When periodontal disease is detected early in its onset, conservative or non-surgical methods of care in combination with improved hygiene routines can restore periodontal health. While periodic, professional cleanings are sufficient to maintain periodontal health in patients that do not have gum disease, once gingivitis is present, deeper cleanings and possibly other non-surgical methods of care are recommended to treat the condition.
The American Academy of Periodontology emphasizes achieving periodontal health by means of the least invasive and cost effective treatment approaches to care. Deeper cleanings, which include Scaling and Root planing, are non-surgical procedures that are considered the first line of defense against the progression of periodontal disease.
With scaling and root planing, any plaque and tartar (hardened dental plaque) that have accumulated below the gumline are carefully removed and then the root surfaces of the teeth are smoothed. Since, periodontal disease is an inflammatory response to plaque, tartar and bacterial toxins, by simply mechanically eliminating these agents, the progression of gum disease can be halted. In addition to removing plaque and tartar with a scaling and root planing procedure, antimicrobial medication placed under the gumline or systemic medications can be used as adjuncts to care to further reduce the bacterial population.
If non-surgical approaches to managing periodontal disease do not achieve the desired outcome, surgery may be recommended to halt its progression and repair damage as possible.
Dental bonding is a procedure that is often used to restore teeth affected by decay as well as for the repair of chipped or fractured teeth and masking a range of dental imperfections such as stains, discolorations, gaps, misshapen, or undersized teeth. A popular method for restoring and improving the appearance of a person’s smile, dental bonding qualifies as a cosmetic procedure by virtue of the fact that the composite resins used for the procedure are tooth-colored and come in a range of shades that blend seamlessly with natural tooth structure. A dental bonding procedure, which is performed to fill a cavity or to cosmetically repair a chip, fracture, enamel defect or gap between teeth is known as a “direct composite restoration.” For a direct composite restoration, both artistry and precision are required as the dentist places the selected shade of composite resin and carefully sculpts it to rebuild or improve the appearance of a tooth. In terms of the cosmetic repair of dental defects, the masking of discolorations or the closure of gaps between teeth, a dental bonding procedure is considered the most economical and quickest method of care out of all the cosmetic solutions available for these types of corrections. Unlike porcelain veneers or ceramic crowns, dental bonding is a minimally invasive, one-visit cosmetic procedure. Moreover, unless a cavity is being cleaned and prepared prior to a dental bonding procedure, no drilling of tooth structure and no anesthesia is required. HOW IS A DENTAL BONDING PROCEDURE PERFORMED? When performing a bonding procedure, it is important to enable the composite resin to firmly adhere to the underlying tooth structure. To do this the surface of the tooth is etched and then painted with a liquid bonding agent just prior to the placement of the filling or cosmetic bonding. As the dentist places the composite resin, it is carefully sculpted to achieve the desired shape and then cured with a special light or allowed to set. Once hardened, the newly bonded restoration is polished and buffed for a smooth finish. Some dentists may offer composite veneers as an alternative to porcelain veneers, artistically bonding and blending successive layers of composite resin to transform the appearance of a tooth. CARING FOR BONDED TEETH While a bonding procedure offers an excellent and cost-effective method of care for the treatment of minor cosmetic dental issues, there are a couple of considerations with this approach. Teeth that are restored or cosmetically enhanced with a dental bonding procedure are as a rule more susceptible to staining and chipping than with other types of cosmetic treatments. For this reason, highly pigmented foods and drinks are to be avoided along with tobacco products. As dental bonding can easily chip and break, it is also important not to bite into hard objects or foods and to avoid oral habits such as biting one’s nails or chewing on pens. However, with proper hygiene and care, a bonded restoration can last for many years.
A teeth whitening procedure or bleaching simply refers to any process that will make the teeth appear whiter. It is considered a non-invasive procedure that is designed to whiten and brighten teeth that are stained, discolored, darkened, or yellowed. First introduced to the public in the 1980’s, the popularity of teeth whitening products and procedures has soared. According to a survey conducted by the American Academy of Cosmetic Dentistry, when respondents were asked, “What would you like to improve most about your smile?” The most common response was: whiter and brighter teeth. How white a tooth appears depends upon how light is reflected and scattered off the enamel, the outermost layer of the tooth. Teeth can look dark or discolored for a variety of reasons, with an imperfect appearance the result of outer surface stains or discoloration from within the tooth. While external tooth stains are typically due to certain foods and tobacco, internal tooth discoloration is mainly the result of hereditary factors, certain medications, tooth decay, restorations, or trauma. Additionally, the aging process can influence the color of a tooth. This is because over time the outer layer of enamel becomes thinner showing more yellowish tones from the underlying layer of dentin. WHAT ARE THE ADVANTAGES OF A PROFESSIONAL TEETH WHITENING PROCEDURE PERFORMED BY A DENTIST? Although over the counter teeth whitening systems purchased in stores or online have become popular, there are health concerns and limitations with these products. If the manufacturers protocol is not correctly followed, certain products can damage the teeth and soft tissues in the mouth, and may not deliver the results as promised. Teeth whitening systems contain varying concentration of either hydrogen peroxide or carbamide peroxide, which act as the bleaching agents. When sensitive teeth, exposed roots, cavities, broken fillings, cracked teeth, or loose dental work are present, a teeth whitening procedure may be contraindicated. Also, since whitening systems do not have an effect on the color of dental fillings, crowns or bridges the presence of restorations is an important cosmetic consideration in treatment planning. In general, individuals with yellow tones to their teeth respond best to teeth whitening procedures. Brown and grayish tinted teeth bleach respond less well and may require significantly longer dentist supervised tooth whitening regimens or alternative cosmetic treatments. Finally, teeth whitening may not be recommended in the presence of sensitive teeth, worn enamel and significant gum disease. As a rule the healthiest and most effective methods of teeth whitening are the ones managed and supervised by the dentist. An in-office teeth whitening procedure as performed by the dentist is the most reliable and safest way to get the maximum results quickly. In as little as one hour a prescription-strength, in-office whitening procedure can dramatically whiten and brighten the natural teeth by several shades, while the surrounding tissues and any sensitive areas of the teeth are carefully isolated and protected from the bleaching agents. A home whitening system from the dentist along with custom trays that have been fitted to the teeth is also an excellent option. Custom trays keep the bleaching agent in maximum contact with the teeth and away from the other areas of the mouth. With a take-home teeth whitening system, maximum results are less rapid than an in office procedure and are typically achieved over a longer period of time. A home whitening system can be used by itself or as recommended by the dentist as a follow up to an in office procedure in order to perfect or maintain the results.
For teeth with imperfections that cannot be addressed with teeth whitening procedures, but are not so flawed as to require full coverage crowns, dental veneers can provide the desired cosmetic improvements. Dental veneers are custom-fabricated facings that offer a conservative and cosmetically pleasing way to improve the appearance of teeth that are chipped, gapped, worn, slightly crooked, misshapen or darkly stained. With dental veneers, the color, shape, size, and length of the teeth can be changed for the better. Bonded to the front surfaces of the teeth, veneers can be used to enhance the appearance of a single tooth or multiple anterior teeth. The two most common types of veneers are porcelain veneers, which are also known as porcelain laminates, and composite veneers. While porcelain veneers are the most commonly offered option in care, composite veneers can also achieve excellent results. Starting with a smile makeover consultation and a comprehensive assessment of a patient’s oral health as well as a discussion of the cosmetic goals, the dentist will determine a treatment plan to achieve the most pleasing outcome of care. PORCELAIN VENEERS Porcelain veneers are ultra-thin facings that are custom fabricated from the highest grade of dental ceramics and offer the following benefits: * Require very little preparation of underlying tooth structure * Can be fabricated from start to finish in just a few visits * Porcelain reflects light in much the same way as teeth for a naturally beautiful looking smile * Once bonded, porcelain veneers are strong and durable and can last for many years with proper care * Resistant to stain and discoloration * Well tolerated by surrounding periodontal tissues COMPOSITE VENEERS When direct composite veneers are the selected method of care, the dentist applies carefully selected shades of tooth-colored composite resins to the fronts of the involved teeth. As the composite resin is placed, it is meticulously sculpted to create the desired shape, length and overall form of each tooth. Each layer of applied composite is then cured with a special light, and additional layers of composite are placed as required to achieve an aesthetically pleasing and functional result. Once the final result is completely set, the dentist will smooth and polish the direct composite veneers to a naturally brilliant finish. While composite veneers frequently offer the advantages of being a single visit procedure, easy to repair and an economical alternative to porcelain veneers, they are not as strong or resistant to staining and wear as dental ceramics. However, by avoiding certain dietary choices and habits, practicing good oral hygiene and getting routine dental care, direct composite veneers can offer an effective and long lasting cosmetic smile improvement.
Traumatic oral injuries can range from dental injuries to the teeth and their supporting tissues to lacerations in and around the mouth as well as more complex and severe damage to the soft tissues and bones of the face. These injuries are often caused by direct physical trauma to the teeth, mouth and face that may be the result of a fall, sports or work related incidents, motor vehicle accidents or assaults. CHIPPED, FRACTURED OR CRACKED TEETH It is not uncommon for a tooth to sustain a chip, crack or fracture. It may happen simply from biting down on a piece of ice, chewing on a pencil, or sustaining trauma such as a direct blow to the face and mouth. The damage to a tooth can range from a minor craze line or a small chip of the dental enamel to a more extensive fracture of the tooth that can even go so far as to fracture the root or split the tooth. Based upon the extent of damage to the fractured or cracked tooth, treatment may simply involve placing a suitable restoration such as a filling or crown or a root canal procedure along with a restoration. When the damage is extensive, an extraction is sometimes required. DENTOALVEOLAR INJURY Dentoalveolar injuries refer to traumatic injuries involving the teeth and the bone surrounding the teeth. These injuries can include teeth that have been dislodged or moved partially out of their sockets, with or without a segment of the adjacent bone, or an avulsion, which means that a tooth has been completely “knocked out” of its socket. In these situations, immediate dental care to reposition and stabilize the involved teeth and/or put the bone back into the correct anatomical positions is required. Beyond the routine post op care to check for tissue healing, the involved teeth are typically followed for a longer period of time to check for subsequent nerve involvement or other issues that may require additional care. SOFT TISSUE INJURIES Soft tissue injuries in and around the oral cavity include lacerations within the mouth (intra-oral) and facial lacerations. If possible clean the area gently with water and apply a cold compress. For puncture wounds, tissue tears, and lacerations to the lips, cheeks, tongue or any other tissues in and around the oral cavity, prompt emergency care is required. DISLOCATED OR FRACTURED JAW Facial trauma that has resulted in a suspected dislocation or jaw fracture requires immediate care as problems with eating and breathing can ensue. Prompt care can minimize complications and accelerate healing. For a fractured jaw, treatment depends upon the extent of the injuries. While some clean breaks may only require immobilization, multiple fractures of the jawbone or displaced breaks involve more complex surgical care. If on the other hand the jaw has been dislocated as a result of a traumatic incident or opening the mouth too widely, it will need to be manipulated back into the correct position. For people who have had more than one dislocation, surgery may be needed to reduce the risk of further dislocations.
A toothache is the most common reason for oral pain. It is an uncomfortable, distressing and debilitating situation that if left untreated can result in serious consequences to an individual’s oral health as well as overall well-being. Depending upon the underlying cause of a toothache and the degree of damage to the tooth and involvement of the surrounding tissues, the type and severity of symptoms can vary. While mild symptoms of discomfort are easy to dismiss and ignore, waiting until toothache pain is more consistent or severe is not advised. The best option is to make a timely appointment with the dentist for a professional assessment and care. Although the reason for most toothaches is cavities (tooth decay/dental caries), a toothache or what may feel like pain related to the teeth can be due to any number of underlying conditions including: * A Cavity * Dentin Hypersensitivity (Sensitive teeth) * Dental Trauma resulting in chips, fractures, cracks or nerve damage to the tooth * Infection or Abscess * Periodontal Disease (Gum Disease) * Bruxism * Erupting or Impacted Teeth (wisdom teeth are often problematic) * Sinus or Ear Infections * Other medical conditions with referred pain to the jaw Different types and degrees of toothache pain can point to different underlying causes and help in the diagnosis of the problem. Sharp and stabbing pain when eating or drinking hot and cold foods may be due to the presence of a cavity or exposed dentin and sensitive teeth. Pain with pressure or biting down may indicate a cavity or even a broken filling, a cracked tooth or periodontal problem. If the pain is continuous or throbbing, it is a sign that tooth decay or trauma has affected the nerve of a tooth or that an infection requiring prompt care is present. Localized swelling around the tooth or more generalized tissue and facial swelling and fever must be taken care of as quickly as possible. Treatment of a toothache depends upon the diagnosis of the underlying problem, the degree of damage to the involved tooth or surrounding tissues and if any infection is present. Once the dentist has performed a comprehensive evaluation of the case, the appropriate recommendations and care to alleviate the symptoms and restore oral health will be provided.