Teeth Whitening

Scaling and root planing is a non-surgical procedure used to treat gum disease. During the scaling process, specialized dental instruments are used to remove dental biofilm and calculus from beneath the gums. Planing is the procedure used to smooth the tooth roots after the scaling process. Root planing helps the gums heal and reattach themselves to a cleaner and smoother root surface.

From Colgate’s website:
More about scaling and root planing from the American Dental Association: Gum disease is caused by a sticky film of bacteria called plaque. Plaque is always forming on your teeth, but if they aren’t cleaned well, the bacteria in plaque can cause your gums to become inflamed. When this happens, your gums will pull away from your teeth and form spaces called pockets. Plaque then gets trapped in these pockets and cannot be removed with regular brushing. If untreated, gum disease could lead to bone and tooth loss.

If gum disease is caught early and hasn’t damaged the structures below the gum line, a professional cleaning should do. If the pockets between your gums and teeth are too deep, however, scaling and root planing may be needed.

A July 2015 study in the Journal of the American Dental Association finds that scaling and root planing is beneficial to patients with chronic periodontitis (gum disease that has advanced past gingivitis). Chronic periodontitis affects 47.2% of adults over 30 in the United States.

Inlays and Onlays
An inlay or onlay is a partial crown restoration that can be placed when there is not sufficient tooth structure to support a filling but enough tooth structure left that a full crown is not needed. Inlays/onlays are made of porcelain or gold, and they aesthetically and functionally replace the missing tooth structure. Inlays/onlays are completed in 1-2 visits.

For larger cavities or a tooth with decay in more than one area, an inlay or onlay may be the best restorative solution. The difference between an inlay and an onlay is the area of the tooth anatomy being restored.  Inlays apply to cavities in the grooves, or pits and fissures, of the tooth’s biting surface. Onlays are used when the decay includes the tooth cusps. Both are used to restore areas where tooth decay is present and the tooth structure has been compromised.

Inlays and onlays can be made with either cast gold alloy or with tooth-colored ceramic or porcelain materials.  A model of the patient’s natural tooth is made prior to any procedure so that the restoration can be made to replicate the shape and function of the natural tooth.

The shape and fit of the restoration can be verified before being cemented or bonded into place, and the inlay or onlay can be extremely durable.

A denture is a removable replacement for missing teeth. There are two types of dentures, complete (full) and partial dentures.

A denture replaces multiple missing teeth. Dentures can be fixed or removable, partial or full, and implant supported or not. Fixed dentures require implants, while removable dentures may or may not rely on implants for attachment.

Full Dentures

Traditional Dentures for the Edentulous Patient

(Missing All Teeth in Either the Upper or Lower Arch)
Traditional dentures are removable, and do not use implants. Traditional dentures include an acrylic base that is custom-made in the dental laboratory to mimic the appearance of natural gums, and this base sits over the gums, holding the denture in place. A complete (full) denture is made after all the teeth in the upper and/or lower jaw have been removed and the gum tissue has healed. Denture paste or adhesive is often to used to assist in holding the denture in place. Removable dentures can be removed and cleaned when not being worn.

Partial Dentures

Traditional Dentures for the Patient Missing Multiple Teeth in One Arch

A traditional partial denture is a removable solution for replacing many teeth in one arch when there are still some natural teeth present. In this case, the acrylic base will also contain some metal attachments that wrap around the existing teeth for added support. Partial dentures can also be attached to crowns on either side of the denture. Removable partial dentures can be removed and cleaned when not being worn.

Implant Supported Dentures

Implants can be used to anchor dentures in place, allowing for a smaller base and less shifting of the prosthesis during use. Implants can support both full and partial dentures as well as both fixed and removable dentures.

A bridge can replace missing teeth without the use of a denture or dental implant. A bridge is composed of two crowns and a replacement tooth or teeth. Crowns are typically placed on the teeth on either side of the space, with the fabricated tooth or teeth attached in between.

Missing one or more teeth is common for many people. The ADA reports that on average adult patients may have three missing or decayed teeth. Fortunately, there are a number of solutions to replace missing teeth, including dental bridges.

A bridge may be used to restore an area with one or more adjacent missing teeth. A bridge has two primary components.  The abutments (or supports) for the bridge are created by placing a crown on either a natural tooth or an implant. The synthetic tooth that replaces the missing tooth is called a pontic.

In the case of one missing tooth, the two teeth on either side will be prepped for crowns and the missing tooth will be replaced with a synthetic tooth that is connected to the crowns on either side of the missing tooth. In the case of several adjacent missing teeth, one or more implants may provide the abutment.

There are four main types of dental bridges:

Traditional Dental Bridge

This is the most common type of dental bridge. The existing teeth are crowned with one or more pontics between and held in place by the crowned abutments. The crowns are cemented onto the teeth adjacent to the missing teeth to create a support structure or “bridge” for the missing teeth.

Cantilever Bridge

This type of bridge is similar to a traditional bridge, except that the structure is supported on only one side instead of both sides. This can cause the restoration to act as a “lever” and may create additional stress on the supporting tooth, causing it to be more likely to loosen or fracture.

Implant Supported Bridge

Instead of using existing teeth to support a bridge, a dental implant may be substituted to provide support for one or both sides of a dental bridge. This is a popular option that can provide a very secure restoration. This solution is particularly helpful when there are several adjacent missing teeth.

Maryland Bridge

This type of bridge is supported by a metal structure which is cemented onto the back of existing teeth. While not as strong as a traditional bridge, it can preserve the tooth structure of the adjacent teeth by avoiding the use of crowns for the abutments. It may not stay in place when heavy forces are placed on the restoration (such as biting and chewing) and does add pressure to the supporting teeth.

Cosmetic bonding is the process of filling or restoring teeth with a tooth-colored material in order to improve a tooth’s appearance. In order to bond a tooth, composite material is added to the tooth structure to adjust the size, shape, or color of the existing tooth.

Cosmetic bonding is the process of applying a tooth-colored composite material to the tooth in order to improve the aesthetics of the smile while allowing the tooth to maintain a natural appearance. In order to bond a tooth, tooth colored material is added to the tooth to build it up.

Bonding is often used to:

• Correct the shape of a chipped tooth
  
• Correct the appearance of a cracked tooth
  
• Provide more even tooth color
  

Advantages of bonding over other treatments include:

• Bonding can be a less expensive treatment than other cosmetic options
  
• An appointment for bonding treatment usually takes less than one hour to complete
  
• Bonding usually allows the tooth’s structure to be preserved
  

Bonding may sometimes be preferred over veneers or crowns but may not be as long-lasting or durable.  Bonding material can stain from coffee, tea, tobacco or some foods so proper home care is important.

Composite fillings use tooth-colored material to restore teeth with cavities and maintain a natural appearance. Once the decay is removed, the tooth is filled with a composite material which is then cured using a specialized light to harden the material. Composite fillings can be completed in one visit.

Identifying and addressing cavities early can prevent the need for more complex and costly dental procedures.  If cavities are found before there has been significant decay, the tooth can be restored with a filling.

Once a tooth has a cavity, the decay will continue to spread unless the decayed area is removed and the tooth is properly restored.  Leaving cavities untreated can lead to the need for more significant restorative procedures such as crowns, bridges, root canals, or dental implants.

While metal (amalgam) fillings used to be common, tooth-colored composite material is now the most recommended filling material.  The composite material blends in with the natural tooth and is less noticeable than a metal filling.  The tooth-colored filling is not as affected by heat and cold as the metal fillings, so the patient is less likely to experience temperature-related sensitivity.

Another important reason composite fillings have replaced amalgam fillings is that they do not use mercury, which was present in metal fillings. Many patients are choosing to have their older amalgam fillings replaced with tooth-colored fillings for this reason.