Crowns and Bridges

Crowns - A crown-sometimes called a �cap� is s dental restoration that covers the entire tooth and provides the following solutions:

• Replaces a cracked or leaking filling
• Replaces a large filling
• Restores a fractured or broken tooth
• Covers a discolored or misshapen tooth
• Covers a dental implant
• Covers a tooth that has been treated with a root canal

Crowns made of tooth-colored porcelain are ideal to camouflage imperfections in your smile. Current technology allows us to closely match the shade of your crown to surrounding teeth-or, if you prefer, you may choose to brighten your smile and have your crown blended to match. Crowns can replace less than atheistic teeth with a carefully shaped and perfectly tinted tooth. Porcelain, or porcelain fused to metal, crowns will be advised based on your specific need. We will discuss all your options to ensure your choice enhances the quality of your smile!

Bridges - A bridge is a custom device anchored to neighboring teeth that replaces one ore more missing teeth. When a lost tooth is replaced with bridges-work, the teeth on either side of the missing one must be prepared as crowns to serve as abut-ments to hold the prosthetic (replacement) teeth in place. Crowns and bridges are most often made from superior materials such as semiprecious or precious metals, porcelain or a combination of metal fused to porcelain. Both appearance and function are considered when selecting the material most suitable for you.

Why is a Crown and Bridge Treatment Necessary?

Losing a permanent tooth- whether it be due to dental decay, periodontal (gum) disease, injury or accident- can cause many serious problems for your neighboring teeth. Because the support and chewing forces are altered, the remaining teeth may begin to shift. The opposing tooth above or below the lost tooth can begin to move up or down and out of the socket, which can accelerate periodontal disease and further break down the bone structure. If the missing tooth is not replaced, more teeth may eventually be lost die to improper forces exerted during chewing.

Crown and bridge treatment reverses the negative impact of missing teeth in a variety ways:

• Restores and maintains, the natural bite
• Prevents unnatural stress on other teeth
• Keeps opposing teeth in their proper place
• Prevents shifting and tilting of adjacent teeth
• Discourages further dental decay and periodontal disease
• Enhances your smile, speech and chewing function

How the Treatment is preformed

Once we determine that a crown and bridge treatment is indicated, a series of appointments will be scheduled for you. It is important for you to keep all of these appointments to prevent any delays in treatment. At the first appointment, we complete a thorough oral examination, including an evaluation of your dental history. Any necessary x-rays are completed at this time.

During the restorative procedure, we first anesthetize the area to be treated. Next, we carefully shape and contour the tooth or teeth to be crowned to allow the crown or bridge sufficient space for proper fit and appearance. Finally, we make an impression of the area and fit the teeth involved with a temporary crown or bridge to protect them until your next appointment.

At the following appointment, we evaluate the final crown or bridge for proper fit before placing it permanently, making final adjustments, if necessary. Other factors we carefully consider at this time include:

• Aesthetics-color match and appearance
• Function-chewing and biting accuracy
• Tissue compatibility- the contour of the bridge must conform to the surrounding tissue in a natural, healthy position

The Best Way to Care for a Crown and Bridge

Care for it as you would any of your other teeth you wish to preserve! Proper oral hygiene, including flossing at least once a day and brushing.

Root Canals

What makes a Root Canal Necessary?

If you have been told that a root canal is necessary to save one of your teeth, it is important that you understand why this procedure is necessary and what happens during a root canal treatment.

Root canal treatment (endodontics) treats disorders of the nerve (also called the pulp) of the tooth. It used to be that a tooth with a diseased or infected nerve had to be removed. In 95 percent of the cases today, however, this is no longer true. We believe in saving the teeth (instead of removing them). We make every effort to help you keep your natural teeth for a lifetime!

The following are the most common factors contributing to a need for a root canal treatment:

• Physical irritation caused by deep decay or a very large filling
• Severe gum disease
• Trauma, such as physical blow to a tooth in the opposite jaw that traumatizes the tooth

Regardless of the initial cause, the tooth pulp becomes irritated and infected. Bacteria grow within the tooth pulp, causing pressure and pain. Sometimes the deterioration of the pulp happens so gradually that little pain is felt. Either way, eventually the bacteria can destroy the pulp. As this happens, the bone surrounding the tooth may become infected and abscessed, which may lead to the destruction of the bone surrounding the tooth.

What Happens During Treatment?

If we determine through x-rays and a clinical examination that root canal treatment is necessary, we will schedule a series of appointments for you. It is important that you keep these appointments to prevent delays in treatment and healing, which can affect the outcome. It�s also essential that you take all antibiotics and medications prescribed to hasten healing and reduce swelling.

1. First, we want to relive any discomfort you might be experiencing and ensure your comfort throughout the treatment. When necessary, an anesthetic is used to numb the tooth and surrounding area. The tooth may be isolated with a rubber dam, which confines the treatment area and protects the mouth from bacteria and chemical agents. An opening is made through the crown of the tooth into the pulp.

2. We carefully remove the diseased pulp. The root canal area inside your tooth is cleaned, enlarged and shaped. Then, depending on your individual case, the root canal and pulp chamber may be permanently filled and sealed.

In some cases, we place a temporary medication in the tooth to control bacterial growth and reduce infection.

3. A temporary filling is placed in the opening of the tooth until the next visit. In some cases, the tooth may be left open in order to allow the infection to drain. We will decide what is right for your case and do whatever is necessary to assure your comfort.

4. At the next appointment, we sterilize the inside of the tooth to remove the bacteria. Throughout the root canal procedure, we take x-rays to ensure that all of the infected pulp is removed and that the walls inside the canal are smooth.

5. To complete the process, the root canal and pulp chamber are permanently filled and sealed.

6. Finally, the tooth is fully restored to chewing function.

What Care Follows the Treatment?

Once the root canal treatment has been completed, you should consider the following:

1. Brittleness- a non-vital (endodontically treated) tooth is more brittle than a vital one and is more susceptible to fracture. Therefore, in most cases, we recommend that your root canal tooth be crowned (capped) following treatment.

2. Discoloration-you may notice that your endodontically treated tooth (especially a front tooth) has undergone a change in color. Though this discoloration is of no medical concern, you may be interested in having the tooth whitened. Be sure to ask us about tooth whitening if we do not decide to place a crown on the tooth.

Gum Disease

Periodontal disease, or simply gum disease, is the single most common cause of tooth loss in adults. This inflammatory disease attacks the gums, bone and other supporting structures of teeth. Gum disease is caused by plaque, a colorless film of bacteria that forms on the teeth. Plaque mixes with sugars and starches in the diet to form acids and other by-products in the mouth, irritating the gums and causing them to become red, tender and swollen. It also causes the gums to bleed easily. If not removed daily, plaque hardens to form calculus (tarter) around the necks of the teeth. The irritants in plaque can destroy the tissue that attaches the gums to the teeth. The gums pull away from the teeth and small pockets form between the teeth and gums. These pockets become filled with more plaque. As the pockets deepen, it becomes impossible for you to clean the plaque out. Eventually, the bone structure supporting the teeth can be destroyed.

Other Causes of Periodontal Disease:

1. Physical and chemical irritants- Impacted food, tobacco products, alcohol and the improper use of dental floss or toothpicks may irritate gum tissue.

2. Abnormal oral conditions or habits- Badly aligned teeth, poorly fitting bridges or partial dentures, defective fillings and harmful habits, such as grinding the teeth and chewing ice, can also cause problems.

3. Unbalanced diet- Evidence shows a link between nutritional deficiency and the body�s ability to fight off infection.

4. Pregnancy- Due to fluctuations in hormone levels, a temporary condition referred to as �pregnancy gingivitis� may occur.

5. Certain medications- Oral contraceptives, anti-epilepsy drugs, steroids and cancer therapy drugs may have a negative effect.

6. Certain diseases- Diabetes, uremia, liver cirrhosis, anemia and leukemia are among the many diseases that may affect the health of your gums.

What Are the Signs?

• Gums that bleed when you brush or floss your teeth
• Red, swollen or tender gums
• Gums that have receded or shrunken away from your teeth
• Pus between your teeth when you press your gums with your finger
• Pain when chewing
• Calculus or tartar buildup
• Teeth that seem loose or that change position
• Changes in your bite
• Changes in the way your partial dentures fit
• Bad breath or chronic bad taste in your mouth
• Teeth that are overly sensitive to hot and cold

Diagnosis

A thorough oral examination, including x-rays, is crucial to diagnosing periodontal disease. In most cases, we recommend an in-office exam and tooth cleaning for all adults twice a year. At that time, we may use a special instrument called a periodontal probe to measure the depth of the pocket between the tooth and the gum tissue. The pocket depth measurement, clinical examination and x-rays help us determine the precise location, extent and severity of gum disease.

Treatment

The type of treatment you require depends on how advanced your particular case is. Individualized treatment may include any of the following:

1. More frequent cleanings. It may take the bacteria at the base of the picket up to three months to colonize into numbers able to destroy bone. Frequent cleanings can prevent this buildup.

2. Scaling and root planning. Scaling is removing the calculus deposits from your teeth. Root planning is the smoothing of the root surfaces so that the gum tissue can reattach to the tooth.

3. Curettage removes the soft tissue lining the periodontal pocket. This helps the gum tissue to heal.

4. Gingivectomy is the surgical removal of the periodontal pocket to allow easier access for cleaning.

5. Flap surgery allows us to gain access to the root of the tooth for removal of calculus, plaque and diseased tissue. The gum is then secured back into place.

Each of us is different, and so is our individual ability to resist disease. Some patients are more susceptible than others to periodontal disease. Fortunately, you don�t have to lose your teeth to gum disease. With today�s state-of-the-art treatment procedures, you can feel assured that most teeth can be saved.

Natural Color Fillings

Today�s cosmetic fillings match your teeth so perfectly it will look like you�ve been cavity free for your entire life! A bright smile commands attention, can open doors to exciting opportunities and gives your self-confidence a boost. If we need to restore a decayed tooth, you may want to ask about natural color fillings. Any surface area where a filling will be noticed may be a great location for a natural color filling. They�re made from resin composites blended to match the color of existing teeth.

The process of applying the natural color filling is similar to a traditional amalgam (silver) filling. The decay is removed and tooth is prepared to accept the tooth-colored composite. The dentist applies several layers of the composite, which is chemically hardened and cured with a special light. The filling is then polished to complete the process. Natural color fillings blend with surrounding teeth and enhance a bright, youthful appearance. No one will notice they�re there- including you!

You may want to consider replacing old, leaking amalgam fillings with new composite (natural color) fillings. You�ll have a whiter smile that looks natural and blends with surrounding teeth.

Veneers

Veneers are custom-made tooth colored porcelain laminates designed to cover the front portion of your tooth and are generally recommended to improve the following dental conditions:

• Spaces between front teeth
• Cracked or chipped teeth
• Slightly crooked or poorly shaped teeth
• Permanently stained teeth
• Worn teeth

Veneers are customized to match the color of your existing teeth-or you may choose to create a whiter smile by combining tooth whitening with your new veneers. Spaces between teeth can be closed, stains and cracks disappear! In many cases, you can have a great smile with perfectly straight teeth in a matter of weeks instead of the years required when straightening teeth with braces.

Veneers require more than one appointment to complete. During the first appointment the tooth is carefully prepared and contoured. An impression of the prepared tooth is taken to create your veneer. The custom veneer is fabricated in a laboratory using the shades and shapes prescribed by your dentist. A return visit is required to bond your veneer toe the front of your tooth. Once completed, your veneers will feel like your own teeth- only better! Stain�s, chips, and crooked teeth disappear and you�re left with a great looking smile and healthy, natural looking teeth.