FAMILY DENTISTRY

Our office is ready to serve your dental needs. Whether it’s a complete exam and cleaning or a cosmetic makeover our office is prepared to exceed your expectations. Painlessly and professionally your entire family can be assured every patient is our first priority.

CLEANINGS AND PREVENTION
A good preventive dental program requires the efforts of the patient, dentist, dental hygienist and dental staff to help keep the teeth and gums healthy and disease-free. Preventing dental disease starts at home with good oral hygiene and a balanced diet. In the dental office, your dentist and dental hygienist will help to educate, promote, restore and maintain your oral health. Of course, dental prevention also includes regular dental exams, cleanings and radiographs (X-rays) of both the teeth and the jaws.
Prevention and diligent care is the key to maintaining your teeth for life. Additionally, the scientific evidence now suggests that improved oral hygiene may help avoid serious health concerns including heart disease, stroke, diabetes, gastric ulcers and even Alzheimer’s.
Not all patients require the same type of cleaning. In all our offices, we focus on a comprehensive oral evaluation and assessment that will determine the proper treatment for your oral condition and in consideration of your overall health.

 1. Soft Tissue and Oral Cancer Exam: Soft tissues in the mouth, including the tongue, cheeks, hard and soft  palate, floor of the mouth and throat will be evaluated for any signs of pathology, such as oral cancer. Additionally, the lips, face and neck will be inspected..

2. Periodontal Evaluation (Gum Disease): Your gums will be evaluated for signs of inflammation and infection. Areas of the gums that bleed upon brushing and flossing will be specifically examined. We understand that these “bleeding spots” contain chronic inflammatory factors that may be linked to your systemic health. Your periodontal exam will also include an evaluation of the bone support around the teeth. Your level of oral hygiene, systemic health and genetic risk factors, tobacco use, gum health and bone levels are all taken into consideration when determining the type of dental cleaning best for you.
3. Review of Diagnostic Radiographs (X-Rays): All of our x-rays are digital, providing you with a more comfortable experience, a higher quality image for better detection and significantly less radiation exposure. Different x-rays are required to detect decay, tumors, cysts and bone loss; your dentist will determine which images will be needed to complete a thorough examination.
4. Decay Detection: Complete cavity inspection will be completed on all tooth surfaces. Often, suspicious areas are verified with the use of special cavity detection dye to ensure accuracy.
5. Examination of Existing Restorations: Our team will check all your current fillings, crowns and root canals.
6. Cosmetic Exam (Smile Assessment): “Are you happy with your smile?” If you have ever considered improving your smile or whitening your teeth, let our dentists complete a smile assessment that includes a complete examination of your occlusion (bite), tooth shape and form, facial form, shade analysis and gingival symmetry assessment. New technologies offer patients a wide range of options to improve their smiles – any of our dentists would be pleased to discuss these options with you.

1. Removal of Dental Plaque: Plaque is an adhesive biofilm that forms on the teeth from a combination of bacteria, food debris and salivary proteins. This bacterial colony produces toxins that inflame the gums and initiate the periodontal disease process.

2. Removal of Tartar: Tartar or Calculus is a mineralized dental plaque

that is now  adhered to the tooth and can not be removed with brushing or flossing. Special instruments are required to remove this mineralized material from the tooth, specifically below the gumline. If left untreated the combination of inflammation and physical irritation will

destroy the bone that supports the teeth.

3. Polishing: Removal of stain

• DENTAL RADIOGRAPHS

Dental radiographs, typically known as dental x-rays, are an essential diagnostic tool. Without x-rays, our dental exams would be incomplete and problem areas may go undetected. Our practice understands your concerns over radiation exposure and that is why all of our offices feature digital x-rays. This allows for 90% less radiation and a clearer picture than the old films.

Dental x-rays may reveal:

1. Infections and dental abscesses
2. Bone loss
3. Cancerous and noncancerous tumors
4. Decay between the teeth (Interproximal decay)
5. Developmental abnormalities
6. TMJ (Tempromandibular Joint) disease
7. Pathology in the neck and sinuses
8. Eruption patterns
9. Position of wisdom teeth
10. Root abnormalities

Our dentists will determine the minimum number of x-rays required to thoroughly exam your dental health. We guarantee, as dental professionals, that the radiographs we require are being taken with your best interest in mind. Once a comprehensive radiographic review has been completed at your initial exam, recall patients will be asked to periodically update these radiographs, the timing for these is determined by the individual patient’s medical/dental health, dental exam, level of home care, signs/symptoms and cavity pattern. Typically, new bitewing pictures (the x-rays that display decay between the teeth) are taken between 6 – 24 months, while new panoramic radiographs (the x-ray that displays the entire picture of the jaws, teeth, sinuses and joints) will be taken between 3-5 years.
By utilizing digital x-ray images they can be displayed on a compute monitor instead of a tiny piece of film, allowing zooming and enhancement for better diagnosis. Additionally, all of our treatment rooms are equipped with flat panel high definition televisions which allow the patient to visualize the picture helping to understand your dental condition. Through a clearer understanding of your dental condition, often apprehension about the procedure is reduced.

• HOMECARE

A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.

1. Place the brush at a 45 degree angle to the gums and gently brush using small circular motions, 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 mouth.

Electric toothbrushes are highly 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 (30-40 cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5 cm) of floss between the hands.
2. Using your thumb 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 gum line. 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 you mouth after brushing and 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: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

1. Bleeding Gums – gums should not bleed even with brushing and flossing
2. Loose Teeth
3. New Spacing between Teeth
4. Persistent Bad Breath
5. Pus around the Teeth and Gums
6. Receding Gums
7. Red and Swollen Gums
8. Tenderness and Discomfort

• DIAGNOSIS
Our dentists take several factors into consideration when diagnosing periodontal disease. First, is the review of periodontal pocket depths. All teeth, both healthy and diseased, have a sulcus or a pocket around the entire tooth. Around a healthy tooth, this pocket has a depth of less than 3mm. Your dentist or dental hygienist will determine this depth for 6 spots around every tooth with an instrument known as a periodontal probe. If the pocket depths exceed 3mm for any spot around the tooth it indicates bone loss; the deeper the pocket the worse the bone loss. Eventually, pockets will get very deep, indicating very little bone support remaining around the tooth, the tooth will typically be loose and many require removal if untreated.
However, periodontal pocketing is not the only means of diagnosing periodontal disease. Your dentist or dental hygienist should also measure areas of recession. Recession of the gum tissue exposes the softer, less cavity resistant and highly sensitive root structure of a tooth. Additionally, severe recession reduces the hold on the tooth and can cause the tooth to become loose. The dentist will add the recession and the pocket depth together for any one spot of concern to gain a measure of the true attachment loss – the higher the number the worse the prognosis for that tooth.
The dentist will also use the patient’s radiographs to diagnose periodontal disease. Bone loss is very evident on x-rays; it can be generalized (throughout the whole mouth) or localized (around one or two teeth). Radiographs will also be used to see if the root morphology of a specific tooth may be influencing the condition or effect eventual healing.
Perhaps most importantly in this diagnosis is the amount of bleeding around the tooth upon exploring with the periodontal probe. Bleeding is a direct indication of gum inflammation. Gum inflammation releases specific cellular mediators that effect a persons overall health. Our goal is to not see any bleeding with probing. Your dentist will use pocket depths, amount of bleeding, inflammation, tooth mobility and x-rays to make a diagnosis of either one of the following categories:

1. Gingivitis: the fist stage of gum disease. Plaque left on the teeth have begun to release toxins, irritating the gums and making them tender and inflamed. Gums with gingivitis are likely to bleed with brushing
2. Early-Moderate Periodontitis: Plaque has now hardened on the tooth to form calculus (tartar). The amount of toxins increases as does the physical irritation of the gums from this calcified bacterial colony on the tooth surface. The gums begin to recede, bleeding increases and bone loss is becoming evident of the radiographs.
3. Advanced Periodontitis: Calculus is often so thick at this point that it has begun to bridge from one tooth to the next making proper oral hygiene impossible. The teeth lose more support as the gums, bone and periodontal ligament continue to be destroyed. Bleeding may be heavy with brushing. The teeth may be very loose and moderate to severe bone loss may be seen on x-rays. The patients may have pain and often complain of severe “bad breath”.

• TREATMENT
Periodontal treatment methods depend upon the type and severity of the disease. Our dental team will evaluate each patient individually, assess their periodontal condition, their risk factors such as diabetes or tobacco use, and personalize an appropriate treatment plan. Good oral hygiene, a balanced diet and regular dental visits will also help to reduce your risk of periodontal disease.
If the disease is caught in the early stages of gingivitis it is likely the patient will receive a thorough cleaning, be counseled on home care, receive a snack index and dietary review and be asked to return every 6 months for recalls.
If the disease has progressed to more advanced stages, a special periodontal cleaning, known as scaling and root planing (deep cleaning) would likely be recommended. Typically, the patient is brought in for a gross debridement, removing the majority of the calculus above the gumline and the superficial calculus below the gumline. The intention of the gross debridement is to remove the majority of the pathologic bacteria allowing improved healing and less chance of infection spread during the next phase of the cleaning. The scaling and root planing follows the gross debridement and is typically performed in two visits, one side of the mouth at a visit, always with anesthesia to achieve adequate patient comfort. In this procedure, tartar, plaque and toxins are removed from below the gumline (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Systemic medications, special medicated mouth rinses, site specific antibiotic therapy and an electric toothbrush may all be recommended to help control infection and promote healing.
Since periodontal disease is never cured and the bone and gums can not return without surgical intervention, we recommend our periodontal maintenance patients have cleanings every 3-4 months. This helps keep the disease arrested.
If pockets do not heal after treatment periodontal surgery may be needed. Our staff recognizes the importance of referring our patients for the care they deserve and we work closely with specialists to help resolve particularly difficult cases.

• MAINTENANCE
Periodontal disease is never cured -- it is only restrained and maintained. Without surgical intervention, the damage done by moderate to advanced periodontal disease will not resolve. However, through diligent homecare and frequent periodontal maintenance visits the disease should remain stable.
Once your periodontal treatment has been completed, our staff recommends that you have regular dental cleanings four times per year. During your recall exams, periodontal pockets will be carefully checked to ensure that they are healthy. Plaque and calculus that has been difficult for you to remove on a daily basis will be easily removed from above and below the gumline and areas of refractory disease will be addressed.

DENTAL RESTORATIONS
If, despite all preventative measures, a cavity develops, it needs to be treated in some manner. The good news is that through public health measures, such as water fluoridation, improved hygiene and frequent dental treatment, your risk for decay has been significantly reduced, in fact almost half of all children in the United States between the ages of 5 and 17, are now free of tooth decay!
 

cavity, the strength of the biting force, cosmetics and patient preference.
Should your teeth ever require a restoration, you can count on our educated staff of dentists and dental hygienists to discuss the options with you and recommend the most comfortable, least invasive and potentially successful restoration.
It is important for all of our dental patients to be aware that, in general, all of our practices place only composite (WHITE) fillings. For years amalgam or silver fillings have been the most commonly placed restorations and although health concerns regarding the mercury content of such restorations are not supported by sound scientific evidence other complications with these fillings have diminished their use. Silver fillings do not bond to tooth structure and therefore require much larger, more invasive and damaging tooth preparations. Large silver fillings are prone to fracturing the surrounding tooth structure often resulting in the need for more invasive and costly dental treatment and in many cases resulting in loss of the tooth. Additionally, silver fillings tend to be unsightly and objectionable to most patients. Lastly, the environmental concerns over disposing of the amalgam waste pose a serious concern. Please feel free to discuss this with any of our dentists if you have any questions or concerns.

• COMPOSITE FILLINGS

Composite fillings, also known as white or invisible fillings, are the restorative material of choice in all of our dental offices. A composite restoration is used to repair a tooth that has been affected by decay, fractures or to improve the cosmetics of discolored of stained teeth.

Reasons for composite fillings are:

1. Cavities
2. Cosmetic Bonding

3. Repair of Fractures and Chips
4. Acid Erosion and Wear from Grinding
5. Repair of Root Cavities and Lesions at the Gumline

Composite fillings offer several advantages to our patients. First, the ability of white restorations to bond to the tooth allows our dentists to remove only the decayed portions of the tooth. Silver restorations, which were held into the tooth by mechanical retention, often necessitated larger preparations and more aggressive procedures. Secondly, white fillings are less likely to cause a fracture of the surrounding tooth. Large amalgam restorations are notorious for fracturing the clinical crown of the tooth often resulting in the need for additional, more involved dental procedures such as root canal therapy, full coverage restorations (caps) and even extraction if the tooth is not restorable. Composite fillings are tooth colored and can be closely matched to the color of the existing tooth allowing for more aesthetic restorations and repairs especially within your smile.
As with all dental restorations, composite fillings are not permanent and may someday need to be replaced. They are very durable however and with diligent homecare and frequent cleanings, should give you beautiful, long-lasting teeth.

• HOW ARE COMPOSITE FILLINGS PLACED IN OUR OFFICES?
Composite fillings are placed in one visit, usually completing multiple restorations in a single visit if needed. Utilizing today’s latest methods to minimize discomfort the tooth will be numbed. The dentist will remove all the decay and the tooth will be verified for remaining cavities with a special cavity indicating dye to assure no decay is left untreated. The tooth will then be thoroughly cleansed using a prescription antimicrobial mouth rinse. If the decay was near the nerve of the tooth, your dentist may choose to apply one of several different medications to help improve the prognosis and comfort. 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 a degree of sensitivity to hot and cold when composite fillings are first placed however, this will subside after your tooth acclimates to the new filling.
At the end of your appointment, the dental staff will be sure to answer any and all questions you may have about the procedure. In addition, special attention will be given to reviewing your homecare and any special instructions that may be warranted.
In all of our offices your comfort is our #1 priority and we will strive to make all appointments enjoyable and relaxing.

• CROWNS
A crown, commonly called a cap, is a dental restoration that covers the entire tooth restoring it to its original shape and size. Crowns are indicated when extensive damage has been done to the original tooth through decay, fracture, erosion or attrition.
Crowns are also indicated for:
 

1. Aesthetics, to change the shape, size, color or angle of the tooth
2. Improved Function
3. Alter Occlusion (bite)
4. Provide Support for a Fixed Bridge or Removable Appliance (partial denture)
5. Prevent Tooth Fracture (typically done in the case of large pre-existing amalgam restorations with suspicious cracks or fracture lines)

metal core with a porcelain covering. The metals used under the porcelain are judged on their gold concentrations, from metal alloys without gold, known as base or nonprecious metal, to the highest gold concentrations, known as high noble or precious metals. As a patient, you can be assured that all PFM’s constructed by our office our done using the highest gold content available, helping to assure improved gingival health and lessen the risks of allergic metal reactions. Crowns can also be made of all gold, typically used on back teeth where improved strength is needed, or crowns can be made of all porcelain, typically used on front teeth where cosmetics are paramount.

• WHAT IS INVOLVED IN A CROWN PREPARATION PROCEDURE?
A crown procedure typically involves two visits. On the day of your first visit you can expect to be put at ease by our team of dental professionals – prior to initiating any treatment the entire procedure will be discussed and all of your questions addressed. Secondly, a series of highly specific impressions will be taken; these will be used to create your crown. Using the most painless technique, the dentist will numb the area to ensure your comfort. The dentist will prepare the tooth by removing all the decay, existing restorations and potential fracture lines. Using a special dye, the preparation will be verified to ensure complete decay removal and cleansed using a prescription antimicrobial rinse. The dentist will then shape the surface of the tooth to properly fit the crown. Once this has been accomplished, a final impression will be completed of the crown preparation. A cosmetic and durable temporary crown will be fabricated and cemented. The temporary crown will be polished and checked for your approval.
At your second appointment, your temporary crown will be removed, the tooth will be cleansed and your new crown will be carefully placed to ensure the spacing and bite is accurate. A specific type of radiograph, known as a bitewing, will be taken to ensure all margins of the crown are completely flush and sealed with the natural tooth. You will be given the opportunity to evaluate the work and the shade of your new crown. Only when the patient is completely happy with the results will the crown be cemented permanently. Our offices pride themselves on maintaining a superior level of care; we promise that we will strive to exceed your expectations both in comfort and quality.
Following the final cementation, our staff will review all important instructions and homecare. Although crowns are highly durable and will last for many years with proper care, they may eventually need to be replaced.

• FIXED BRIDGES

1. Fill Space Left by Missing Teeth
2. Maintain Facial Shape, Facial Height and Lip Support
3. Prevent Adjacent and Opposing Teeth from Shifting
4. Restore Your Ability to Chew
5. Prevent Changes in Your Speech
6. Restore Your Smile
7. Upgrade from a Removable Appliance, like a partial denture or flipper

ROOT CANALS (ENDODONTIC TREATMENT)
If ever a reputation preceded a procedure in dentistry, it would be that of root canal therapy. Unfortunately, the myth that root canal therapy, also known as endodontic treatment, is painful has prevented many people from saving teeth from unnecessary extractions.
Our dentists strive to make all procedures painless.
We welcome the opportunity to surprise you with how painless, and even enjoyable, a root canal can be. One tooth at a time, our dentists hope to dispel the myth that root canals are painful and help you to save your teeth for a lifetime.

• WHY DO I NEED A ROOT CANAL?
Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. When bacteria (from decay, fracture, trauma, etc.) first invade the nerve of the tooth, they will elicit an inflammatory response from the nerve, if this inflammatory process occurs slowly, it may be completely painless and without any symptoms. If this process occurs quickly, the inflammation will cause swelling within the tooth which is rigid and does not expand to accommodate the increase pressure resulting in severe pain. Once the nerve tissue is completely infected, bacteria may escape into the surrounding bone resulting in an infection which can be quite severe causing pain, destruction of the surrounding bone and spread of the infection to adjacent teeth.
If the diseased nerve tissue is not removed from the tooth via a root canal treatment, the tooth will eventually have to be removed. By completing the root canal and removing the diseased nerve, we are removing the source of the bacteria, preventing spread of the infection and allowing the opportunity for the patient’s natural immunity to clear any lingering infection in the surrounding bone. In the past, teeth with diseased nerves (pulps) were routinely extracted. Unfortunately, this is still true today, partially because root canal therapy is viewed by patients to be expensive and painful. Our dentists and staff urge all patients considering extraction rather then root canal therapy to discuss the options thoroughly. Often times removing the tooth may be the most costly option. Root canal therapy is the treatment of choice to save an otherwise healthy tooth. Our staff will help you make an educated treatment decision and work to dispel the myth of the painful root canal.
Signs and symptoms that you may need a root canal include:

1. An abscess (or bump) on the gums
2. Sensitivity to hot and cold, particularly to hot and especially if the pain lingers
3. Severe toothache
4. Swelling or tenderness to touch
5. Fractured or broken teeth with not symptoms at all
6. Pain that wakes you at night or worsens when lying down

• WHAT DOES ROOT CANAL THERAPY INVOLVE?
The first, most important point to remember is – it’s not painful. The second, most important point to remember is – it’s not painful! In fact, the top 10, most important points to remember regarding root canal therapy are all – it’s not painful.
A root canal procedure requires one or more appointments, depending on the number of canals present, the degree of difficulty and the size of the infection present. The procedure can be performed by a general dentist or an endodontist (a root canal specialist). Depending on the findings of your general dentist, you may be referred to the specialist for treatment if the dentist feels that the success of the procedure will be improved with an endodontist. If you are referred to a specialist, do not be concerned that the procedure will be more difficult. In fact, on the contrary, most referrals are made wit the attempt of keeping the patient comfortable and improving the overall outcome.
 

It is essential to remember that all teeth that have had root canal treatment should have a crown (cap) placed to ensure a favorable long term prognosis. A crown helps to prevent leakage into the root canal, protect the tooth from fracturing and restores the tooth to its full function.

1. Replace One or More Missing Teeth, without affecting the adjacent teeth
2. Restore a Patients Confident Smile
3. Improve Quality of Life, through improved function and speech
4. Maintain Alveolar Bone and therefore prevent changes to facial form and height
5. Support a Removable Denture, making them more secure and comfortable.

• WHO PLACES THE IMPLANT?
The implant surgery phase, the act of placing the implant into the jaw bone, is done by either an oral surgeon or a periodontist. The prosthetic phase, the act of restoring that implant with a single tooth, bridge or denture, is done by a general dentist or prosthodontist.
Experience Counts!! Possibly more than any other dental procedure, the success of the dental implant relies heavily on the knowledge and experience of the restoring dentist, in addition to the coordination between the restoring dentist and the surgeon placing the implants.
All patients considering dental implants should be assured that our office is highly trained in restoring all types of dental implant systems. All of our dentists have done extensive graduate and postgraduate training in implant restorations and our office has been working closely with our referring specialists since the early use of implants in clinical practice. Additionally, we pride ourselves on our team based approach to implant design and restoration. When choosing our office to restore your smile you should know that not only will the dentist and specialist be in constant communication regarding your case but all implant cases are discussed amongst the dentists in our weekly implant study club thus ensuring the most thorough treatment planning and preprosthetic evaluation possible. Please do not hesitate to ask any of our dentists what training they have in implant procedures, how many implants they have restored, what implant systems they prefer and why and what their personal success and failure rates are. In addition, you should know that our office, from dentist to hygienist, is committed to caring for you after the implants have been placed. With thousands of successful implant cases completed we are confident that we will exceed your expectations.

• WHAT DOES GETTING A DENTAL IMPLANT INVOLVE?
Careful evaluation and treatment planning well before the implant surgery is one of the keys to our success in dental implants. Our pretreatment evaluation will involve at least an initial consult with our staff, a consult with the treating surgeon and often a radiologist. Our consult will involve the completion of all necessary radiographs, evaluation of the periodontal health, the remaining dentition and the space available between the upper and lower arches, as well as the health of the tempromandibular joint and a bite evaluation.
 

Once properly designed, the surgeon will place the implants and allow healing; this process can take up to 6 months and longer if needed. During the healing phase, the patient will be able to wear a temporary and avoid any cosmetic objections.
 

process and as our patient you should feel secure in our dedication to the success of your

treatment.

DENTURES AND PARTIAL DENTURES

1. Complete Denture – Loss of all teeth in an arch
2. Partial Denture – Loss of several teeth in an arch
3. Enhancing smile and facial tissues
4. 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 dentures, ensuring a natural and comfortable fit.
It is normal to experience increased salivary flow, some soreness and possible speech and chewing difficulty during the early days with your new denture. As you become accustomed to the new appliance and adjustments are made, the appliance will begin to feel more natural.
You will be given homecare instructions for your new dentures, as well as a new denture cup and denture brush. Proper cleaning of your new dental appliance, good oral hygiene and regular dental visits will aid in the life of your new denture.
It is important to continue having regular dental check-ups so that a dentist can examine oral tissues for signs of disease or cancer. As you age, your mouth will continue to change as the bone under you denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself.