Pregnancy Complications

Women in general are at increased risk of developing periodontal disease because of hormone fluctuations that occur during puberty, pregnancy and menopause.  Research suggests that pregnant women suffering from periodontal disease are more at risk of preeclampsia and delivering underweight, premature babies.

Periodontitis increases levels of prostaglandin, which is one of the labor-inducing chemicals.  Elevated levels prostaglandin may trigger premature labor, and increase the chances of delivering an underweight baby.  Periodontal disease also elevates C-reactive proteins (which have previously been linked to heart disease).  Heightened levels of these proteins can amplify the inflammatory response of the body and increase the chances of preeclampsia and low birth weight babies.

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Respiratory Disease

Oral bacterium linked with gum disease has been shown to possibly cause or worsen conditions such as emphysema, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).  Oral bacteria can be drawn into the lower respiratory tract during the course of normal inhalation and colonize; causing bacterial infections.  Studies have shown that the repeated infections which characterize COPD may be linked with periodontitis.

In addition to the bacterial risk, inflammation in gum tissue can lead to severe inflammation in the lining of the lungs, which aggravates pneumonia.  Individuals who suffer from chronic or persistent respiratory issues generally have low immunity.  This means that bacteria can readily colonize beneath the gum line unchallenged by body’s immune system.

If you have questions or concerns about periodontal disease and the mouth-body connection, please ask your dentist. We care about your overall health and your smile!

 

What is Periodontal (Gum) Disease?

The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

 

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

    Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.

    Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.

    Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.

    Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

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Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

    Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.

    Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.

    Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.

    Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

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Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis

Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.

Advanced Periodontitis

The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

 

Treatment

Periodontal treatment methods depend upon the type and severity of the disease.  Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

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Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

  •     Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
  •     Examination of existing restorations: Check current fillings, crowns, etc.
  •     Examination of tooth decay: Check all tooth surfaces for decay.
  •     Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
  •     Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
  •     Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

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Restorations


Composite Fillings  |  Crowns (Caps)  |  Dentures & Partial Dentures  |  Fixed Bridges  |  Root Canal Therapy

It’s great news that the incidence of tooth decay has significantly diminished over the years due to the use of fluorides and an increase in patient awareness.  However, teeth are still susceptible to decay, infection, and breakage and sometimes need to be restored back to health.  Through improved techniques and modern technology, we are now able to offer more options for restoring a tooth back to its normal shape, appearance and function.

Should your teeth ever require a restorative treatment, you can rest assured knowing we will always discuss with you the available options, and recommend what we believe to be the most comfortable and least invasive treatment.  Providing you with excellent care is our number one priority when creating your beautiful smile.

Reasons for restorative dentistry:

  •     Enhance your smile.
  •     Fill in unattractive spaces between teeth.
  •     Improve or correct an improper bite.
  •     Prevent the loss of a tooth.
  •     Relieve dental pain.
  •     Repair damaged and decayed teeth.
  •     Replace missing teeth.
  •     Replace old, unattractive dental treatments.
  •     Restore normal eating and chewing.

Remember to give your teeth the attention they need today!

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Composite Fillings

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

  •     Chipped teeth.
  •     Closing space between two teeth.
  •     Cracked or broken teeth.
  •     Decayed teeth.
  •     Worn teeth.

How are composite fillings placed?
 
Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as necessary.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

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Crowns (Caps)

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

  •     Broken or fractured teeth.
  •     Cosmetic enhancement.
  •     Decayed teeth.
  •     Fractured fillings.
  •     Large fillings.
  •     Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

 

Dentures & Partial Dentures

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures - complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks.  During this time the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments will have to be made.

Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear.

Reasons for dentures:

  •     Complete Denture - Loss of all teeth in an arch.
  •     Partial Denture - Loss of several teeth in an arch.
  •     Enhancing smile and facial tissues.
  •     Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks.  Highly accurate impressions (molds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

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Fixed Bridges

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

  •     Fill space of missing teeth.
  •     Maintain facial shape.
  •     Prevent remaining teeth from drifting out of position.
  •     Restore chewing and speaking ability.
  •     Restore your smile.
  •     Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

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Root Canal Therapy

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed.  Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.

Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

  •     An abscess (or pimple) on the gums.
  •     Sensitivity to hot and cold.
  •     Severe toothache pain.
  •     Sometimes no symptoms are present.
  •     Swelling and/or tenderness.

Reasons for root canal therapy:

  •     Decay has reached the tooth pulp (the living tissue inside the tooth).
  •     Infection or abscess have developed inside the tooth or at the root tip.
  •     Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment.  Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.


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