Regular dental cleanings and periodic oral exams are important in the prevention of gum disease, tooth decay and other oral disorders. In addition to brushing and flossing thoroughly everyday, it is recommended to have a professional dental cleaning done every few months. Routine cleanings removes stains and tartar, preventing gum disease and helps in maintaining an optimum oral health.
Regular dental cleanings are routinely performed by our professionally trained staff. Any external deposits on the teeth like the tartar or stains are removed with the help of manual scalars or the ultrasonic machines. The teeth are polished following a thorough cleaning to make it difficult for plaque to adhere.
Root canals are the hollow channels reaching from the central chamber called pulp chamber to the bottom of the tooth roots. When healthy, pulp chamber and root canals are filled with soft tissue called pulp which contains nerves, blood vessels and connective tissue.
When do I need a root canal?
When the pulp is diseased or injured and cant repair itself, it dies. The most common cause of pulp death is a cracked tooth or a deep cavity. Both of these problems can let germs (bacteria) enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the root tip, in the jawbone, forming a pus-pocket called an abscess. An abscess can cause damage to the bone around the teeth.
Left without treatment the tooth would hurt. An alternative to root canal treatment to evade pain would be extrating the tooth. But once the tooth is extracted it would only cause more problems as the neighboring teeth would move in to the place. Also, it would be more expensive to restore the tooth with an implant or three unit bridge.
What is involved in the Root Canal Procedure?
Root canal procedure is usually performed under local anesthesia. An opening is made in to the pulp chamber. The dentist removes the tissue within the pulp chamber and clears any remaining nerve tissue from the root canals. Once the dental pulp tissue has been cleared, the dentist widens the root canal slightly and straightens the pulp chamber to prepare it for filling. The inside of the tooth is then disinfected.
When the tooth has been properly prepared, the root canals are filled with a rubber-like material called gutta-percha filling. The pulp chamber is packed with cotton, and a temporary filling is used to seal the opening. during the subsequent vist a permanenet filling is placed. If you are misssing lot of tooth stucture then posts are placed in to the root canlas to retain the core build up.
It is very important that you follow up with a crown after the root canal as you are missing lot of tooth structure.
How long will the restored tooth last?
Your restored tooth could last a lifetime, if you continue to care for your teeth and gums. However, regular checkups are necessary. As long as the root(s) of a treated tooth are nourished by the tissues around it, your tooth will remain healthy.
Wisdom teeth, also called third molars are the last teeth to erupt within the mouth. When they align properly, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen.
The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully. When they are partially erupted, the opening around the tooth allows bacteria to grow the tooth would get decayed and will eventually cause an infection. This would lead to swelling and pain. Sometime the pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. Sometimes tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure
When patients presents for extractions x-rays are taken to evaluate the position of wisdom teeth and also any potential problems. Regular wisdom teeth extractions are performed under local anesthesia. Once the teeth are removed, the gum is sutured. And post operative instructions are given. If required antibiotics and pain killers would be prescribed.
Sometimes you would be referred to a specialist if the tooth position requires it.
Fillings are done to repair or restore the teeth that are damaged usually from decay or fracture. Traditional fillings often appear as unattractive, dark-colored spots on the teeth. These dark colored unappealing fillings can be removed and replaced with natural-looking tooth-colored fillings. Tooth-colored fillings are made of a resin that is colored to match and blend into the surrounding tooth, rendering the filling virtually invisible. Tooth colored fillings are bonded to the tooth structure thus making them more resistant to cracks and fractures & also these filings require less tooth preparation than those for silver fillings, thus conserving natural tooth structure.
A denture is a removable appliance that replaces missing teeth and their surrounding facial structures. Dentures can help correct pronunciation and chewing problems caused by missing teeth, as well as add support to facial muscles and prevent remaining teeth from shifting. There are different types of dentures, including full dentures, which replace all upper or all lower teeth, and partial dentures, which replace individual missing teeth.
Removable Partial dentures:
It is a prosthesis that contains artificial teeth supported on a metal framework and retained and supported by natural teeth with clasps and rests. Removable partial dentures not only replace missing teeth, but also help to prevent the remaining teeth from shifting.
An ERA (Extra Resilient Attachment) supported partial dentures has far more stability, than a regular partial with clasps that go around the teeth. Crowns are placed on the teeth next to the missing teeth to which a female component is attached. A male component is attached to the removable partial and this attaches to the female component of the crown.
Complete Dentures:
These dentures replace all of the missing teeth and neighboring structure. There are different types of complete dentures.
- Conventional
- Over dentures
- Immediate dentures
- Implant supported dentures
Conventional dentures:
When the dentures are made after all the teeth are lost and gums and bone have healed, they are called conventional dentures.
Immediate dentures:
Immediate dentures are dentures that are inserted immediately after the removal of the remaining teeth. To make immediate dentures the dentist takes measurements and makes the models of the patient's jaws during the preliminary visits.
An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 months.
Over dentures and Implant supported over-denture:
Some times when patients have few remaining teeth with good bone support over-dentures are recommended. This process involves treating the remaining teeth with root canal treatment. Then the dentures are made to fit on the roots of these teeth. Over-dentures preserve bone and greatly increase denture stability.
An Implant-supported denture is a type of over-denture that is supported by and attached to implants. It is the best alternative when patient has been wearing denture but they are loose and fit less firmly. It is usually recommended when a person doesn't have any teeth in the jaw, but has enough bone in the jaw to support implants. Some times bone can be added by surgical procedures. An implant-supported denture has special attachments that snap onto attachments on the implants. Implant-supported dentures are usually recommended for the lower jaw because regular dentures tend to be less stable there. However, you can receive an implant-supported denture in either the upper or lower jaw. You can remove an implant supported denture easily. These dentures provide far more stability than traditional dentures.
Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.
Gingivitis
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional dental treatment and good oral home care.
Periodontitis
If left untreated, gingivitis can lead to periodontitis. In time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque then irritate the gums. The toxins stimulate a chronic inflammatory response in which the body turns on itself and the tissues and bone that support the teeth are breakdown and are destroyed. The Gums then separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.
TREATMENT
Periodontal scaling
Periodontal scaling procedures "include the removal of plaque, calculus and stain from the crown and root surfaces of teeth. Root planing is a specialized skill involving scaling of the root of the tooth, made up of cementum. Because cementum is softer than enamel, it is affected more by ongoing build-up and inflammatory byproducts. A smooth cementum provides less opportunity for bacteria to hang out and form calculus, so root planing is an important part of stopping periodontal disease where it is at, and preventing periodontal disease from getting worse, specifically once deeper pockets have formed in the gums, which is really in the bone. So, root planing is a specific treatment that removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins.
Because in periodontal disease pockets form that are deeper than the usual gingival depth, such scaling and root planing are often referred to as deep cleaning or SRP, and may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.
Scaling and root planing or deep cleaning is considered the basic treatment of periodontal diseases and may be the only treatment required to treat mild cases of periodontitis; however, it may also be the initial therapy prior to future surgical needs. For the procedure to be considered effective, the patient must be able to be maintained at a level of periodontal health that will prevent re-infection with periodontal pathogens. This requires optimal home care and ongoing maintenance therapy at more frequent intervals to sustain health. The dentist may also suggest a rotary tooth brush, more frequent flossing, and a change in diet.
Medications
Medications may be used with treatment that includes scaling and root planing. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used:
| What is it? | Why is it used? | How is it used? | |
| Prescription antimicrobial mouth rinse | A prescription mouth rinse containing an antimicrobial called chlorhexidine | To control bacteria when treating gingivitis and after gum surgery | It's used like a regular mouthwash |
| Antiseptic "chip" | A tiny piece of gelatin filled with the medicine chlorhexidine | To control bacteria and reduce the size of periodontal pockets | After root planing, it's placed in the pockets where the medicine is slowly released over time. |
| Antibiotic gel | A gel that contains the antibiotic doxycycline | To control bacteria and reduce the size of periodontal pockets | The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days. |
| Antibiotic micro-spheres | Tiny, round particles that contain the antibiotic minocycline | To control bacteria and reduce the size of periodontal pockets | The periodontist puts the micro-spheres into the pockets after scaling and root planing. The particles release minocycline slowly over time. |
| Enzyme suppressant | A low dose of the medication doxycycline that keeps destructive enzymes in check | To hold back the body's enzyme response — if not controlled, certain enzymes can break down gum tissue | This medication is in pill form. It is used in combination with scaling and root planing. |